Osteoarthritis

Please remember the advice we give is general and not meant to be used as a substitute for professional medical or health advice, diagnosis, or treatment. If you want specific advice then please seek help from your doctor or local physio

What is osteoarthritis?

The word osteoarthritis can be split into three to help understand what it means:

• Osteo - from the Greek ostéon, meaning bone.
• Arthritis - from the Greek arthro-, meaning joint and -itis, meaning inflammation.

So the term osteoarthritis literally refers to inflammation of the joints between bones. In practice, we can think of Osteoarthritis as a condition that presents as pain, stiffness, swelling and movement restrictions in any of the joints of the body. The most commonly affected joints are the knees, hips, hands and shoulders. This definition is important because it highlights the fact that osteoarthritis affects the whole joint, including the bones, ligaments, joint capsule and cartilage. It’s valuable to our understanding of the condition to point out that whilst cartilage can change in osteoarthritis (usually becoming thinner), it is only one piece of the puzzle. 

It's important to recognise that findings from imaging such as X-ray or MRI do not give us the full picture. Many people with imaging findings of osteoarthritis have no symptoms, whilst many people with symptoms of osteoarthritis have very little radiographic signs of osteoarthritis. So a diagnosis should only be made based on your symptoms, NOT imaging findings.

There is a prevalent idea that osteoarthritis is a “wear and tear” or “degenerative” condition, whereby after years of work or physical activity, the joint cartilage thins, until the joint may even become “bone on bone”. This is an inaccurate description of what osteoarthritis really is. Our bodies are not simple mechanical machines that wear out with use. They are living, adaptable organisms. And as we have just pointed out, what we see on imaging (and therefore how "worn out" your joint is) is really not a reliable indicator or predictor of pain and function. Our bodies can grow, change and heal, even with osteoarthritis. Your joint and the muscles around it can be strengthened, the bones become stronger and more dense, and the joint can become more mobile and flexible.

Osteoarthritis is a complex, multi-faceted condition, there are many factors that contribute to it beyond simply the thickness of the cartilage within the joint, such as:

• Age
• Sex
• Heredity
• Previous injury
• Body mass
• Physical activity levels
• Beliefs and expectations
• Past experiences of pain
• Comorbidities
• Sleep

How can you treat Osteoarthritis?

Education

Understanding that osteoarthritis is not simply mechanical 'wear and tear' and that the physical condition of your joint can be improved will hopefully give you a more positive outlook. Understanding that there are many factors than can influence your pain and function, can also be helpful, as it gives you lots of treatment options to try. In the list of relevant factors above, there are of course some things you cannot change, but there are several which you can!

Weight Management

Keeping in the healthy weight range can also have a big impact on osteoarthritis symptoms. In fact there is a dose-response relationship between weight loss and improvements in osteoarthritis symptoms and function. In other words, if you are overweight and you lose even a small amount of bodyweight, you should notice that your joint starts to feel better, in addition to all the other huge benefits!

Exercise

Exercise has so many positive effects on our health. There are so many that it would be impossible to list them all here. Here is a brief list of the direct benefits that exercise has on osteoarthritis:

• Helps with managing weight
• Improves the strength of the muscles around the joint
• Increases the joint’s ability to tolerate load - meaning you can handle more before the onset of symptoms
• Makes difficult daily tasks easier
• Provides an analgesic effect - exercise causes the release of ‘feel good’ chemicals in your brain that make you feel better, and can also lessen pain

Any kind of land-based exercise has been shown to be effective. (As opposed to water-based exercise such as swimming or aqua aerobics, which have not been shown to be as effective).

We recommend aiming for the minimum physical activity guidelines of:

• 150 minutes of moderate aerobic or 75 minutes of vigorous aerobic exercise each week (or a combination of the two)
• Muscle strengthening exercise on at least 2 days per week
• Aim to be physically active each day 

If you can't reach these initially, starting with a smaller amount and aiming to build up will still be very beneficial!

But what if it really hurts to exercise?

It’s good to remember that hurt does not equal harm. There are obvious exceptions to this rule - such as a broken bone, but in the case of a persistent issue like osteoarthritis, pain during exercise is simply an alert that you are loading a sensitive joint.

Joints, like other tissues in our body, are adaptable. So as you become more accustomed to the exercise, and the joints gets used to the loading and movement, your symptoms should slowly decrease. This is true, even in the case of osteoarthritis. The key is finding the appropriate starting point. This simply means finding a level of exercise that you can tolerate, both at the time, and in the 24-48 hours following the activity.

How to modify painful exercises

Joint replacement surgery

When to consider joint replacement surgery for osteoarthritis is an individual decision for you to make with input from your medical team. We recommend trying to manage your condition with exercise, weight loss, and addressing some of the other factors discussed in this article, for as long as possible, only resorting to surgery when your joint function is significantly impacting your quality of life.

Kneeling on a painful knee

We have included this section here as it's something we do get asked about occasionally.

It can be difficult to kneel when you are experiencing knee pain. In this case, use as much cushioning/padding as you need to make it tolerable. If you can't make it tolerable, substitute kneeling exercises for non-kneeling counterparts instead. 

Regarding kneeling on a knee which has had a total knee replacement. Generally speaking this is fine to do, however it is always something you should check with your surgeon first.