Osteoarthritis (OA) is one of the most common and chronic joint conditions.
It causes degeneration of the cartilage — the “cushion” that protects the bones and allows smooth, pain-free movement.
It appears most often in the knees, hips, and hands, and affects more than 300 million people worldwide (Fransen et al., 2015).
Its prevalence increases with age, obesity, and low levels of physical activity (Conley et al., 2023).

🔹 What Causes Osteoarthritis?

OA develops when the natural balance between cartilage wear and repair is disrupted.
When the degeneration process outweighs the repair process, the cartilage thins, the bones rub against each other, and pain appears (Conley et al., 2023).

The main risk factors include:

• 🧓 Age
• 👩‍🦰 Gender (women are more often affected)
• ⚖️ Obesity
• 🧬 Heredity
• 🤕 Previous joint injury (van Doormaal et al., 2020)

🔹 What Are the Symptoms?

The most common signs of OA include:
• Pain and stiffness, especially in the morning
• Swelling (edema)
• Joint deformity
• Reduced range of motion
• Difficulty performing simple daily activities, such as:
o walking,
o climbing or descending stairs,
o sitting down or standing up from a chair,
o standing for long periods or getting dressed (Raposo et al., 2021).

💪 Movement Is the Best Medicine

Although there is no drug that can “cure” OA, there are many effective ways to control the symptoms and maintain joint function.
Scientific evidence shows that the following approaches are the most beneficial:

1️⃣ Therapeutic Exercise

Exercise is the first and most important line of treatment for OA (Fransen et al., 2015; Raposo et al., 2021).
It may include:
• Aerobic activities (e.g. walking, cycling)
• Strength and resistance exercises
• Holistic methods such as Clinical Pilates and Tai Chi

A personalized exercise program, with gradual progression in intensity and duration, has been shown to improve strength, reduce pain, and increase mobility.
Even home-based or online programs have demonstrated excellent results (Mao et al., 2024; Si et al., 2023).
👉 Read more about the importance of exercise here

2️⃣ Manual Therapy

Manual Therapy techniques help reduce pain and improve range of motion, especially in patients with knee or hip OA (Tsokanos et al., 2021).
Combining Manual Therapy with therapeutic exercise provides better outcomes than either approach alone (Sampath et al., 2015).

3️⃣ Patient Education

Education is a key component of treatment.
When patients understand what OA is, how it affects daily life, and what they can do to manage it, they gain greater control and confidence (Conley et al., 2023).

4️⃣ Weight Management

Losing 5–7% of body weight can significantly reduce pain and improve function, especially in overweight individuals (van Doormaal et al., 2020).

5️⃣ Medication

In some cases, the physician may recommend non-steroidal anti-inflammatory drugs (NSAIDs) for short-term use to help manage pain (Conley et al., 2023).

6️⃣ Surgical Treatment

Surgery (e.g. joint replacement) is considered only when conservative methods fail and the pain severely limits quality of life (Gademan et al., 2016).

🏥 How Physiotherapy Can Help

At Chania Physiotherapy Clinic, every patient is assessed individually, and a personalized rehabilitation program is designed, combining:
• Therapeutic Exercise
• Manual Therapy
• Education & Guidance

Our goal is to:
• reduce pain,
• improve mobility,
• strengthen muscles and stability,
• and help each person return to an active, pain-free daily life.

👉 Movement is medicine. With the right physiotherapeutic guidance, OA can be managed effectively — and quality of life can be significantly improved.

📚 References

1. Fransen M. et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 2015.
2. Conley J. et al. Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines. Arthritis Care & Research, 2023.
3. Raposo M. et al. Effects of exercise on knee osteoarthritis: A systematic review. Musculoskeletal Care, 2021.
4. van Doormaal M. et al. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care, 2020.
5. Mao J. et al. Efficacy of home-based exercise in the treatment of pain and disability at the hip and knee in patients with osteoarthritis. BMC Musculoskeletal Disorders, 2024.
6. Si H. et al. Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis. Journal of Orthopaedic Surgery and Research, 2023.
7. Tsokanos A. et al. The Efficacy of Manual Therapy in Patients with Knee Osteoarthritis. Medicina, 2021.
8. Gademan M. et al. Indication criteria for total hip or knee arthroplasty in osteoarthritis. BMC Musculoskeletal Disorders, 2016.
9. Sampath K. et al. The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis. Clinical Rehabilitation, 2015.

