Today 12 October 2017 Is World Arthritis Day
What is osteoarthritis?
What we know about osteoarthritis (OA) is that it there are changes in the articular cartilage that covers the end of the bones. Osteoarthritis is driven by biomechanical and pro-inflammatory process.
Osteoarthrits typically occurs in load bearing joints e.g. back, hips, knees and ankles. It can occur in any joint but in this article we will focus on the conservative management of it in the knee.
Risk factors for OA include obesity, previous injury and a family history.
What are the signs and symptoms of osteoarthritis of the knee?
Joints can be stiff especially first thing in the morning, or after a period of inactivity e.g. getting up from sitting. The stiffness typically will ease once you get moving. Your knee can be swollen and warm. Sometimes when you overdo things you can have a painful and swollen joint. People often complain of difficulty doing stairs, kneeling, and walking.
What is the management for knee osteoarthritis?
Osteoarthritis is about managing the load- either we need to decrease the load going through the joints- this is where weight loss comes in, or we need to increase the capacity of the joints to better cope with load- this is where strength and exercise comes in.
Current conservative management of osteoarthritis includes weight loss and exercise. In a recent study by Meisser et al (2015), participants were put into one of three groups: the exercise only group, the diet only group and the diet + exercise group. For those in the diet group, the goal was to loose more than 10% of their body weight. Over an 18 month period those in the diet and exercise group had the biggest gains in both pain reduction and an increase in function. What is important to see here is that it was over a long period of time.
Among overweight and obese adults with knee OA, after 18 months, participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels (this is an indication of the amount of inflammation in the body) than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group.
What exercise is best?
The stronger the supporting muscles are around the knee , the better your muscle strength and the better you can cope with the load. You want to strengthen your muscle around the front of your thigh- the quadriceps. Research has also shown the stronger we are around the pelvis i.e gluteal muscles the more we are able to unload the knee, and control movement at the knee joint. An exercise program may also have some stretching in to improve your flexability. A physiotherapist can assess both your strength and flexibility and help build a program best for you.
In the study by Meisser et al (2015), client did both aerobic and strength training. For the aerobic exercise they did a brisk walk.
Fransen et al (2015) in a review of the literature found that land based exercises provided a short term benefit of a decrease in pain, that was sustained for 2-6 months once stopped. Exercise also an improvement in quality of life for people with knee OA. The treatment effect was comparable to those taking non-steroidal anti-inflammatories. If you don’t cope with land based exercises, considering hydrotherapy may be an option too- this is doing exercise in water.
Balance is also an important part of any exercise program. Having good balance reduces the risk of a fall or stumble, which can jar a sore joint.
We have a series of exercises on our YouTube channel to get you started: General Strengthening
The importance of weight loss
For every 1kg that you loose in weight, this decreases the load through the knees by 3kg. When we look at forces going through the knee joint with normal activity we can see the impact of excess force. Walking on a flat surface, the forces through the knee are half that of body weight. When walking up stairs then this is 2.5 X your body weight, and coming down stairs is 3.5x your body weight. This will explain why coming down stairs or walking down a ramp or a hill is what is often most painful when your knees are sore. If you are carrying excess weight then this will increase the load going through the joint with each of those activities and will have a significant impact on the pain that you feel. It is often worth consulting with a dietician to get you started on the right track.
Recent thinking in Pain Neuroscience
A shift in current thinking has looked at the role of our brain and pain. When you have had pain for more than 3 months we look at chronic pain. Osteoarthritic can fall into this category. Often because of clicking and pain in the join we can become fearful of movement. The good thing is exercise helps this, as well as understanding the condition, and having a chance to talk about your fears. Understanding why we have pain can go along way to being in charge of the pain. Watch this video by Lorimer Mosely on chronic pain: Tame the beast
If you would like support in getting you on the right track with regards an exercise program, or to understand persistent pain please contact our rooms for and appointment. Call 011-884-8488.
References:
- Meisser S P, Mihalko S L, Lagault C, Miller G D, Nicklas BJ, DeVita P, Beavers D P, Hunter D J, Lyles M F, Eckstein F, Williamson J D, Carr J, Guermazi A, Loeser R (2013). Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis. JAMA; 310 (12): 1263-1273 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450354/
- Fransen M , McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL (2015) Exercise for osteoarthritis of the knee. Cochrane Database System Rev. 2015 Jan 9; 1:CD004376. doi 10.1002/14651858.CD004376.pub3. https://www.ncbi.nlm.gov/pubmed/25569281