Surgery Archives - Praxis Physiotherapy

Knee Osteoarthritis: Is ‘Bone on Bone’ a painful life sentence?

by Stephen Timms | May 16, 2023 | Knee, Osteoarthritis, Pain, Surgery

Knee Osteoarthritis is a common ailment responsible for pain, loss of function and reduced quality of life
Rates of knee OA are set to increase
Whilst there is no cure, exercise therapy under the guidance of a physiotherapist is considered a front line treatment to help reduce the severity of symptoms
There are options before a knee replacement

Do your knees go crackle and pop? Pain with walking, stairs or getting out of a chair? Stiffness and pain first thing in the morning or after a long car ride? These are signs that you may be living with the early or even advanced symptoms of knee osteoarthritis (OA). Don’t fear though – there is plenty that can be done immediately.

What is “OA”?

Osteoarthritis (OA) is an increasingly prevalent source of musculoskeletal pain and dysfunction. OA is a disease of the joint – including cartilage, bone, capsule and other associated tissues. This disease process can cause chronic pain, reduced physical function and diminished quality of life. The ageing population and increased global prevalence of obesity are anticipated to dramatically increase the impacts of knee OA and its associated impairments [1]. Although osteoarthritis can affect any joint, OA is knee is one of the most common complaints.

Presentation

It most commonly presents in people over the age of 50, and is often described as being painful, stiff and occasionally swollen. In terms of a tissue level, knee OA describes the gradual deterioration of the supportive cartilage within the knee joint. As the cartilage wears away with time, the protective joint space between the bones decreases. With a reduced cartilage lining to protect and support the spacing of the knee joint, the Femur and Tibia (knee bones) are increasingly less likely to dissipate forces through the joint . With time, it should be expected that bone spurs (osteophytes) may form in and around the joint as the bones react to repetitive contact with each other.

Management

The management of knee OA largely consists of exercises addressing strength, range of motion, quality of movement, emphasizing joint control, pain reduction and weight management.

Strength Training

Strength training should be the cornerstone of addressing knee OA, particularly the early signs. Strengthening the muscles around the knee joint, such as the quadriceps, hamstrings, and glutes provide better support to the knee, reducing stress on the joint and helping to alleviate pain and discomfort. Movement associated with exercise has an added benefit – It increases joint lubrication. Loading of the joint stimulates the production and distribution of synovial fluid within the joint. This fluid acts as a lubricant, reducing friction and providing cushioning to the joint surfaces. Improved lubrication can help alleviate pain during movement.

Range of motion

Knee osteoarthritis often leads to stiffness and limited range of motion in the joint. Physiotherapy can include specific exercises, manual therapy and stretches to improve joint flexibility, helping to restore a more normal range of motion and enhancing mobility. The greater the restoration of range, the better the knee feels.

Pain reduction

Both strength training and physiotherapy can help reduce pain associated with knee OA. As mentioned, stronger muscles provide better support to the joint, relieving pressure and reducing pain during movement. Physiotherapy may provide education of aggravating and easing factors (eg. hot / cold packs, hydrotherapy) as well as liaise with your GP for adequate analgesic medications.

Lifestyle modifications

Adopting a healthy lifestyle can play a pivotal role in managing knee osteoarthritis. Maintaining a healthy weight reduces the stress on the knee joints. Regular low-impact exercises such as swimming, cycling and reformer pilates help improve strength, flexibility, and overall joint health. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can promote weight loss and provide essential nutrients for joint health. Quitting smoking and minimizing alcohol consumption are also beneficial.

Improved weight management

Regular exercise can assist in weight management, which is crucial for individuals with knee osteoarthritis. Excess weight puts additional strain on the knee joint, contributing to pain and progression of the condition. By maintaining a healthy weight, exercise helps to reduce the load on the joint and alleviate pain.

Surgical Interventions

When conservative measures fail to provide relief, surgical interventions may be necessary. Procedures such as arthroscopy, osteotomy, and joint replacement surgery can help repair damaged tissues, realign the joint, or replace the damaged joint with a prosthetic. These surgeries can significantly improve mobility and reduce pain, allowing individuals to resume their daily activities. Physiotherapy can aid in preparing you for the surgery, as well as rebuild your “new” knee after a knee replacement has been completed.

