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Osteoarthritis – What’s new?

by Carmen Andrews - Physiotherapist

Osteoarthritis – What’s new?

I recently read an article that stated, in its first paragraph, that joints can wear out. The article was published in a running magazine and gave the impression that runners will inevitably wear out their knees / hips / back. Which, as a stand-alone statement, is simply not true.

Because it takes 17 years for research to reach mainstream, let’s look at what’s at the forefront of osteoarthritis (OA) research in 2019.

Who is more likely to develop arthritis:

The strongest risk factors for developing OA are age, obesity/being overweight, and previous injury. There is also a link between family history and predisposition to developing OA.

Man in exercise clothes sitting and holding his knee

Age

The majority of people over the age of 65 are diagnosed with radiographic changes in one or more joints.

Interesting fact: changes on scans are not well correlated to pain and disability! A person can have perfect x-rays and a very painful joint, or have an x-ray showing significant degeneration and have no pain! (3)

But while a time machine is being invented…we can address the modifiable factors.

Obesity:

Being overweight or obese is strongly associated with developing OA. But not specifically because of increased weight through the joints. OA is not just thought of as simple ‘wear and tear’ anymore.

Being overweight is thought to contribute to low-grade, chronic inflammation. There is an interesting article which gives a broader understanding of low-grade systemic inflammation: see ref (4).

Being “skinny fat” is also a risk. Which means, even if you don’t carry much excess weight but you have insulin resistance, high blood pressure, and high cholesterol (3 of 5 conditions that make up the ‘metabolic syndrome’ cluster) you’re more likely to have OA pain. (8)

This is where the idea that “you can’t outrun a bad diet” comes from.

Genetics:

An inherited predisposition to OA has been known for many years from family-based studies.

Recently genetic testing has been gaining popularity. Done by health care practitioners (such as functional medicine practitioners, registered dieticians and homeopaths), the results from your genetic tests can give you information that allows you to control your exposure to your specific modifiable factors.

Sports injuries:

Knee injury is the major cause of OA in young adults, increasing the risk for OA more than four times.

Recent clinical reports showed that 41%–51% of participants with previous knee injuries have radiographic signs of knee OA in later years. Cartilage tissue tear, joint dislocation, and ligament strains or tears are the most common injuries seen clinically that may lead to OA.

Manage your risk:

Road bike and shadow

If you had an injury years ago (knee, hip, back…), this might be the nudge you need to make sure you prioritise the health of your joints.

Joints rely on muscles to control small back-and-forth movements within a joint as it bends, and to attenuate ground reaction forces (impact). Muscles also control movement to prevent strain on the joint capsule, the ligaments, and the cartilage covering the joint surfaces. This includes preventing strain on the menisci in the knee and the labrum in the hip.

The stronger and better coordinated your muscle system, the better supported and protected your joints are. Varied training (cross training) improves general coordination, strength and joint range. This results in better protection of joints.

Best practise to manage osteoarthritis:

Man doing strength training

If you’ve been given the diagnosis of ‘bone on bone’ arthritis, it is enough to scare the living daylights out of anyone! And you may feel that you should retreat to an armchair to stop wearing the joint out any further. But don’t!

Exercise:

Once you have symptomatic OA the undisputed fact is that exercise is the best management. (3) The body changes in response to load. In a heathy body increased load (exercise), in conjunction with appropriate recovery (rest), will result in positive change and gains in strength. (7)

If you have a sore joint, it can be very hard to get going. Generally, the advice is to exercise without pain. But here is an interesting finding: a research paper looked at the effect of exercising with pain.

“A recent systematic review and meta-analysis of painful exercises versus pain free exercises for chronic musculoskeletal pain that included seven randomised controlled trials found that protocols allowing painful exercises offered a small, but statistically significant, benefit over pain-free exercises in the short-term.” (1)

Ask your physio for advice and the best exercise plan for you.

Avoid NSAIDs:

Avoid relying on NSAIDs to give you pain relief. When misused, they are a leading cause of hospitalisation.

“Preventable adverse drug reactions (ADRs) are responsible for 10% of hospital admissions in older people at a cost of around £800 million annually. Non-steroidal anti-inflammatory drugs (NSAIDs) are responsible for 30% of hospital admissions for ADRs, mainly due to bleeding, heart attack, stroke, and renal damage.” (6)

Does running cause arthritis?

Runners at sunrise

Straight from the horse’s mouth, the Journal of Orthopaedic & Sports Physical Therapy:

“Recreational runners had less chance of developing knee and hip arthritis compared to nonrunners/sedentary individuals and competitive runners. The researchers concluded that running at a recreational level for many years—up to 15 years and possibly more—may be safely recommended as a general health exercise, and benefits hip and knee joint health. Their findings indicate that remaining sedentary and forgoing exercise increases your rate of knee and hip arthritis, compared with regular recreational running. However, high-volume and high-intensity training also may increase your risk for arthritis. Other researchers who found a link between high-volume and -intensity runners with knee and hip arthritis defined high-volume running as running more than 57 miles (92 km) per week. The benefits of running are numerous. This study allows you to be confident that recreational running will not harm, and may improve, your hip or knee joint health.” (2)

So, you can run with a happy heart! Bear in mind the following tips to address the risk factors mentioned above:

  • Cross train
  • Manage your weight
  • Look after your systemic health (cholesterol, blood pressure, sugar) – you can’t out run a bad diet!
  • Prevent injury by following a good training program
  • Take care of niggles that don’t ease within 2 weeks of rest,
  • Address your ‘weak’ joints where you had a previous injury!!
  • If you already have OA (especially young athletes) – research still needs to be done to understand the response of cartilage to running, but the current consensus is that the cartilage responds in the same way as healthy cartilage, but you need more recovery time. (9)

References

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About the author: Carmen A is mom to two small children, she has a love for the outdoor life and has competed at a high level in endurance adventure sports (particularly in running and mountain bike stage races). She is passionate about running and getting moms back to running after pregnancy. You can make a booking to see her to work out your injury prevention strategy.


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