OSTEOARTHRITIS  (OA)

WHAT IS OSTEOARTHRITIS ?

Osteoarthritis (OA) is a joint problem that can cause persistent joint pain and difficulties with daily activities. There is no single cause of OA, having genetic, lifestyle, and mechanical risk factors. 

OA first shows itself as a change to the biological processes and cell structures within the joint, followed by changes to cartilage and bone, resulting in inflammation. Current evidence supports OA as a ‘whole person condition’ in which joint health is influenced by the interaction of several factors that modulate inflammatory processes and tissue sensitivity. These factors include tissue changes, general health, activity levels, behavioural responses, stress and sleep quality. 

There are many things you can do to help with your OA pain and function, and the outlook for most people is positive. With the right approach there is every chance you will be able to keep doing all the things that are important to you.  

CONTRIBUTING FACTORS

Changes to the joint tissues, your mood, anxiety, stress levels, poor sleep, fatigue, or sometimes just focusing too much on the pain can all affect your experience of pain. 

OA is more common in older people but can affect younger people as well. There are certain factors which may make some people more susceptible to developing OA, such as:

- Genetic factors

- Physical inactivity / sedentary lifestyle 

- Other joint disorders such as rheumatoid arthritis

- Previous injury (trauma) or surgery

- Joint mechanics in some cases

- Being overweight or obese

- Heavy occupational and/or high sporting stress to the joint

For many people the precise cause of their OA is not known. This is not a problem, as the cause does not influence the management plan.

While the video above focuses specifically on knee OA, the principles apply to OA in general.

BREAKING THE VICIOUS CYCLE OF OA

It is possible to stop this cycle.  Remember, pain does not mean you are doing more harm and staying active is the key to doing well.

VICIOUS CYCLE OF OA

OA Pain cycle.PNG

BREAK THE CYCLE WITH EXERCISE 

Positive OA cycle.PNG

MYTHS & MISCONCEPTIONS ABOUT OA

Osteoarthritis is often referred to as ‘wear and tear’, a term that implies our joints simply wear out through use.  It is not correct to describe OA as a simple process of wear and tear, as OA is an active condition with several contributing factors, rather than a simple wearing down of the joint.  To highlight this, for example, studies looking at physical activity and OA show that recreational / amatuer runners have healthier knees and less pain than sedentary individuals.  Physical activity is safe, it doesn’t cause more joint degeneration, and it can decrease pain in those with OA.

The pain we feel with OA is not all about tissue damage (pain is always multifactorial in nature). Pain does not necessarily mean harm and X-rays are not essential for diagnosing OA or to decide on the best treatments for you. This is because x-ray results are poorly related to how much pain, stiffness or disability you may experience.  What your knee, hip or shoulder looks like on the inside and how it feels, are two quite separate things. Some individuals experience little or no pain but show significant changes on scans, whereas other individuals may experience pain with little or no changes.  

Joint pain from OA is a modifiable symptom related to sensitised joint structures and influenced by a variety of biopsychosocial factors, rather than solely related to damaged structures. Pain and function can improve without making changes to what we see on scans so lets focus on the things we can do.

Osteoarthritis is more common in older populations, however it is not an inevitable part of ageing and is not necessarily progressive.  For most people, OA will be stable with occasional flare-ups from time to time. Flare ups are periods of worse pain but do not mean there is more damage within the joint and the pain will usually settle down again in time.  Mild to moderate pain during activity is not associated with worsening of or progression of OA.

For most people, their OA will not become severe enough to need a joint replacement. Taking control of your osteoarthritis and learning ways to manage your pain are really important. 

ROLE OF STRENGTH

EXERCISES & PHYSICAL ACTIVITY

Although there is no cure for osteoarthritis, treatment options are available to manage symptoms and optimise quality of life. Clinical guidelines recommend exercise, education, and weight loss (when necessary) as the first line of treatment for all individuals with OA. Exercise has similar sized pain reducing effects as analgesic medication and can reduce the chances of you requiring joint replacement surgery.

One such program, the GLA:D (Good Life with Arthritis: Denmark), which is based on education and appropriately prescribed exercise has been shown to result in:

  • Less pain and reduced symptom progression

  • Improved quality of life

  • Reduced use of joint related pain medication

  • Increased physical activity.

Pyramid.PNG

Exercise is safe and effective for individuals at all stages of OA, even in those eligible for joint replacement. Furthermore, for those where surgery becomes necessary, supervised exercise prior to surgery is associated with a faster postoperative recovery. 

Strengthening exercises for the muscles around the joint and general physical activity to increase fitness is advised.  The exercises prescribed and the activities recommended will depend on your current level of function, pain symptoms, goals, and your activity preferences (eg, strength training, walking, cycling, swimming / water exercise, Tai Chi, and many more).  For some individuals, more frequent, shorter bouts of exercise might be best suited.  You may experience some temporary increase in pain, stiffness, and swelling, but this does not mean that your osteoarthritis is getting worse.

Inactivity leads to muscle weakness, weight gain, feelings of joint instability and can impact on your mood and sleep. These factors can in turn make your pain feel even worse.

Data shows that only a small proportion of people with OA meet physical activity guidelines (the recommendation is at least 150 min per week of moderate intensity exercise).  We have seen that appropriately prescribed exercise can help with pain and function in OA, but it is also effective in preventing and treating many chronic conditions including high blood pressure, diabetes, cardiovascular disease, depression, anxiety, and obesity.   

Staying active is the key to doing well.

‘every cell in the body is capable of adaptation until the day we die’