Physiofit’s proactive approach to osteoarthritis
Arthritis is a term to describe inflammation of a joint(s). Osteoarthritis is often thought of as a ‘wear and tear’ problem that should be expected with aging and little one can do to change it. However, that notion is being challenged by research highlighting the positive impact that a healthy diet and exercise can make.
Research at The University of Surrey has discovered that lack of exercise with a poor diet can cause the cells in the body to begin producing less energy. To compensate, the cells begin to produce more glucose for energy and left unused this is converted in to lactic acid which causes inflammation with the cartilage lining our joints.
The message about arthritis and exercise has changed from one of rest to encouraging a slow and steady buildup of exercise where more is good. The key is to establish a baseline of what you can do now without flaring up the symptoms. There is now strong evidence that if you allow your body time to adapt to the new level of exercise applied to it, the body will adapt and get stronger and can then tolerate more. Where people go wrong is introducing sudden spikes in activity level. For example, spring cleaning the house, gardening all day or a prolonged walk that exceeds your normal average. The joints then swell and prevent you exercising for several days and then you yoyo between exercise and having to rest. Try writing down your current activity level over the last 4 weeks. Take an average of activity over the last 4 weeks and add 10% to this week’s load. For example, if you can walk with only mild pain for 10 minutes a day now (70 mins per week), this week you can do10% more ie 77mins. Try to spread this over the week to pace yourself.
Obesity is one of the highest risk factors for developing and advancing osteoarthritis. In a study at the University of California, people who lost 5-10% of their body weight over 4 years had slower degeneration of their knee joint cartilage and 50% less pain. In addition, greater weight gain inevitability places greater stress on the body with evidence suggesting that a weight gain of 1 pound equates to 4-8 pounds of pressure through the knees. For every pound you lose there is over half a stone less strain on the knees.
Following a thorough assessment with one of our team to establish what is weak and where you need to focus your efforts, a set of easy to follow online exercises will be prescribed.
It’s vital to keep your joints moving. Find the balance between too much making your joint swell and become painful and too little where it gets weaker and stiffer. Not only will exercise reduce weight but is essential to strengthen the muscles around a joint to enhance control and stability and reduce your risk of the knee giving way. Friction from lack of balance or stability will place greater strain on joints and advance osteoarthritis at a greater rate. Strength or resistance training especially for muscles around the hip and knee has been shown to slow the progression of osteoarthritis in the knee. In the knee it is really important to make sure you can keen the range of movement to straighten your leg, so the joint is stable.
Low impact, aerobic exercise such as swimming, cycling and Tai Chi can help build strength and increase weight loss as well as many other health benefits. Our physios can help you decide what is best for you.
Research suggests that acupuncture can help with arthritis symptoms. By releasing endorphins, acupuncture may offer some people pain relief from their symptoms. There are few side effects and whilst the evidence is being established there is little down side to trying it so that with less pain you can do the exercises to get stronger.
Historically, wearing a support was claimed to make you weaker, however research showed that wearing a simple elastic support can help build confidence and allow you to do more exercise to gain strength. Braces are available which can subtly alter the load bearing area of the knee giving pain relief. Physiofit stock several ‘unloader’ braces.
Research in Salford has found that placing a wedge under the foot within an orthoses can gently realign pressure on the knee. If you only have osteoarthritis in one compartment of the knee, shifting the weight gently nearer to the other side can help. Salford insoles make a “lateral wedge” product which can be ordered online but Physiofit make a comparably priced bespoke pair that caters for individuals who only have one knee affected or who may need greater or less support than a standard device.
Identifying optimal footwear for your knees is important. The degree of heel and level of support within the shoe both for men and women affects load on the knee. Very flat shoes may encourage people to “overpronate” towards a flat foot which can increase load. Equally a high arched shoe can restrict probation and increase symptoms. A podiatrist can help you understand what shoe is best for you. Heel height is also important with generally a high heel loading the knee cap and causing pain.
Other treatment approaches
• Methylsulfonylmethane (MSM)
• Glucosamine and Chondroitin
• Capsaicin cream – cream containing pepper
• Vit D
Heat and ice
If your knee is hot, swollen or inflamed, applying an ice pack or frozen peas for 10-15 minutes may help. Place a damp tea towel between the pack and your skin to prevent an ice burn.
If the joint is stiff more than painful, heat is more effective.
A doctor or pharmacist can advise on what medication might be most suited to you. These might include over-the-counter painkillers such as paracetamol or low-dose ibuprofen, or pain-relieving creams, gels or sprays. It is good to get pain under control, so you can do the exercises prescribed.
When tablet forms of medications are not effective, injections may help.
Hyaluronic acid supplements – Hyaluronic acid occurs naturally in the joint acting as a lubricant.
It is yet to be know why but in some people it breaks down contributing to the process of arthritis. In some people having a series of injections (Synvisc and Hyalgan) can reduce pain and inflammation. Injecting it into a joint may lessen pain and inflammation.
Corticosteroid Injections – Although steroid injections were used widely several years ago their popularity has lessened as some negative effects were noted such as they may contribute to cartilage breakdown. They can be used when perhaps surgery is not an option for quick relief but should not be used around the time of surgery and the number limited.
Keyhole surgery was commonly used to Ali I ate the pain in arthritis “washing out” the joint to remove loose bodies. In recent years this has been shown to be less effective than thought and has been factored to advance degenerative changes in the knee. This may still be offered for true meniscal tears but should no longer be considered for degenerative meniscal fraying.
Advances in technology have meant that half or full knee replacement surgery is now considered for younger patients with longer life span for the new joint and improved techniques giving better outcomes.
Food and osteoarthritis
There are foods that are proinflammatory to the body and may increase inflammation and others that are naturally anti-inflammatory. Everyone is different so you need to be patient and experiment.
1. Cider vinegar
2. Fish with high levels of omega 3 fatty acids
4. Match green tea
5. Fruit high in antioxidants such as blueberries
6. Oils such as advocado, olive, grape seed and walnut
7. Onions, garlic, shallots, leeks have high levels of antioxidants and quercetin in which inhibit inflammation and attack harmful free radicals
8. Pineapple has high levels of bromelain
10. Nuts and seeds especially walnuts and brazil nuts
11. Spices – turmeric, cayenne pepper and cinnamon
Proinflammatory or harmful foods
Foods that are acidic seem to cause greater levels of inflammation in the body. Try to therefore reduce the levels of plums, rhubarb, cranberries, tomatoes, citrus fruits, white wine, pork and red meat. Other studies have questioned whether wheat and food from the night shade family – tomatoes, potatoes, peppers, aubergines might also exacerbate arthritis in some people. Food exclusion diets have had conflicting results in the research so do not omit major food groups without expert guidance.
This is not an exhaustive list and more research is being released every month. If you have any ideas, then let us know. For more help with your individual arthritis symptoms please do contact us for more specific advice.The information in this article has been collated based on personal opinion and relevant research. Please seek medical advice before trying any of the approaches and individuals react in many ways.