Osteoarthritis (OA) is an extremely common condition that affects millions of people in the UK. Traditional views on OA would lead us to believe the following:-
- It's 'wear and tear' or a 'degeneration' within a joint
- It's always painful
- It is linked to activity - i.e. the more active your lifestyle the more likely you are to suffer
NONE OF THESE THINGS ARE ACCURATE.
Recent changes in the way we view OA have changed our opinion and can hugely influence your outlook or management strategies if you are suffering.
A more accurate description would be:
- OA is a regenerative process - All joints have an innate capacity to re-build. Osteoarthritis appears to occur when the body is attempting to re-build - lay down additional structures to help a joint do its job effectively. If you have a thinning or slight change within the outer layer of cartilage that lines the bones within a joint, your body will start a recovery process. This may be visible on an X-Ray and lead to a diagnosis of OA. BUT....
- It's not always painful! High numbers of people will have these changes on an X-Ray but will feel no pain. This process is normally so slow & gradual that the body adapts along the way and your body doesn't always feel the need to tell you about it. You may feel no pain whatsoever.
- This process can happen at any age & the evidence doesn't suggest it's linked to activity levels. A typical view might be:
"Well I've always had a manual job so what did I expect?"
Or
"I've done long distance running all my life so I was always going to wear out eventually"
These things are not true. There's no consistent link between activity levels and OA. This can happen at any age, to anybody but there are always things that can be done.
- The presence of OA doesn't mean inevitable pain, and pain CAN change.
If we refer to OA as degenerative, which we now know is inaccurate, it sends the message that symptoms are only going to worsen. This can be a widely accepted concept with regards to pain - it's only going to get worse right??
WRONG!
By improving muscle function, by gradually changing your day-to-day exercise routine, by gradually encouraging your body to get better at tolerating exercise, you can reduce your pain!
The advice nowadays from versusarthritis.org, the Chartered Society of Physiotherapy and the NHS (to name but a few) is that exercise and lifestyle changes are essential.
- Exercise - make it part of your regular routine, make it tolerable, make it something you enjoy. Don't push through pain but embrace the importance of frequency & regularity.
- Weight loss. Occasionally the elephant in the room! This is sometimes a particularly sticky subject but smart choices about diet and exercise are recommended - By changing your diet to focus on healthy options whilst increasing your exercise levels - your bodyweight should change! Don't over complicate it, just be smart.
- Pain relief - Speak to your GP about pain medication to help bring your sensitivity down. You're not masking the pain! By controlling it you should be able to increase your exercise levels more comfortably and ultimately bring your sensitivity down.
As with most of the issues we as Physiotherapists see, the emphasis here when managing OA should be to try to encourage adaptation. If you want your pain or function to change, YOU HAVE TO ASK IT TO CHANGE! Doing the same old thing won't work!