Osteoarthritis- What is the best treatment? (Part 1)

08 Nov Osteoarthritis- What is the best treatment? (Part 1)

How can you treat osteoarthritis (OA)?

Currently, there is no known way of curing cartilage loss. Initial treatment focuses on reducing symptoms and improving function of the joint. Based on evidence, the recommended treatment for osteoarthritis is outlined by the pyramid in Figure 1.

Figure 1. The treatment of osteoarthritis can be shown by this pyramid. The lower part is education, exercise and weight loss (if necessary). This should be offered to anyone with osteoarthritis right away. The middle part should be offered to those who did not improve with education and exercise. Surgery (typically joint replacement) should only be offered when no other treatment has worked.

Figure 1. The treatment of osteoarthritis can be shown by this pyramid. The lower part is education, exercise and weight loss (if necessary). This should be offered to anyone with osteoarthritis right away. The middle part should be offered to those who did not improve with education and exercise. Surgery (typically joint replacement) should only be offered when no other treatment has worked.

 

First Line Treatment Recommendations:

 

Education

Everyone with OA should understand the basic information about how it affects your life. Learning about the condition is a good way to improve your knowledge and confidence in managing it. Read HERE about further information on OA.

Weight reduction (if necessary)

When moving, the load on the joint is much more than the actual amount of body weight applied. For every 1kg of weight lost, knee joint load decreases by 2.2kg. And for every 10% loss of weight, symptoms/function improve by 50%.

Exercise

Exercise has consistently been supported by strong research as the best treatment for people with OA. Loading the joint through exercise is important for cartilage, joint and muscle health.

What exercise is best? Land-based exercise such as walking and strength training are all effective in managing OA.  We recommend any exercise or group of exercises that will:

  • Load the joint (weight-bearing exercises) eg. squats for hip and knee
  • Strengthen muscles around the joint
  • Move the joint
  • Improve neuromuscular control- quality of movement and function
  • Help lose weight (if required)

 

At SportsFit we currently have the GLA:D program which encompasses all of the above and education. Exercises are also supervised and progressed individually which has been shown to be most effective. Read HERE for more information on GLA:D.

Depending on your physical capacity and exercise preferences, our physios in Glen Iris and Malvern East can tailor an exercise program to suit your situation. 

When I exercise it hurts, so am I causing harm? No, a recent review article on the most relevant research concluded “knee joint loading exercise seems not to harm articular cartilage in participants at increased risk of, or with, knee osteoarthritis.” (Bricca et al. 2019). The biggest key is to find the APPROPRIATE amount of exercise. Too little exercise is not enough to stimulate cartilage regeneration. Too much exercise can make your symptoms worse. Given some degree of loading (exercise) is beneficial for cartilage regeneration, it is important to find an amount of exercise that’s right for you.

Pain can be a useful guide to help determine this, as seen below.

Is it okay to exercise when it hurts? Yes, it is okay to exercise while in pain. It is important to differentiate between muscle and joint pain. Your joint pain should never exceed your acceptable limit of pain DURING exercise. This joint pain should ALSO return back to baseline (pre-exercise) levels within 24 hours of exercise. You should lower the intensity of your exercise if joint pain goes over your acceptable limit or continues for over 24 hours.

Note: it is normal to experience a slight increase in pain at the commencement of a new exercise program

pain-scale

 

In Part II (upcoming)- we highlight other treatment strategies for OA.

 

References:

Bricca, A., Juhl, C. B., Steultjens, M., Wirth, W., & Roos, E. M. (2019). Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. British journal of sports medicine, 53(15), 940-947.

Acknowledgements:

GLA:D Australia providing information for this blog

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