What is it? And what it isn’t?
Osteoarthritis (OA) is the most common form of arthritis in Australia, and the fastest-growing cause of disability in the world, impacting people’s ability to perform their daily activities. Osteoarthritis is characterised by pain and swelling around the knee joint.
Why do I have osteoarthritis?
While there are many modifiable factors that might help with managing knee osteoarthritis a little better, the most likely cause or contributor of osteoarthritis is genetics. To keep it simple, here are some other factors that contribute to the development of osteoarthritis.
Modifiable factors: weight, diet, physical activity levels, smoking
Non-modifiable factors: genetics, age, gender, structural changes, previous history of knee trauma
But my x-ray says I have bone on bone!
The good news is that we know there is not a clear association between pain and damage, which means you might have the ugliest knee in the world on x-ray but not have any pain. So without pain, should you stop doing the things you love? Hell no! And vice versa, some patients may have a very mild presentation of osteoarthritis on an x-ray, but have significant pain. This begs the question, well why does it hurt? In all honesty, we aren’t entirely sure. What are sure about, it what we do about it. And we are wildly optimistic that we can help you!
Okay…. So what can be done about it?
Well first, I should probably say what not to do. Rest. Rest is only going to lower your tissues capacity. We want to keep you strong and moving so your tissues and joints are better at tolerating load. Exercise is really really really helpful in managing OA, and it absolutely does not cause damage. But that doesn’t mean “no pain no gain”! We like to call it “goldilocks”, finding the ideal balance of loading and managing pain. The gold standard treatment for osteoarthritis management is to get it moving and maintain physical activity levels. They type of exercise does not have to be too specific. We are big fans of strength training, because we know it works and we can show you how. But if you like playing tennis or golf, happy days keep going!
Low-grade whole-body inflammation associated with higher BMI happens due to increased inflammatory cells coming from fat tissue. High BMI is a modifiable factor in OA development and symptom severity. A reduction of just 5-10% of fat mass in those with high BMI can relieve symptoms, improve function, improve quality of life and reduce the role of fat tissue-related inflammation. This is where help from a dietitian can be really important.
Do I need surgery?
I think everyone would know or know of someone who has had or is having some type of joint replacement surgery. So of course that is the first thing we are going to ponder when someone tells us we have osteoarthritis, we’re only human right!
Surgery is always an option, but it definitely shouldn’t be the first option. We have great evidence to show the benefits of exercise in significantly reducing pain symptoms from
osteoarthritis. We always encourage at least 3 months worth before considering seeking the advice from a specialist, because to be honest, they’re probably going to tell you to come and spend a few months with me first.
However, if conservative rehab fails, speaking with an orthopaedic surgeon is always an option. The even better news is that joint replacement surgery is one of the most successful surgeries we currently have. But don’t count on it just yet!
Should I be wearing a knee brace? Or getting a massage? Or trying dry needling?
The answer to all of these questions quite simply is, no probably not. However, they may be easy options in the short term for symptom modification. And I mean short term, 1-2 weeks tops! During this time we will work on finding some longer term solutions to help your problem, a brace, massage or dry needling is just putting a bandaid on it, and it’s going to get you nowhere!