Authors:
Zacharias Sifakis, BSc, OMT, MHCPC, MAACP, MMACP, CGIMS — Specialist Physiotherapist in Musculoskeletal and Sports Rehabilitation Charalampos Bolis, MSc, BSc, MT — Physiotherapist specialized in Sports Physiotherapy, Pilates Instructor

Chania Physiotherapy Clinic
Chania – Kalyves – Palaiochora
🌐 www.chpc.gr | 📞 +30 28210 58711

Scoliosis is a deformity of the backbone (spine). It’s when the spine has a side-to-side curve and rotation. The curve of the spine measures 10 degrees or more.

A normal spine appears straight when looked at from behind. But a child or an adult with scoliosis has a spine with an S or C shape. The child may look like he or she is leaning to one side. The curve can happen on the right or left side of the spine or it can happen on both sides in different sections. The cervical and/or middle (thoracic) and/or the lower (lumbar) spine may be affected.

What are the causes of scoliosis?

In most cases, the cause of scoliosis is unknown. A child may be born with it or he/she can develop it later in life. It’s most often seen in children between 10 and 18. It tends to affect more girls than boys.

What are the symptoms of scoliosis?

The symptoms of scoliosis can occur a bit differently in each child. The most common symptoms can include:

• Uneven shoulder height
• The head is not centered with the rest of the body
• Uneven in hip height or position
• Uneven in the way the arms hang beside the body when the person stands straight
• Uneven height of the sides of the back when the person bends forward

What are the risk factors of scoliosis?

• Age. Signs and symptoms usually start during the growth spurt that occurs just before puberty hits.
• Sex. It is more likely for women to have scoliosis than men.
• Family history. Although, not all people with a family history have scoliosis.

If scoliosis is left untreated can cause complications including:

• The difference in someone’s appearance.
• Back problems, like back pain.
• Lung and heart damage in severe scoliosis.

How can scoliosis be diagnosed?

• X-ray
• Computed tomography scan (CT or CAT scan)
• Magnetic resonance imaging (MRI)

What are the treatment options for scoliosis?

• Conservative scoliosis management program. It is a personalized exercise program based on the scoliosis and the needs of each person. We have specialized staff in the conservative management of scoliosis, trained in the Schroth method, which aims to improve body posture, stability and strength of the trunk, self-management and understanding of the spine, improving breathing and the reduction of possible coexisting pain.
• Brace therapy: scoliosis between 25-40 degrees curve. Braces should be checked regularly to ensure proper fit and may need to be worn 16 to 23 hours a day until the growth of the curve stops.
• Surgical therapy: recommended for scoliosis ≥ 50 degrees curve.

What are the expected results from a specific physical therapy program for scoliosis?

• Prevention of the progression of scoliosis and may reduce Cobb degrees of curve
• Improved posture
• Improved symmetry
• Increased muscle endurance
• Pain reduction
• Improved the quality of life
• Improved core stability and strength
• Improved breathing
• Better pelvic alignment

Is it ever too late to fix scoliosis?

Thanks to modern technology and advanced medicine, treating scoliosis is not too late. If you experience back pain, numbness, stiffness, or even fatigue (from strained muscles), it's essential to get the care you need.
In our clinic, there are specially trained staff aimed to manage your scoliosis most effectively. If you are concerned about your scoliosis and would like further information and guidance on its management, please do not hesitate to contact us.

Αναφορές:

https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-017-0145-8

A meniscal tear can be due to injury or degeneration due to wear and tear. Some meniscal tears may just be a normal part of structural changes that go along with ageing. Annually, more than 4 million people worldwide- according to the American Orthopedic Sports Medicine Association - undergo knee arthroscopy. (3) New evidence showed that arthroscopic surgery is not more effective compared to physical therapy for some types of meniscal injuries. (4)

(Picture from: https://blog.crossoversymmetry.com/guide-to-meniscus-tears/ )

Let's take them one by one.

