Written by Kate Thompson, Physiotherapist 

 

Many diagnoses and conditions are prescribed medication to help manage it. Diabetes is treated with insulin or high cholesterol with some variety of statin medication. For OA, one of the best-known treatment options is exercise, when dosed correctly and specific to you.

How Exercise Can Help Manage Your Osteoarthritis Symptoms

Ongoing research suggests that exercise can promote change both directly, at the joint, and indirectly, by improving your overall function and movement quality [1]. Osteoarthritis commonly involves the breakdown of the joint, inflammation, and decreased cell metabolism or turnover.

Studies show that exercise may have a protective effect on the joint by stimulating a process called ‘autophagy’, which recycles old and/or damaged cells into newer, healthier ones! [1] This is an amazing process that the body goes through that essentially goes out with the old, and in with the new.

Exercise can promote positive change indirectly as well, by improving stability and function by increasing muscle strength and helping you move in a way that distributes the load of your body more efficiently. One of the most well-known research programs studying the effect of exercise on individuals living with hip and knee osteoarthritis is called Good Life with osteoArthritis in Denmark (GLA:D). 

This consists of 2 weeks of education and 6 weeks of neuromuscular training led by a physiotherapist. In one GLA:D study with nearly 10,000 participants, pain intensity and quality of life improved significantly following the completion of the program! Furthermore, participants who completed the program reported they took fewer painkillers and took fewer sick days [2].

Introducing Peak Arthritis: A Physiotherapy Program for Osteoarthritis

The Peak Osteoarthritis Intervention Program is an 8-week exercise program that is based on GLA:D research and combines education and neuromuscular training to help individuals living with OA manage their symptoms and continue to participate in the activities they enjoy.

Participants will be assessed by a physiotherapist and be provided with a plan specific to them, and be guided through an 8-week exercise program at 2x 1-hr sessions/week. Sessions are structured as circuit training, where participants learn the fundamentals of strength training in a way that is of special benefit to Osteoarthritic joints. 

You start by learning the fundamentals of how to hinge, squat and lunge and then we progressively load these movements, based on your ability levels. You will have 1:1 sessions with a physiotherapist throughout your program, and have access to group exercise facilities to perform your exercises.

What Are the Goals of the Program?

The ultimate goal of the program is to help you be able to do more of the things you love in life. We want to help you feel fulfilled and happy. Whether that is being able to feel like you can go up and down the stairs without clinging on to a railing, being able to walk 3 blocks instead of 1, getting back into an exercise routine, playing tennis, getting back into golf, whatever your WHY is! Let our Peak Health physio know what your goals are at the beginning of the program and you can set realistic expectations together for what you hope to achieve from the program.

 

Short-term goals for how to help you achieve your longer-term goal are as follows:

• Get stronger
• Move smarter
• Gain confidence (In the way you move, in your ability to complete daily tasks, in your knowledge about what OA is and how it affects your body)

How Do I Know if I Would Be a Good Fit for the Program?

There is no specific age requirement for participation in this program! We welcome beginner to experienced exercisers and most levels of OA patients (mild OA to severe OA). Regardless of your experience with exercise, we will adapt the program to your unique ability level. 

You may not be a good fit for the program if you are unable to stand or walk independently without a higher-level gait aid such as a walker. If you would like more information to know if you would be a good fit for the program, please call the clinic at 403-287-7325 and you can request that the lead physiotherapist for the program call you with more information.

We can’t WAIT to see how exercise rehabilitation can help you move better!

Book a discovery call with our physiotherapist Kate today HERE.

