Osteoarthritis is one of the leading causes of disability worldwide, being associated with significant joint pain and activity limitation. In practice, many patients are referred to an orthopaedic surgeon when they complain of pain and an inability to perform their normal work or sporting tasks. Often, they are told that they are “too good” for a joint replacement and to return when their symptoms have become worse. This can lead to the perception that nothing further can be done - and that the patient must give up the painful activities. This often leads them to become progressively more sedentary and, in many cases, gaining body weight; both leading to increased overall health risks.
I am often asked if someone should stop running due to some x-ray changes suggestive of arthritis to ‘preserve their knees’. If symptoms are manageable, I encourage them to keep some form of running in their life, as it has so many health benefits. In relation to recreational running and osteoarthritis risk, the risk of osteoarthritis and arthritis progression is higher being sedentary and a ‘non-runner’. This is largely due to the association of higher body weight plus the lack of impact forces, which can be cartilage protective. In a study looking at 125,000 people, only 3.5% of recreational runners had hip or knee arthritis; compared with those who were sedentary and did not run having a higher rate (10.2%) of hip or knee arthritis.
In reality, there are a large number of simple interventions that can have a huge impact on a patient’s pain. Education is an essential part of an effective treatment plan. It is important to explain to patients that their symptoms may well improve with treatment – despite them having an abnormal x-ray with some degree of arthritis. This is often very helpful as many patients assume that they will not get better and resign themselves to ongoing disability and inactivity. Encouraging activity, even when it is a little painful, is almost always a good idea. Targeted rehabilitation programmes, which incorporate muscle strengthening and non or partial weight-bearing exercise, can be very effective treatments.
Weight loss is also a key strategy. Losing between 5-10% of body weight, generally though a combination of optimal nutrition and exercise, has been shown to reduce pain by approximately 50%. This compares with an average improvement of 25% with regular anti-inflammatory medication usage. Orthotics and braces can also help improve pain and allow patients to remain active.
Medications and injections can also be useful. Recent research has shown that paracetamol, despite being widely prescribed, is generally not effective (with a less than 5% chance of helping a patient’s symptoms) while NSAID’s (anti-inflammatory medication) are very likely to help to some degree (>90% likely). This must be balanced with the side effect profile associated with these drugs. Other medication, like neuro-modulating agents (for example amitriptyline) may also have a role and should be considered when a patient’s symptoms prove refractory to treatment – or when longer-term treatment is needed. A variety of injection therapies can be used. Corticosteroid injections are very effective pain relievers in the short term, but on average only give 3 months of relief. In contrast, visco-supplementation injections (synthetic hyaluronic acid) and platelet-rich plasma (PRP) injections may provide longer-term symptom relief and may be more appropriate in younger patients with less significant joint disease. These injections have been shown to improve pain to a similar extent to regular NSAID for more than one year. Despite their cost, approximately $500, a single injection is often a more appealing option than regular NSAID use.
As there are a large number of treatment options available it is important that a treatment plan is targeted to each individual patient and direct the overall management plan. An interdisciplinary approach is useful - physiotherapists, podiatrists, strength and conditioning, dietitian – and Axis Sports Physicians (Dr Sarah Beable) in Queenstown are able to coordinate this for you.
So, don’t hang up the running shoes or give up on your goals just yet. You may have heard the phrase ‘exercise is medicine’ (more in next week’s blog) and as with osteoarthritis this is true – with education, exercise and an individualised plan often making a considerable difference to your daily symptoms and function.
Dr Sarah Beable
To make an appointment with Sarah
Axis Sports Medicine - Queenstown is run by Dr Sarah Beable, a locally based Sport and Exercise Medicine Physician, she is one of the New Zealand Olympic team doctors and also works with the New Zealand Snow Sports team. Sarah is a keen athlete herself and she has excellent knowledge of the demands of certain outdoor pursuits and physical occupations specialising in the diagnosis, and management tailored to your goal.
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