Meniscal injuries are among the most common athletic injuries (6-7/1000 people, men are more likely to occur) and can be divided into acute or degenerative causes.(1,2) Acute injuries can happen in younger people, usually under 45 years old as a result of a combination of forces, such as loading and/or twisting the knee. Degenerative causes can usually happen in people over 45 years old as a result of ageing, and makeup about 30% of all meniscal tears.

(5,2) Activities such as ‘taking a wrong step’ or twisting to get into the car can accumulate stress on the knee over time and make the meniscus more susceptible to damage with small traumas. (6)

A meniscal tear can be clearly diagnosed by imaging (the most accurate method appears to be MRI with 93% sensitivity and 88% specificity),(7) but also, there are some quick, hands-on clinical tests that healthcare clinicians do in order to highlight a potential injury to these structures.(2) Early diagnosis and appropriate-personalised treatment play a major role in its progression. The fun fact about meniscus injuries is that 3 to 5 persons without knee pain have a tear!

For persons who have tears located on the region of the meniscus, it would likely be repaired because there is better blood flow there. Furthermore, people with known meniscal injury have accelerated cartilage wear, leading to the early onset of osteoarthritis, compared to people with no meniscal injury.(10) Studies have shown that those with a history of arthroscopic meniscectomy are 3 times more likely to get a knee replacement later in life – meaning that it is beneficial if surgery can be avoided! (11)

For the most common meniscal injuries, two main rehabilitation approaches are now recommended: exclusively conservative therapy (physiotherapy) or surgical intervention in combination with physiotherapy. The final decision of the most appropriate approach for each individual is determined after analyzing many parameters such as age, type of tear, and individual’s needs, capabilities, expectations and beliefs. For example, someone may need surgery if he has a huge tear or one that causes him the knee lock. (10)

(Picture from https://nazpta.com/physical-therapy-treatments/manual-therapy-kingman-bullhead-city-az-northern-arizona-pt/ )

According to the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), partial meniscectomy surgeries have decreased the latest years, both for acute and degenerative meniscal injuries. This has happened because of increasing awareness of the effects of surgery in this area, such as the increased likelihood of early osteoarthritis. (12) Expert opinion and research evidence show that approximately 3 in 4 people with a degenerative meniscal injury do well with physical therapy alone, while 1 in 4 people end up in surgery due to unforeseen causes (13), physical therapy becomes a strong option of people with meniscal injury as the first line of treatment.

A physiotherapy rehabilitation program is designed based on the individual's needs and goals and may include load modifications, interventions to reduce pain and improve range of motion, and therapeutic exercise.

Several studies have shown that, in persons who have degenerative tears, improvements in pain and function are the same whether somebody has surgery or physiotherapy. (5,4) Last but not least, even when surgery is the first treatment choice for a meniscal tear, it has great outcomes and post-operative physiotherapy is strongly recommended to get somebody back to his daily life and activities in the safest and most effective way.

Do not hesitate to seek advice and discuss your worries with your attending physician and/or physiotherapist in order to inform you further.

References

1. https://www.rheumatologynetwork.com/view/managing-meniscal-injuries-diagnosis
2. https://www.researchgate.net/publication/264053972_Treatment_of_meniscal_tears_An_evidence_based_approach
3. https://www.acumenresearchandconsulting.com/arthroscopy-market
4. https://pubmed.ncbi.nlm.nih.gov/29974216/
5. https://pubmed.ncbi.nlm.nih.gov/33896812/
6. https://pubmed.ncbi.nlm.nih.gov/34911509/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914628/
8. https://pubmed.ncbi.nlm.nih.gov/30285177/
9. https://pubmed.ncbi.nlm.nih.gov/12933452/
10. https://pubmed.ncbi.nlm.nih.gov/32271405/
11. https://pubmed.ncbi.nlm.nih.gov/27712957/
12. https://www.esska.org/news/555974/ESSKA-consensus-on-degenerative-and-traumatic-meniscus-lesions.htm#:~:text=The%20conclusion%20of%20this%20consensus,APM%20than%20after%20meniscus%20preservation.
13. https://pubmed.ncbi.nlm.nih.gov/33550450/

• Many people who experience back pain believe it is due to a disc herniation.

