When we hear the term osteoarthritis (OA), it may sound scary. You may have heard layman’s terms used to describe OA like bone-on-bone, bone spurs, degeneration, or wear and tear. OA is one of the most common chronic conditions of the joints - particularly the knee, hip, lower back, and small joints of the fingers and toes. Despite the diagnosis of arthritis, the majority of clients can live happy, healthy lives as life does not stop after the diagnosis! We’ll run down why exercise is such an important component and some other treatment options for osteoarthritis in this post.

Causes of Osteoarthritis

In normal joints, hyaline cartilage covers the end of each bone. Hyaline cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In clients with OA, the cartilage has broken down, causing pain, swelling and the development of spurs. Thus, an inflammatory process occurs where further damage to the cartilage takes place.  

Common Misconceptions

There are often misconceptions about OA that result in activity modification, fear, and depression. It’s only natural that you might assume that your arthritic knee pain will worsen with exercise. Too many health care professionals counsel their patients to stop running, speed walking, elliptical, treadmill, etc. to “save” their joints. Most of the time, you need to do just the opposite!

Some people are not educated thoroughly enough to understand that you can live an active life with OA. In facts, researchers have shown that OA is less common in runners! As Health Professionals, we need to realize that words can do more harm than good. When we throw out terms such as “degeneration”, “wear and tear”, and “aging” - it can leave people with the wrong impression.  It may sound counterintuitive to exercise while knowing you have OA, however, exercise is one of the best treatment options. It is an essential component of rehabilitation (if your goal is to avoid surgery)!  

When people let this fear of exercise in, this may cause a reduction in healthy activities, and client’s often don’t realize the secondary effects this may lead to. In an effort to minimize the harm to the “bone on bone” knee action, a reduction in activity can increase the risk of:

• developing heart disease

• stroke 

• dementia 

• and further health-related issues from stopping one’s previous exercise habits.  

Why is Osteoarthritis Painful?

OA is usually not a mechanical wear and tear process. It is important to grasp that exercise will not wear out your joints faster. In fact, it will do quite the opposite! In the case of your knees, OA exercises have been shown to relieve the pain of mild knee arthritis and additionally, does not harm the cartilage of the knee joint.

This then leads us to the question: Where does the pain come from?  

Believe it or not, the bone-on-bone image we see on x-ray is not the pain generator. There are no nerve endings on the bone itself. Thus, in theory if two bones are rubbing together, you will not feel pain from that. The cartilage in the knee also does not have nerve endings and thus, the thinning cartilage we are informed of will not hurt in and of itself. 

So, what brings on the pain? There are three main contributing factors to knee arthritis:  

1.        The periosteum- this is the thin tissue that wraps around the bone and supplies blood to the bone. The periosteum indeed has nerve endings! The pain experienced is due to the tearing of the periosteum.  

2.        The synovium- this is the lining that surrounds the knee joint. Lots of nerve endings are located here and when synovitis (inflammation of the lining tissue or synovium) occurs- it is this that causes pain. 

3.        Bone Marrow Edema/Inflammation - when this occurs in bones it makes the bones weaker. Thus, when the cartilage thins, the cushioning thins and puts an increased amount of stress in the bone- which can lead to edema. Typically, this may occur more often in woman due to osteoporosis.  

It is important to note that not everyone with OA may experience periosteum pain, synovitis, or bone marrow edema. Typically pain due to these three contributors will settle in a few weeks or months and your knee status will return to baseline. However, some may experience severe pain which leads to unresponsive non-surgical measures despite one’s best effort. For these individuals, a knee replacement may be the right alternative.  

Important Points

Strength-Based Exercise

You’re not wearing your knee joint out by exercises. The stronger your legs are, the more flexible you are, the more active you are, the longer you will go before needing to consider surgery. As long as the pain is 3-4/10, then keep going! Pain does not necessarily imply that you are doing harm. Exercise has significant anti-inflammatory effects. This sounds counter-intuitive, and many may not be convinced of this, and that is because many people think OA is a wear and tear etiology. The benefit of exercise is enormous!  

Imaging

X-ray's are not the whole picture! It is important to treat the patient and not the x-ray as patient symptoms may not correlate with imaging. It is vital to not modify activities solely based on what the x-ray looks like.  

Cardiovascular Exercise

Aerobic exercise improves your cardiovascular system and improves metabolic health, decreases the risk of stroke, heart attacks, dementia, and other chronic diseases. Walking, cycling, jogging often makes your knee feel better as it stimulates the production of your natural anti-inflammatory markers.  

Pain Killers

NSAIDS vs. Injections- Topical NSAIDS are strongly recommended for knee OA. Hyaluronic acid injections are inconsistent for knee OA. Cortisone injections have a truly little role in the management of knee pain from OA. Cortisone has a harmful effect on cartilage and should not be used routinely and should be considered on few occasions. This is because it has a temporary effect to reduce pain- whether it is for days or months. 

Thus, with a little bit of knowledge, a better contextual understanding of misconceptions, and a stable lifestyle routine can help many of people avoid over-treatment or lack of!  

If you’re experiencing pain related to knee, shoulder, wrist or back osteoarthritis then you need to check out our In-Home Physiotherapy services!

We can see clients in Vancouver, Burnaby, Richmond, Surrey or Langley!

Our client’s love our In-Home Physiotherapy, Acupuncture and Massage sessions because it allows them time to recover at home and the convenience of having exceptional rehab delivered to your door. Our clients don’t have to worry about arranging transportation, traffic or parking!