By Tracy Hartley, PT, DPT
Degenerative Joint Disease at a Glance
Osteoarthritis is the number one cause of degenerative joint disease leading to disability in America, especially in the elderly. Osteoarthritis is the most common form of arthritis leading to degenerative joint disease. Degenerative joint disease (DJD) is a condition in which joint surfaces deteriorate causing pain and functional limitations. The joint surfaces exposed to weight bearing have a higher incidence of joint disease. DJD treatment options to date have mostly targeted the relief of pain rather than slowing or reversing the progression of the disease process.
Masking the Arthritic Pain
Medication options for DJD pain control are available but have no effect on the disease process. Acetaminophen (Tylenol) is the most widely used drug for pain relief. Ibuprofen (Advil, Motrin) and naproxen (Naprosyn) are non-steroidal anti-inflammatory (NSAIDS) medications also commonly used for DJD pain control and are available over the counter and in prescription strengths. NSAIDS are generally more effective for pain control in mild to moderate DJD, but adverse side effects with long-term use can be a deterrent. Many other NSAIDS are available by prescription only. Opioids are another class of drugs used for more severe joint disease pain control but should only be used short term for a couple of months due to side effects and potential for addiction and abuse.
Optimism in Clinical Trials of New Drugs
Another type of medication is in the infant stage of development. These new drugs, known as diseasemodulating agents, have the potential to change the clinical management of osteoarthritis and DJD. Their goal is to slow or halt the progression of DJD. These drugs are only in the clinical trial stage at this point.
Treatment for Severe Degenerative Joint Disease
Severe DJD results in significant degrees of functional limitations usually because of debilitating pain. In these most severe cases, eventually the treatment of choice isjoint replacement. Since weight-bearing joints wear faster with osteoarthritis and DJD, the majority of joint replacement surgeries involve total knee and total hip replacements. Obesity remains the number one modifiable risk factor for developing osteoarthritis and DJD that leads to joint replacement surgery.
Diet and Exercise for Degenerative Joint Disease
Studies show weight loss and exercise are both beneficial for decreasing DJD pain. Further, studies also show that weight loss with exercise are more effective than either one alone for relieving pain and preventing the need for joint replacement surgery.
Physical Therapy Interventions for Degenerative Joint Disease
Physical therapy studies involving subjects with osteoarthritis and DJD have associated manual therapy and patient specific exercises with improvements in walking distance, pain, stiffness, and function. Furthermore, subjects that received physical therapy were 4 times less likely to undergo joint replacement surgery at one-year after discharge. The patient specific exercises provided during physical therapy included low impact and stabilization exercises for hip and knee strength that were continued as a home exercise program.
The low impact exercises included exercise bike, elliptical trainer, water walking, and water aerobics with a frequency ranging from 3-5 days per week. Stabilization exercises consisted of strengthening the quads and hip muscles called adductors and abductors using isometrics. The isometric exercises consisted of contracting the quads, adductors, and abductors without movement of the diseased joint. Researchers hypothesized that stabilization exercises resulted in improved control of joint motion in the involved degenerative joint. Patients that adhered to their prescribed home exercise program demonstrated greater benefits at the one-year follow up after discharge.
Fine-Tuning Degenerative Joint Disease Treatment for the Individual
Treating degenerative joint disease consists of pain control and exercise that is fine-tuned to meet the specific needs of the individual. Mild to moderate pain control consists of a combination of medication and lifestyle changes including managing obesity. Your doctor will best determine the medication that is right for you and help you develop a safe and effective weight loss program. A physical therapist can fine-tune an exercise plan that limits impact on the degenerative joint usually consisting of low impact and stabilization exercises eventually incorporated into a home exercise program. The goal is to customize an exercise program that provides all of the benefits of exercise but also prevents further degeneration of the compromised joint surfaces and further decline in function.
Managing degenerative joint disease (DJD) does require some effort and diligence to maintain function and control pain. However, with your efforts come great rewards with improvements in walking distance, pain, stiffness, and function.