HEALTH & WELLBEING
Physiotherapy for hip and knee pain Dr Jo Coldron advises on treatments So many things seemed to have stopped in their tracks over the two years spent battling covid, but now many are possible again, including elective hip and knee replacements. However, the backlog of people waiting for surgery, and the ongoing barriers to getting things going again, like staff sickness and chronic staff shortages, are causing continuing delays to treatment. Devon is particularly impacted; the NHS waiting list comparison website at nhswaitlist. lcp.uk.com shows that for orthopaedic waiting times we are ranked around 100th out of 106 areas in England, with the median waiting time of 24 weeks and 18,432 people on the orthopaedic waiting list as of the end of March 22 (that’s the whole orthopaedic list, not just knees and hips). Given this situation, when a patient comes to discuss chronic hip or knee pain which is stopping them walking, sleeping and enjoying life, understandably they are sometimes frustrated, upset, or even angry when we tell them that before we can refer them to an orthopaedic surgeon, they must have completed a 3-month course of physiotherapy, either private or NHS. At that point in the consultation, it must feel like another huge barrier and enforced wait, especially as the waiting times to see NHS physiotherapists are also weeks and sometimes months at the moment. The requirement for physiotherapy isn’t a new thing, and
there are referral requirements for lots of different specialties and conditions. If you’re interested you can see them all at southwest.devonformularyguidance.nhs. uk/referral-guidance/western-locality. All the referral guidelines detailed on this website have been developed with specialists to enable them to provide the best, most efficient and safest care for as many people as possible. For some conditions your GP needs to have done certain blood tests, x-rays or investigations before they can refer you, or tried various different treatments for a certain amount of time and only if they haven’t helped can we then ask for specialist review. GPs have to follow the referral rules, and if we send a referral that doesn’t comply with these guidelines it will be rejected. The main reason for suggesting prereferral physiotherapy for hip and knee arthritis is that in many cases it can drastically reduce your symptoms of pain and stiffness and can significantly improve your quality of life. Although osteoarthritis can’t be ‘cured’, in many cases the symptoms can be improved. I shall try and explain (although a physiotherapist would do it far better, I’m sure). If you have a niggle in your knee, the body then tries to protect that knee so changes the way you walk and move. This then causes weaknesses in muscle groups in that leg, which then destabilise the knee more so it hurts more, so you get weaker, and it hurts more…You are then caught in a vicious circle of increasing pain and decreasing function. A physiotherapist can assess you and give you specific exercises to build these muscles back up in a way that doesn’t stress the knee, thereby stabilising the knee and reducing the pain. I have experienced this first hand. I thought I was pretty fit and healthy and doing
all the right things for my body, but a couple of years ago my knee became so painful I was hobbling around. I couldn’t exercise, everything seemed to exacerbate it. Imaging showed arthritis of the knee and I was advised to see a physio. I went and was told I had really weak muscles on that side. After three months of tailored exercises I was pain free (almost – there are twinges to remind me) and able to run again. I continue the exercises now, because if I lapse my knee hurts, whereas if I do them it doesn’t. Some people who engage with physiotherapy will not need a specialist review or embark on joint replacement surgery because their symptoms will be so much better. For those that do still need an operation there is some evidence that suggests they will do better after surgery if they have had physiotherapy input before. There are some other things that you can do to stabilise and support the leg which can complement physiotherapy: •
Make sure your footwear supports your arch, or get arch inserts
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Use a walking stick
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Lose weight if overweight
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Wear a knee brace
Engage in low impact rather than high impact exercise While waiting for your personal review you could do some of the most common exercises detailed at www.versusarthritis.org and go to the ‘exercising with arthritis’ page.
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Dr Jo Coldron Tavyside Health Centre, Tavistock 13
