Most people either know someone dealing with arthritis or have experienced it firsthand. It is a very common condition affecting joints throughout the body, but most commonly seen in the hip and knee. It is characterized by a loss of articular cartilage in the affected joint. Articular cartilage is a layer of tissue that helps to decrease friction and distribute load throughout the joint. There are several myths regarding the different causes of arthritis, and what you should or should not be doing once you have received this diagnosis. The goal of this post is to dispel some of those myths to help you get back to doing the things that matter the most to you.
Osteoarthritis Fact vs Fiction
If you have arthritis exercise will wear out your joints faster: Fiction
Exercise has been shown to be very effective for treating early and mid stage arthritis. Exercise decreases proteins and compounds in the knee harmful to cartilage and promotes a chemical called IL-10 which is good for the health of the articular cartilage.5 Numerous studies have shown exercise to be largely beneficial in improving symptoms with those who have osteoarthritis, and has not been shown to increase the rate of cartilage degeneration.9
Osteoarthritis will always cause pain: Fiction
A recent systematic review by the British Journal of Sports Medicine showed that between 19% and 43% of asymptomatic individuals over 40 years old had presence of knee osteoarthritis on an MRI.3 This shows that there are multiple factors that comprise how much pain you are in, and that the body has a natural ability to compensate. It also shows that if you receive this diagnosis, it does not mean that you are guaranteed to be living in pain.
Osteoarthritis may be caused by genetics: Fact
Unfortunately there are some factors that are out of your control and your genetics are one of them. If you have a parent who was diagnosed with osteoarthritis, the changes of you developing this condition are increased as well. There are other large risk factors for developing knee osteoarthritis, with the biggest risk factor being a previous injury to the knee, such as a ligament or meniscus tear. Other risk factors include old age, obesity, female gender and repetitive use of joints.4
Exercise is more effective than Medication/Injections: Fact
Although some medication can be helpful in certain cases, research has proven exercise to be far more beneficial in terms of overall pain reduction. One common medication used is over-the-counter non steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. These can be effective in managing pain in the short term but have to be weighed against potential side effects.2 The most common side effect is gastrointestinal issues with long term use. The FDA has also issued a warning that states that NSAIDS taken in higher doses can increase the risk of heart attack or stroke.10
Another common medication used to treat osteoarthritis is a cortisone injection. Cortisone is a powerful steroidal anti-inflammatory drug that has quick fast acting pain relieving capability via removal of inflammation. This is an option for many people due to the powerful pain relieving capabilities of this drug. However, these should also be taken with careful consideration of the negative effects. Cortisone has been shown to be associated with a risk of greater cartilage degeneration greater than 12 months after administration.2 Due to this reason it is important to limit the amount of these injections that you receive.
Not only has exercise been proven to be more effective than these two most common types of medication, but it carries a significantly lower risk of negative side effects. In fact, there are several other health benefits associated with exercise as well including improving cardiovascular health, improving blood pressure, weight loss, strengthening muscles and bones, improving mental health, improving sleep quality, and reducing risk of all cause mortality.1
I shouldn’t strength train: Fiction
Resistance training has several important health benefits not limited to improved knee health. It has been shown to help decrease pain, improve strength, as well as reduce the risk for all cause mortality including cardiovascular events.9 This works in several ways. The first being the increased strength helping to support the knee. The second being central effects of exercises including increased presence of healthy chemicals in the involved joints which promotes articular cartilage health.5 There are several different types of exercises that are great to do. It is best to perform a well rounded program that targets multiple muscle groups at the affected joint, as well as the joints above and below the area you are working on to provide additional support.
Losing weight can help decrease pain: Fact
Many people wonder if losing weight will help manage the pain caused by arthritis. Research has shown that this can have a small to moderate effect on pain. This is likely accomplished by having a decreased amount of force being placed through the joints as well as other positive lifestyle changes accompanied with weight loss, often including a healthier diet which can potentially lead to less inflammation in joints, as well as more being more physically active which was discussed above.8
Running will make my arthritis worse: Fiction
A recent study found that runners over 50 years old with knee osteoarthritis were able to continue running without making their arthritis worse. X-rays were taken at baseline and again four years later and no significant differences were found. These individuals performed self selected running, meaning that the duration, pace, and frequency of their running was based on their current symptoms. Results also showed a decrease in pain at a four year follow up in the majority of the runners, when compared to non runners.8
When is it time to consider a joint replacement?
The main surgical method to treat osteoarthritis is a total joint replacement. These are most commonly performed on the hip and knee, but can also be performed on the ankle, wrist, elbow, and shoulder. A joint replacement may be the best option for some people with severe osteoarthritis to be able to get back to doing the things they love and to get relief from their symptoms. This should be considered after trialing all non-invasive treatment options mentioned above including exercise and weight loss/dietary changes. These procedures are generally very effective pain reduction with several studies showing a greater than 80% satisfaction rate among patients.6 Post-operative rehabilitation is crucial following a joint replacement, in order to ensure that optimal strength and range of motion is achieved in the affected and surrounding joints in order to maximize function and quality of life.
If you are someone who is dealing with osteoarthritis, a physical therapist at Marathon can help identify the specific things you can work on to help get you back on your feet and moving!
References:
- Benefits Of Exercise: Medlineplus. [online] Medlineplus.gov. Available at: https://medlineplus.gov/benefitsofexercise.html [Accessed 30 October 2020].
- Charlesworth, J., Fitzpatrick, J., Perera, N.K.P. et al. Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee. BMC Musculoskelet Disord 20, 151 (2019). https://doi.org/10.1186/s12891-019-2525-0
- Culvenor, A., 2020. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and metaanalysis. British Journal of Sports Medicine, 53, pp.1268-1278.
- Heidari, B., 2020. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Internal Med., 2(2), pp.205-212.
- Helmark, I.C., Mikkelsen, U.R., Børglum, J. et al. Exercise increases interleukin-10 levels both intraarticularly and peri-synovially in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Res Ther 12, R126 (2010). https://doi.org/10.1186/ar3064
- Kahlenberg, C., 2020. Patient Satisfaction After Total Knee Replacement: A Systematic Review. HSS J, 14(2), pp.192-201.
- Lo, G., 2020. Running Does Not Increase Symptoms or Structural Progression in People with Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Clinical Rheumatology, 37(9).
- Robson, E., 2020. Effectiveness of Weight-Loss Interventions for Reducing Pain and Disability in People With Common Musculoskeletal Disorders: A Systematic Review With Meta-Analysis. JOSPT, 50(6).
- Teo, P., 2020. Identifying and Prioritizing Clinical Guideline Recommendations Most Relevant to Physical Therapy Practice for Hip and/or Knee Osteoarthritis. JOSPT, 49(7), pp.501-512.
- U.S. Food and Drug Administration. 2020. Stronger Warnings For Nsaids. [online] Available at: https://www.fda.gov/consumers/consumer-updates/fda-strengthens-warning-heart-attack-and-stroke-risk-non-steroidal-anti-inflammatory-drugs [Accessed 30 October 2020].
https://medlineplus.gov/benefitsofexercise.html
https://www.jospt.org/doi/10.2519/jospt.2020.9041
Source: Running Does Not Increase Symptoms or Structural Progression in People with Knee Osteoarthritis: Data from the Osteoarthritis Initiative