Pathology of Osteoarthritis

How Osteoarthritis affects the body? Pathophysiology of Osteoarthritis

Do you suffer from swollen, painful, and restricted joint movements? Are you diagnosed with Osteoarthritis? If yes, then you should start taking treatment and should also self-educate yourself regarding this condition. After reading this blog you will be certainly able to answer the queries that you might have in your mind regarding osteoarthritis.

What is osteoarthritis?

Osteoarthritis is a chronic progressive degenerative condition of the joints, meaning that the condition will deteriorate over time as it is a continuous process. Osteoarthritis affects mainly the articular cartilage of the big weight-bearing joints of the body mainly in aged individuals. It can be broadly classified into two types.

• Primary Osteoarthritis
• Secondary Osteoarthritis

Primary osteoarthritis is due to the wear and tear changes occurring in old age in which weight-bearing joints like the hips and knees are more commonly affected. It is uncommon in non-weight-bearing joints like the shoulder and the elbow.

Secondary osteoarthritis is due to abnormal wear and tear in a joint, caused by mechanical incongruity (lack of symmetry) of the articular surfaces. This incongruity may be the result of a preceding fracture involving the articular surface or partial destruction or deformity due to a previous disease. It can arise as a consequence of other conditions such as hyperthyroidism, dislocation, hemophilia, infection (tracking into a joint from an open wound) or tuberculosis of a joint, etc.

An osteoarthritic joint might be

• Painful
• Swollen
• Stiff
• Tender on restricted movements
• Crackling or grating sound
• Bowlegs deformity (in later cases)

What changes take place in our joints due to osteoarthritis?

• Articular cartilage of the surface

The place, where 2 bones meet, is normally covered with a rubbery material called cartilage. This material allows the bones to slide over each other without causing pain. When osteoarthritis sets in, the cartilage begins to break down and undergoes degeneration. As it is cyclically loaded during movements of joints, it undergoes fatigue failure leading to the fragmentation of the surface and fibrillation (cracks and fissures). In the later stages, the cartilage gets completely eroded, exposing the sclerosed or eburnated (hard and thick) bone and the subchondral cyst is also formed (Subchondral is the layer of bone just below the cartilage in a joint, chondral refers to cartilage. Subchondral bone is a shock absorber in weight-bearing joints. It has many blood vessels supplying it with nutrients and oxygen and taking away wastes).

• Bone

The bone surfaces become hard and polished as they lose protection from the cartilage. Subchondral cysts and cavities are formed as the eburnated bones are brittle. Blood flow may be reduced by venous occlusion (blockage of a blood vessel) and the development of microemboli (small particle often a blood clot) in the subchondral vessels occurs.

And microfractures occur allowing the passage of synovial fluid into the bone tissue. There can be venous congestion (when arterial inflow is greater than venous outflow) also. The bone undergoes hypertrophy (increase in no and size) forming peripheral osteophytes (bony projections)

• Synovial membrane

The synovial membrane undergoes hyperemia (excess blood in the vessels) dry and reactive inflammatory thickening. Reduction of synovial fluid secretion results in loss of nutrition and lubrication of the articular cartilage.

• Capsule

There is degeneration of the capsule along with chronic inflammation.

• Ligaments

Ligaments become contracted or elongated.

• Muscles

Muscles undergo atrophy meaning muscle wasting due to loss of movement and function, as a result of pain

• Joint space

Joint spaces become narrow and joints become stiff. The stiffness is maximum at the end of a long rest period and loosens for few minutes during activity.

There is no permanent cure for osteoarthritis but with a good diet and exercise, you can stop the condition from progressing further. The management involves the role of Doctors, Dieticians, Pharmacists, Occupational therapists, and Physiotherapists.

