Clearing the confusion around arthritis
As a physiotherapist, I am always explaining the differences between osteo and rheumatoid arthritis. There is a common misconception that they are the same disease, however, they are very different.
When reading through X-Ray or MRI reports together with my patients, this discussion about the differing arthritis conditions typically arises. These scan reports speak of 'degenerative changes', 'bony spurring', 'osteophytes', and 'osteoarthrosis.' These words all sound a little scary, don't they? However, it is often said that if each person over 40 were scanned from head to toe, there would be these changes in every one of these people in at least one of their joints. It really is a natural part of aging and shouldn't be viewed as a catastrophe!
Practitioners, doctors and those with these X-ray changes should really look to the associated symptoms felt at these affected joints (if there are even any?) before rushing to blaming these findings as the cause of pain and dysfunction. Often investigations such as scans like these can show the presence of 'degenerative changes' but without any associated pain or other symptom. Scans really should be read and used with caution for this very reason.
Let's look in more depth at the main characteristics of osteoarthritis (OA) this month. In our next newsletter, we will explore rheumatoid arthritis (RA).
The 5 features of osteoarthritis.
- OA is the most prevalent type of arthritis with a report from the Australian government from December 2015 reporting that self-reported OA is as high as 1 in 13 Australians. Of these, every 2 in 3 are female. It is not at all common in children and comes with ages over 40.
- OA is also known as the 'wear and tear' arthritis or degenerative joint disease. It is mostly found in the fingers, thumb, big toe, lumbar spine, hips and knees. It is most painful and symptomatic in the hips and knees. When someone is off to have their knee and/or hip joint replaced, they are typically receiving new stainless steel or titanium joints to replace their old worn out ones from the degenerative process of OA. The before mentioned Australian government report states that there was a 32% rise in total knee replacements from 2004 to 2014.
- OA is caused by the slow breakdown or erosion of the cartilage which lines our joints. This cartilage acts as a cushioning between the 2 bones making up a joint. The cartilage allows for the smooth sliding of one joint surface over the other as we move and can absorb impact and pressures like a shock absorber. If a joint is used too much or has excessive loading such as with some repetitive movements of sport or from carrying too much weight, the watery composure of the cartilage breaks down almost to the point of bone rubbing on bone. This stimulates the body to respond, changing the affected joint's muscle and bone. This is where thickening of the soft tissue or the growth of bone spurs will occur.
- Bone spurs- also called osteophytes- are the body's clever response to the bone on bone abnormality of an affected arthritic joint. The exposed bone within the joint can become inflamed and this stimulates further bone to grow around the edges of the joint. It can be thought of as the body trying to increase the surface area of the joint to spread the pressures and stresses across a greater area. Unfortunately, some osteophytes can cause problems, but this is not a blanket norm. In some joints such as the small facet joints on the spine, bony spurring can restrict the space of a nerve canal, causing possible irritation of the nerve. Another problematic spurring of bone can be at the big toe. Generally bone spurs themselves are not problematic, but they are a signal of an underlying problem that often needs to be addressed. They can be documented to help assess the severity of a condition such as arthritis.
- OA is characterised by stiffness and limited movement in the affected joint. Initially, pain is felt after activity and settles with rest. There may be some stiffness in the morning, but this is mild and lasts less than 30 minutes. As the OA worsens, the joint may become enlarged and tender due to bony spurring. Tis can affect pain free movement and alter the mechanics of good movement across the region, making everyday activities such as walking difficult.
How can exercise like Pilates assist with pain associated with osteoarthritis?
As OA is a 'wear and tear' disease that is associated with aging, often is cannot be helped. However, its progression or severity can be altered with a few practices.
Exercise is a well documented management for those suffering from OA. This is a broad statement and to dissect it a little is time well spent. Here are some points to consider:
- OA needs the right balance between exercise and rest. Too much of the wrong exercise can load up the affected joints more and cause increases in pain and stiffness. Too much rest and no exercise makes the joints also stiffen and the muscles around to weaken.
- All joints in the human body require synovial fluid and lubrication to stay mobile. This fluid will be secreted by the cells in your joint with the response to movement. So, move it, or lose it ( as they say)!
- Too much heavy weight bearing exercise such as jogging, jumping, lifting can over load already painful eroded joints. Preventing repetitive joint loading tasks where possible, including kneeling, squatting or heavy lifting
- Muscular support and strength about the OA joints will make will offer support and shock absorption that would otherwise be transmitted into the painful joint. Good muscle condition is paramount.
- Exercise will assist in keeping weight controlled and down. There is nothing less a knee, hip or spine likes than carrying about too much weight. Ow!
So, for those of you with OA or any painful joint, you need to move, strengthen your muscles but without repetitive excessive loading on your sore joints.
There is still so much choice for you to keep up the exercise. Why not try:
- Pilates? Controlled, weighted exercise without the repetitive pounding on your joints. And on top of that, improving posture and mindfulness to keep your painful joints well aligned. Well aligned joints will be happy loaded joints.
- Swimming or aqua-aerobics? Resisted exercise in the pool without the effects of gravity stressing your joints. You'd be surprised with the workout you get with some of the props and equipment that gets used in the pool for these classes.
- Weights and cardio equipment? A targeted weights program can really build your muscle strength. Speak with a physio about guiding you through the best exercises for your OA. Your physio can work with a trainer to help your program become established without the flare-up of your pain.
Feel free to chat with our physio team if you need guidance and treatment for your painful joints.