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.
Some of the most interesting findings of the OA guidelines were not about the best treatments are but what treatments it is best to avoid. There were many common treatments that have been around for a long time with no evidence that they improve any symptoms. Some of these include taping of the knee, shock absorbing insoles, anti-inflammatory creams, PRP injections or turmeric.
Other treatments are proven not to work and some could possibly have negative health effects, including: specialised footwear or knee braces, ultrasound or shockwave therapy, opioid drugs, stem cell therapy, glucosamine, vitamin D and arthroscopic surgeries.
Even with these recommendations from the Royal Australian College of General Practitioners our doctors are not correctly referring patients suffering with OA. GPs often choose to refer for surgical reviews (11.9% of the time) over any form of exercise therapy (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. Having strong muscles surrounding the joint will improve support during times of increased load demand. It will also hold the joint in a much safer, stable position. In fact weak quadriceps (thigh) muscles is a high risk factor of developing knee OA and for people with knee OA their pain is often related not to the damage of cartilage but the strength of the quadriceps. 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 recommended for managing OA pain: weight loss. For every kilogram of body weight that we carry there is roughly 4kg of pressure on the knee joint and 6kg of pressure on the hip joint depending on what you are doing. This means that if you are carrying around an extra 10kg of fat the forces on your knee and hip would be 40kg and 60kg respectively. That is a lot of pressure and for these reasons it is very important to minimise the impact on your joints by losing weight. Remember weight loss is not easy; it can take a long time and quite a few changes to your diet and exercise routine.
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.