 

postnatal care and recovery: physiotherapy exercises after pregnancy

Post Natal Care & Recovery: Physiotherapy Exercises after Pregnancy

Almost within 48 hours of delivery most of the mothers are at their homes and the time taken to return to fitness varies according to the lifestyle and the type of delivery. It takes longer to recover from a cesarean section than from an uncomplicated delivery, the recovery also depends upon the fitness level of the woman. Besides visiting an obstetrician, the women should also be visiting a physiotherapist (the professionals trained in women’s health and incontinence). A physiotherapy session should be attended within the first 6 weeks. The physiotherapist plans designs and repeats the body movements to ensure fitness.

Why should we exercise after Pregnancy?

Doing exercises during the postpartum phase of pregnancy provides the following benefits;

• ·         Provides post-operative care for a cesarean section.
• ·         Strengthens the pelvic floor muscles.
• ·         Relieves perineal pain.
• ·         Strengthens abdominal muscles.
• ·         Prevention of back pain.
• ·         Improves fitness and decreases weight.

Exercise techniques used by the physiotherapist during the post-partum phase:

Breathing exercises.

Deep breathing, huffing, and coughing exercises are used to prevent pulmonary complications. Coughing is difficult because of incisional pain, an alternative method is huffing. Huffing must be done quickly with the pillow or hands held over the incision and say ' ha ' forcefully and repetitively while contracting the abdominal muscles.

Rom exercises

Initiate ankle pumps, active lower extremity ROM exercise, walking to promote circulation and prevent venous stasis. Bed mobility- rolling into and out of the bed should be taught.

Pelvic floor muscles

It is important to start Pelvic floor exercises within 6 hours of the delivery to regain the strength of these stretched muscles. The contractions should be done four to five times at frequent intervals throughout the day. The exercises are done to treat stress incontinence. The exercises increase circulation, promote healing, decreases inflammation thus relieving pain. Interferential therapy is used to re-educate the pelvic floor muscles. Initiate pelvic floor exercises to regain tone and control the muscles of the perineum.

Abdominal muscles

Abdominal exercises are important to maintain mobility and increase circulation to promote healing. Initiate non-stressful muscle setting techniques and progress as tolerated. Avoid activities like lifting heavy objects, avoid straight sit-ups, bed mobility – rolling onto the side to get out and into the bed should be practiced, because normal support of the abdominals for the lumbar spine is diminished and due to the ligamentous laxity the lumbar is prone to strains.

Diastasis recti

Diastasis is more common in women who have had several pregnancies.  Check for diastasis recti and protect the area of the incision as with diastasis exercises. The abdominal muscles should be contracted and released slowly at first and jerking must be avoided.

Relief of perineal pain

A ring cushion can be used for sitting so that pressure on the perineum is relieved. Side sitting or side-lying may be tried for breastfeeding. Prone lying with pillows under the lower legs and the abdomen to relieve pressure on the breasts may be restful. Cryotherapy can be applied for 4- 5 minutes twice a day. Ultrasound can be used around the scar to soften the tissue.

Postural correction

Retrain postural awareness and help realign the posture. Develop control of the shoulder girdle muscles which often get stressed due to the increased stress of carrying the new baby. Instruct to stand straight, stretch tall tighten buttocks, walk tall to prevent backache. During lactation, the mother should take care of her posture. Pillow should be kept under the thighs to prevent sliding and another pillow under the knee on the side of feeding.

Exercises after 6 week

The exercise regime should be continued and progressed to enable the mother to return to her normal activities.

• Hydrotherapy exercises can be done to strengthen the abdominal and pelvic floor muscles.  General trunk, leg, and arm movements can be done.
• Sit-ups, leg lifts,
• Abdominal and pelvic floor contractions and pelvic tilting can be performed during activities such as washing dishes or standing in a queue in the market places.
• Crook lying exercises can be performed by making the baby lie prone on the mother's tummy and chest
• In prone kneeling, the baby can lie between the mother’s arms.
• Other exercises are back humping and hollowing, pelvis swinging from side to side, alternate leg stretching backward with abdominal contractions.
• In standing, the baby can be held in arms and the mother bends and stretches the knees and hips with her back against the wall.

