Osteoarthritis related joint pain – What to do

Osteoarthritis related pain is the most common joint disorder in adults across the world. It is responsible for a high proportion of people dropping out of sport and recreational activities. In fact many people are told quite clearly not to run or play high impact sport because of their osteoarthritis. This can lead to an increased sedentary lifestyle and social isolation. So, it is a big deal and we need to make sure that the advice we (as health professionals) are giving out is the evidence based truth.

What is osteoarthritis?

image courtesy of arthritis-health.com
Osteoarthritis is the degeneration/damage of the cartilage layer over the bone ends in the joints. This cartilage layer (known as articular cartilage) cushions your bone ends from impact and allows for smooth movement. There is a thin membrane over the cartilage called the synovium which produces a thick fluid, that decreases friction within the joint and helps to keep the cartilage healthy. In the knee’s walking (and running) as the leg hits the ground and the body passes over the leg, there is compression of the cartilage, and much like a sponge, when the compression is removed, say when the leg comes off the ground, nutrients flood into the cartilage – Movement of the joint helps to keep the synovium healthy as it promotes a flow of nutrients.
Years of movement (life) or direct injury can irritate or wear down or damage the  the cartilage, making movements stiffer, jerkier and causing muscle spasm around the joint. This discomfort can decrease the amount the joint is moved. This affects the joint further as it can’t access the nutrients it needs from the synovial fluid that is released by movement.
Osteoarthritis usually affects the weight bearing joints of the knees and ankle, but also the shoulder, elbow and hands. Osteoarthritis related pain is usually associated with discomfort both with sudden movements and prolonged rest, as well as stiffness and swelling. Osteoarthritis related pain of the lower limbs especially the knees, can make it difficult to go up and down stairs, sit in low chairs or walk easily. Osteoarthritis related pain of the shoulders, elbows or wrists can make it tricky to manage taps, work in the garden or play racquet sports.

Perhaps your doctor has told you they suspect early signs of osteoarthritis, or maybe you’ve seen some changes firsthand to the cartilage on an X-ray. This can be a quite unsettling to hear and see. However age related changes are normal and what you see on an image does not  correlate with how you feel or move. With ageing all parts of the body change – just look at your skin, your hair. Just because your skin is creased or your hair is grey it still does it’s job, right? Well the same can be said of the joints.

Some people will have very little pain or limitation yet on their images their joints are “bone on bone” meaning that there is very little articular cartilage remaining. Other people will be in awful debilitating pain yet their imaging shows quite mild degeneration of the joint. Why is that?

The pain and swelling people with osteoarthritis feel, doesn’t simply come from the worn out cartilage. It also caused by the poor movement patterns around the joint that have developed over time. Changes in the joint surface can alter the joints range and make it clicky or sound crunchy which is disconcerting, but isn’t always associated with pain, and isn’t functional concern. 

We also know that pain is an expression/experience from the brain, it doesn’t mean you are doing damage or that you are about to do damage. As an expression from the brain, the pain experience is influenced by emotional factors such as what you have been told in the past (you have the knee’s of a 90 year old), what you have seen in the past (it’s in my genetics – grandpa on a walking frame because his knee’s were worn out) as well as what you expect (I’m just getting old). 

So what should you do if osteoarthritis related pain is limiting you? 

See a Vital Core Physiotherapist

Physiotherapists are a great first point of call when joint pain strikes. This is what we do best. We understand the pathology of the joint condition as well as pain science. We also understand movement and how to get the best out of a joint and the body as a whole.

At Vital Core Physio we will listen to you and your concerns, what worries you the most about the joint pain? What aren’t you able to do at the moment because of it? What do you understand to be causing your pain? What have you been told in the past? Once we understand where you’ve been and where you are now, we will help you to set new goals.  It is far easier to exercise when you are working towards a goal. You can read more about goal setting here.

At Vital Core we will assess your problem joint as well as the rest of your body, because it all works together. Whilst a large focus of your Vital Core Physio management will be exercise we do also provide manual therapy such as massage or gentle joint mobilisation which can really help (temporarily) with pain relief. 

Most importantly for osteoarthritis joint pain, at Vital Core we will structure an individualised, graded exercise program to help you achieve your goals. We guide and support you through this program adapting it to your feedback until you achieve your goals.

What sort of exercise is best for osteoarthritis?

An individualised exercise program is the absolute gold standard for osteoarthritis joint pain. Whilst there are some fabulous new programs that have had good results for knee osteoarthritis (i.e the GLAD program), at Vital Core we still find that every person is a little bit different in their ability so the starting level of every program will be a little bit different too.

The evidence overwhelmingly suggests that a combination of cardio and resistance training is essential for health and wellbeing, with the World Health Organisation recommending a minimum of 150 total minutes of moderate intensity physical activity per week. That does not alter for those with osteoarthritis, however it can be very challenging to achieve if your knee’s or hips don’t like a lot of walking. So the importance initially is to get the muscles around those joints stronger to allow the person to move easier.


                                               Exercising in a class is much more fun then going solo

Your Vital Core Physio will put together an easy to follow home exercise program to get you moving towards your goal(s). Sometimes exercising in a group can be more motivating. If you think this may suit you, Vital Core has many suitable options for those with osteoarthritis. Low impact closely supervised exercise classes such as Vital Core’s;

  • Strength and conditioning
  • Clinical Rehabilitation (formerly Clinical Pilates)
  • Mature Movers
  • Back to Basics mat classes
  • Strong core

These are all excellent ways to improve movement patterns and strengthen muscles around osteoarthritic joints. Take a moment to check out our class timetable.

What about medications?

Whilst we all want to be as natural as possible, there is a time and a place for the use of our modern medicines. Medications for osteoarthritis such as paracetamol can have good effect when taken regularly. Anti-inflammatories can also provide relief by temporarily reducing swelling.

These medications act by stopping the pain message which reassures your brain that things are okay, which makes movement and exercise in general easier, and ultimately reduces the pain in a positive feedback loop. You will feel and move better – which is the ultimate aim. At Vital Core we encourage you to take your pain relieving medications as directed by your doctor to help get you moving.

Get started today

Osteoarthritis doesn’t have to stop your life. Nor do you need to head straight to the surgeons office. Helping you move better can make a huge difference in your ability to cope with osteoarthritis and get back to the most important things in life such as bush walking, chasing kids or being active with friends.

The team at Vital Core physio will work with you so you get back to living the way you want. Book an appointment today.