In conclusion, while knee osteoarthritis can be challenging, it is not a condition that should hinder individuals from leading fulfilling lives. By implementing lifestyle modifications, exploring various treatment options, and working closely with your physiotherapist, individuals can effectively manage their symptoms, alleviate pain, and enjoy an active lifestyle with a sense of well-being. If conservative options fail, there are surgical interventions that can be investigated. If you are wanting to look after your knees, or already suffering from knee pain, chat to our knowledgeable Praxis Physios to discuss your treatment options at any stage of OA’s progression.

Until next time,

Praxis what you Preach

FACT OR FICTION FRIDAY || All rotator cuffs tears need surgery.

by Stephen Timms | Dec 28, 2019 | Pain, Shoulder, Surgery

Answer: FICTION. The devil is in the detail!

The rotator cuff is a group of 4 muscles that aid in providing stability through range for the shoulder joint, particularly overhead. There are multiple risk factors for RC tears, but most are down to overactivity of the shoulder joint decreased conditioning of the shoulder complex, which comes with age. In fact, cuff tears are common in individuals over the age of 40 with linear increase in incidence as we get older.

Pain with movement and function is one of the biggest symptoms of a rotator cuff tear. However, it is important to know that a sizeable portion of RC tears are actually asymptomatic and don’t cause the person any pain or discomfort! A study by Minagawa and Yamamoto in 2013 found that in a screening of 664 village residents, 147 subjects had RC tears on a medical imaging screening. Surprisingly 65% of them had no symptoms at all and didn’t have any shoulder complaints.

Mid Potion Achilles Tendinopathy Location

The two main ways of treating a cuff tear is either through conservative management with your physiotherapist or down the surgical route, which is also then followed by physiotherapy rehabilitation.

SO, back to the original question: “Do I need surgery?”. As always – it is a case by case decision!! There is no definitive evidence for supporting one over the other generally speaking!

However, it is vitally important to note that each option comes with their own pros and cons. Furthermore, it is important to remember that just as every person is different, each case of rotator cuff tear is different. Young vs old, acute vs degenerative RC tear, current and desired future function, pain levels, radiographic findings, previous history of shoulder trauma and the patient’s wishes are only some of the questions that aid in the decision process.

The best way to decide would be to contact us to asses you and discuss both options and what your goals of rehab are so that a tailored plan can be developed WITH you. To read more about RC tears, read our blog here

To get your shoulder back on track, book online or give us a call on (07) 3102 3337.

Team Praxis

PREVENT | PREPARE | PERFORM

ROTATOR CUFF TEARS || Do I Need Surgery?

by Stephen Timms | Sep 14, 2019 | Pain, Shoulder, Surgery

That age old question in which the answers seems to be becoming increasingly more difficult to answer. We have looked over the research and tried to simply things for those who are unsure about what to do with their shoulder.

SUMMARY:

A rotator cuff (RC) tear is a common cause of pain and disability among adults.
There are multiple risk factors for RC tears, but most are down to overactivity of the shoulder joint decreased conditioning of the shoulder complex, which comes with age.
Most common in individuals over the age of 40 with linear increase in incidence as we get older.
A well-constructed strength program and active lifestyle is pivotal for preventing RC tears.
Diagnosis of a RC tear is done through first a physical examination, which is then followed by a positive finding on medical imaging.
To two main ways of treating a RC tear is either through conservative management with your physiotherapist or down the surgical route, which is also then followed by physiotherapy rehabilitation.
There is evidence for both choices and the decision between the two is down to many factors and the well-trained and experienced physiotherapists at Praxis Physiotherapy can greatly assist you in making the decision!

ANATOMY

The rotator cuff (RC) muscles are a group of four muscles that act as rotators and stabilisers of the shoulder. These are supraspinatus, infraspinatus, subscapularis and teres minor. Supraspinatus is the most frequently torn of this group.

