Welcome to our newest blog article on osteoarthritis (OA). The purpose of this blog is to educate you about what OA is/is not, what to expect when your GP or health professional says you have OA and to show you there are things that can be done to improve your symptoms if they are indeed due to OA changes.
OA is a broad term used to describe changes within the synovial joints of our body. The majority of joints in our body are what we call synovial, meaning they are a joint comprised of bones with articular cartilage covering their adjoining surfaces and a joint capsule that encloses the entire joint and holds synovial fluid (think of this fluid as a very special ‘grease’ for your knee) and then surrounding ligaments, tendons and muscle. Each of these components have specific jobs within the joint; the bones provide support, the articular cartilage is very slippery, reduces friction and helps to disperse load evenly within the joint to the underlying bone, the synovial fluid also helps to reduce friction and deliver nutrients and the ligaments, tendons and muscles deliver support and control movement.
The changes seen in joints that cause us to label them [not always helpfully] as osteoarthritic include a decrease in joint space (the space between the bones meeting within the joint) and a thinning or change in the structure of the articular cartilage that covers the end of each bone.
When it comes to talking about OA, the health professions have often used terms such as ‘bone-on-bone’ and ‘wear and tear’ to describe the changes within the joint and while they seem at face value to describe what’s going on, they don’t tell the whole story. I much prefer to refer to them as wrinkles on the inside (thanks very much to a Canadian physio named Greg Lehman for this term). The reason I prefer this description is that it is more accurate in describing the possibilities of living with OA.
In terms of wrinkles, we know they’re a sign of aging. The cellular make-up of our skin changes over time due to age, lifestyle and genetics…but most importantly, we neither fear them, nor seek to change them from a pain perspective. There are some things that we can do to improve the condition of our skin, but they’re generally secondary things like changing habits and addressing our health. And believe me when I say OA is much the same. The degree to which our joints change as we age is related to many, many factors. Age, movement, exercise, strength and health….sounds like wrinkles right?!
There is also a large mismatch between what we see on scans and what we can expect to experience in terms of pain. It’s a very interesting topic, but one much too important to try and cover in a few sentences here, so for the moment I’ll just say that changes seen within a joint do not necessarily equal pain. Many people who have spent decades upon decades on this planet do not experience ongoing pain in the majority of their joints, yet how many of those joints would show osteoarthritic changes if we were to scan them? My bet (and the research agrees) is quite a few!
Please also recognise that I’m in no way saying that OA absolutely cannot be a cause for pain or discomfort, I’m simply saying that pain doesn’t necessarily have to be experienced just because there are OA changes within a joint.
Just because your joints show osteoarthritic changes does not mean you have to be in pain.
Now for the good news: Remember those habits and health factors we mentioned earlier in regard to ‘joint wrinkles’ (OA)? We have the power to change them and therefore improve our ability to go about our daily lives!
Research has shown that not only can we slow down the continued changes within a joint, but we also have the ability to improve on their current condition. Our bodies are brilliant at adapting to environmental and tasks specific demands, so if we ask our joints to be better at moving, being strong and dispersing loads, our body will slowly remodel the specific tissues responsible for those tasks and our ability to perform them improves. The best way for us to do this with OA is to improve your strength.
Yep, research has shown [relative] heavy loading is the best way for us to stimulate improvements in the quality of the cartilage within your joints.
Here at KineticsCorrect, we completely recognise that it’s not always that easy. Sometimes even just the smallest changes in activity or movement can cause your joints to flare-up and hurt for days. But that’s why we work with people on an individual level. Intensity and loading are relative things, so we work with people at their current level of function and advance them slowly as we see improvements. Evidence also shows that combining land-based strength training with cardiovascular and balance training activities provides further benefit so we also address these were appropriate in our programming.
Quality of life and confidence is at the forefront of all that we do. For that reason, we also educate while we train together. Discussions surrounding your everyday movements and hobbies will help you to identify activities that are more and less aggravating. From there you can develop plans to minimise discomfort and challenge yourself bit-by-bit, all while keeping as active as possible and promoting the positive changes mentioned above.
Matt Bushell, Physiotherapist/Exercise Scientist
- Bannuru et. al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage 27, pg 1578-1589.
- Ecstein et. al. (2006). The effects of exercise on human articular cartilage. Journal of Anatomy 208, pg 491-512.