Osteoarthritis (OA) is a heterogeneous joint disease that may have a different aetiology but a similar clinical, biological, pathological and radiographic progress. The disease is characterised by degenerative process which primarily involves articular cartilage and is associated with secondary reparative changes. Unlike age-related symptoms, OA triggers degradation processes in the cartilage, leading to its destruction.

OA is a model disease, the incidence of which grows with physiological aging. After the age of 80 years, it occurs almost in all individuals. Recovery or improvement of physical activity of patients with OA is an important part of the therapy not only to maintain physical fitness but also mental abilities, mainly in older patients.

Patients should be treated in a comprehensive way and informed about the nature of the disease, including the fact that it is not an inflammatory condition that would require a continuous pharmacotherapy. Patients should know that of primary importance in OA management are the factors of healthy lifestyle, such as reduction of extra body weight, well-balanced diet and regular physical activity. Pharmacological therapy should be used only in the phase of joint decompensation, with continuous pain, including pain at rest, on motion and at night, and sudden, marked restriction of the function. The basis of non-pharmacological OA treatment is physical therapy and the use of various means of physical medicine.

Physical therapy helps maintain the function, improves coordination, contributes to general fitness of patients and serves as a prevention of falls and various injuries, commonly sustained by the elderly. It helps them compensate the common stress and other pitfalls of everyday life.

The elderly should follow the principle “use it or lose it” [4], reminding them that inactivity leads to restriction or loss of mobility.

A typical finding are hard or bony swellings of distal and proximal interphalangeal joints, Heberden’s and Bouchard’s nodes and in the advanced stage also axial malalignment.

They are accompanied by frequent episodes of inflammatory exacerbation and gradual development of deformity which, however, rarely impair the hand function. Prognosis of OA of small joints is good, and after subsidence of the acute phase, DIP and PIP joints are usually asymptomatic. Women are often affected by this condition as early as during menopause. OA of small joints of the hand (DIP and PIP) is highly associated with arthritis of the knee joints. The most severe and painful is rhizarthrosis – arthritis of the thumb carpometacarpal (CMC) joint, which is in addition to joint symptoms characterised by hypotrophy of the short muscles of the thenar and restricts the basic function of the thumb, the grip or grasp. Rhizarthrosis is often hereditary and is common in women at the age around 50 years.

OA of the hip usually develops insidiously, sometimes over decades, without marked symptoms. Only in a minority of patients it proceeds more rapidly, with episodes of sudden exacerbation, intensive pain and restriction of mobility. Pain may radiate into the groins, the greater trochanter and into the medial knee, which sometimes leads to diagnostic errors. The initial episodic pain is gradually accompanied by pain after heavier physical activity and in the acute phase also by pain at night. Muscle attachments around the hip are usually tender to pressure; occasionally there occurs a small joint effusion. Muscle imbalance associated with OA of the hip results in shortening, later in contractures of extrarotators, flexors and adductors. Due to shortening of flexors and weakening of hip muscles, anteversion of the pelvis increases and results in deepening of the lumbar lordosis and increased tension of paravertebral muscles. The limb seems to get shorter, the affected joint does not adequately tolerate weight bearing and the patient walks with a noticeable limp.

OA of the hip affects both males and females; in younger age groups, it is more common in men; later in life the incidence is the same in both sexes. It may occur also as an isolated disorder without involvement of other joints.

In the acute phase, it is most important for the patient to follow bed rest regimen for 2–3 days which, in addition to pharmacotherapy, helps relieve symptoms of pain and inflammation. During the bed rest, it is necessary to position the limb in such a way to avoid its excessive rotation and to prevent flexion contracture by lying prone several times a day. The tone of abdominal, femoral and hip muscles should be maintained by isometric contractions, preventing atrophy due to inactivity. Isometric exercises against resistance (absolutely resisted exercises) help restore muscle strength. Stretching of shortened muscles gradually releases painful contractions. Ideally, exercises in OA of the hip should be performed with the suspended limb or in water which increases the therapeutic effect by a combination of the lifting force and hydraulic pressure and warm bath. Aquatic exercises are performed in all directions within the pain-free range. The speed of the motion is regulated by intensity of the resistance provided by water. Exercise intensity and water temperature are adjusted to the patient’s age and general health. After subsidence of acute symptoms, patients may start walking with crutches without weight bearing of the limb. Full weight bearing of the limb must be gradual, cautious and within the pain-free range. Older patients should always use a walking stick. Active exercises are commenced in the phase of compensated arthritis, but their duration and frequency must be carefully regulated, as active movements alone already put relatively high demands on the affected joint. Muscle strength is increased by common techniques (isometric and resistance exercises), where appropriate, an adjustable-load pulley may be used. The principle of rehabilitation of the joint is to load but not overload the joint, which applies to all activities of patients with osteoarthritis.