 

Pregnancy and Physiotherapy

Pregnancy & Physiotherapy: Exercises for Pregnant Women

One of the most common questions asked by pregnant females is, whether exercising is safe during pregnancy or not? Pregnancy is a time of tremendous musculoskeletal, physical and emotional change but we can maintain wellness by doing exercises with moderation. Exercises play a major role, as long as your pregnancy is healthy and don’t have any health complication. Exercising during pregnancy does not increase the risk of miscarriage, low birth weight babies, or preterm labour. Although exercising is safe but you should always consult your physiotherapist before exercising. Exercising is not advisable during few complications like hypertension, cardiovascular problem, low lying placenta, triplet or twin pregnancy, or short cervix.

Why should we exercise during Pregnancy?

Pregnancy, which spans 40 weeks from conception to delivery, is divided into three trimesters. There are characteristic changes during each trimester. Considerable changes occur in the women’s body as the pregnancy progresses. The changes can be:

·         Pregnancy weight gain.

·         Organs increase in size.

·         Posture and balance changes.

·         Diastasis recti.

·         Low back pain and pelvic pain.

·         Varicose veins.

·         Pelvic floor dysfunction and urinary incontinence.

·         Joint laxity.

·         Compression syndrome.

Benefits of exercises

·         Improve the stamina to endure through labour and delivery.

·         Prevents the risk of gestational diabetes.

·         Reduces back strains and pelvic pain.

·         Reduces constipation and bloating

·         Increases energy level

·         Elevates mood

·         Decrease swelling

·         Reduces muscle cramps

·         Helps sleep better

Physiotherapy during pregnancy

Exercise techniques are used by your physiotherapist to make you feel healthier and stronger during pregnancy:

·         Relaxation and breathing technique:

Techniques of conscious relaxation allow you to control and cope with a variety of imposed stresses by being mentally alert. This is particularly important during labour and delivery when there are times when the women should relax and allow the physiological process to occur without excessive tension in unrelated muscles.

·         Aerobic exercises:

Aerobic exercises help in maintaining your cardiovascular/ pulmonary fitness. Submaximal exercises should be done in moderation.  Taking a walk, swimming, aqua or water exercises and static- cycling are beneficial. Studies have shown that mothers, who continue endurance exercises in the third trimester, their newborns have slightly better neurodevelopment status in addition to lean body mass.

·         Stretching ( with caution):

Stretching exercises increase flexibility and decrease stiffness.  The Upper neck extensors and scalene, scapular protractors, shoulder internal rotators, and levator scapulae. Low back extensors, hip adductors, and hamstrings and Ankle plantar flexors should be stretched gently.

·         Strengthening ( low intensity):

Resistive exercises to appropriate muscles of upper neck flexors, lower neck and upper thoracic extensors, scapula retractors and depressors, shoulder rotators, trunk flexors, hip and knee extensors and ankle dorsiflexors, should be given with low intensity.

·         Abdominal exercises and exercises for diastasis recti:

As pregnancy progresses abdominals undergo extreme overstretching. Check for the diastasis recti must always be performed before initiating abdominal exercises. Exercises like

Head lift, head lift with pelvic tilt, leg sliding, pelvic tilt exercises, trunk curls, pelvic lifts should be performed with care.

·         Pelvic motion training:

These exercises help to strengthen the muscles of the pelvic floor and thus help to reduce urinary incontinence (urine leakage). Kegel’s exercise can be used for strengthening the pelvic floor muscles by contracting the pelvic floor muscles for 3 -5 seconds. Relax for 3-5 seconds and repeat the contract-relax technique 10 times. It also uses quick contraction techniques for strengthening the muscles.

·         Elastic support stockings can be used to reduce the swelling.

NOTE: Drink water after every 15 minutes while doing exercises. Activities that decrease the risk of falling should be performed. All exercises should be done safely with moderation but you need to check with your physiotherapist before exercising.