ARTHRITIS

Arthritis physio is mostly about managing osteoarthritis and rheumatoid arthritis - two different beasts, but the goal is the same: keep you moving, reduce pain, and slow down loss of function.

1. *Osteoarthritis - the "wear and tear" type*

Most common in knees, hips, hands, spine. Cartilage wears down, joint gets stiff and painful.

*What physio does:*

- *Strength training*: Strong quads/glutes for knee OA, glutes/core for hip OA. Strong muscles offload the joint better than any brace. Research shows high-load resistance training is safe and effective even in moderate OA.

- *Aerobic exercise*: Walking, cycling, swimming. 150 min/week helps with pain, stiffness, and overall health. Low-impact is key if flaring.

- *Range of motion & mobility*: Gentle stretching for tight muscles around the joint. Stiff hip flexors/calves make knee OA worse.

- *Load management*: Adjusting activity so you don’t flare. That means pacing, not avoiding movement entirely.

- *Education*: Weight management matters - every 1 kg lost reduces knee load by ∼4 kg per step.

- *Manual therapy*: Helps short-term for stiffness, but exercise is the main driver long-term.

2. *Rheumatoid Arthritis - the autoimmune type*

Joints are inflamed from the immune system attacking them. 

*What physio does:*

- *Protect joints during flares*: Gentle range of motion, avoid aggressive strengthening when joints are hot/swollen.

- *Strength in remission*: Once inflammation is controlled with meds, progressive strengthening prevents muscle wasting. RA patients lose muscle fast if inactive.

- *Hand function*: Splinting, grip strengthening, fine motor drills for hand RA.

- *Fatigue management*: Pacing strategies, graded exercise. Exercise actually reduces RA fatigue despite it feeling counterintuitive.

- *Posture & joint protection*: Teaching ways to open jars, lift, sit that reduce stress on inflamed joints.

3. *What _doesn’t_ fix arthritis*

- Resting completely makes it worse. Joints need movement for nutrition and strength.

- Passive modalities like ultrasound, TENS, heat/ice help pain short-term but don’t change joint structure or function.

- “Bone on bone” on an X-ray doesn’t equal “can’t exercise”. Pain and function correlate poorly with imaging.

4. *Typical treatment plan*

*Phase 1: Reduce irritability*  

Gentle movement, education on pacing, manual therapy if stiff. Avoid aggravating activities for 1-2 weeks.

*Phase 2: Build capacity*  

Progressive strengthening 2-3x/week. Start with bodyweight, bands, then add load. Focus on quads, glutes, core for lower limb OA.

*Phase 3: Function & maintenance*  

Return to walking, stairs, gardening, sport at a tolerable level. Most people stay on a maintenance program 2x/week indefinitely - it’s like brushing your teeth for joints.

5. *Red flags to get checked*

- Sudden severe swelling, redness, heat in one joint

- Morning stiffness >1 hour that doesn’t ease with movement

- Joint deformity, instability, or locking

Bottom line

Exercise is the most effective non-drug treatment for arthritis. It sounds backwards when joints hurt, but controlled loading reduces pain and improves function better than rest. A physio’s job is to find your starting point and progress you without flaring things up.

Which joint is giving you trouble, and do you know if it’s OA or RA? That changes the approach quite a bit.

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