Guidelines - Osteoarthritis

This tool provides information to facilitate the management of osteoarthritis (general) in adults.

Focused examination

1. Patient History 

  • Rule out risk factors for major structural or other pathologies. If required, refer to an appropriate healthcare provider.

  • Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.

  • Address prognostic factors that may delay recovery.

Major structural or other pathologies (red flags):

  • History of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot, swollen joint, history of malignancy, vertebral infection, osteoporotic fractures, traumatic fracture, myelopathy, brain haemmorrhage/mass lesion, inflammatory arthritis

Examples of other conditions/co-morbidities:

  • Physical conditions: back pain, headache

  • Psychological symptoms: depression, anxiety

  • Co-morbidities: diabetes, heart disease

Examples of prognostic factors that may delay recovery:

  • Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization

2. Physical Examination

  • Rule out major structural or other pathologies.

  • Diagnose osteoarthritis clinically without investigations if a person is over 45 years of age AND has activity-related joint pain AND has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.

3. Management 

  • Offer information on nature, management, and the course of osteoarthritis.

  • Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.

Non-pharmacological management of osteoarthritis 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider local muscle strengthening and general aerobic exercise

  • Consider heat/cold 

  • Consider manipulation and stretching (particularly for osteoarthritis of the hip)

  • Consider interventions to achieve weight loss for those who are overweight or obese

  • Consider transcutaneous electrical nerve stimulation (TENS) for pain relief 

  • Consider appropriate footwear with shock-absorbing properties

  • Consider assessment for bracing/joint supports/insoles

  • Consider assistive devices (e.g., walking sticks and tap turners)

  • Do not offer acupuncture 

  • Do not offer glucosamine or chondrotin products

Pharmacological management of osteoarthritis

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider oral analgesics 

  • Consider topical treatments 

  • Consider non-steroidal anti-inflammatory drugs and highly selective COX-2 inhibitors

  • Consider intra-articular injections

  • Do not offer intra-articular hyaluronan injections

Invasive management of osteoarthritis 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice):

  • Do not refer for arthroscopic lavage and debridement unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose bodies)

*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.

Care Pathway for the management of osteoarthritis

(click here for French version)

4. Reevaluation and Discharge

  • Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.

  • Monitor for any emerging factors that may delay recovery.

5. Referrals and Collaboration

  • Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms or new physical or psychological symptoms.

  • Facebook Social Icon
  • Twitter Social Icon
  • YouTube Social  Icon
  • LinkedIn Social Icon

CCGI is funded by provincial associations and regulatory boards, and national associations including the Canadian Chiropractic Association

and Canadian Chiropractic Protective Association. CCGI maintains editorial independence from funders.

OnTEchU logo_transparent.png