Osteoarthritis Treatment at
Our Centre of Excellence
Osteoarthritis and Treatment with the Centre of Excellence (OACE)
OACE will help, if you:
- Have hip or knee osteoarthritis
- Are interested in a comprehensive approach to decrease your pain, and to improve your mobility/activities
- Wish to maximize treatment of your OA prior to considering surgery
- Review of your medical history, nutritional status and lifestyle in relation to your knee/hip OA
- Questionnaires to help determine what treatment would be best for you
- Access to leading-edge treatment options
- Opportunity for face-to-face discussions with qualified professionals who will discuss your particular situation and develop an individualized treatment action plan
- Learning ways to help yourself without medication such as exercise/strengthening programs
- Up-to-date educational material and resources
- Thorough follow-up from OACE professionals to better ensure success
You will receive treatment from a Sports Medicine Doctor with special interest in OA treatment. They have a physician education focused on developing an individualized treatment plan for their patients. They will provide you with OA treatment plan and assessment that includes a review of your medical history, a physical examination, a review of lifestyle and nutrition states in relation to OA.
No fee for physician assessment and physician education. Private insurance or benefits plans often cover other services or treatment options.
What OA Therapy Services are Available?
The following services will be offered based on your individual OA needs:
- Written and on-line educational resources
- One-on-one education and counseling
- Medication and supplement prescription
- Injections ( e.g., corticosteroid, viscosupplementation)
- Exercise counseling
- Strengthening program design
- Physiotherapy treatment
- Weight loss programming
- Nutritional advice
- OA unloader bracing
- Thorough follow-up to improve chances of success
How Do I Obtain Further Information About OACE and OA Treatment?
You may contact us by email: oace@grsm.ca
The Ultimate Guide to Osteoarthritis and Treatment
Who Does Osteoarthritis Affect?
Does your knee pain stop you from walking as much as you want to? Does your hip ache after a round of golf? Does your knee swell after your weekend hockey tournament? Have you had to cut down on your weekly running mileage due to painful joints? Or is your knee or hip just making your life miserable throughout your regular daily life? There are many causes of joint pain, but osteoarthritis (OA) is one of the more common reasons for people to seek medical advice
In addition, for those who are not regularly active, knee OA is more common and can significantly affect activities of daily living. Over 10 million Canadians suffer from osteoarthritis. In addition, by the age of 65, the majority of Canadians have some degree of OA in their knees or hips. OA also affects other joints such as shoulders, ankle, hands and feet.
What is Osteoarthritis?
Osteoarthritis is the “wear and tear” type of arthritis that involves degeneration of the cartilage that normally surrounds and protects the bone surfaces in the affected joint. For example, cartilage is the white gristle that you see at the end of a chicken leg bone. The process of OA involves the roughening and thinning of this normally smooth protective surface. There are other changes within the osteoarthritic joint such as thinning of the joint (“synovial”) fluid and occasionally inflammatory changes. This type of arthritis is very different from other conditions such as rheumatoid arthritis which is very inflammatory in nature.
What Does Osteoarthritis Feel Like?
The pain of OA is often described as an “achiness” or “stiffness. However, OA pain may also be sharp and severe, especially with sudden twisting movements. This pain may start gradually or more suddenly after the joint surface has been irritated by injury. OA must be differentiated from other conditions and sports injuries (e.g., tendonitis and meniscal cartilage tears) since the treatment can be quite different.
How is Osteoarthritis Diagnosed?
The diagnosis of osteoarthritis is usually made by your physician by listening to the type of symptoms you are having, examining your affected joints, and by confirming the arthritic changes by sending you for X-rays. Only very rarely are more specialized imaging tests needed (e.g., MRI, bone scan). Also, laboratory blood tests are sometimes to rule out other types of inflammatory arthritis (e.g., rheumatoid arthritis).
What is the Best Treatment for Osteoarthritis?