At Peak Health And Performance, we offer a wide range of treatment options including massage therapy and concussion care to address a variety of conditions and help improve your quality of life. Some of the common conditions we can help with include:

• Poor posture
• Connective tissue issues
• Knee injuries and Knee pain
• Joint pain relief
• Impaired range of motion

References:

1. Kong H, Wang XQ, Zhang XA. Exercise for Osteoarthritis: A Literature Review of Pathology and Mechanism. Front Aging Neurosci. 2022 May 3;14:854026. doi: 10.3389/fnagi.2022.854026. PMID: 35592699; PMCID: PMC9110817.
2. Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord. 2017 Feb 7;18(1):72. doi: 10.1186/s12891-017-1439-y. PMID: 28173795; PMCID: PMC5297181.

Written by Kate Thompson, Physiotherapist

 

What Are Some Common Myths About Osteoarthritis?

Although a very common diagnosis, there seem to be many misconceptions about what Osteoarthritis is or what may affect it. Let’s dive into some of these together! 

Myth #1: I Heard That Running Gives You OA

 “I enjoy running for exercise. I don’t think I have Osteoarthritis, but I have heard that continuing to run long distances can put me at risk for developing Osteoarthritis.”

What the research says: Research has shown that both non-runners and runners exposed to high-volume training loads (>92 km/week) have higher rates of Osteoarthritis than recreational runners [1]. Therefore, due to the numerous other health benefits of running, it is not sound advice to tell recreational runners to stop running [1,2].

It is important to consider that these studies do not account for other risk factors of Osteoarthritis, such as age, previous trauma and obesity, which may have had an effect on the results of these studies. 

Myth #2: Running Will Worsen My OA.

 “I have Osteoarthritis and have been told that I should stop running, as it will make my Osteoarthritis worse.”

What the research says: There have been a variety of studies that have found that running does not appear to accelerate the progression of existing knee OA in runners >50 years of age [1]. There have however been some small-scale studies that have suggested that individuals with OA who run may require increased recovery time from running [1]. 

Therefore, it is recommended that if an individual has OA, enjoys running, and is managing their symptoms well, they should continue to run as long as they monitor running frequency to ensure adequate recovery time between bouts [1]. For example, if you run 3 days/week, I would recommend spreading the runs out throughout the week instead of running 3 days consecutively.

Myth #3: I Have OA so I Can’t Do Anything Fun Anymore.

 “I have been diagnosed with Osteoarthritis and have been told to stick to ‘low-impact’ activities. I want to continue to play hockey for as long as I can but I am nervous that it will make my OA worse.”

What the research says: There have been multiple studies to suggest that long-term participation in high-impact activities are not associated with the development of OA [2,3]. That being said, these studies are limited, as it is challenging to control for other risk factors of Osteoarthritis. Thus, it may be more productive to make these decisions based on your current symptoms. 

For example, if you experience a mild increase in pain while playing hockey, however, the pain returns to your baseline by the next day, it is likely safe for you to continue playing. On the contrary, if playing hockey increases your pain significantly after playing and takes 2-3 days to return to baseline levels, I would recommend discontinuing until you have a thorough assessment from a physiotherapist in Calgary. 

The physiotherapist will be able to tell you if playing hockey is a realistic goal, and if it is, they can help you make activity modifications and provide you with exercises to help you return to hockey with fewer symptoms! If it is not a realistic goal for you, they will help you find other ways to stay active in a way that fits with your lifestyle and your goals. 

Myth #4: I Have OA in My Back so I Can’t Twist.

“I have Osteoarthritis in my spine. I was told I should avoid bending forward or twisting.”

What the research says: What you do with your spine is not as important as how you do it. Your spine is made to twist and bend, however, over time some of these movements can become stiff and painful. 

Gentle mobility exercises and performing movements that load your spine such as squats, hinges, pushes and pulls can make your spine more resilient and allow you to complete your daily activities with less irritation and risk of injury.

Myth #5: There Is a One Size Fits All Plan for OA

“I heard that there is one specific exercise program that you can do that will help you manage Osteoarthritis symptoms.”

What the research says: Exercise is a leading treatment approach for Osteoarthritis, however, there is no ‘one size fits all’ formula to exercising with Osteoarthritis [4]. A great place to start is learning how to squat, hinge, lunge, push and pull with good technique, as these are movements that occur naturally throughout the day as you complete daily activities. 

