It is estimated that at least 5 million people in the UK have osteoarthritis, making it the most common cause of disability in the country. This disease causes joint pain and stiffness due to the degradation of cartilage leading to bone on bone contact, which can severely reduce quality of life. It is the most common form of arthritis and is usually seen in the hands, knees, hips, feet and spine. There is still no known cause for osteoarthritis (but there are some things which can increase your chances of seeing the condition) and it cannot be cured (but can be managed). However, it is known to be more prevalent in women and can occur at any age, although it is more likely to develop in later years. One known additional contributing factor is joint injury, which can be a trigger even many years after the initial accident. Despite there being no cure, this form of arthritis may become stable after a few years and there are now various effective ways of relieving symptoms.
Osteoarthritis occurs when the delicate balance between the breakdown and repair of joint tissues becomes disrupted (Eyre, 2004: Clin Orthop Relat Res. Oct; (427 Suppl):S118-22). It can result in the loss or erosion of articular cartilage, damage to the subchondral bone, meniscal degeneration, synovial inflammatory response and overgrowth of bone and cartilage. Cartilage initially becomes pitted and brittleness increases, with the underlying bone then thickening to reduce the load on the cartilage. As the disease progresses, bony outgrowths form along the outer edges of the affected joint. Visually, the joint begins to look knobbly. Synovial membranes and joint capsules thicken, which cause the space inside the joint to narrow. All the above changes eventually lead to joint stiffness and pain during movement, although many affected individuals can be asymptomatic.
There are several things that you can do to help reduce the pain and symptoms associated with osteoarthritis. Your GP may prescribe pain-killing drugs or anti-inflammatories, and severe cases may be treated with joint replacement, if the location is suitable. In the meantime, there are self-help methods for relieving pain and stiffness. Losing weight is important, as this reduces stress on your weight-bearing joints. Massage of painful joints and muscles can give effective relief, as can acupuncture, aromatherapy and relaxation classes. A healthy diet containing crucial bone-building calcium should be undertaken and, as your body needs vitamin D to utilise calcium, you should try to spend at least 10 minutes of each day in the sun. Most importantly, regular exercises will help to strengthen your muscles as this again reduces the stress on your joints.
Charities are available to help
Several charities run self-management programmes to teach life skills that enable you to cope with the condition and achieve the best level of help from your healthcare team. Examples of charities in the UK include Arthritis Research UK, Arthritis Care, Arthritis Action and The National Osteoporosis Society.
Different types of exercises for osteoarthritis
There has been a common misconception that exercise, particularly of the lower joints in the body, may lead to joint damage. This has now been refuted for moderate exercise participants, unless they have a history of previous damage to a joint.
It may seem paradoxical to an osteoarthritis patient that they are encouraged to adopt and persist in the very thing that causes them pain, movement. However, moderate levels of exercise are beneficial and will help manage the pain, although analgesics may initially be needed to make exercise tolerable. Alternatively, elastic supports or braces specifically designed to fit the painful joint can be effective support when worn for several hours. Whether you have osteoarthritis or not, it is important to be active, to keep your joints moving and mobile. There are two main types of exercise that should be undertaken: strengthening exercises and aerobic exercises.
Strengthening exercises work to build up the strength and tone of muscles that control joint movement. Stronger muscles will help stabilise joints and therefore, by acting as shock absorbers, will help reduce the pain. This usually involves weight-bearing exercises, as performed during circuit training, which load the muscles to improve their ability to work. Flexibility and stretching exercises such as yoga or pilates are excellent for expanding or preserving the range of motion and elasticity of affected joints, thus relieving stiffness and pain. These two disciplines also help combat depression that may result from living in constant pain or in a drug-induced haze and therefore help to improve quality of life.
The spine is a most complex structure, with all its associated muscles, ligaments, tendons and nerves, and it is one of the areas of the body most prone to osteoarthritis. Core strength exercises should therefore be included in any exercise regime as these lead to a strong well-conditioned back that can withstand more stress and effectively keep the vertebrae in alignment, thus facilitating movements that extend or twist the spine. Remember, the body is a holistic unit and should be exercised with this in mind. For example, back pain may be relieved by working on the flexibility of the hamstrings, etc.
Aerobic exercise can be classed as any activity that increases your pulse rate for a sustained period of time. The benefits of this can include a better night’s sleep, increased general health and well-being and reduced pain, as exercise raises the level of endorphins in the body. These biochemicals are the body’s natural painkillers and their frequent release can help a patient to reduce their reliance on pain medication. Without stimulation, cartilage undergoes atrophy, but the reverse is also true. Therefore physical activity can play an important role in protection against osteoarthritis. Individuals with osteoarthritis are encouraged to undertake consistent low-impact aerobic exercises such as walking, cycling and using a step machine or elliptical trainer. Swimming is particularly encouraged, as buoyancy supports 90% of body weight in water and limits the compressive load on the knees and hips. Swimming is therefore beneficial for everyone but particularly so for people who are overweight. As well as swimming lengths of a pool, aqua aerobics and strengthening and stretching exercises may be performed in a pool, along with other specially developed aquatic exercises such as Ai Chi. Water therapy exercises are particularly useful for patients who are in so much pain that they cannot tolerate land based exercises on a mat or hard floor, or for the very elderly. In the same way as for swimming, seated cycling reduces weight load on the knees and can be a beneficial source of low-impact exercise.
As arthritis rates are two-fold higher in obese people compared with non-obese, the uptake of aerobic exercise along with a healthy diet can decrease the pain and symptoms associated with the disease, due to reducing the pressure on the joints.
Before starting on a new exercise regime, particularly if you have previously been relatively inactive, it is important to check with your GP that you have no contraindicative health problems. Your GP should be able to provide guidance on the best exercises for your condition, and may refer you to a physiotherapist. A good exercise program has been shown to slow down the progression of osteoarthritis and relieve its symptoms. It is important to get started but it is also important to stick at it. It may take six to eight weeks before you start to experience the first signs of improvement, so commitment is needed. If motivation is not your strong point, you may benefit from a personal trainer who can put together a program that includes strategies for pain relief, exercises to increase your joint range of motion, a programme of stretching and strength training as well as an aerobic routine.