Osteoarthritis is a degenerative joint condition and the most common form of arthritis. It’s characterized by breakdown of the cartilage, particularly in the larger joints of the body, but it can also affect smaller joints like the joints in the hand. The big thing to understand about osteoarthritis is that it is not just a consequence of aging. It is not normal wear and tear of the joints. It is an actual disease process.

Despite an incredible amount of research, we don’t know the exact cause of osteoarthritis. However, researchers have been able to determine who is at greatest risk and understand that there might be multiple causes. For example, people who have had a previous joint injury, have high levels of fat tissue, weak muscles, and genetic predispositions are more likely to develop osteoarthritis. Women are also more likely to have OA than men. We are not sure why, but these are fairly well-established risk factors.

There are two groups of people who get osteoarthritis. The first group, and the one most people link to this disease, includes older adults who start to develop joint pain later in life, so in their 50s, 60s, 70s, and 80s. The second group includes young adults who have experienced a previous joint injury.

If we take into consideration that 80 per cent of people that have osteoarthritis have it in their knees, and that 10 to 15 years after a knee injury one can start to develop signs of OA, and then we consider that the most common age to have a knee injury is between 16 and 35, it is not uncommon to see people in their 20s and 30s with signs of OA in their knees if they have had a previous joint injury.

Once someone hurts their knee at a young age, we know they have about a six-fold increased risk of osteoarthritis and that about 50 per cent of them will go on to develop osteoarthritis within five to 10 years.

One of the most established risk factors for osteoarthritis is a joint injury. Considering that 80 per cent of osteoarthritis involves the knee, injuries that are most concerning when it comes to OA, or what we refer to as “post-traumatic” or “post-injury” OA, are knee injuries. People are most likely to injure their knees between age 16 and 35, and most commonly, those injuries are a result of participating in some sort of physical activity or a sport and recreational activity. Once someone hurts their knee at that young age, we know they have about a six-fold increased risk of osteoarthritis and that about 50 per cent of them will go on to develop it. The risk of OA after a youth sport or activity-related joint injury differs depending on the type of injury. Certain injuries, like an anterior cruciate ligament tear (ACL tear) are associated with a very high risk of osteoarthritis. There are also other injuries that aren’t quite as severe that are still associated with a higher risk of osteoarthritis than one would have if they didn’t have an injury.

Here are the three biggest myths, or misconceptions, about osteoarthritis:

1) Only older people get it and it’s a consequence of aging and wear and tear of the joints. This isn’t the case. Young people can get osteoarthritis, which is a disease process and not a natural consequence of aging.

2) Osteoarthritis is caused by weight-bearing activities like running or jumping, as well as high-impact activities. What we are starting to understand is that osteoarthritis can actually be caused by inactivity and by really high levels of impact activity. Between those two levels, there is a very healthy amount of impact that keeps the joint healthy and functioning well.

3) There is nothing you can do about osteoarthritis. You just have to suffer with it until an orthopedic surgeon says, “Hey, it’s time. You can go ahead and have joint replacement surgery.” This is not true. We have really good evidence to suggest that many things can be done to minimize a person’s pain and improve their function to reduce symptoms and prevent osteoarthritis from impeding everyday life.

The most shocking statistic about osteoarthritis is that it decreases a person’s life expectancy. A lot of people think osteoarthritis is just pain that interferes with someone’s ability to do things. But there is irrefutable evidence that people with osteoarthritis have a shorter life expectancy than people without it. This is largely because pain often leads to decreased physical activity, which is associated with weight gain and the development of other chronic conditions. Osteoarthritis is a serious disease that needs to be addressed before a person goes down the road of becoming inactive, gaining weight and developing additional chronic diseases, which may shorten their life span.

Osteoarthritis is one of the fastest growing conditions in the world and rates for the disease are highest in North America. In Canada, about four million people currently have osteoarthritis and it is expected that one quarter of Canadians will have it by 2040, which is somewhere around 11.5 to 12 million people.

It really depends on the individual, but we know that some people who start to have degeneration in their joints develop pain. That pain can start to restrict their ability to function in a physical sense so that they might have difficulty walking, climbing stairs, or doing the activities that are important to them (whether that be related to recreation, family life, or occupation).