For example, you have to squat to sit on a chair, lunge to get up the stairs, and hinge to unload your dishwasher. Factors such as the weight you lift, distance you move, and sets/reps you complete should vary based on your symptoms and fitness level.

In summary, every individual is unique and your presentation requires a specific exercise and management plan designed for you. Contact Peak today to see if you would be a good candidate for a physiotherapy assessment and personalized exercise rehabilitation plan to help manage your OA. Click HERE to book your discovery call today. 

At Peak Health And Performance, we offer a wide range of treatment options including massage therapy and concussion care to address a variety of conditions and help improve your quality of life. Some of the common conditions we can help with include:

• Poor posture
• Connective tissue issues
• Knee injuries and Knee pain
• Joint pain relief
• Impaired range of motion

 

References:

1. Alexander JLN, Willy RW, Culvenor AG, et al. Infographic. Running Myth: recreational running causes knee osteoarthritis. British Journal of Sports Medicine 2022;56:357-358.
2. Horga LM, Henckel J, Fotiadou A, et al 3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners. BMJ Open Sport & Exercise Medicine 2021;7:e000997. doi: 10.1136/bmjsem-2020-000997
3. Chang AH, Lee J, Chmiel JS, Almagor O, Song J, Sharma L. Association of Long-term Strenuous Physical Activity and Extensive Sitting With Incident Radiographic Knee Osteoarthritis. JAMA Netw Open. 2020;3(5):e204049. doi:10.1001/jamanetworkopen.2020.4049
4. Kong H, Wang XQ, Zhang XA. Exercise for Osteoarthritis: A Literature Review of Pathology and Mechanism. Front Aging Neurosci. 2022 May 3;14:854026. doi: 10.3389/fnagi.2022.854026. PMID: 35592699; PMCID: PMC9110817.

Written by Kate Thompson, Physiotherapist 

So You’ve Been Told You Have Osteoarthritis. You’ve Landed on The Right Page…

What Is Osteoarthritis?

Osteoarthritis (OA) is a disease that commonly affects joints of the body such as the hip and knee, shoulders and hands [1], and is a lot more common than people think. If we zoom into what is going on at the joint, it helps paint a picture of what is actually going on when an individual develops OA.

A joint is where two bones come together, and serve the function of absorbing and distributing mechanical load in your body [1]. A healthy joint should have cartilage covering the surface of the bones, enough space between the bones so they do not rub against each other, as well as ligaments and muscles surrounding them to support them and keep them stable.

OA results in changes to the cartilage, bone and joint space, and can also affect the surrounding ligaments, tendons and muscles [1]. As a result, the structure and function of the joint change which can result in symptoms such as pain, stiffness and instability [1].

 

 

“If you have knee osteoarthritis, you may feel unsteady when putting all of your weight through one leg while going down the stairs. This is because the muscles, ligaments, and joint structure are not able to support and disperse the weight of your body as it normally should.”

 

Who Is at Risk of Developing OA?

Known risk factors for developing OA include [1]:

• Aging
• Obesity
• Genetics
• Previous trauma/injury to the area
• Gender (females have a higher incidence than males)
• Hormones and metabolic disease

It is important to note, however, that OA is not inevitable if you have one of these risk factors! For example, although aging increases your risk of developing OA, not everyone who ages develops OA [1].

My Doctor Diagnosed Me With Osteoarthritis, but I Have Never Had an X-Ray. Do I Need One To Confirm the Diagnosis?

This is a tricky subject. In the past, it was common practice for health practitioners to refer patients for X-rays to guide the diagnosis of musculoskeletal conditions. Newer research, however, has identified that there may not always be a strong correlation between imaging findings and patient symptoms [2,3]. 