These muscles work to help raise and rotate your arm for everyday activities such as putting on a t-shirt, combing your hair or putting away dishes on a high shelf. In sport the cuff works as a dynamic stabilisers of the shoulder to help cope with the forces associated with overhead activities such as swimming, tennis serving, throwing or weight lifting. Simply put, the cuff aids in keeping the ball (head) of your upper-arm bone (humerus) in your shoulder socket with movement.

CAUSES, SYMPTOMS & RISK FACTORS

The cause of RC tears is multifactorial. Degeneration (which comes with age), impingement and overload, may all contribute in varying degrees to the development of rotator cuff tears.

This disease is primarily of middle aged and older patients with observational data reveals a nearly linear increase in the frequency of rotator cuff tears with age. Pain with movement and function is one of the biggest symptoms of a rotator cuff tear. However, it is important to know that a sizeable portion of rotator cuff tears are actually asymptomatic and don’t cause the person any pain or discomfort! A study by Minagawa and Yamamoto in 2013 found that in a screening of 664 village residents, 147 subjects had RC tears on a medical imaging screening. Surprisingly 65% of them had no symptoms at all and didn’t have any shoulder complaints.

Why is this important? Well if you end up going to a GP and he/she send you for a scan and finds a torn RC, most will assume that it is the cause of them pain, but as seen in the study this is definitely not always the case. Before it can be decided whether the RC tear is the causes of the pain there are numerous structures in and around the shoulder that have to be examined and “crossed off the list” of possible causes of the pain. This can only be done by a physical examination of the shoulder which can be done by an experienced physiotherapist.

TREATMENT: CONSERVATIVE OR SURGICAL

The decision of treatment for rotator cuff tears is dependent on many factors. The current literature on the topic states three main modalities of treatment for a symptomatic RC tear; these being:

Use of a corticosteroid injection
Physiotherapy intervention
Surgical management

The use of corticosteroid injections is commonly recommended by GP’s for treatment of pain in RC tears. They may provide pain reduction in some patients but is important that you talk to your GP about both the pro’s and con’s of these injections as the current evidence does support that these injections do in fact have a detrimental effect on tendon health and strength.

In addressing whether a surgical or conservative route should be taken, there is currently very limited literature and evidence to support one modality over the other. A study by Lambers and van Raay in 2015 looked at comparing the effectiveness of surgical versus conservative management of 56 patients with rotator cuff repairs. They followed up over a year and the results showed no significant difference in pain and disability in favour of either modality.

However, a study by Moosymayer and colleagues collected data from 103 patients with RC tears, with half having surgical repairs and half being treated conservatively with physiotherapy. They were followed up over 10 years at 6 months, 1, 2, 5 and 10 year marks. The first three follow up saw no difference in results between both modalities. However at the 5 and 10 year follow ups they found preferable outcomes for surgical repair over conservative treatment, with a small proportion of the conservative management patients opting for surgical treatment at the 5 and 10 year marks due to decreased satisfaction in results from conservative management.

The big answer for the whether conservative management or surgical management is best for a rotator cuff tear………….

As always – it is a case by case decision!! There is no definitive evidence for supporting one over the other generally speaking! However, it is vitally important to note that each option comes with their own pros and cons. Furthermore, it is important to remember that just as every person is different, each case of rotator cuff tear is different. Young vs old, acute vs degenerative RC tear, current and desired future function, pain levels, radiographic findings, previous history of shoulder trauma and the patient’s wishes are only some of the questions that aid in the decision process. The best way to decide would be to contact your physiotherapist and have chat about both options and what the goals of rehab are so that a tailored plan can be developed WITH you.

We here at Praxis Physiotherapy pride ourselves on providing the best possible treatment and advice on all things musculoskeletal and are more than happy to assist, and advise you on your decision regarding rotator cuff tears. We also work closely with a number of excellent orthopedic surgeons specialising in shoulders in Brisbane to ensure you get the best possible advice and intervention if you require it. So stop waiting and suffering, give us a ring and book an appointment on (07) 3102 3337 or simply book online

Till Next Time, Praxis What You Preach

The Praxis Team

PREVENT | PREPARE | PERFORM