Osteoarthritis (OA) is a chronic disease that affects one or many joints of the body and can include damage to the joint cartilage, inflammation of surrounding tissue and degeneration. It is the most common form of chronic arthritis and is characterised by pain in the joint, stiffness and swelling.
Any joint can suffer with OA but the most common joints affected are the hand, knees and hips. Although OA is more common in the older population, >55 years, it can affect people of any age especially in people who are overweight. The number of Australians with OA is expected to rise from 2.2 million in 2015 to almost 3.1 million by 2030.
There is currently no cure for OA and people need to be cautious of any products or treatments that would make similar claims. However these are many effective treatments to help manage pain and symptoms. For most people OA will not cause any serious problems or disability but it can progress if not well managed and possibly need surgery.
Last year the Royal Australian College of General Practitioners released guidelines for management of knee and osteoarthritis. GP’s are quite often the first point of call for patients suffering with OA and these recommendations use the most recent scientific research to guide our doctors towards the best treatment strategies.
On top of the guidelines is Lifestyle. The first recommendation made for managing OA is regular exercise and it is the only treatment that is “strongly recommended”. Exercise is consistently being proven to be the safest and most effective treatment for managing arthritic pain, while the report advises against other regularly used treatments.
The best exercise for people with OA could not be determined due to limited research. However muscle strengthening exercises, walking and Tai Chi are all strongly recommended while cycling, yoga and aquatic exercises may be beneficial. The evidence highlights the benefit of a supervised exercise program for greatest results when compared to self managed programs.
Interestingly, due to a lack of evidence, the OA guidelines recommended against the usage of some common treatment methods, many of which have been utilised by professionals for years. These included taping of the knee, shock absorbing insoles, anti-inflammatory creams, Platelet-Rich Protein (PRP) injections and turmeric.
The new guidelines are a little stronger in suggesting against therapies like specialised footwear or knee braces, ultrasound or shockwave therapy, opioid drugs, stem cell therapy, glucosamine, vitamin D and arthroscopic surgeries, even suggesting some of these therapies may in fact do more harm.
At the time of print, and despite these guidelines, GPs referred their patients for a surgical review 11.9% of the time, whilst referring for exercise therapy from professionals like ourselves just 3.7% of the time.
When pain and stiffness are the main symptoms of OA, exercise can often be the last thing you want to do and it is hard to imagine that it will help at all. This is the reason why so many people believe exercise to be detrimental and damaging to OA. So how come exercise is considered to be the most effective non-drug treatment for reducing pain when all these other treatments are being disproven?
When we start exercising we get our joints moving, the muscles start pumping, the ligaments stretch and we begin to get more blood flow and lubrication to the area. This blood flow will also bring with it oxygen and nutrients that will improve the health of the joints. Not only do we now have slightly healthier and more flexible joints but exercise helps improve the strength and function of the surrounding muscles and connective tissues. Strong muscles improve the support of our joints during times of increased load. It also holds the joint in a much more stable position, in the case of the knee of the knee this can reduce shear stress.
Evidence suggests weak quadriceps (thigh) musculature is a high risk factor of developing knee OA. For people with knee OA their pain is often related not to the damage of cartilage, but the lack of quadricep strength. It is because of these reasons that it is very important to exercise with OA and more specifically perform strength and flexibility exercises to improve the join health.
Finally there is one other Lifestyle treatment/strategy the guidelines recommend and that is weight loss. Research suggests that when someone increases their weight by 1kg, this adds roughly 4kg of pressure to the knee joint and 6kg of pressure to the hip joint, depending on the activity. Some simple mathematics indicate that if you increase your weight by 5kg, the pressure on your knees and hips increases by 20kg and 30kg respectively. For this reason, it is very important to minimise the impact on your joints by lugging around less fat!
Remember, sustainable fat loss takes time and is challenging to maintain long term, often requiring some individualised education, strategies and support.
On conclusion –
- Exercise is strongly recommended by the Royal Australian College of General Practitioners in the management of hip and knee osteoarthritis
- Many other common treatments and not recommended including – anti-inflammatory creams, stem cell, PRP, arthroscopic surgery
- Flexibility and strength exercises are important for maintaining good joint health
- Weight loss will take significant pressure of hip and knee joints reducing OA pain – diet and exercise changes are required for weight loss.
At Active One, we are keen to help you reduce OA pain. We have a great team of professionals that can help you improve your strength and flexibility and assist you in maintaining your healthiest weight. Don’t hesitate to get in touch if you would like an individualised plan.