Because they are less active and can do less of what they need to do, they can sometimes become socially isolated. We can see an increase in depression because of that. If someone is less physically active they can start to gain weight or fat tissue and that can lead to the development of other chronic conditions like diabetes and/or cardiovascular disease, which can limit or reduce a person’s life expectancy. Osteoarthritis often reduces overall quality of life.

Ideally, someone would have an injury and seek medical attention for that injury. This might involve visiting an emergency room, family physician, or a physiotherapist. The person would then receive a diagnosis and be referred to a physiotherapist to undergo rehabilitation. Depending on the severity of the injury, some people may require just rehabilitation with a physiotherapist, or they may also require surgery, which can involve waiting. Ideally, individuals requiring surgery would continue with physiotherapy during that wait, as well as after surgery. Ultimately, the goal would be to get back to a level of physical functioning that would allow a return to sport.

Although that’s the ideal pathway, the reality, especially in Canada, is that private insurance coverage dictates whether a person can do physiotherapy. Someone can have an injury, access a medical practitioner, the emergency room or a family physician at no cost. However, whether or not someone goes to physiotherapy, and the amount of physiotherapy they receive, depends on the insurance coverage they have. So there isn’t a nice, linear path of care before someone is discharged and returns to their sport.

People often see a physician and a physiotherapist once or twice. They then try to work on their rehabilitation at home or they might see a surgeon and continue with rehab on their own and/or have surgery. They then make a decision about whether they should return to sport without actually knowing if they’ve got the capacity or functionally to do so.

That’s the million dollar question! We don’t know for sure. We do know what increases a person’s risk. If you prevent a joint injury, you are less likely to get osteoarthritis. We also know that people with a lot of fat tissue are at an increased risk for OA. In theory, if we can help a person not gain fat tissue or reduce the amount of fat tissue they have, we should be able to lower osteoarthritis risk. But the reality of the situation is we don’t have the scientific research to show that we can prevent this disease. We have theories about how we can do it but we haven’t been able to conduct those studies. A big reason for that is, when someone hurts their knee, they don’t develop OA until 10 years later. We would need to construct a study that would follow people for 10 years. Or, if someone was going to reduce their risk for osteoarthritis by losing weight, it takes a period of time to lose weight before we would see an improvement. In theory, we can prevent osteoarthritis by reducing joint injuries, decreasing the number of people that have a lot of fat tissue or who are overweight or obese, keeping people physically active, living healthy lifestyles and eating healthy foods. However, we don’t have the studies to show this yet.

SOAR, or STOP OsteoARthritis, is a new knee health program. It’s virtually delivered and designed to help people, who have had a previous knee joint injury, navigate their knee health and reduce their risk for osteoarthritis once they’ve been discharged from care for that knee injury.

The program consists of education, a home-based exercise and physical activity program with tracking, and one-to-one physiotherapy counselling.

We know that people who have experienced a joint injury are at an increased risk of developing osteoarthritis. We also know that risk never goes away. It’s unrealistic that people are going to continue to get care over the 10 to 15 year period before they develop OA. So SOAR gives people the tools to manage their own knee health over that period of time, and hopefully also reduce their risk for osteoarthritis.

Currently, there aren’t a lot of osteoarthritis prevention programs. Some work has been done to try to reduce obesity as a risk factor for OA, but there aren’t many programs that target people after they’ve had a joint injury and before they develop signs and symptoms of the disease. The SOAR Program is also individualized and based on the priorities of participants in the program. We don’t tell them what exercises to do. Instead, we work with individuals to identify what their priorities are and to develop a program that meets their needs.

SOAR is also unique because it focuses on young people that are at an increased risk of developing osteoarthritis because they’ve had a joint-related injury (so people in their 20s and 30s).

Ultimately, we hope the SOAR Program will reduce the number of people that get osteoarthritis. Or, we hope it reduces the severity of OA that people have and also empowers them to manage their own knee health from a young age through to the point where they may actually develop osteoarthritis. We want OA to have less of an impact on people and their overall quality of life.