Having OA does not necessarily mean that you have to continue to suffer, nor have to stop your favourite sport or activity, or for you daily life to be miserable. There are many treatment options available that can decrease your OA symptoms and improve your quality of life. For most osteoarthritic joints, there are many treatment options available, such as:
- Lifestyle changes (e.g., weight loss, activity modification)
- Exercise and strengthening
- Physiotherapy and athletic therapy
- Other therapies (e.g., massage therapy, chiropractic, acupuncture)
- Medications and supplements
- Braces and orthotic devices
- Injections
- Surgery
A proper treatment plan should be tailored to the individual and to his or her lifestyle and exercise program. Not every treatment option is suitable for each person. For example, certain injections work better at earlier stages of OA and certain braces only work for OA in a particular location in the knee. So don’t let osteoarthritis stop you from staying active and from enjoying your daily life. A well-formulated approach to managing your osteoarthritis is essential to keeping you active. Make your joints happy with good OA treatment!
Does Physiotherapy Help Osteoarthritis?
Osteoarthritis (OA) can be a very debilitating condition. It is often characterized by joint pain, swelling, weakness around the affected joint, and a lack of flexibility and balance. These impairments may lead to weight gain, reduced mobility and poor quality of life. Here are the ways that physiotherapy can help in treating your osteoarthritis…
What will a Physiotherapist do for Your Osteoarthritis?
Physiotherapists are trained to treat injuries and diseases that affect the muscles, joints and bones of the body. They know how the joints, tendons, muscles and other associated structures relate to one another and how they function within the body. Physiotherapists understand why the body can become injured and how to train the muscles, bones and joints to function more effectively. OA can affect each individual differently and thus requires an individualized assessment and treatment plan. A physiotherapist will discuss your medical history and perform a thorough physical examination. The physio will assess joint mobility, flexibility, strength, functional strength, pain, swelling as well as functional limitations and disabilities (i.e., unable to climb stairs, unable to run/walk) associated with the condition. With the physiotherapist’s understanding of OA and your specific history, the physio is then able to design the appropriate treatment program for you.
What are the Benefits of Physiotherapy for Osteoarthritis?
- Education: Your physio will help you understand what OA is and how it is treated
- Exercise Advice: Giving you the dos and don’ts of exercise and appropriate modifications of daily activities, as well as the role of exercise in weight loss
- Decreased Pain, Swelling and Stiffness: Your physio will use various hands-on techniques (e.g., joint mobilizations and manipulations) and modalities (e.g., acupuncture, ultrasound, thermal and electrical units) to decrease your pain and stiffness from OA. Your physio will also give you flexibility exercises that will help your joint range of motion.
- Improved Strength and Mobility: Your physiotherapist will give you an individualized program to strengthen the muscles that stabilize your osteoarthritis joints which will minimize your pain and mobility
- Improved Function: Your osteoarthritis physiotherapist will help to improve function in daily life activities (e.g., squatting, stairs, walking), as well as more complex physical activities and sports.
In summary, physiotherapy is very beneficial for treating osteoarthritis and is one of the most common treatments for OA. Research studies have shown that physiotherapy, either as an individually delivered treatment or in a small group format, is an effective intervention for patients with knee and hip OA.
Physiotherapist Advice on How Exercise Helps Osteoarthritis?
Osteoarthritis can be a very debilitating condition. It is characterized by joint pain, swelling, weakness around the affected joint, and a lack of flexibility and balance. These impairments may lead to weight gain, a decline in functional mobility and reduced quality of life. Exercise is one of the main ways you can combat the effects of OA.
What are the Benefits of Exercise for Osteoarthritis?
- Reduce pain
- Increase flexibility and joint mobility
- Increase strength •
- Improve balance
- Improve cardiovascular fitness (ability to walk etc.)
- Improve functional strength (ability to climb stairs, squat etc.)
- Improve general quality of life
What Should an Osteoarthritis Exercise Program Look Like?
An OA exercise program should incorporate strengthening exercises for each joint, general overall strengthening, flexibility exercises, functional exercises and aerobic activity (such as walking, biking and swimming). Studies have shown that exercises such as yoga, Tai Chi, walking and running in water provide beneficial effects such as decreased pain and joint tenderness. It is very important to increase the difficulty of all components of the program as they become too easy. It is recommended that the program be based on the specific symptoms (i.e., pain, weakness), and function (i.e., unable to climb stairs). The reported effects of a thorough OA exercise program include: decreased joint pain, increased function, increased energy levels, increased physical mobility and positive effects on weight control. The benefits of exercise depend on the severity of the OA. An individual with mild to moderate OA may respond better to an exercise program than someone with severe OA.
How Can You be Successful Doing Exercise for Osteoarthritis?
