My mission is to provide a point of current education and treatment options around first and second-line physiotherapy treatment options for hip and knee OA patients. I have been offering programs since their arrival to us and very much enjoy equipping patients with these tools to better self-manage their symptoms. With the recent growth of telehealth options, I am pleased that I can broaden my reach to include offering program participation to interested patients living anywhere in BC.

First Line Treatment

Exercise:  Exercise is a strongly-recommended core strategy in all cases of hip and knee OA, regardless of whether other health conditions also exist for a person or not. Exercise is most effective when it is structured, supervised and as specific as possible to each patient. Neuromuscular, cardiovascular and strength-based exercise programs can all be effective and should all be fully explored by those living with hip and knee OA.  Exercise tends to be more effective when combined with self-management interventions or weight loss programs.

Education:  Having current and accurate knowledge really helps one to live as well as possible with a health condition.  In my OA work, we talk about making choices in the face of pain.  We talk about why exercise is so important for OA joints and why is it realistic to achieve less pain and more function when living with this diagnosis.  In my experience, busting some of these common myths is extremely liberating for those living with hip and knee pain.

Weight Loss:   Extra body weight is known to have a negative impact on osteoarthritic joints. The good news, however, is that even small losses in body weight can have significant impacts on how one’s OA joints feel and function.  Extra body weight is also known to have an impact on the body’s Cortisol levels and overall inflammation.

Second Line Treatment

It is not uncommon to meet patients who are pursuing first and second line treatments at the same time.  In general, second line strategies are more individualized in nature and can be explored if the first line strategies are not proving effective enough over time. 

I have a good working knowledge of second-line strategies such as braces and orthotics and, particularly in my first-line program time with patients, I will often develop a sense of who may benefit further from some individual work with me post-group work.  In the second-line strategies that are not within a physiotherapist’s scope of practice, I am happy to suggest referrals of those who can advise further.   

Nadine Plotnikoff


Physiotherapist M.Sc. PT, C Gunn IMS, FCAMPT
Sport Physiotherapy Canada Diploma Holder
Registered International Sport Physical Therapist
Private Practice Co – Owner, Form Physiotherapy

Osteoarthritis-related certifications:
Certified GLAD Canada provider
Certified PEAK provider

 

A 30 year career gives time for a few chapters. In addition to my OA focus, my chapters have included a long and, hopefully, never-finished chapter in high performance sport and the opportunity to complete a Masters' thesis with a focus on shoulder injuries.

Establishing a private practice 17 years ago was a pivotal change in how I deliver my patient care. Our practice, Form Physiotherapy was one of the first in Vancouver to offer one-on-one treatment sessions where thorough assessment and treatment, clear goal-setting and patient education and empowerment could be prioritized.

A physiotherapy career is rich in learning and professional community. I have pursued the Canadian Physiotherapy Association's top designations for orthopaedic and sport physiotherapy and been lucky to have meaningful volunteer opportunities, including serving two terms as Sport Physiotherapy Canada's National Chairperson. Newer ventures include delivering learning opportunities to UBC School of Medicine Family Practice Residents.

Along the way, what drew me to becoming a physiotherapist remains the same. I simply really enjoy helping people to maintain better overall health by helping them remain or become active in ways that are meaningful to them.

It is in this context that the hip and knee OA patients have always existed within my caseload. Typically they have arrived at my office in search of strategies to improve their quality of life and perhaps avoid joint surgery. But with their expectations set very low. The recent arrival of a highly evidence-based treatment stream and first-line treatment programs, such as GLAD and PEAK, have, in my opinion, represented a paradigm shift in how we will manage hip and knee OA going forward. As I tell my patients now, if you're going to be diagnosed with OA, it's the best time to do so.

FEEDBACK

 

Knee OA - reducing pain, increasing mobility

When I began the GLAD program with Nadine, I could barely walk a block and stairs had become a formidable barrier. I needed to lose weight and moving so little made that objective much more difficult.

I am 77 and could not do as many repetitions as my more active classmates, but after a couple weeks, I could feel more fluidity in my knee joint and much less pain. In fact, most days now I do not need any pain medication. That is a big change - I was taking tylenol for arthritis every 8 hours.

The exercises are simple - and most can be continued at home - but having Nadine watching and making suggestions has been very important.

GLAD makes one feel that there is a way to control and manage OA. We do not need to be passive recipients of the discomfort.

Meg, Vancouver

Knee OA Treatment - GLA:D program has changed my life for the better!

In 2019 I became a client of Nadine’s after my family physician referred me to her for unresolved shoulder pain from a car accident. During the course of my shoulder treatment we got talking about other parts of my body that needed treatment. I have had surgeries on both knees for various issues and was told that knee replacement surgery would be in my future. I definitely wanted to avoid that! Nadine informed me about the GLA:D program and she suggested that I research the program, which I did. There was a GLA:D class that started in January 2020 and I join it.

The class size was kept small and it was very educational and fun. I learned a lot about pain and pain management. It was part of the program to be aware of which exercises caused pain, how long it lasted and what was the level of pain. Adjustments to the exercises could be made if necessary to keep the pain at a workable level. But we still had to do the work! Nadine has a wealth of knowledge and experience. She kept the classes engaging and informative. We learned about osteoarthritis and how to improve and maintain joint stability by doing the exercises on a regular basis. It is important to follow through with the program to build neuromuscular memory for proper joint alignment and stability. While I know this, I am not very regular in my current structured exercise program...

I have been able to maintain a regular program of walking approximately 5-6 km per day. I have been able to loose weight to lessen the load on my joints, which is extremely important. I am much more aware of my alignment when ascending and descending stairs and carrying objects.

The help and knowledge that I received from Nadine has changed my life for the better. I am able to participate in regular physical activity. I feel better and am currently living without hip or knee pain.

Thank you Nadine for your expertise and ability to deliver an excellent program.

Nancy W, Vancouver