Before we start these are the 5 things you need to know:
- Very common condition affecting most individuals at some time in their life.
- May be a normal part of ageing process.
- Just because you have OA doesn’t mean you have to have pain.
- Exercise and lifestyle is often key in its management.
- It’s about finding the right exercise and the right amount for YOU.
What is osteoarthritis ?
The first part of this blog may seem a bit confronting and doom and gloom. However its good to know what osteoarthritis is and that there are very successful and simple ways to manage it.
Osteoarthritis, (OA), is the most common musculoskeletal disorder affecting people today. It is often held as the prime villan in most painful joint related conditions in the over 50 age group if not younger.
But what is osteoarthritis ?
It has commonly been thought of as a disease process of the articular cartilage but it is more accurate to say that it is a condition that affects the entire anatomy of the joint.
It’s probably even more accurate to describe it as a NORMAL part of the ageing process that can in some cases affect the structure and function of the joint.
Presence of OA DOES NOT mean you have to bee in pain, that’s the great news.
Research has shown that OA changes occur in the following components of the joint. So let us start with a little bit of anatomy to set the scene.
Hyaline articular cartilage provides the articulating surface of synovial joints. Its complex composition evenly transfers forces from one bony subchondral plate to the other.
Hyaline cartilage is composed of the following :
- Extracellular matrix.
- Calcium salts
The chondrocytes help to balance the production of new collagen and proteglycans to replace those that are breaking down.
Bone consists of;
- The thick outer layer of subchondral bone,
- The underlying honeycomb like trabecular bone
- The bone marrow space.
Bone is an active tissue undergoes process of remodelling and modelling.
Remodelling is when the older bone is resorbed and replaced with newer bone.
Modelling is when new bone is made to change the structure and quantity of the bone.
The synovium is a a tissue lining the inner side of the capsule and joint and is responsible for producing synovial fluid. This acts as a lubricant to keep the joint moving nice and smoothly.
What happens to the joint cartilage and bone in osteoarthritis ?
OA results from a failure in balancing the breakdown of tissue with the laying down of new tissue resulting in inflammation and damage to the cartilage and underlying bone.
Osteoarthritis and cartilage
The following observations have been made in OA affected joints;
- increased water content.
- decreased proteoglycan content.
- weakening of the collagen network.
- Destruction of chondrocytes.
These changes result in degenerative changes in the cartilage that start off as a softening in the outer layers and lead to a cartilage thinning with cracks or fissures present.
Over time these changes become more pronounced leading to areas of no or very thin layers of cartilage leaving the underlying bone exposed.
Osteoarthritis and bone
OA alters the processes of remodelling and modelling in the bone which results in changes in its structure. These changes affect the joint function and include:
- Abnormal hardening of the bone known as sclerosis.
- Development of bone marrow lesions, areas of oedema and inflammation in the bone..
- Increase in the subchondral bone plate thickness.
- Change in the architecture of subchondral trabecular bone,
- Formation of new bone at the joint margins – osteophytes or spurs.
It is thought however that some of these changes may actually be an attempt by the body to preserve the function of the joint rather than sources of pain . This is especially true of osteophyte formation which is commonly seen in affected joints.
Osteoarthritis and the synovium
In an OA affected joint the synovium becomes hypertrophied , enlarged and inflammed and affects the natural mechanics of the joint.
The presence of osteoarthritis does not mean you have to be in pain
Of significance are the findings that the presence of OA findings in X-rays and other scans are not a definitive indication that you should have pain. Certainly in late stage OA the joint can have significant structural change that more invasive procedures can be needed e.g knee or hip replacements.
In fact the science behind why OA causes pain is complex and not fully understood but seems to involve complex chemical interactions that cause pain that can then affect the stability and function of the joint.
There is plenty of research showing the presence of OA changes in ASYMPTOMATIC individuals. It seems to be that OA can exist in a dormant inactive state or in an active painful state.
The key is understanding what makes your OA more active and painful and what can be done to make it inactive.
Now for the good stuff …How to effectively manage osteoarthritis
This is the good news part of he story and relates to how you can have a really positive effect on the health of your joints.
If you’ve ever seen or participated in masters sport you can see there are a lot of arthritic joints moving pretty gracefully and quickly. The reason behind certainly has a lot to do with exercise.
Even if masters sport is not your thing, exercise should be if you want to manage OA successfully. It has been described as “panadol for the joints”.
Exercise provides pain relief in short term and a long term solution in OA.
Exercise has a significant role in the management of OA related conditions.
Exercise involves the muscles, ligaments and tendons, bone and articular cartilage of the joint and can have very quick immediate effects on pain to longer term significant effects on function and pain.
In fact studies have shown effective exercise programs reduce the need for total knee replacements by around 30%.
Moderate exercise has been shown to have the following beneficial also leads to;
- Increased activity of our own anti-inflammatory chemicals, (cytokines).
- Decreases the activity of the inflammatory chemicals that are present in active OA joint..
- Increased tissue building,(anabolic), activity of not only muscles , tendons and ligaments surrounding the joint but also components of the hyaline cartilage.
- With prolonged exercise more muscular support and less weight through the joint will lead to less pain.
- Helps manage body weight. A 5-10% loss in weight has been shown to reduce pain and slow down cartilage damage.
The trick is getting the type and amount of exercise right for you and your condition, its the Goldilocks theory: Not too much and not too little its getting it just right.
Need to see a physio regarding OA related aches and pains, book here to see one of our team