• Many people who have back pain will have an image that finds a disc herniation.

• Many people who find out they have a disc herniation will suffer greatly and feel disabled.

This is a vicious and unnecessary cycle that physios need to educate the public on.

1. What is a disc herniation?

A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. Unlike mechanical back pain, herniated disc-related pain is often burning or stinging, and may radiate into the lower extremity. Furthermore, in more severe cases, it can be associated with weakness or sensation changes.

2. Can a disc herniation heal?

Disc herniations are very common and occur in both symptomatic and asymptomatic people. We see that disc herniations can come and go, with around 80% having complete resolution without medical intervention.

3. Is it the cause of my back pain?

Pain is a complex experience and difficult to say one thing causes it. A disc herniation may contribute to and sensitise the region, increasing the nociception and pain experienced. It may be a confounder and not involved - we don’t know. What we know is that what someone believes (such as believing their pain is due to the disc herniation) matters much more. This can have a huge impact on the person's pain and the suffering he/she experiences.

4. Should I get a scan?

People are quick to get scanned when having back pain. It’s unclear if it really benefits the situation, and it can come with a negative impact. If there are signs of something more severe going on and there are “suspicious” symptoms reported (such as bowel or bladder issues etc.), then it’s good to consult your GP in order to get the scan. If there are no “warning” signs of more severe conditions, then the scan probably doesn’t worth your bothering.

5. Should I get surgery?

Surgery is often perceived as a magical fix for pain, but in reality, it doesn’t necessarily have better results than non-operative rehab and shouldn’t be the first-line treatment of choice.

6. Is exercise good for disc herniation?

Exercise is always a good choice! Beyond the general benefits of exercise, it brings the opportunity to challenge any fears & false beliefs regarding your body, improve its load capacity, and build tolerance. The key point is the adaptation of the exercise to your current level as well as the gradual escalation.

Most people start with isometric strengthening, mobility, and more general training. As you gain control of your symptoms & confidence in movement variability, exercise progression to the spinal full-range exercises with load is necessary. Over-time graded exposure strengthens the involved muscle groups and restores your daily function and exercise routine.

Soft tissue injuries (muscles, ligaments and tendons), are inevitable events during the career of almost every athlete. These injuries usually occur following an impact force from an external stimulus, when there is a contact-related history, or due to strain and/or compression load in the non-contact cases. Most of the non-contact injuries are related with doing too much too fast, after doing too little for too long.

Over the past decades, R.I.C.E.

• Rest
• Ice
• Compression
• Elevation

was the main approach to the management of acute soft tissue injuries, but its effectiveness is being questioned by researchers.

This article provides enriched updated recommendations for optimum and efficient acute soft tissue injury management (from rest & recovery phase to progress to exercise and return to performance), based on a recently published review of research.

What is necessary in an acute injury?

All injuries at their initial stage, have to undergo a healing process which is vital to enhance tissue remodeling & recovery. According to the recent data, soft tissue injuries on their immediate care simply need P.E.A.C.E. The acronym arises from

• Protection
• Elevation
• Avoid anti-inflammatory modalities
• Compression
• Education.

Protection over the first days of an injury is required to minimize bleeding, prevent distension of injured fibers and reduce the risk of injury aggravation by unloading the injured limb and restricting movements that would increase pain.

Elevation while resting (positioning the limb higher than the heart), promotes interstitial fluid flow out of the injured area.

Despite the lack of evidence of its use, elevation is still considered safe given its low risk-benefit ratio. Avoid anti-inflammatory medication (NSAID’s) and ice use over the first 48h as it may potentially disrupt the inflammation process and lead to impaired tissue regeneration in the long-term tissue healing.

As the various phases of inflammation contribute to optimal soft tissue regeneration, inhibiting such an important process using medication or ice is not recommended. When appropriate, NSAID’S dosage should always be prescribed by a licensed health care professional.