For example, if you took 100 people off the street and took an X-ray of their knees, some people without any knee pain at all may have X-rays that indicate OA, and some people with severe, debilitating knee pain may have X-ray results showing a healthy joint. In addition, if you are an older adult, it is common for there to be structural abnormalities found on your imaging that simply have developed over time and are not related to your symptoms at all [2].

Therefore, recent recommendations advise that OA should be diagnosed based on your symptoms, instead of through X-ray.

For example, if your symptoms follow a typical presentation of OA, such as joint pain, stiffness in the morning lasting <30 mins, crepitus with movement and weakness/instability, it is acceptable to be diagnosed without a referral for an X-ray [2,3]. 

Your doctor may request an X-ray if you have an atypical presentation and/or if there is suspicion of a different diagnosis2. Examples of an atypical presentation may include severe local inflammation, redness around the joint and rapid, progressive pain that is unrelated to use [2].

How Do I Know When I Need Surgery?

A better question might be, “How do I know if I need surgery?”. It’s important to consider that not everyone diagnosed with OA requires a joint replacement! It is recommended that patients diagnosed with OA try conservative management for a significant period of time to manage their symptoms, improve function and delay further changes to the joint structure [4]. 

The Osteoarthritis Research Society International suggests that NSAIDs (non-steroidal anti-inflammatory drugs) and exercise have the highest level of evidence for improving knee and hip OA symptoms [4]. If you have spent a significant amount of time trying conservative methods and still are unable to manage your pain, and your pain is considerably impacting your quality of life, it may be time to have a conversation with your doctor about other options.

Although there is significant evidence demonstrating that joint replacement surgery can improve symptoms, function and quality of life, surgical candidates are often under-educated about the risks of surgery and what the recovery process might look like [5]. For example, it can take months of physiotherapy to restore your mobility and strength following surgery. 

Furthermore, you may still experience pain in the months following surgery as you progress through rehab to optimize your new joint function. In addition, there is a risk that you may not regain a full range of motion following surgery [5]. 

It is important to remember that everyone has a unique anatomy, fitness level, stress level, and life experiences going into surgery and all of these factors will play a role in your recovery. If you are currently waiting for surgery, it is important to consult with a Peak Health physiotherapist on how you can best prepare for the surgery to optimize your outcomes after the operation.

To learn more about Osteoarthritis, check out our other blogs on the topic or reach out to me directly at kate@peakhealthcalgary.com! I would be more than happy to answer any questions you may have on how physiotherapy and exercise rehabilitation can help you manage your OA diagnosis.

To book a free discovery call with me, click here.

At Peak Health And Performance, we offer a wide range of treatment options including massage therapy to address a variety of conditions and help you get back to your daily activities pain-free. Some of the common conditions we can help with include:

• Poor posture
• Connective tissue issues
• Knee injuries
• Joint pain relief

References:

1. He Y, Li Z, Alexander PG, Ocasio-Nieves BD, Yocum L, Lin H, Tuan RS. Pathogenesis of Osteoarthritis: Risk Factors, Regulatory Pathways in Chondrocytes, and Experimental Models. Biology. 2020; 9(8):194. https://doi.org/10.3390/biology9080194
2. Xia Wang, Win Min Oo, James M Linklater, What is the role of imaging in the clinical diagnosis of osteoarthritis and disease management?, Rheumatology, Volume 57, Issue suppl_4, May 2018, Pages iv51–iv60, https://doi.org/10.1093/rheumatology/kex501
3. Wood G, Neilson J, Cottrell E, Hoole S P. Osteoarthritis in people over 16: diagnosis and management—updated summary of NICE guidance BMJ 2023; 380 :p24 doi:10.1136/bmj.p24
4. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578-1589. doi: 10.1016/j.joca.2019.06.011. Epub 2019 Jul 3. PMID: 31278997.
5. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012 Feb 22;2(1):e000435. doi: 10.1136/bmjopen-2011-000435. PMID: 22357571; PMCID: PMC3289991.

