Treatment for Osteoarthritis

Many pain management clinicians are starting to rethink the way they look at persistent joint pains such as osteoarthritis. Using the knee as an example, many people in a given age group without knee pain will have the same features of osteoarthritis on x-rays as patients who do have pain And so we have to ask ourselves, ‘is this a useful way to look at persistent joint pain?’  Given the often weak relationship between reported pain and arthritic changes visible on scans, the answer would have to be, ‘perhaps, sometimes, but only to a limited extent.’  Tissue quality is one variable that can influence pain perception but it is only one of many factors and, on its own, is certainly not a barrier to getting better and functioning well.

However, we regularly see patients who have been told by various healthcare professionals that they have ‘bone on bone’, that ‘their joints are wearing out’, that ‘loading joints, especially with impact exercise, is bad for you’ and that ‘it is inevitable that they will need surgery at some point’.  These patients often tell us that they have become fearful of moving or doing anything and that they are getting worse as s result.  This is really poor practice from these medical professionals who should know better.  The vast majority of patients with generalised joint symptoms will tell us that they feel stiff and uncomfortable when they first try to get going; inevitably this is worse first thing in the morning after having spent several hours lying down to sleep, and to a degree after have spent time sitting down for a while.  But after a short period of moving around again they seem to feel somewhat better albeit with the cycle repeating itself.  So really they are telling us that movement feels good.  Like anything that is stiff, lubricating it and moving it generally makes it more capable again. Patients then feel more confident and less fearful of movement the next time as they have lowered the anticipation that it is going to be a problem.

A better way to talk to these patients might be, ‘Everyone’s tissues, including joint cartilage will age over time.’  ‘But don't worry about those knee x-rays too much because most people of your age with no pain in their knees will have the same findings and so this is not always a barrier to getting yourself feeling better again.’ This is a natural process and quite normal, in the same way that the skin under your heel gets thicker, and your hair might grey, as you age.’  ‘It is a normal physiological process that tissues under load adapt to that stress by becoming thicker or stronger. Around the edges of joints, this can mean that the thicker bone can sometimes make your movements feel a little stiff - and potentially uncomfortable.’  ‘However, it is important that you keep moving and exercising as normal; exercise, even with a small amount of discomfort, is not harmful for your joints. In fact regular exercise may even serve to improve joint cartilage and movement ability and can certainly improve pain and stiffness.’

As osteoarthritis becomes more chronic, however, it can lead to enough physical limitation of movement that normal function can become too difficult for patients to overcome. Basic movements involved in normal walking and functional activity like sitting in and out of a chair and climbing stairs become too stiff to achieve normally. As patients get into a viscous cycle of reduced movement and subsequent stiffness and pain their ability to make significant progress becomes increasingly limited. At this stage surgery to replace joints becomes something quite life-changing and we work closely with many orthopaedic consultants to facilitate this process and provide really thorough care before and afterwards to ensure the best possible recovery.