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Osteoarthritis (OA) is a joint disease that is characterised by damage to the joints which affects synovial fluid, cartilage, bones, muscles, blood supply and nerves. It happens when the protective cartilage that covers the tips of our bones is gradually worn down and this causes multiple bones to rub against each other. This ultimately leads to pain and eventual loss of function.

Osteoarthritis also affects other connective tissues and muscles related to the affected joint. For example, knee osteoarthritis may affect the connective tissues and muscles in the thighs, calf, buttock and even other joints like the hip and ankle. Having said that, OA does not only affect the knee joint, it also affects the joints in the hands, hips, and spine.

Proper use of the joints will keep it lubricated and this stimulates the repair and rebuilding process. On the other hand, lack of joint use causes the cartilage to become dryer, more brittle and more prone to damage over time. This tends to happen in the parts of the joint surface that is related to ranges of motion that are not being used sufficiently. As time passes, the damage and pain become so severe that it leads to deformities that cannot be corrected and this would leave surgery as the only option.

The 5 Stages of Knee OA

OA of the knee progresses in stages and takes many years to develop. This condition can be hard to treat because symptoms may not appear until OA reaches an advanced stage. OA is divided into five stages (5) with stage 0 representing a healthy & stable knee. As the stages progress, pain and stiffness increase. Here we will focus on the 4 Stages of OA, from Minor to Severe.


Stage 1 - Minor / Doubtful

Stage 2 - Mild

Stage 3 - Moderate

Stage 4 - Severe

Primary Osteoarthritis vs Secondary Osteoarthritis

Osteoarthritis can be classified into 2 categories:

Who Tends to get OA?

Symptomatic knee OA is currently the fourth leading cause of disability worldwide, [4] with an estimated prevalence of 70–80% in the population aged 55 years and older [5]. An ageing Asia with longer lifespan suggests ever-greater numbers of knee OA, among other chronic conditions [6]. The point prevalence of knee OA in Malaysia today is estimated to be 10–20% of the total adult population [7].

Crude prevalence of knee pain and knee osteoarthritis by age
Crude prevalence of knee pain and knee osteoarthritis by ethnicity according to age group

Which Joints Get Osteoarthritis?

While osteoarthritis can occur in any joint due to injury or abnormality it is much more common in certain joints, particularly weight bearing ones. It is often symmetrical, occurring to some degree in joints on both sides.

We shall look into the signs and symptoms of OA and how Oxidative Stress can lead to OA in our next Blog.

Learn more how Hi-Bliss Hydrogen Therapy can help slow down the progression of OA here :


OA is diagnosed by a triad of typical symptoms, physical findings, and radiographic changes. The American College of Rheumatology has set forth classification criteria to aid in the identification of patients with symptomatic OA that include, but do not rely solely on, radiographic findings. Diagnosis of Osteoarthritis is done by noting the signs and symptoms:

Impact of OA on Quality of Life

There are several ways in which OA can impact the quality of life such as increasing stress and sleep disruption due to pain that has intensified. Osteoarthritis also reduces the ability to perform normal activities in our daily life and reduces productivity. It can also lead to problems with anxiety and depression.

Pain and stiffness can decrease your desire to be active. Not only does a lack of activity limit your enjoyment of life — it can also reduce muscle mass which leads to muscle tightness and a risk of falling and suffering from other injuries. Muscles are more prone to injury when it is tight or weak, and micro-tears lead to scarring of the muscles that can disrupt normal muscle function, therefore affecting the surrounding connective tissues.

Lack of activity can also lead to weight gain. Extra weight may exacerbate OA symptoms, and this may lead to an increased risk of getting other complications such as:

Other complications that can arise from OA are:

Prevention of Osteoarthritis

A number of factors may put a person at risk of developing OA. Making changes may not prevent the condition, but a person may be able to reduce their risk or keep OA from advancing.

The Arthritis Foundation suggest the following:

How Oxidative Stress can lead to Osteoarthritis?

Oxidative stress happens when there is an imbalance between the number of free radicals and antioxidants in our body. This is particularly harmful as it can lead to cell and tissue damage. Oxidative stress is considered a main causative factor in the pathogenesis of OA. Many pro-inflammatory mediators or free radicals are elevated in OA, including Reactive Oxygen Species (ROS), and Reactive Nitrogen Species (RNS).

Fig. 1. Oxidative stress-related mechanisms of osteoarthritis pathogenesis. mtDNA, mitochondrial DNA.

The excessive production of free radicals can harm cell functionality as it damages cellular lipids, proteins and DNA. Free radicals can give rise to cartilage apoptosis/ cell death, thus accelerating articular cartilage dysfunction and degeneration.

Oxidative stress is known to be detrimental to many cells and to occur during disease and with ageing. It has also been implicated in the development of OA. Although osteoarthritis has been traditionally classified as a non-inflammatory arthritis, however evidence has increasingly shown that inflammation occurs as cytokines and metalloproteinases are released into the joint. Inflammation get worse when more of these agents are released, especially when triggered by excessive free radicals. Inflammation in the cartilage and synovial leads to loss of joint structure and progressive damage to the cartilage, causing OA to become worse. Inflamed articular cartilage still remains a huge hurdle to treat due to the limited self-healing capacity of the cartilage which lacks nerves and blood supply.

How Hydrogen Therapy Can Help?

Hydrogen therapy is one of the newest and most effective treatments to manage arthritis due to its role as a therapeutic antioxidant. It is able to selectively neutralize free radicals in the affected area which reduces inflammation and prevents further damage to the joint, thereby slowing down the progression of OA. As hydrogen is the smallest molecule on earth, it is able to diffuse itself into the targeted cells without affecting the functions of other cells and organs.

Based on a research by Ding Li and Wan Chun Wang in the year of 2012, hydrogen is considered to be a selective antioxidant and can be used as a kind of therapeutic medical gas. This further reinforces the idea that hydrogen treatment can help to decrease the damage of cartilage caused by oxidative stress.

In Hi-Bliss Hydrogen therapy centre, we combine the therapeutic benefits of hydrogen therapy with osteopathic manual practices. Our certified physiotherapist will perform the Osteopathic Structural and Functional Examination on the lower limb area to find out the root cause of the pain by measuring the Range of Motion (ROM), Muscle Strength, Gait Analysis, Posture Alignment, Quality of Movement, Pain during Movement, Muscle Bulk and Tone. The hydrogen treatment aims to suppress inflammatory factors such as free radicals and slow down the progression of osteoarthritis.

By combining the Hydrogen with Osteopathic practices, we help our clients reduce pain in the joint, slow down the progression of OA and ultimately help them return to normal daily life. Hydrogen therapy is efficient in treating the inflamed joints caused by OA by repairing the internal cells in our body while our physiotherapy/osteopathic techniques helps to improve the external muscles caused by muscle imbalance. We will also educate clients about suitable stretching and strengthening exercise that aims to manage symptoms and improve joint function, flexibility and balance.

By reducing the number of OA symptoms, it will improve your ability to get around and increase your quality of life.

Learn more how Hi-Bliss Hydrogen Therapy can help slow down the progression of OA here :


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