Have you noticed that one shoulder sits higher than the other? Do you find you tend to always lean to one side? Or maybe you’ve noticed that your waist looks fuller on one side, and that your clothes fit a bit funny. You may have something called scoliosis, which is an abnormal curvature of the spine. It can lead to back pain, hip pain, difficulty breathing, poorly fitting clothes, and in some cases, nerve impingement and nerve pain. Read on to learn more. 

Progression of Scoliosis(1,3)

In adolescence or early stages, scoliosis can be painless, and can often be missed if it is mild. If left untreated and allowed to progress, scoliosis can cause an aching back pain, which typically feels like the muscles on one side of the back are constantly tight. As the scoliosis progresses, you can begin to develop breathing challenges, as the ribcage will be more compressed on one side of the body, making it difficult to take in a full breath. Sometimes, the bottom-most rib can even touch the top of the hip bone on one side which can lead to sharp, acute pain. Over time, the intervertebral discs can become wedged-shaped which can cause nerve complications such as numbness and tingling, nerve pain, and nerve root compression.

What Causes Scoliosis?(1)

80-90% of scoliosis cases are idiopathic – which means there is no known cause. Adolescent Idiopathic Scoliosis is the most common type of scoliosis, affecting adolescents aged 9-17, and typically affects girls more than boys. The remaining 10-20% of scoliosis causes are due to congenital abnormalities (from birth), neuropathic or neuro-muscular conditions, or other systemic diseases. 

How Can I Check if I Have Scoliosis?(1)

Perform this quick checklist to see if you may have scoliosis:

• • Is one shoulder or shoulder blade higher than the other? 

• • Is one arm farther away from the body?

• • Does your body look tilted to one side?

• • Are your hips uneven in height or twisted?

• • Is one leg shorter than the other?

• • Do you find it hard to take a full deep breath?

• • When exercising, do some moves feel easier on one side of the body? 

• • Do you have consistent achy pain on one side of the upper or lower back only?

• • Is there a hump on one side of your back when you bend forward?

• • Do your lower ribs stick out in front on one side of your body? 

• • Does one foot turn in/out more than the other?

A physiotherapist will also be able to help figure out whether your scoliosis is functional or structural.

If you have functional scoliosis, you may answer yes to some of the screening questions above and appear to have a curvature, however on x-ray, the spine remains straight. That is because functional scoliosis is due to muscle imbalances and postural habits, rather than the structure of the spine itself.  For this reason, this type of scoliosis responds very well to orthopaedic physiotherapy treatments.

Structural scoliosis involves visible changes to the vertebrae on x-ray, and the shape of the spine is physically deformed. Physiotherapy treatments are also very beneficial for structural scoliosis, however depending on the severity, you may also require bracing and/or surgery.  

Treatment of Scoliosis

1. Physiotherapy (1,3)

Traditional Orthopaedic Physiotherapy treatment typically consists of core stabilization exercises combined with appropriate back strengthening. The goal is to stretch the tight muscles on the inside of the curve, and strengthen the elongated muscles of the outside of the curve, while also working on the deep core unit to provide overall stability to the whole body. An exercise program will be developed based on your symptoms, and will aim to address areas of pain and stiffness that you are experiencing. 

Schroth Therapy is a specific exercise-based approach to treating scoliosis and other postural dysfunctions. The exercises combine postural corrections with breathing mechanics to work towards curve correction. The overall aim of Schroth therapy is to improve motor control of the body and essentially ‘re-learning’ where straight is. When the scoliosis is detected early, and rapid intervention with Schroth is implemented, correction of the abnormal spine curvatures towards a more normal postural alignment is possible. 

