Osteoarthritis-Related Joint Pain Management

These facts apply to all joints potentially affected by osteoarthritis, including most commonly in the knee, hip, thumb, wrist, elbow, shoulder, neck (medically called “spondylosis”), low back, ankle, and/or big toe joint.

What is OA?

• Osteoarthritis (OA) or as most just refer to as "arthritis," is the most common cause of “flare-ups” described as a group of symptoms experienced more often by those after the age of 45 years old, where other inflammatory joint conditions are unlikely. OA flare-up symptoms are often described as a confusing awareness of increased stiffness and/or pain around a joint and its muscle and tendons that can occur with self-resolving mild to moderate joint swelling. These flare-ups can occur spontaneously (such as upon waking, too quickly blamed on “sleeping in the wrong position”) or occur after physical activity. Our modern understanding of OA and its occasional flare-ups, is that it is defined by these initially confusing symptoms which are normal to be considerably diverse in description and tolerance between different people, fluctuate yearly yet should be expected to be non-progressive for your remaining decades of life (Osteoarthritis: diagnosis and management 2022 | NICE).

• Symptoms of a joint flare-up feel different between different joints. For example:

  • Hip joint pain flare up can be mistaken for “only being” hip flexor muscle or gluteal tendon pain. 

  • Neck joint flare-ups can be mistaken for a headache or blamed on a cranky nerve due to confusing symptoms of dizziness and nausea, “confirmed” by medical imaging, often unknowingly normal and healthy age-related joint changes which don’t change despite symptoms improving in the future (Patients' beliefs about diagnosis and treatment of cervical spondylosis with radiculopathy). 

  • Knee pain flare-ups can be blamed on meniscus pain (My knee just feels weird. What's that all about? - Greg Lehman). 

  • Shoulder joint flare-ups might be blamed on a grumpy shoulder tendon (Most rotator cuff tears don’t hurt- The Shoulder Physio Podcast). 

  • All the origins of these symptoms can be due to joint flare-up but lead many being misled to outdated or unhelpful management options to manage the symptoms rather than joint health itself (Assessing Reactive Approaches to Pain). 

Why me?

• Even though age cut-offs are used to discriminate likelihood from other joint conditions, age on its own has little effect on symptomatic OA, as less than 40% of those older than 75 will experience symptomatic OA (Arthritis Seminar). Exposure to years of modifiable risk factors like obesity, low physical activity, and joint trauma, such as a joint dislocation or ligament sprain around a joint, is more impactful on OA development than age on its own (Relationship of Chronic Systemic Inflammation to Both Chronic Lifestyle-Related Diseases and Osteoarthritis: The Case for Lifestyle Medicine for Osteoarthritis + Is osteoarthritis an inflammatory disease? Apple Podcasts + Why is Osteoarthritis an Age-Related Disease?). You can have osteoarthritis in your childhood and young adulthood if you are exposed to years of modifiable and non-modifiable risk factors (The substantial personal burden experienced by younger people with hip or knee osteoarthritis - PubMed). What about other more modifiable risk factors for OA? Modifiable risk factors for OA include:

  • Being overweight, as reflected by having a BMI higher than 27 or a large waist circumference, is the most predictive risk factor for OA (Does obesity cause knee replacements? - Joint Action) 

    • This might not just be because of increased “load” to the joint, as why wouldn’t we adapt to this load, like we do with exercise? Likely more related to the effects of long-term exposure to increased whole-body inflammation originating from the hormone release from excess stored body fat (Is increased joint loading detrimental to obese patients with knee osteoarthritis? + Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program + Metabolic syndrome is associated with more pain in hand osteoarthritis + Inflammatory mechanisms linking obesity and tendinopathy - ScienceDirect). Also, increased muscle mass around a joint, despite technically contributing to increased bodyweight, ensures good joint health likely releasing daily anti-inflammatory “myokines” (Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults + Muscle–Organ Crosstalk: The Emerging Roles of Myokines). 

• Speaking of muscle mass, being inactive and not meeting Weekly Physical Activity Guidelines each week is a risk factor for future OA. 

  • “Resting” your joints or behaving in a sedentary way to “protect your joints” is a more harmful risk factor for OA than overloading. Astronauts display worsening joint health after space travel (Joint Cartilage in Long-Duration Spaceflight + Effects of Spaceflight on Musculoskeletal Health: A Systematic Review and Meta-analysis, Considerations for Interplanetary Travel + Articular cartilage and sternal fibrocartilage respond differently to extended microgravity). Most strategies to “protect the joint” actually lead to worse joint health in the long term (Reasons why osteoarthritis predicts mortality + You don't need fixing - the value of resuming meaningful activities to get your life back). Being very active on its own is unlikely to be harmful, unless a traumatic injury occurs during exercise, which, independent of exercise, is another risk factor for OA. It is common to believe that movement “wears out a joint” or that increased exercise or sport in early life causes arthritis. Instead, the effect of physical activity and exercise on joint health is very positive (Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis). Increased sedentary behaviour and not meeting weekly physical activity guidelines are decisive risk factors for OA development (What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? + Do radiographic disease and pain account for why people with or at high risk of knee osteoarthritis do not meet physical activity guidelines? + Meeting physical activity guidelines and the risk of incident knee osteoarthritis).