Compression (external mechanical pressure) on the injured area, with the use of taping methods, limits intra-articular edema & tissue hemorrhage.

Compression also improves quality of life in ankle sprain injuries. Patient information and education is a major contributing factor and should always be provided by a specialized health professional on these topics in order to raise realistic expectations on the rehabilitation times. Instead of looking for a magic treatment approach up on “Dr” Google, you should consult your physician or physiotherapist to learn more about the nature of your injury condition, recovery times, and how to apply load management.

How much rest is enough?

You should first worry about complete healing and then about the rest & recovery management, as these are key ingredients in any training program. If you don’t allow your body the time needed to recover properly, and instead you push it into exercise the injury won’t heal, while it is also likely to turn into an overuse/chronic condition with persistent symptoms.

Chronic pain is a much greater threat to your sports performance than resting! In general, it's feasible to rest/protect against an injury while still maintaining fitness with modified exercise even from the first days.

How much rest is required prior to exercise introduction, is in general determined by the pain presence and the nature of the injury.

In a recent study, a group of athletes with muscle injuries, who were introduced to exercise sooner (2 days post-injury), shortened the interval from injury to pain-free recovery and returned to sports 3 weeks earlier compared to the athletes who rested for 9 days (see figure). No increased risk of injury recurrence was identified between the two groups. Most of the references set at least a 48h rest period for muscle strains.

When can I progress to training? (loading phase)

When the acute symptoms subside and there is no aggravation in specific movements, pain behavior is guiding the removal of protection and gradual reloading. At this stage, rehabilitation must be driven by L.O.V.E. where the acronym consists of

• Load
• Optimism
• Vascularisation
• Exercise.

Optimal loading during the subacute phase of recovery promotes the long-term tissue repair and remodeling, and the capacity of tendons, muscles, and ligaments. Optimal load, as well as persistent pain management for athletes, has been described in another article.

The mental status of the athlete has a key role in sports injury rehabilitation, as emotional distress can decrease significantly the recovery rate. A successful rehabilitation should be driven by consistency, optimism, and trust between the coach, the athlete, and the sports physiotherapist.

A pain-free aerobic exercise represents a cornerstone in the management of musculoskeletal injuries as it boosts athlete’s motivation while at the same time it increases blood flow and facilitates vascularisation to the injured structures. It has also been highlighted that it improves function, work status, optimism while reducing the need for painkillers. Cardiovascular activity is recommended to be introduced as soon as possible, although there are no guidelines on dosage.

In a conclusion, systematic exercise restores mobility, strength, endurance proprioception, agility, and other important aspects of fitness capability, in order to return to desired sports performance. Progression in any activity is been guided by symptoms behavior and comprehensive design.

Any implementation of the provided information should be individualized to fit the biopsychosocial profile of each athlete.

Sources:

• https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/
• https://www.physio-network.com/how-much-should-you-train-during-injury/?fbclid=IwAR3DeKPUGqBOXmrk82dSQ9N_D0_Xp2SKSjSi8jLOCgtTv52yiprHC6Ni_wU
• https://www.painscience.com/articles/art-of-rest.php
• https://www.researchgate.net/publication/320085728_Early_versus_Delayed_Rehabilitation_after_Acute_Muscle_Injury
• http://www.drmirkin.com/fitness/why-ice-delays-recovery.html
• https://www.researchgate.net/publication/260529407_Regeneration_of_injured_skeletal_muscle_after_the_injury

“Hurt doesn’t equal harm” is a common mindset, among people who exercise on a regular basis either for recreational purposes or elite sports performance. Phrases like “no pain no gain” or “the pain you feel today is the strength you feel tomorrow” are printed on fitness T-shirts & gym walls as the representation of the dominant mindset in the fitness world.

In general, for someone putting effort to improve sports performance in terms of aerobic capacity, muscle strength & endurance, flexibility, as well as other aspects of exercise, it is absolutely normal to put stress on the body into vigorous soreness and fatigue levels, during a workout session.

What happens when pain persists for a long time and doesn’t seem to be relieved with training, medication, physiotherapy, or even injections?