The success of a strengthening and cardiovascular program is dependent upon compliance to the program and the appropriate progression of exercises. That means that the exercises must be completed regularly and must be challenging for the person performing the exercises. The program should include strengthening exercises specific to each joint, combined with flexibility, functional exercises and aerobic exercise. If this program is not followed regularly, the positive effects will not last. Other studies have shown that a comprehensive home exercise program is important in the management of OA of the knee. Other group exercise programs have also been shown to be beneficial in reducing pain, as well as reducing medications used to control symptoms. GLA:D® is an example of a group exercise program that includes an education and exercise program developed by researchers in Denmark for those with hip or knee osteoarthritis symptoms.
What are Best Medications for Osteoarthritis?
Medications and over-the-counter supplements have long been used to lessen the pain from osteoarthritis (OA). Before using any prescription medication, you and your family physician will need to weigh the risks and benefits of taking medication in relation to your personal preferences and health status. The following is a summary of some common medications used for osteoarthritis:
What Over-the-Counter Analgesics Help OA Pain?
These medications are “pain-relievers”. The most useful is acetaminophen (e.g., Tylenol) which can be used in regular doses with minimal side effects and is available without prescription. This medication can be quite helpful in relieving the mild “achiness” that can often occur with osteoarthritis. See below for NSAIDs and creams that are available over the counter.
Do Non-Steroidal Anti-Inflammatories (NSAIDs) Help OA Pain?
These medications decrease inflammation but also relieve pain. Medical doctors usually reserve using NSAIDs for acute exacerbations of OA or if there is an obvious inflammatory component (a lot of pain and swelling). NSAIDs can play an important role in managing osteoarthritis. A two-week course medication can do wonders to settle down an acutely inflamed and swollen joint. In the sports medicine field, this short-term use of NSAIDs is similar to their use for relieving inflammation in acute sports injuries. Some NSAIDs, such as ibuprofen (e.g., Motrin, Advil), are available over-the-counter. Others, such as meloxicam, are only available by prescription. NSAIDs have a risk of irritating the stomach lining and causing ulcers, which is more of a concern in those who are older in age or who have other significant illnesses. Some NSAIDs (such as Celebrex and Vimovo) have a lower risk of ulcers and stomach side effects. NSAIDs may also have adverse effects on the cardiovascular system in older individuals especially if they have pre-existing heart problems. Before using an NSAID, you should review your situation with your family physician to ensure an NSAID is safe and appropriate for you to use.
Do Topical Medications and Creams Help OA?
These medications are in the form of creams or ointments. The most commonly used and most effective are topical NSAIDs (e.g., Voltaren or diclofenac cream) which can be obtained with or without a prescription. The prescribed version is stronger and should be more effective and has been validated by research. These topical NSAIDs appear to be quite safe. There are many other creams that may act as temporary pain relievers (e.g., Biofreeze) and may be of some use for some patients but there is not much research conducted that prove their effectiveness. Other creams, such as capsaicin, do have some research showing they can relieve pain to some degree.
How Does Nutrition Affect Osteoarthritis (OA)?
Osteoarthritis (OA) is a degenerative joint disease which causes pain and decreased function. Unfortunately, OA is quite common and is affecting roughly 10 million Canadians. Commonly affected joints include hips, knees or fingers. Diet and exercise together can help you gain back your function and reduce pain and inflammation.
How Important is Weight Loss in Managing Osteoarthritis?
Joint inflammation can be influenced by how much body fat we carry. That is, because fat cells tend to pump out pro-inflammatory markers (adipokine and cytokines), which can cause pain and inflammation and continue to accelerate the progression of OA.
Research shows that in individuals with a BMI of 30 or more are likely to benefit from weight reduction. As little as 5-10% reduction in weight can result in decreased pain, stiffness, pro-inflammatory markers and significantly improves functional movements. When studies look at the best outcomes of weight loss studies, they show that the best combination is diet + exercise compared to diet alone or exercise alone.
Three Best Weight Loss Tips for Osteoarthritis:
Watch Your Drink
Replacing juice/pop/alcohol with water can decrease your overall energy intake
High Protein Snacks
As we age (over 50) we lose 1% of our muscle mass each year and are also less sensitive to the protein we eat, plus it keeps us from snacking pleasurable foods.
