Dicky Hips and Rusty Knees

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Osteoarthritis (OA) is one of the most common conditions affecting Australians. It has been reported that a whopping 24% of the adult population is noted to have some kind of knee OA and 11% have OA of the hip(1). Additionally in older populations of people, it is noted as the most common cause of pain and chronic disability(2).

 

To summarise it’s not much fun.

So what can be done?

There are a lot of different things that can be done to help with hip and knee OA and they range from medications to surgery to chiro/physio to psychology etc etc the list goes on.
On a side note if you ever have to look down the barrel of a knee or hip replacement the following is a great resource to make the most of it: https://www.youtube.com/watch?v=xAL_TrQdtTY
The focus of what we are going to talk about here though, is in regards to conservative management, because that’s kind of our thing at Your Health Sport and Spine in Dural.
A solid evidence based guideline paper was put together by a group known as European League Against Rheumatism (EULAR) in 2013 called EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis3 and most of what we’re talking about will come from there.

 

So pretty much the research involved getting together a group of experts in the field to come up with a list of things that can be done back by the best available evidence at the time. The group included two nurses, one psychologist, one dietician, two occupational therapists, three physiotherapists, five rheumatologists, two orthopaedic surgeons, one general practitioner, two people with hip and knee OA, one clinical epidemiologist and another researcher.

 

Overall the consensus was quite clear. For the best outcome an individualized approach to care should be undertaken utilizing an evidence based multi-modal approach.

 

A summary of the recommendations were as follows:

  • Initial assessment should use what’s known as a “biopsychosocial approach” looking at physical status, activities of daily living (ADLs), participation in life, mood and health education.
  • Treatment should be individualised taking into account the wishes and expectations of the patient.
  • All treatment should involve education, pacing of activity, regular exercise, weight loss if need be, reduction of factors that are known to make it worse.
  • Goal setting for lifestyle modification
  • Education about what is OA
  • Regular exercise linking in to improving ADLs
  • Strengthening/rehab of the muscles around the hip and improving range of motion with a goal of self management
  • Education on weight loss
  • Good comfy shoes
  • Walking aids as required
  • An ability to stay in the workforce with appropriate occupational changes

In short the goal is to make sure people know what is happening to their hips and knees and empowering the person to take control of their condition. To be honest it is very true of many musculoskeletal conditions because a lot of the time in the long term, the thing you do for yourself, more often than not is more important than the thing that can be done in clinic. Because your health matters

About the Author

Alex Fielding is the owner and principal clinician at Your Health Sport and Spine, an evidence based chiropractic and exercise rehab clinic based in a medical centre in Dural. Alex is a trained Chiropractor graduating from Macquarie University in 2010 and is currently halfway through the Doctor of Physiotherapy Programme at Macquarie Uni as well. He has a special interest in chronic injuries of the back and lower limbs and currently looks after the injury management side of things for Westbrook Junior AFL Club and Redfield Oldboys Rugby Union Club. He can be contacted on 9651 1395

 

References
1. Pereira D, Peleteiro B, Araujo J, et al. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage 2011;19:1270–85.
2. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003;81:646–56.
3. Fernandes L, Hagen K, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125-35.