For many, a diagnosis of osteoarthritis (OA) is difficult to accept. Our preconceived ideas of what this means to our mobility and quality of life can be distressing. The good news is there is a lot you can do to slow down the progression of the condition and to remain mobile and comfortable. Exercise for OA is the key. So here are 7 facts to help get you exercising when you have osteoarthritis.
1. The Evidence Supporting “Exercise for OA” is Indisputable.
Exercise for OA is recommended in clinical guidelines around the world as the best first line treatment. In fact, just this year the Australian GP guidelines (RACGP Guidelines for the management of hip and knee osteoarthritis) have been updated, recommending land based exercise and weight loss as the best initial management.
For people with OA, exercise has been shown to help cartilage health, improve collagen structure, reduce pain levels and improve quality of life. When you have a flare up, rest in the short term is appropriate. However in the longer term, the main recommendation is to stay active and exercise regularly.
Maintaining a healthy weight is important to reduce load on your joints. The good news is that evidence shows that for every 1kg of body weight lost, there is an 8kg reduction in load on your knees. So a small reduction in body weight often makes a big impact quite quickly.
2. Pain Doesn’t Equal More Damage
Have you had a MRI or X-ray showing OA in your joints? Are you concerned that pain when moving or exercising is doing more damage? A large body of research has been conducted to determine if findings of OA on scans relate to clinical symptoms such as pain and stiffness. So what did they find? Evidence of OA on scans does not correlate to pain and joint dysfunction. So, two people with similar looking OA changes on scans, can have have very different pain experiences.
Pain itself is complex, influenced by many things such as sleep, stress, and anxiety. We experience pain only when our brain determines that our body or part of our body is under threat and needs protecting. Like many processes in the body this response can become over-active, leading to reduced activity and fear of movement.
Starting a new activity may be a little daunting when you are in pain, however the evidence tells us that exercise for OA is the best treatment to maintain your activity levels and reduce pain in the longer term.
3. Some Pain is Okay During Exercise
As mentioned above, we know that pain doesn’t equal damage, but we know it can be difficult to know what your limits are when starting a new activity or exercise regime. Keep in mind these two rules of thumb.
- Set an acceptable level of pain to work up to. This is usually a 5/10 (0/10 being no pain and 10/10 being the worst pain). Keep exercising unless your pain exceeds 5/10, then modify the exercises by reducing the repetitions or sets and re-asses your pain levels. Seek a review from your physiotherapist to check your exercise technique if the pain doesn’t settle.
- Secondly any increase in pain should settle to pre-exercise levels within 24 hours after exercising.
4. Land and Water Exercise for OA
Current evidence supports several different forms of exercise for OA. Aerobic exercise such as walking or swimming, strength training, Thai Chi and finally neuromuscular exercise, such as the GLA:D program* are all effective forms of exercise for OA. If you cannot exercise comfortably on land, we also recommend Hydrotherapy or aqua exercise.
5. The Amount of Exercise Matters
Much like taking medication, getting enough each week is important. Your Physiotherapist will tailor your exercise needs to suit your situation. The recommendations in current guidelines are; supervised exercise sessions of 30-60 minutes per session, twice a week for 6 weeks minimum. If you do your exercises three or four times a week for 12 weeks, results are even better. So make sure you seek out your local physiotherapist to get the best exercise set-up and amount each week to manage your OA.
6. Manage Flare-ups with Combined Treatments
You may need to combine exercise with another treatment to manage a flare-up. Medications such as anti-inflammatories or pain killers, can help in the short term.
Braces and walking aids can provide a sense of stability and help when you are having a flare-up. They can reduce limping and other compensations. Be sure to continue with your exercises as much as possible and gradually wean off the brace or walking aid as symptoms settle.
Hands on treatment such as remedial massage, manual therapy, acupuncture etc can help in the short term to keep you active and exercising.
You may be referred to see a specialist for an opinion and further treatment options, if symptoms don’t settle. Surgery for OA is now considered the last line of treatment.
7. Leave Surgery for As Long As Possible
Current evidence does not recommend key hole (arthroscopic) surgery for OA. Arthroscopic surgery does not result in reduced pain and improved function for OA and can aggravate the joint. OA may progress rapidly after arthroscopy resulting in the need for total joint replacement surgery sooner. However arthroscopic surgery is indicated if the joint locks up and does not improve with exercises. Joint replacement is considered if symptoms are no longer tolerable, limit daily function and an appropriate exercise program has failed to improve symptoms. Exercise prior to surgery is recommended to build up supporting muscle strength and aid post-operative recovery.
In summary, evidence supports exercise for OA as the initial starting point for treatment, all the way through to maintenance after joint replacement surgery.
*GLA:D program: stands for Good Life with osteoarthritis in Denmark. GLA:D is a six week supervised exercise and education program specifically for hip and knee OA run by Physiotherapists. The program has been run in hospitals and private practice clinics since 2015. We introduced the GLA:D program to the Adelaide Crows Sports Medicine Clinic in September 2018. So far our participants have said:
“ I was very happy with the program, I felt I had made an improvement. I would like to continue a session once a week”
“Especially useful was the attention to correct alignment when doing the exercises and modifications as needed for individual situations”.
“I was very worried doing exercises I have previously avoided because of pain, but I feel the program has helped enormously. My knee is feeling stronger”
“I would definitely recommend GLA:D program. With (the) improvement I have had I would encourage anyone with this program.”
If you are interested in finding out more about GLA:D, please contact the clinic on 8347 2043.
Written by Physiotherapist Crystal Waters, December 2018