Load up on Veggies
½ your plate should be colourful and fibrous vegetables
Is My Osteoarthritis Pain Affected by the Type of Fats I Eat?
It really is true that we are what we eat when it comes to fat. The quality and quantity of the fats we eat each day are also important in managing inflammation. There are three main types that you may be familiar with: trans fats, saturated fats and unsaturated fats. I like to explain these in terms of dimmer switches. We want to shut off/not consume trans fats because these are not naturally occurring in food and are the byproduct of food processing. They are deemed to be harmful to our heart health and are also pro-inflammatory. Now, when it comes to saturated vs unsaturated, we need both, however a typical western diet tends to be higher in saturated fats (cream, butter, margarine, red meats, coconut oil), and lower in unsaturated fats (fish, olive oil, nuts and seeds) and therefore we are going to try to turn down/lower the saturated fat and turn up/increase the unsaturated fats in the diet. This way we have a better balance between the two types of fats.
It is highly encouraged to eat fatty fish such as salmon, herring, mackerel 3 times a week to make sure you get enough of omega 3 fatty acid, which will help reduce pro-inflammatory markers. Adequate amounts of omega 3 can reduce inflammation and decrease your reliance on non-steroidal anti inflammatory medications. You can also consume daily sources of plant omega 3 such as chia seeds, walnuts or ground flax. The plant sources are not as efficient as the fish source, as only 5-20% of the fat in the plant sources makes it to the active form of omega 3 in the body.
Is Sugar Bad For My OA Pain? Does Fibre Help My Osteoarthritis?
Fibre is a non-digestible carbohydrate which is found in the food we eat. It serves many purposes including assisting us in managing our cholesterol and blood sugars, provides bulk to our diet to help us feel fuller for longer, provides valuable food for good gut bacteria and much more! All of the above results will help you manage your inflammation and your OA pain and possibly slow its progression.
Firstly, high cholesterol can accumulate in the cartilage which can increase the inflammation in the joint and can also lead to increased cartilage damage. Second, if you have diabetes and your blood sugars are high, this can result in something called Advanced Glycation End Products, which can impair the cells that are responsible for collagen formation and regulation. It has also been shown that having type 2 diabetes is a risk factor for severe OA, and a predictor of the joint space, and therefore is an important issue to address.
Lastly, fibre is food for the good gut bacteria, which in some research, they believe the inflammation can start from the gut! This of course is a new and developing area and much more work is needed. Needless to say, your fibre intake is important!
Simple Switches to Increase Fibre
Cheerios + milk = steel cut oat + milk
Chips = roasted chickpeas
Tuna on white bread = tuna on whole grain bread + a side salad with nuts
Rice = mix of rice and lentils
Sugar, especially added sugar, may also increase your inflammation. However, it is important to understand that it is challenging to put the blame on one nutrient as eating and dietary patterns are multifactorial. For example, they do find that diets higher in added sugar and pop result in more inflammation, however, this could also be due to the higher amounts of packaged and processed foods, which also tend to be higher in saturated fats and lower nutritional value. Compare this to higher fibre intakes, which can reduce your CRP (pro-inflammatory marker) by 25%!
Bottom line is, we want to aim for a good quality for the majority of our eating, with some freedom to enjoy social events and include enjoyable foods as well.
What is the Best Brace for Knee Osteoarthritis (OA)?
Many advances have been made over the past decade in the area of bracing for treating osteoarthritis (OA) of the knee. Today’s braces are lighter, yet made of stronger and more durable materials. A brace for OA is most useful for those who have most of their pain when they are weightbearing (such as prolonged standing, walking or doing other physical activity). Bracing for hip OA has not yet been shown to be effective. Here is a breakdown on the options for OA knee bracing:
Does a Knee Sleeve Help Osteoarthritis?
This type of sleeve is usually made of a stretchy material such as neoprene. There are some newer materials that are not as hot and thick as neoprene, thereby enhancing comfort. A knee sleeve is the least expensive bracing option, but research has shown that a sleeve can help to decrease pain, probably by improving the balance sense around the knee.
Does a Patellar (knee cap) or Patellofemoral Brace Help Osteoarthritis
This brace is a soft brace like a knee sleeve, but it has special straps and reinforcements to help decrease the stresses on the knee cap. This type of brace would help those who have osteoarthritis mainly behind the knee cap (patellofemoral OA) rather than OA throughout the whole knee. So if you have pain mainly at the front of your knee (anterior knee) then the best osteoarthritis brace for you is probably a patellar brace.
