Do you have knee and/or hip osteoarthritis? Here’s what the evidence says is best
1 in 11 Australians suffer from osteoarthritis, which is defined as the degeneration of joints over time (including the cartilage and the bones themselves). The hip and knee joints are particularly vulnerable to wear and tear because they are weight-bearing joints, taking the load as humans when we stand and move around on our two feet.
The good news is, there is a growing body of research showing that management of osteoarthritis isn’t simply about going straight to medications or surgery. Lifestyle changes tend to be more affordable and lower risk in the long term, and are well worth the investment of time early on in the osteoarthritis journey.
So what has been proven to work?
Exercise: Considering that osteoarthritis is a degenerative condition of the joint cartilage and bones, it makes perfect sense to strengthen up the muscles surrounding the joints to improve function and reduce pain. A personalised exercise regime including strengthening of the glutes, quadriceps, hamstrings and calf muscles is recommended by the research; alongside any form of aerobic exercise that is tolerated (eg: swimming, cycling, walking).
- Education: Learning more about this condition can help people to take control of their pain and understand what flares them up, and what settles things down. This can be achieved with an Accredited Exercise Physiologist, Physiotherapist, Osteopath, Chiropractor or other trusted health professional who has a good understanding of osteoarthritis. Your local clinic may even offer the GLA:D® Program - a combination of exercise and education specifically designed for hip and knee osteoarthritis. You can search your location here: https://gladaustralia.com.au/locations/
Weight management: Research has shown that intentional weight loss of 10% in those who are overweight or obese reduces pain and improves function, particularly in those with knee osteoarthritis. Alongside the reduction in forces for the knee joints, it has been found that the pathways to weight loss (exercise and healthy eating) has a protective, anti-inflammatory effect which can slow down the degeneration of all joints.
- Activity pacing: This strategy is known as “smoothing out the load”, or spacing activities over time, or balancing the right amount of rest and valued tasks. To better understand pacing, it may help to understand what it is not - which would be sitting all week, with little to no exercise, and then getting out in the garden for a whole day over the weekend (a very common scenario!). In this example, the joints have become accustomed to their reduced forces during the week, and then become aggravated by the sudden increase in activity on the weekend. Some practical ways of implementing pacing include:
Planning out your week strategically: schedule housework on a different day to other physical pursuits such as walking or child-minding
Taking breaks early and often: don’t wait for pain to signal that it’s time to stop! Set a timer and take 5-10 minutes off your feet for every 45-60 minutes of activity.
- Prioritise and ask for help: if you love being out in the garden, can someone assist you with the heavy lifting or moving the bins at the end of the day?
We know that pacing has been successful when people get to the end of their activity and feel that they still have energy or function “left in the tank”. This is a good sign! This means that a flare up is far less likely to occur afterwards.
With all of that in mind, it is also reassuring to know that the above strategies are suitable for anyone who is going down (or has been down) a surgical path for their osteoarthritis. Because lifestyle strategies can take time to see a difference, it is recommended to really give them a go and stick at them for at least 12 weeks before making a decision. Having a healthcare team who is on board with this will be key to keep you accountable, set goals and track your progress over time.
Bennell, K.L., Bayram, C., Harrison, C., Brand, C., Buchbinder, R., Haas, R. and Hinman, R.S., 2021. Trends in management of hip and knee osteoarthritis in general practice in Australia over an 11-year window: a nationwide cross-sectional survey. The Lancet Regional Health-Western Pacific, 12, p.100187.
Fernandes, L., Hagen, K.B., Bijlsma, J.W., Andreassen, O., Christensen, P., Conaghan, P.G., Doherty, M., Geenen, R., Hammond, A., Kjeken, I. and Lohmander, L.S., 2013. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Annals of the rheumatic diseases, 72(7), pp.1125-1135.
Messier, S.P., Resnik, A.E., Beavers, D.P., Mihalko, S.L., Miller, G.D., Nicklas, B.J., DeVita, P., Hunter, D.J., Lyles, M.F., Eckstein, F. and Guermazi, A., 2018. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better?. Arthritis care & research, 70(11), pp.1569-1575.
Murphy, S.L., Lyden, A.K., Smith, D.M., Dong, Q. and Koliba, J.F., 2010. Effects of a tailored activity pacing intervention on pain and fatigue for adults with osteoarthritis. The American journal of occupational therapy, 64(6), pp.869-876.