  • Also having low muscle strength around a joint is not good for joint health. Either strength training directly reduces OA risk (Does Strong Muscle Matter in OA?- Vimeo) or having good strength is a surrogate measure for having an active, healthy joint (Lower Extremity Muscle Strength and Risk of Self-Reported Hip or Knee Osteoarthritis).

• Large joint injuries, such as non-volitional joint dislocation's, ligament injuries, and bone breaks, sets up early and accelerated joint changes that, if not managed well, increase OA risk (Prevention of osteoarthritis following injury -Acast + OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis).

• Negative body beliefs, often originating from well-intended but outdated health care professionals (Making sense of osteoarthritis: A narrative review - Osteoarthritis and Cartilage + Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis + Common misconceptions and beliefs about osteoarthritis – Apple Podcasts + General practitioners’ views on managing knee osteoarthritis). 

  • Many unhelpful beliefs like “the body is a machine that wears and tears” are responsible for avoiding exercise (Exercise Therapy “Wears Down” My Knee Joint: Myth or Reality?), increased imaging and invasive injection or surgical management-seeking behaviour. This in turn has a high cost on the healthcare system, affecting your income and increasing national tax requirements, and is not necessary for many. Replace this mindset with “wear and repair,” or “bend it to mend it,” or “motion is potion,” or “don’t use it, you lose it,” or “move it to lube it.”

  • Many believe joint changes in the long term are inevitable. This is untrue (Is osteoarthritis an inevitable – Apple Podcasts + Trajectories and risk profiles of pain in persons with radiographic, symptomatic knee osteoarthritis + What Have We Learned From Trajectory Analysis of Clinical Outcomes in Knee and Hip Osteoarthritis Before Surgery?). OA is a condition that has fluctuating long-term symptoms, but these symptoms will not worsen if you manage your joint health well. It is just common for most not to manage their joint health well, so the belief that OA “gets worse with time” is widespread. 

  • Most of the time, these unhelpful beliefs have come from well-intended health care professionals (Changing the narrative on osteoarthritis + Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation + Sticks and stones – Apple Podcasts). It is unfortunately common for many healthcare providers “with years of experience," just like many without knowledge of OA, to believe that OA is merely a “part of old age” and has limited treatment options. These say things like “nothing can be done” or cause is “bone on bone” (Words about Arthritis + Why it hurts - Is it Bone on Bone?) or “wear and tear” (Why it hurts - Is it Wear and Tear?). Other examples might include exaggerating imaging findings or assessment findings like “you have the joint of a … year old.” Be wary of the quality of your care if you hear any of these beliefs. Or, competing time demands from other health conditions like heart disease or diabetes might prioritise attention during routine visits, not giving doctors or surgeons time to explain OA very well (What should I expect from my GP? - Joint Action). 

  • We know that outdated beliefs and negative mood influence sleep health, which in turn affects future joint health (The impact of sleep on osteoarthritis– Apple Podcasts).

(Systemic osteoarthritis: the difficulty of categorically naming a continuous condition)

Why your joint symptoms might get worse over time, due to your thoughts and behaviour rather “inevitable joint changes” (Aches and Pains Cycle).

Inaccurate beliefs and thoughts about your joints do not help your long-term joint health (Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis). 

Non-modifiable risk factors for OA include: 

• Genetics. The contribution of genetics to radiographic (visible but not necessarily painful) osteoarthritis is estimated to be between 40% and 80% (Genetic risk of knee osteoarthritis: a sibling study).

• Gender. Females are at increased risk of OA (Does sex matter?  – Apple Podcasts + Hormones, menopause, and joint health – Apple Podcasts).

• Although some report weather changes contributing to joint flare-ups (The surprising link between weather and joint pain), you cannot modify the weather, and we know negative beliefs about any concern can cause joint flare-ups, likely contributing to reports of weather causing increased joint pain (On the belief that arthritis pain is related to the weather + Pain-related fear and daily functioning in patients with osteoarthritis). Optimism is a powerful pain medication. 