Best Brace for Osteoarthritis? An OA Unloading Brace…
This is the classic osteoarthritis brace which is the best brace for OA. These days, the OA braces are made of high-tech metals and composites such as carbon fibre, titanium and airplane-grade aluminum. They must be strong but also light and comfortable. Most of these braces are custom-fit to provide for the most comfort possible and for the best function. These braces are modeled after the sports braces that many athletes use for ligament injuries. The manner in which OA braces work is to “unload” the part of the knee that has the most degenerative changes. For example, if the inner or “medial” part of your knee is most affected by the OA, the brace would be constructed to take some of the pressure off of the medial part of your knee.
Research studies have shown that these braces are helpful in decreasing pain and disability in knee osteoarthritis, especially when the OA is confined to one part of the knee. According to research and clinical observations, this type of brace appears to work better than simply using a knee sleeve. There are many different brands of OA braces, each with slight variations in their structure and materials. For example, a person who does a lot of downhill skiing would probably opt for a shorter bottom end to fit into a ski boot properly. Alternatively, someone who is interested in maximum comfort may opt for an OA brace with a softer material at the top end.
Other Braces or Aids Help for Knee Osteoarthritis:
Ligament Stabilization Braces
People who have ligament tears or “a loose knee”, in addition to having OA, would probably benefit from a ligament stabilization brace. A knee that is more stable has less stress on it and less irritation of the arthritic areas. The features of a ligament stabilization brace can now be combined with the features of an OA unloading brace.
Poles, Canes, Walkers
People who enjoy walking and hiking but are limited by their knee or hip OA, often benefit from using walking or hiking poles. These poles help to transfer weight from the knees and hips to the upper body. Canes can also be used to take pressure off of the affected knee or hip while walking. In more severe cases, especially when there is a balance problem, a walker can allow an elderly person to have more mobility and independence.
Are There Any Problems From Using Knee OA Braces?
There aren’t really any side effects of bracing except the occasional person who gets some skin irritation from a pressure point or from a reaction to the bracing material, both of which are usually easily correctable. OA braces are usually worn beneath clothing so are often not visible. Also, the brace is only worn when you are doing weightbearing activities and are taken off when not on your feet.
Summary of Bracing for Knee OA
Using a brace for the knee can certainly help in decreasing pain and improving function in an osteoarthritic knee. The benefits of bracing depend on determining the right brace for a particular person, as well as getting a proper fit. One of the major advantages of bracing is that it can decrease pain quite quickly upon starting to use the brace. In addition, an effective brace usually allows people to exercise more and to have a much easier time going about their weight-bearing daily activities.
GRSM Injection Services
Platelet-Rich Plasma is a new and exciting treatment. PRP is becoming increasingly popular because of its effectiveness in treating various sports injuries, as well as, osteoarthritis.
Although they have been used to treat osteoarthritis (OA) for more than 30 years, viscosupplementation or “visco” injections are still viewed as one of the newer advances for treating OA. These injections can be very successful in treating osteoarthritis. They are also known as “gel”, “lubricant”, “hyaluronic acid”, and “synovial fluid” injections.
Common injections include corticosteroid (“cortisone”) and viscosupplementation (“lubricant”) as well as newer injections such as platelet-rich plasma (PRP) and stem cells. Injections done by ultrasound guidance have been shown to be better than regular injections. See below to find out why…
Possible Side Effects with All Injections
Injections that are performed by a properly trained physician tend to be a relatively safe procedure.
However, there are possible side effects that are possible with any type of injection. These include the following:
- Local pain or discomfort during or after the injection (e.g., needle discomfort, temporary tightness or fullness after the injection).
- Skin bruising, bleeding or discoloration
- Local tissue irritation and/or swelling
- Allergy to the local analgesic (“freezing”) agent (topical xylocaine) • Suffering a “vasovagal reaction” (fainting or feeling weak/faint/dizzy)
- Infection (risk is estimated statistically to be between 1:10,000 to 1:50,000)
- Needle break
- Nerve injury • Blood vessel injury
- Lack of improvement
- Worsened pain or function
Services
Our mission is to help athletes and active individuals achieve their sports and exercise goals!