Osteoarthritis related joint pain management
16 Nov 2023
Table of contents:
What you can do about your joint pain
What you should know about arthritis
What you can do about your joint pain?
The two most effective recommendations physiotherapy assists in completing are regular exercise tailored to your needs and goals and maintaining or achieving a healthy weight.
The role of physiotherapy is to help you get your life and pain under control by assisting you with the likely lifestyle changes needed to achieve regular exercise and weight management.
Returning you to the activities you enjoy and increasing your tolerance to daily physical and mental stress is essential to help you cope with the OA of your joints. You might have pain and stiffness, but you do not need to suffer and not participate in activities you enjoy.
Based on your history, expectations, goals, previous attempted experience with pain treatments, and current movement tolerance we have heard from you, we will develop a shared long-term plan to help you improve or maintain your joint health.
We do not offer “quick fixes” for OA management. Clinicians offering only “quick fixes” and lacking a comprehensive long-term management plan are common reasons people do not live well with OA.
Have you been told to stop the activities you enjoy entirely because of your OA? We do not recommend this. Ask for help to maintain your participation, modified in dosage potentially, in these valued activities to maintain your quality of life.
Treatment for OA is not about finding a cure or aiming never to have a joint flare-up again. At the joint level, management aims to reduce the severity of long synovitis and the frequency of flare-ups. We aim to help you embrace your diagnosis and will help you live well with it, and assist you in finding ways to tolerate, participate, or return to your valued activities. A diagnosis of OA should not stop you from completing your loved activities.
Gradual return to normal valued movement, hobbies, or sports is always safe. We assist you in finding the progressively tolerated dosage to reduce the risk of a joint flare-up. Discuss return to full unaffected work or sport with us.
Pain flare-ups will still occur and do not represent failure or increased need for surgery. A realistic goal is to aim for decreased yearly frequency and life impact of your joint flare-ups. We encourage temporarily modifying any valued activities that might be causing frequent flare-ups. We will help you make a plan to return with improved tolerance to these activities and reduced flare-up frequency.
In some cases, we will also put you in touch with other healthcare professionals to increase your access to support and services physiotherapy can’t provide. Counselling and dietetics are beneficial for managing the effects of OA in some people.
What is unlikely to help your OA?
Bed rest or living a sedentary life. This can worsen your osteoarthritis and also increase your risk of other lifestyle-related diseases such as diabetes and cardiovascular disease. Two out of 3 people already with OA have co-morbidities, including cardiovascular disease, type 2 diabetes, and mental health conditions. One or more of such chronic diseases are predictive of faster worsening of OA https://doi.org/10.1093/rheumatology/kes288 https://doi.org/10.1136/bmj.d1165
Avoiding enjoyable activities.
Unprescribed or excessive medication.
Thinking or accepting that nothing will help your pain or joint pain is inevitable.
Asking for a manual therapy-only approach. As manual therapy does not cause tissue change, it is only helpful for pain modification, especially if you expect it to. Manual therapy should be used to increase exposure to activities that improve your joint health, like exercise and good sleep.
Not making a flare-up plan or believing a flare-up is causing rapid damage and, therefore, changing management plans prematurely.
Relying on passive methods of pain relief such as braces, pain medication or manual therapy.
Avoid using valued or fun activities during periods of increased joint pain.
Healthcare providers and the evidence translation to practice gap.
Perceptions among healthcare providers can be that OA is merely a part of normal aging, with limited treatment options and competing demands from other comorbid health conditions prioritise attention during routine visits.
Ironically, a doctor or other health care professional's advice or comments can be unhelpful and contribute to unhelpful behavior. Examples include exaggerating imaging or assessment findings, prompting outdated advice, not explaining your condition fully, and not supporting exercise habits due to time constraints. Health care professionals’ views can be perceived to be negative, for example, ‘nothing can be done’ and ‘it’s your age.’ Unhelpful descriptions and terminology can easily transfer from the X-ray report into the consultation
Additionally, lack of knowledge or training of how to deliver exercise is common in doctors and other health care professionals.
When patients are offered treatment options that are no better than placebo, harmful, or expensive, it is not surprising that many are dissatisfied or disillusioned with current Western medical practice and seek alternative treatments and/or premature joint replacement.
Speak to your PT about as much as possible about what a doctor or another health care professional has shared with you. If you have not talked about your OA with your doctor extensively. If your doctor appears not to take your OA seriously, ask them why not. Ensure you are not part of statistics of people receiving inappropriate quality of care for OA. https://doi.org/10.5694/mja12.10510
https://doi.org/10.1016/j.joca.2016.04.004 Clinical algorithms to aid osteoarthritis guideline dissemination.
https://aci.health.nsw.gov.au/chronic-pain/brain-injury/understanding-pain/pacing
