Hip and Knee Osteoarthritis Guideline for Nonsurgical Management
Hello, I'm Norman Swan. Welcome to this programon the new guidelines for the nonsurgical managementof hip and knee osteoarthritis. It's a timely program, as we're broadcastingduring Arthritis Awareness Week. Arthritis, as you know, is a major causeof disability and chronic pain. There's around 100 different formsof arthritis, and osteoarthritis is the most common.
This program is the thirdin a series of four on the musculoskeletal guidelines that have been developedby the Royal Australian College of GPs and approved by the NH and MRC. This program will cover the diagnosisof osteoarthritis and discuss recommendednonpharmacological and pharmacological interventions in a multidisciplinaryprimary healthcare setting.
As always,you'll find a number of resources available on the Rural Health EducationFoundation's website: Let's meet our panel. Geoff McColl is a rheumatologistand professor of Medical Education and Trainingat the University of Melbourne. Welcome, Geoff. Thank you, Norman. Geoff is the current president ofthe Australian Rheumatology Association and was part of the working partydeveloping this guideline.
Rana Hinman is a physiotherapistand senior lecturer in the University of Melbourne Schoolof Health Sciences. Welcome, Rana. Rana has particular expertisein evaluating conservative treatments for osteoarthritis, and was alsoa member of the working party. Michael Yellandis a general practitioner and associate professorof Primary Health Care at Griffith University in Queensland.Welcome, Michael. His teaching and research interestsfocus on evidencebased diagnosis
and the treatmentof musculoskeletal pain. And David Ng, who's a pharmacist and director of the South Australianand Northern Territory Branch of the Pharmaceutical Societyof Australia. Welcome, David. Thank you, Norman. From the home of fish oil. That's correct. We'll talk about fish oil later to see whether or not it'sthe magic panacea for osteoarthritis.
Many myths about osteoarthritis,Geoffreyé There are many myths, Norman. Probably the best place to start is that this is an illness that you acquireas you grow old that you can do nothing about. You're just going to creak your wayto the wall at the bottom of the garden. Absolutely. There's a certain acceptancethat this is the way it will be. NORMAN:Are you telling me it's reversibleé
What can you expect at the when seeking conservative treatment for Hip OA
What can you expect at the when seekingconservative treatment for hip oaé So you know all of us are a little bit different,there are so many physical therapists, chiropractors and osteopathic physicians out there and weare all a little bit different but there are a lot of similarities. There are really three main areas that weall want to approach any patient with. We want to evaluate them, give them a fullthrough evaluation to find out, because you might have hip osteoarthritis but you couldalso have other dysfunctions around your lower back or your knee that play a role in thatperson's individual care plan.
So after the evaluation, we'll kind of sitdown with the patient and let them know what impairments we've found; what's moving toomuch, what's not moving enough, what is tight and what is weak.And so we want to teach them exercises, very specific exercises, but if the person is verystiff and can't move, what good is strengthening something that can't moveé So we want to startoftentimes with manual therapy. Every patient is a little bit different. Somepatients need a lot of manual therapy and then they progress into exercise while othersdon't need any manual therapy and they are ready for exercise right away. That has todo with the severity of the hip osteoarthritis.
So someone comes in and we find that theyhave a stiffening capsule around that hip joint. There are a dozen or more hands ontechniques that we can do. So physical therapists and chiropractors will do joint manipulationsand mobilizations. If you go to the HipTrac website or channel you'll see somedemonstrations of these techniques. You can go to the channel and youcan see demonstrations of some of these techniques. Some of them are very relaxing, very gentle,very pain relieving. They are all very safe. Then there are ones that are a little lesscomfortable. Sometimes we have to stretch that joint that is already irritated. It'ssafe and the person will feel better later
on, but it's sort of like flossing your teethfor the first time. If you haven't flossed and you begin to floss,then you expect your gums to bleed a little bit, be a little irritated but if you areconsistent with that flossing the gums stop bleeding the tissues remodels andthen you have healthier tissue after that. So you have to really educate patients aboutthis process because we are going to do some techniques that are not comfortable but ifyou remind them of that, once they start seeing that improve, they really like it. So we'lldo a number of hands on techniques to really work on stretching out that joint capsuleto take the pressure off the hip and get their
mobility to start to improve. Then we'll transitionto some of these exercises. The exercise will range from very small movementsâ€“ lying on your bed, lying on the floor â€“ and you slowly want to progress that personover weeks and months to tolerate more weightbearing exercise. Weightbearing exercise is importantbecause that's our position of function. We don't usually walk or work or live lyingon our backs the whole time. We need to be able to go up and down stairs, squat, pickup our children, pick up our grandchildren, sit down in a chair in a restaurant, someof the simplest functions. so you really want to begin nonweightbearingexercise and then progress to more functional,
weightbearing exercise again, dependingon the severity of the osteoarthritis. And education is important, patient educationshould include information like what position to sleep in,how should you be driving, how often should you get up from your computer during the dayhow much water should you drink, what supplements should you be taking if any, nutritional informationand other information like that. If you combine that patient education withthat manual therapy and corrective therapeutic exercise, that's your best chance of â€“ reallythat's your only chance of trying to improve your functionality and quality of life whileyou 're waiting for that hip replacement surgery.