Arthritis Educator Cathie Dowell spoke with Physiotherapist Sarah Tulloch about all things hip and knee arthritis. 

Sarah Tulloch has been a physiotherapist for more than 15 years, and for the past 10 years or so has been practising at TBI Health in the Wellington region. TBI Health provides comprehensive injury management and rehab service. One of those services is a hip, knee, and spine osteoarthritis programme, which is funded by the Hutt Valley DHB.

Can people access a physiotherapist for hip and knee arthritis, and what’s the process for that?

Yes. Any physiotherapist will be able to help you with hip and knee or any other kind of arthritis. Since it won’t be funded by ACC because it’s a degenerative condition, you would have to access the service privately, so be a privately paying client. If you can’t afford to pay for physiotherapy, then your GP can refer you to your local DHB and they have physiotherapists who can help you manage your pain with your arthritis.

Is there a waiting list if you go through the DHB?

Yes. All DHBs are different, in some DHBs it can be up to a year.

What are some of the common complaints about hips and knees that people come to see you with?

Pain is the biggest complaint that people have with arthritis. Next is the loss of movement, loss of flexibility, difficulty walking or doing their normal activities of daily living, and poor sleep.

Do you have some common exercises that you prescribe for people with knee issues?

The main thing that you want to do for any load-bearing joint is to actually use it. It’s use it or lose it, the less you walk and the less you do activities, the less muscle tone you have, and then the less support you have around the joints. You need to do exercises that strengthen those muscles, so strengthen the quads muscles on the front of your thigh and strengthen the hamstrings and the glutes at the back. Things like step-ups, sit to stand squats, calf raises, and leg extensions. These are exercises that people can more easily start to implement into their own daily lives.

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What other tips can you offer people for managing hip and knee arthritis?

Just keep moving. Try and move within what you see as your limits of pain. Use the traffic light system here, green is you’re good to go, you can do as much activity within that pain level as you feel that you can. Go from zero out of 10, zero being no pain at all to a three out of ten, which is discomfort, but not too much pain. Any activity at that level is fine. Four to five is called the orange light region, and it’s a bit more uncomfortable and you might need to have a little rest after doing that kind of activity, and then anything from six to ten is our red light, so you don’t really want to be pushing into that range, because it’s harder to come back to a nice baseline level.

Pace yourself, not overdoing things. Do little and often, and the more you do that, weeks down the track, you’ll find that you can cope with more.

Also, it is important to remember that pain doesn’t mean that you are causing yourself more harm. It can be a sign that there is a bit more inflammation. You may have had a bad night’s sleep or something else is stressing you at the moment, which causes a big flare in pain. It doesn’t necessarily mean that there is more damage going on in your joint at that time.

What about joint replacements?

A joint replacement might not take all your pain away. If you’ve got muscle imbalances or weak muscles on either side of those joints then a lot of that pain from the degeneration of the joint will be gone, but there will still be some discomfort if you have still got that same weakness in those surrounding tissues. It is very important to strengthen the muscles up post-surgery, otherwise, you may be left with the same problem that you had pre-surgery.

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