During a competitive training and the days following, a tissue adaptation process is triggered by different body systems in order to compensate for the new physical demands. When our body is healthy, it is expected to recover within a few hours following a vigorous exercise session and up to a couple of weeks in the case of marathon runners and other similar endurance sports.

For example, muscle tissue adaptation sensation (aka Delayed Onset Muscle Soreness) can be triggered even 24h following an exercise session and it shouldn’t persist for more than a few days to ease off. Regardless of how strenuous a training session is, it would become easier, for the same person to perform exactly the same exercise program a few days later, at least in some aspects of the program.

There are many cases of athletes who struggle to improve their performance without any significant success in the end due to recurrent or long-standing pain. When the occurrence of pain is directly related to the training sessions and there is no sufficient improvement in sports performance over time, it is most likely to be attributed to an overuse injury condition. Overuse injuries in sports participation have common behavioral characteristics like the recurrence or even gradual aggravation of debilitating symptoms with medium or minimal intensity training.

There are numerous underlying reasons for the trigger and progress of an overuse condition to an athlete. In general, such condition is mainly attributed to gradual insufficient tissue adaptation to training workloads, due to imbalance in load & rest analogy. There are also cases where an acute injury has occurred prior to the gradual turn into a chronic overuse state.

That is mainly caused by primary recurrent injuries on the same location or secondarily due to the excessive strain of adjacent musculoskeletal structures. Important contributing factors are training load modification, recovery time efficiency between the same training tasks or the whole training sessions, quality of sleep, pain behavior monitoring, pre-season design et al.

There are plenty of sports-related musculoskeletal pathologies & disorders with an overuse component on the sports performance. Some of the most known are reactive or chronic tendinopathy, medial Tibial stress syndrome, chronic fatigue syndrome, repetitive strain injuries on hamstrings, and other parts of the body.

Overuse is also one of the most common etiologic factors that lead to injuries in pediatric and adolescent athletes.

What is the solution to an overuse condition?

As the term "overuse" indicates the individual experiencing pain has done too much for too long, someone would assume that rest is all we need. Our body tissues (bones, muscles, tendons, ligaments, cartilage et al.) are always affected by training stimulus or immobilization in a never-ending process. For example, if you stop using a specific part of your body for a while, this will cause, muscle atrophy, bones will become less dense, cartilage will be triggered by a degenerative process, ligaments and tendons will lose some of their elasticity. Even in a painful condition, absolute rest in an athlete comes with undesirable side effects. In most pathologies, continuous training load adaptation (optimal load management) is the main rehab strategy in order to overcome an overuse condition.

Optimal loading means replacing rest with a balanced and incremental rehabilitation program. A comprehensive rehabilitation design should be based on a proper diagnosis, a thorough assessment, and recognition of contributing factors as well as the appliance of individualized exercise prescription. The solution may be just as simple to put into words, but as the injuries and biopsychosocial background of each athlete varies, it is hard to implement/apply a single "one size fits all" rehab strategy.

In conclusion, if you are experiencing persistent pain when exercising and you have been diagnosed with an overuse injury condition,  you would, then, probably need a modification on training loads. While processing your way back to sports participation, you should also consider if there are any contributing factors to be addressed as well for the prevention of injury recurrence.

The information provided by this article is meant to help you become more effective and robust when exercising, so as to be able to return to desired performance levels.

If you still struggle without any significant success, then you should refer to a clinical specialist for athletes (an orthopaedic surgeon or a sports physio) to assist & guide you on your way back to sports participation. The same principles are not applicable to athletes with acute trauma or in a post-surgery state, and the contribution of exercise in these conditions will be well-explained in another following article.

Sources:

-https://www.ncbi.nlm.nih.gov/pubmed/29406788

-https://bjsm.bmj.com/content/50/5/273

-http://www.aspetar.com/journal/viewarticle.aspx?id=339#.XMBuKZMzbOQ

-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394138/

-https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-1017-5

-https://pediatrics.aappublications.org/content/119/6/1242.long

-https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1191

-https://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=15&page=ES205

-https://journals.sagepub.com/doi/abs/10.1177/0363546506298279