2. Bracing (1,2,3)

Depending on the severity of your curve on x-ray, an orthopaedic surgeon who specializes in scoliosis may recommend a full body brace. Sometimes, this can result in a slight straightening of the curve, however this is not the primary goal. The brace is typically worn until skeletal maturity has been achieved, and works to prevent further progression of the scoliosis curves. They are typically prescribed to be worn full time (up to 23 hours per day), and work to provide counter-pressure on the outside of the curves while offloading the fatigued muscles on the inside of the curves.

3. Surgery (2)

If or when scoliosis progresses, it can begin to cause compression of the spinal cord. If it does not respond to more conservative treatments (physiotherapy, exercise and bracing), surgery may be required. The surgery would aim to stop curve progression, reduce the deformity, and maintain/regain balance through the trunk. Surgery typically involves spinal fusion where the bones of the spine are fused with hardware to secure the spine in a straightened position. There are also some newer approaches to scoliosis correction surgery that do not involve fusion, but rather are based on pressure/counter-pressure systems, pulleys, and tethers to gradually straighten the spine.

5 FAQ’s about Scoliosis

1. I have scoliosis, will I have to have spinal surgery?

No! The need for surgery is based on the severity of the curve(s), how much it is impacting your daily life, and how you have responded to non-surgical treatment approaches. Having scoliosis does not necessarily mean you have to have surgery.

2. Will my scoliosis just keep getting worse?

Not necessarily. Once skeletal maturity has been reached, the structural component (the bones visible on x-ray) will not worsen until later adulthood, and even then it is not inevitable. It can appear to worsen due to muscle imbalances, depending on habitual postures, exercise habits, workplace ergonomics, etc. This is where a physiotherapy exercise based approach can be VERY helpful!   

3. I was told to just “wait and see” what my scoliosis does before treating it. How long should I wait before seeking treatment for my scoliosis?

The ‘wait and see’ approach is an outdated approach to scoliosis management that we now know is not the way to go.  The faster you get treatment, the better your chances are of stopping or slowing the curve progression, and avoid worsening symptoms. 

4. Does swimming help manage my scoliosis?

Unfortunately, no. Although swimming is a great exercise for overall health and wellness, it can actually accelerate the progression of the curve, as it encourages the flattening of the thoracic spine. Historically, it was recommended as the “best” exercise for patients with scoliosis, as being in the water eliminates the force of gravity. Originally, it was thought that gravity played a role in scoliosis curve progression. However, we now know that this is untrue and have since advanced our treatment protocols for the condition such as the Schroth method outlined above. This is not to say that people with scoliosis should not swim recreationally, however competitive levels or very frequent participation should be avoided.

5. Does scoliosis only affect females?

Although more common in girls, boys can and do get scoliosis as well. Research shows there is a slightly higher prevalence of scoliosis in gymnasts and ballerinas/dancers, which are historically more female-dominant sports. This is more due to the overuse of one side of the body, or putting the body into positions that promote a flatter spine, rather than having more females in the sports. 

What Next?

If you suspect you might have scoliosis, or you have already been diagnosed with scoliosis, check in with a physiotherapist for a spine assessment! Even if you currently don’t have any pain, the sooner you start treatment, the better chance you’ll have to stop the curve progression, avoid more serious symptoms, and potentially decrease the severity of the curve. The Peak Health physiotherapist will be able to assess whether you have functional or structural scoliosis, however, requesting full spine x-rays from your doctor would also be beneficial to get a good look at the true shape of the spine. If you would like to pursue Schroth therapy, an x-ray prior to the assessment is mandatory, as the physiotherapist will need to examine the x-ray images before you attend.  

References:

1. Negrini, S., Donzelli, S., Aulisa, A.G. et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 13, 3 (2018). https://doi.org/10.1186/s13013-017-0145-8
2. American Association of Neurological Surgeons (n.d.). Scoliosis. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis#:~:text=Scoliosis%20affects%202%2D3%20percent,occurring%20equally%20among%20both%20genders. 
3. UK Scoliosis Clinic (n.d.). What is Scoliosis?. https://scoliosisclinic.co.uk/what-is-scoliosis/.