As health care providers, our number one priority is to help you! Whether that means relieving your pain, helping to recover from an operation, or getting you get back to sport or work; we aim to fix every single person that walks through our doors. Unfortunately, even we - your physio extraordinaires - have our limitations. There are some injuries, diseases and conditions, that despite our best efforts, we are unable to cure. This multi-part blog is dedicated to the management of those lifelong and (currently) incurable conditions.
Osteoarthritis (OA) is an inflammatory disease of the joints that most commonly affects the knees and hips and is listed as the number one health problem in older Australians. OA is generally thought to be synonymous with usual “wear and tear” of the joints and accepted as an unavoidable part of the aging process. Neither of these are true! OA is actually a very dynamic process, not just a gradual degeneration of the joint as it is often portrayed. Cartilage and bone are constantly undergoing a natural cycle of degeneration and repair as they respond and adapt to everyday stresses. OA occurs when this system becomes unbalanced. An overenthusiastic repair response can lead to formation of unwanted bony spurs often seen in imaging of arthritic joints. In response, the degenerative activity is accelerated to compensate for the increased repair. This tug-of-war continues within the joint, ultimately leading to a loss of joint tissue. This process is best described as “wear and repair”.
While it may seem like semantics, this “wear and tear” vs “wear and repair” mentality makes a huge difference in the disease management. “Wear and tear” implies that all activity is causing irreversible damage to the joint. This is simply not true. While repetitive, high-impact activities MAY be a contributor, multiple other factors are thought to increase the risk of OA including; obesity, genetic predisposition, abnormal joint alignment, and previous joint injury. If physical activity is viewed as the cause of the problem, the obvious solution becomes to cease activity and save the joint from further damage. This couldn’t be more wrong! Sedentary behaviour will have no effect on stalling the progression of the disease and in fact, will likely further exacerbate the problem. Without regular use, the affected joint becomes stiffer and begins to lose function. The tissues around the joint will also be affected by disuse, quickly losing mass and strength. This begins a vicious cycle of inactivity; as you get weaker and stiffer you lose function and activity becomes more difficult. This leads to increased sedentary behaviour and in turn, more maladaptive changes that further impact function. Eventually, this can become completely disabling and lead to loss of independence. Unfortunately, prolonged physical inactivity, precipitated by the symptoms of OA, predisposes one to a host of cardiovascular issues and greatly increases the overall risk of mortality.
Alternatively, approaching your OA from a “wear and repair” perspective requires an understanding that there is an ongoing process within the joint. The stress or “wear” on the joint, is completely normal and the “repair” is the natural response to stress. It’s the same adaptive process that causes muscles to become bigger and stronger and bones to become more dense with use. The “wear and repair” mentality also presents a more accurate representation of OA and can aid in the understanding of the disease. Accepting that the joint’s “repair” cycle is malfunctioning and cannot be fixed, but understanding that the SYMPTOMS from this process CAN be reduced are crucial to effective management. Most importantly, “wear and repair” does not demonize physical activity and create a fear of exercise that will lead to further deconditioning and associated complications.
Exercise is so effective in the management of OA that it is considered a cornerstone of regular treatment. Mechanically, constant movement of a joint will help preserve its range of motion and keep it functional. Regular movement will also help to stimulate the production of synovial fluid, the fluid within a joint that acts as a natural lubricant to keep the joint moving smoothly. Constant load through the joint will help preserve the muscle mass around the joint and prevent deconditioning. A strength training program is highly recommend as an increase in upper leg strength has been found to be a key factor in decreasing OA pain in the knee. The stronger the muscles are surrounding the joint, the more load they are able to take, lessening the stress through the joint itself!
Exercise can also be used more specifically to target the risk factors of OA. In obese populations, exercise to promote weight loss, complimented by an effective diet, can have a huge impact on decreasing joint loads and reducing symptoms. If abnormal joint positions and/or movement patterns are detected, exercise can be used to target these aggravating factors and decrease symptoms. Lastly, physical activity is well known for its positive impact on psychological and cardiovascular health and regular exercise will help to achieve these benefits.
Effective exercise can come in many variations. Low-impact activities are generally recommended, as they are less stressful on the joints. Examples include walking, cycling, yoga, pilates and water-based activities. For optimal, all-round benefits, an exercise program should include a strengthening and aerobic component. Whatever exercise you choose, make sure to ease into it and progress gradually to allow your body to adapt appropriately. Most importantly, find a form of activity that you enjoy! All the positive effects of exercise only last as long as the exercise is continued. For effective, lifelong management of OA regular activity needs to become a permanent part of your daily routine!
Note: There are of course pharmaceutical and surgical options available for the treatment and management of OA. Exercise should remain an important part of your management plan in conjunction with any other medical options you choose to pursue! Speak to a qualified medical provider if you wish to learn more about these other avenues of OA treatment.
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