Osteoarthritis and 'wear and tear'

Ben de Riter
PHYSIOTHERAPIST
3
Minutes to read

A diagnosis of osteoarthritis is no cause for panic.

I often remember a time many years ago, an interaction with an Orthopaedic Surgeon following a very simple right hip arthroscope, it was a follow up appointment and maybe a fortnight or so later I felt fine, was back on the bike and in to some rehabilitation.

What they said in that appointment has stuck in my mind like glue, initially and for a very long time in a negative context. They said; “You have some early degenerative changes and will most likely require a joint replacement in the future”. I was 19 at the time! Words stick, let us use them carefully.

It is not uncommon for people to describe their painful and sore joints as having been through a process of “wear and tear”, and a lot of the time they have received similar messaging as above from health care clinicians. The belief that osteoarthritis (OA) is caused by wear and tear results in “worry that weight bearing exercise will exacerbate joint damage and these concerns may cause people to reduce activity levels or avoid activity" (Darlow et al., 2018).

Creating fear around movement is not helpful messaging. Lo et al., (2018) followed 1,203 individuals who were already diagnosed with knee OA over 10 years and they found that “self-selected running was associated with improved knee pain and not with worsening radiographically defined structural progression”. What does this mean? It means that loading our joints through running helps with knee pain and does not damage knee joints. That is just one example of a large cohort study that clearly suggest that if we load our joints we will not wear them out, in fact they will thank you for it!

You may have a scan on your joints already that says scary things like “joint space narrowing”,“osteoarthritic changes” and “degeneration”, and while these are all reportable findings, they are also normal signs of ageing. Culvenoret al., (2018) demonstrated in a recent systematic review that the knees of 4751 asymptomatic adults over the age of 40 when scanned had an impressive 19-43% with findings consistent with Osteoarthritis. So, you can have joint findings suggestive of osteoarthritis and experience no pain!

From Noigroup.A picture of a tree

What if we framed the narrative, instead of saying “wear and tear” we are “sore but safe”, knowing that with movement comes many important benefits, for example the production of anti-inflammatory factors such as IL-6 (myokine), IL-1ra and IL-10 (Runhaar etal., 2019).

So, you could say that motion is lotion.

If you would like help with managing your OA symptoms or if you are concerned about your knee pain feel free to get in contact with the team at The Biomechanics.

 

References:

  1. Culvenor,Adam G, Øiestad, Britt Elin, Hart, Harvi F, Stefanik, Joshua J, Guermazi, Ali,& Crossley, Kay M. (2018). Prevalence of knee osteoarthritis features onmagnetic resonance imaging in asymptomatic uninjured adults: a systematicreview and meta-analysis. British Journal of Sports Medicine53(20),1268–1278. https://doi.org/10.1136/bjsports-2018-099257
  2. Darlow, B.,Brown, M., Thompson, B., Hudson, B., Grainger, R., McKinlay, E., & Abbott,J. H. (2018). Living with osteoarthritis is a balancing act: An exploration ofpatients' beliefs about. BMC Rheumatology2, 15. doi:10.1186/s41927-018-0023-x
  3. Lo, G. H.,Musa, S. M., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B.,Petersen, N. J., Storti, K. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D.,Kwoh, C. K., Nevitt, M. C., & Suarez-Almazor, M. E. (2018). Running doesnot increase symptoms or structural progression in people with kneeosteoarthritis: data from the osteoarthritis initiative. Clinicalrheumatology37(9), 2497–2504. https://doi.org/10.1007/s10067-018-4121-3
  4. Runhaar, J.,Beavers, D. P., Miller, G. D., Nicklas, B. J., Loeser, R. F., Bierma-Zeinstra,S., & Messier, S. P. (2019). Inflammatory cytokines mediate the effects ofdiet and exercise on pain and function in knee osteoarthritis independent ofBMI. Osteoarthritis and cartilage27(8), 1118–1123. https://doi.org/10.1016/j.joca.2019.04.009

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WE WOULD LIKE TO ACKNOWLEDGE THE BOON WURRUNG AND WURUNDJERI PEOPLES OF THE KULIN NATIONS WHO ARE THE CUSTODIANS OF THE LAND ON WHICH WE GATHER. WE PAY OUT RESPECTS TO THEIR ELDERS, PAST, PRESENT AND EMERGING.