Since the start of the Covid-19 pandemic, we have seen some unprecedented changes in our day to day life. With government restrictions on daily activities and social distancing measures being put in place, for the majority of people this has meant more time indoors at home and less time being out and about. This has had a huge impact on a full spectrum of our normal weekly activities, from daily tasks such as walking around a supermarket, through to going for a weekly swim, gym workout, or even playing a round or two of golf. These changes have impacted a lot of people in many different ways. For people living with osteoarthritis, this may have resulted in exacerbation of their symptoms, so it is important to consider the reasons for this impact and the ways to best manage this moving forward.
What is osteoarthritis of the knee?
This is something we have discussed in previous blogs, but I thought it would be useful to do a quick recap. Osteoarthritis (OA) is a form of joint inflammation that features the progressive breakdown and loss of the cartilage within one or more joints. This cartilage is a firm, rubbery, protein based material which cushions the ends of the thigh and shin bones, and reduces friction in the knee when we move and load them during activities such as walking or running.
Although not everyone with OA develops symptoms, they can develop slowly over time and you may begin to notice one or more of the following:
- Pain or soreness deep inside your knee when you move;
- Pain following periods of prolonged inactivity such as sitting;
- The affected joints may also be stiff or creaky;
- Stiffness first thing in the morning that resolves within 30 minutes of moving around
There are many factors which can contribute to the development of OA, including a history of OA within your family, a joint abnormality, an injury from a traumatic accident, or pre-existing diseases. Gender also plays a role with more women than men over the age of 50 developing the condition.
However, Osteoarthritis is most commonly a result of natural wear and tear from the ageing of the joint. In most cases this type of OA, known as primary osteoarthritis, develops in the weight-bearing joints of the knees, hips, or spine. Every joint comes with a natural shock absorbing cartilage, but over time, the water content of this cartilage increases and its protein levels degenerate. At the same time our joints are naturally becoming stiffer as we age, and this weakened cartilage can become more vulnerable to damage. Repetitive use of the joints over the years can irritate the cartilage, and if it deteriorates enough, the cartilage layer become thinner, causing pain and reducing range of motion in the knee joint.
There is no blood test for the diagnosis of osteoarthritis, this is based primarily on your symptoms alongside tests such as X-rays to examine the integrity of the joint.
What impact has social distancing and lockdown had on OA?
The change in activity levels over recent months may have caused a flare up in your OA symptoms and you may have noticed:
- Increased pain or soreness when you move or load your knee such as during walking, on stairs or slopes;
- Increased pain or stiffness following periods of prolonged inactivity such as sitting down;
- You may find it takes longer in the morning for the stiffness in your knees to subside after you get up from bed;
- You may notice your affected knee becomes warm red or swollen
It is important to seek appropriate treatment to address these symptoms and look at the best ways to reduce the risk of your OA from becoming irritated.
Weight gain and OA
Many people will have recently experienced a reduced opportunity to achieve natural exercise such as going out for regular walks, and this may have resulted in a more sedentary lifestyle leading to extra weight gain. This extra weight will cause added load to weightbearing joints such as the knees during day to day activities. Even modest weight loss has been shown to reduce symptoms of osteoarthritis by easing the strain on weight-bearing joints. So losing excess weight may not only reduce pain, but may also reduce long-term joint damage.
How to help your OA knee?
The goal of treatment for osteoarthritis is to reduce joint pain and inflammation while improving and maintaining the function of the joint. Exercise is known to be beneficial for OA by aiming to increase joint flexibility, dexterity and strength. This has been shown to make long-term changes in pain and improve general activity levels, which in turn maintains joints for longer. It is important to find some activities you enjoy doing and can access regularly that do not irritate your symptoms. This could include anything from walking, to swimming or aqua aerobics, through to yoga, Pilates and other sporting activities. Some people with osteoarthritis avoid exercise out of concern that it will cause pain, so your physiotherapist will be able to help identify the best types of exercises and volumes specific to your lifestyle, likes/dislikes and functional needs. Hot and cold treatment as well as joint mobilisations and stretching have been shown to also add benefit, when used in combination with exercise-based physiotherapy.
Training with light weights can also help by strengthening the muscles that surround your knee and can help reduce pain. Progression on to gradually heavier resistance training with weights has been shown to improve bone density, even within OA degenerated joints.
So what is resistance training?
People often think of resistance training as just lifting big weights at the gym. However, resistance training can easily be done anywhere, it is simply about finding different ways to challenge your musculoskeletal system under load. This can be anything from your own bodyweight, through to resistance bands, small handheld weights, or even objects around the house such as a heavy water bottle or shopping bag.
Evidence suggests resistance training for older adults can cause positive changes by:
- Increasing muscle size;
- Increasing bone mineral density;
- Reducing symptoms of osteoarthritis such as pain and stiffness;
- Reducing the risk of osteoporosis;
- Promoting independence in daily task;
- Reducing the risk of falls by improving balance
What if your joints are very irritated?
If joints are severely irritated at the moment, then they need to rest. It is beneficial to keep joints active, but it is important to only do as much exercise as comfortable. When osteoarthritis flares up, many people may find relief with over-the-counter pain relief and anti-inflammatory medication, such as aspirin, ibuprofen, or acetaminophen. Please speak to your doctor who will be able to advise you on the most appropriate medication to take. Pain-relieving creams or sprays can also help when applied directly to the sore area. If pain persists despite the use of pills or creams, your doctor may suggest an injection of steroids or hyaluronans directly into the joint. Treatments will be based around your symptoms and level of function rather than your X-ray findings. It is important to remember that only 25% of OA patients require surgery and this should only be considered an option when other attempts at symptom management have been exhausted.
Take Home Message
- Reduced activity levels during recent months may have caused a change in your OA symptoms.
- If your joint is acutely irritated, it is important to first seek appropriate medical advice to settle these symptoms prior to starting increased activity.
- Exercising the knee joint can help reduce your joint stiffness and pain and make the muscles around the joint stronger.
- This exercise can come in many forms such as walking, body weight exercises, swimming, yoga or Pilates, many of which can be easily done at home.
- Resistance training has been shown to create positive long-term changes in the management of OA.
- Maintaining a healthy weight is important to prevent an overload to the knee joint when you are standing and walking.
- Find activities or exercises which you enjoy, can easy do and fits into your current lifestyle, so you are more likely to stick with it.
If you are concerned about symptoms which match the description of osteoarthritis or have an existing diagnosis and want to know the best approach to treating your pain and function, then come and see us at the Shawe Physio clinic. Our expert Physiotherapists can help address your symptoms, and create a manageable plan for you moving forward to help you control your osteoarthritis and get the most out of life!