What Do Physical Therapists Know About Joint Disease and Osteoarthritis?

by Chris Knudsen, DPT

Clinic Director of The Rehab Center - Physical Therapy in Lancaster

Our previous article addressed the anatomy of a joint.  In today's article we will discuss the definition of Joint Disease.

Did you know that physical therapists now must have seven years of college, and earn a Doctor of Physical Therapy degree, in order to become a physical therapist?  The schooling is very rigorous and thorough.  Any physical therapist can teach you about joint disease.  Many things can happen to the normal joint to make it diseased.  A disease process can harm the joint in several ways.  It can attack the cartilage on the ends of the bones, it can affect the inside lining of

the joint capsule (the synovium), or attack the joint capsule itself (for more anatomy details, see Osteoarthritis: What is that popping noise? ). 

A diseased joint is usually painful, stiff, and sometimes swells.  Sound familiar?  Movement is hampered by these symptoms.  I always tell my patients that simply resting a painful joint may not make it better.  In fact, it might actually get worse with rest.  You see, rest decreases the blood supply to the joint and also causes the joint lubricating fluid (synovial fluid) to thicken.  On the other hand, movement increases blood flow, which then increases the supply of nutrients and fluids to the joint for nourishment and joint repair.  Have you ever noticed that you feel stiff and sore in your joints in the morning after lying around all night, but feel better after you get up and move around?

Osteoarthritis develops in our joints after years of "wear and rear."  You see, after walking thousands of miles, after grasping and turning a thousand bottle lids, after getting up and down from a chair ten thousand times, the cartilage on the ends of our bones has undergone numerous little insults which result in tiny microscopic cracks.  These tiny little cracks in the cartilage have been repaired over and over again with non-cartilaginous scar tissue (it is difficult to get cartilage to reform and repair itself because the blood supply is so poor). 

After our bone ends have become riddled with hundreds, even thousands of little cracks, they begin to show changes visible to the naked eye.  We can see fibrous scars and calcium deposits on the surface of our long bone ends where the normal smooth cartilage used to be.  This creates an irregular, rough surface.  The normally smooth movement of one bone upon another is now disrupted and the movement is more coarse and "sand-papery". 

This rubbing of one rough surface upon another creates joint irritation with thickening of the synovial fluid, and leads to the process we call inflammation, the body's way of trying to repair damage. 

Inflammation causes pain, increased blood flow into the joint (which causes redness and warmth) and leaky capillaries, which increases fluid accumulation into and around the joint (resulting in swelling).

When people have these symptoms they should see their family physician and consider asking for a prescription for Physical Therapy.

In my next article we will address the available treatments for osteoarthritis: including NSAIDs, topical analgesics, diet, and Physical Therapy.  If you have immediate questions feel free to call one of our physical therapists at The Rehab Center closest to you.  Click Here for the phone numbers.