Mark: Hi, it’s Mark from TLR. I’m here with Ryan Corkal of Body Works Sports Physiotherapy in North Vancouver. And we’re going to talk about arthritis. How are you doing Ryan?
Ryan: I’m doing well. How are you?
Mark: Good. So hip and knee arthritis specifically. What’s going on there?
Ryan: Yeah. So hip and knee arthritis, specifically we’re going to talk about osteoarthritis today. So there are many different types of arthritis. And today we’ll talk about osteoarthritis. So the reason why I do specify which type is because the different types of arthritis, we would kind of treat and address differently. So osteoarthritis does affect a lot of different joints across the body, but the hip and knee are two of the more common ones.
Essentially what happens is normally in a joint, we have very smooth cartilage at the ends of the bones and the joints that helps the joint move smoothly. Sometimes as we age, if someone starts to develop osteoarthritis, they’ll start to have that cartilage breakdown a little bit. So that’ll lead to issues with pain, swelling, decrease in range of motion and all sorts of things like that.
Mark: And so how do you diagnose it? I mean, the symptoms are obvious. It hurts, but what happens after that?
Ryan: Yeah. So common types of pain, let’s say for the hip is that you might start to notice pain deep into the groin. So that’s like into the front of the hip. So that’s a very common type of pain for hip arthritis.
For the knee, it could be felt in different parts of the knee. It could be kind of to the inner part of the knee or the outer part. There’s different compartments of that joint. So what would kind of depend which compartments that it’s affecting? Other things that you might notice is a lot of the time your hip or knee might feel really painful or stiff first thing in the morning when you wake up and then as you start to move around, usually within 30 minutes, things will loosen up and start to feel better.
If that joint stays really painful or stiff for longer than that. It could be more of a sign of a different type of arthritis or something else that’s going on. Once we would see them in the clinic, there’s also other signs that we can start to gather. So we might notice that somebody is limping or favoring that leg that they have arthritis in. Then once we start to assess it a little bit further, we might start to notice some major restrictions in their range of motion. So they can’t fully bend or straighten their knee.
Or they could only flex their hip or rotate their hips so far. And usually these types of range of motion, they might be associated with significant pain. Another common finding less so for the hip, but a lot of the time in the knee, you’ll start to see some significant swelling into that joint.
Mark: So, okay. You’ve diagnosed it. What’s the treatment?
Ryan: Yeah, so there’s a lot of different options for treatment. So one thing that you could consider, especially for knees, less so for hips, is bracing. So there are specific types of braces that can actually be help kind of open up the joint and take pressure off where the arthritis is. So sometimes that could be very effective.
Also in the clinic, we can do different types of treatments in terms of hands-on mobilization. So trying to get in there with our hands and gain back some of that range of motion. If the arthritis hasn’t developed to a certain point that can be effective. Also working through the muscles, trying to release the muscles with some massage work, soft tissue work. Sometimes different types of acupuncture could help with that.
Another big option that we have as well is exercise. So basically trying to strengthen up the muscles around the joints has proven to be very effective. So for example, for the knees, trying to really strengthen up the quadriceps, the hamstrings, the calf muscles. For the hip, trying to strengthen the gluteal muscles and the hip abductors, the different muscles around the hip can be very effective as well.
In addition to strengthening, we do have other options simply such as kind of a walking program, biking, or even aquatic exercise like walking or running in a pool or swimming. Things like that could all be really good options to.
Mark: So movement’s going to help quite a bit in other words.
Ryan: Yeah, absolutely. We do want to try to kind of move the joint as much as we can, without trying to aggravate our symptoms too much, kind of keep those joints as mobile as possible. And that kind of thing. The other thing I should mention is if you know, all of these types of treatments are not working or the joints are progressively getting worse and worse, than it is important to have the patient chat with their doctor, potentially get some x-rays. And at a certain point, sometimes a joint replacement is needed.
Mark: So once this path has started, is there a way, you are just, it’s a delaying action really. What you’re doing. You can’t, it’s not going to regenerate in that way or typically so far, at least we haven’t seen that.
Ryan: Yeah. As far as I know, I mean, the big thing we watch for is joint space narrowing, it’s called. So as we kind of lose some of this cartilage, you actually lose the joint space. So the space in between the bones. So as far as I know, we’re not going to gain that joint space back but doing these things such as strengthening the joints and treating it in different ways, will help delay the progression of the arthritis. And it’s also going to help with our symptoms and just generally improving strength around the joints as well.
Mark: So, is it fair to say it’s important to get in as soon as possible when you start noticing it, like don’t wait until you’ve toughed it out for a couple of years and then, Oh God, I guess I’ll go see somebody. It’s better to actually be there and start doing the process so that you delay the hip replacement or knee replacement.
Ryan: Yeah, the sooner you get in the quicker that we could find out kind of what your deficit is. Whether it’s range of motion or strength and just kind of get you on an exercise program to address that. For some people it’s inevitable that they may have to get a joint replacement as well, but it’s going to be an easier process and rehab afterwards. If you try to kind of get it in there and start strengthening things up beforehand as well.
Mark: So what’s a typical kind of outcome from doing this treatment. How long does it take?
Ryan: Good question. And it’s gonna vary a lot from person to person. So, someone who kind of catches things pretty early on when they start to get symptoms and comes in. Might only have to kind of come in a few times. Get set up with a bit of an exercise program and after a month or so it might be managing well on their own. Maybe kind of coming in for intermittent follow-ups every couple of months or so.
Someone who’s further along, they might not be able to get their symptoms under control as fast, and they also might be kind of at the point where we can’t have as good of an effect on the outcome. So they might be coming in intermittently kind of for months and months until things either start to improve or again, they need to get a specialist with a surgeon.
Mark: If you’re having some hip and knee pain, the people to see in North Vancouver are Body Works Sports Physiotherapy in North Van, you can call them and book at (604) 983-6616. Or you can book on the website, body-works.ca. Give them a call. They’ll get you feeling a little bit better. Thanks Ryan.
Ryan: Thanks Mark. Take care.