Treatments for osteoarthritis: physiotherapist perspective

Professor Kim Bennell, physiotherapist 

Quality physiotherapy for osteoarthritis management would include advice and education from the physiotherapist exercise and a home-based program as well as perhaps manual therapy, bracing, use of walking stick but it wouldn't include simply getting machines placed on your knee such as ultrasound or laser therapy. So, the total treatment benefit is not just made  up of the benefit that you get from that  specific treatment but it also depends on  a range of other factors such as your belief in  the treatment, your expectation or whether or not  you're going to get benefit and that's why trying  some of these therapies where there actually is no evidence that they're more effective than a sham therapy they do have benefits because  people have a strong belief that they're going  to work and we know that pain comes from the  brain that that's where you experience pain and so a number of factors are going to influence that,  your emotions, your thoughts, your beliefs and  that's why you will get benefits in some cases.

Exercise & weight loss

Most important treatments for osteoarthritis really have two main one’s exercise and weight loss, if overweight. With exercise, structured exercise is really important to help strengthen up the muscles to improve your fitness and to improve range of motion but it's not just structured exercise also just being more physically active in everyday life is really important parking the car a bit further away walking and so forth. The second one is weight loss and sometimes people think that it needs to be a Biggest Loser amount, and it doesn't need to be that even just small amounts of weight loss a couple of kilos have really important benefits in terms of reducing the load on the joints and improving function and reducing pain. Research shows that exercise is beneficial for everyone with osteoarthritis regardless of how old they are, how severe their disease is, what it looks like on their x-ray, how to be their pain levels are or their function.

Splints

There's a variety of different splints that are available that you can either have over the counter or you can get custom-made and some of the splints can be simply elastic material like the wetsuit material that you pull on over the joint and they can help reduce pain. There are other braces that are much more rigid and provide a lot of support and can even help to unload the joints and they have been shown to reduce pain and improve function. There are also resting splints for night and they're very good for hand osteoarthritis and again the research has showed that resting night splints can be effective for reducing pain over the longer term.

Insoles

Insoles are devices that can be placed inside the shoes there's a whole range of different insoles some support the arch others a wedge on the inside or the outside and they have different purposes. It's best to talk to a health professional as to the best type of insole for you because there are a range of different insoles, and they have different purposes and they're going to suit different foot types and achieve different outcomes.

TENS machine (transcutaneous electrical nerve stimulator)

A TENS machine is a small portable device that delivers small electric impulses via electrodes placed onto the skin and those electrical currents interfere with the pain signals that the brain gets from the painful area and helps to reduce pain. People can use TENS devices on a continuous basis you can basically apply the electrodes to the area that it's painful you wear the little device around and you can wear that all day and apply that as you need.  In terms of the effectiveness, the research is a bit mixed and so what is recommended is that if you have tried all other treatments and they haven't worked that you would then try TENS but it's not a treatment that you would use as your first line of management. If people have tried all the other treatments and they haven't been effective, then it can be worth renting machine and seeing if it’s going to be beneficial for you and in that way, you can gauge whether or not it's going to be something that's going to be useful.

Ultrasound

The research shows that treatments such as ultrasound electrotherapy where machines are being put on to the painful part really aren't effective and so they're not recommended for  the management of osteoarthritis.