Factors not to be concerned about for preventing OA

• Flexibility. Lack of flexibility does not predict OA pain onset (The Case for Retiring Flexibility as a Major Component of Physical Fitness). However, strengthening and movement exercises can still be helpful to improve flexibility in stiff-feeling joints. Also, your feelings of “stiffness” are often not proportional to actual joint stiffness, but correlate to how much conscious and subconscious protective adaptation you are experiencing ("But it feels swollen!": the frequency and clinical characteristics of people with knee osteoarthritis who report subjective knee swelling in the absence of objective swelling). 

• Joint "Alignment". Unless alignment changes are caused by joint trauma, such as unfortunate bone injury healing, alignment changes are actually a side effect of OA rather than a cause (Does anatomical alignment influence your knee osteoarthritis risk?).

• Age. As mentioned above, the majority of people over 20 will have pain-free imaging findings in one or more joints in their bodies. Still, age on its own does not predict getting OA symptoms (The incidence and natural history of knee osteoarthritis). Changing your behaviour as you get older to avoid imaging changes is not helpful for your joint health, despite feeling “protective.” (Is osteoarthritis an inevitable part of aging? - Joint Action). Cardiovascular disease, high blood pressure and dementia are seen more with increasing ages, but most would not think of these conditions as “normal” for our age. You should think the same for joint pain and not resign to suffering because of the inevitability of aging. We have hundreds if not thousands of studies saying we can improve or prevent joint pain despite aging (Osteoarthritis Year In Review 2024: Rehabilitation and outcomes). 

• Joint cracking, like you can do with your knuckles or what is sought with the hope of managing a joint pain flare-up, does not cause OA in the future. Common in those with and without OA (Crepitus: Expectations vs. Reality | Barbell Medicine). 

Is medical imaging like getting an X-ray or MRI helpful for understanding your OA?

• Imaging is often not helpful for guiding management decisions for OA. To emphasize what is still poorly understood, even by many clinicians (Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis), is that signs of OA on X-ray or MRI imaging, that might have previously been ordered to “validate” a flare-up, called “radiographic” OA can progress with time on imaging. However, what is not understood is that the symptoms of OA can and should remain stable for decades or the remaining of your lifespan if managed well with a modern understanding of OA. OA is affected by changes around the whole-body, not just the sore joint and often silently affects multiple joints you might have never known about (Systemic osteoarthritis: the difficulty of categorically naming a continuous condition). Unfortunately, our current imaging technology cannot identify and separate “radiographic OA,” which could be also called “normal age-related joint findings” (like grey hair and wrinkles) from the complex changes contributing to “symptomatic OA” (Should I get an MRI for my knee osteoarthritis? + Can MRI predict the development of osteoarthritis – Apple Podcasts + Incidentalomas, SPEW, and VOMIT—radiological dyspepsia?).

• More reasons why imaging is not helpful to for OA is that: 

  • The severity of joint flare-up symptoms will not predictably represent joint changes you have on imaging as you can pain flare-ups without imaging changes (Absence of pain in subjects with advanced radiographic knee osteoarthritis), or

  • Your symptoms will often improve without changes on imaging being necessary (Ageing and the pathogenesis of osteoarthritis + The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature + Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults). Yes, you might have been told you have “severe” arthritis around a joint or nerve based on imaging, but this often overestimates these findings explaining your symptoms, and doesn't explain why high-quality management can improve your symptoms without changing what your joint looks like on imaging (Dr. Tasha Stanton - Rethinking Osteoarthritis – Is It More Than Just The Joint? - YouTube). So imaging is often not helpful to validate why you have your symptoms or help you decide how to manage your joint health (Do imaging findings modify the effect of non-surgical treatment in patients with knee and hip osteoarthritis?), and only supports outdated views that OA flare-ups are caused by “too much use” and “inevitable with age”.

  • “Wear and tear,” “bone on bone” or “overuse” described based off imaging are poor descriptors of OA and might be the sign that you are talking to a well-intended but outdated healthcare clinician (Three Words that Cause Harm: "Bone on Bone" + Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis + Radiology Recommendations).

    
    

So what is helpful for OA?

The three “biggest rocks” to focus on for OA management are 1) maintain regular access to high-quality OA education 2) regular exercise, and 3) maintain low body fat, to help with management of this long-term fluctuating but stable condition. 

Education principles to follow long-term for joint health:

• It is your responsibility to advocate or seek more education for your joint health to ensure you are not part of the statistics of people receiving inappropriate quality of care for OA (CareTrack: assessing the appropriateness of health care delivery in Australia). Hopefully this article and many other links in this article can help (Joint Action - YouTube + Dr. Tasha Stanton - Targeting Pain From Many Angles + A-Z of Osteoarthritis Part 1 + Part 2 + Part 3 + Osteoarthritis with Professor David Hunter + Osteoarthritis Pain - PEER Pain Calculator + OA Optimism - a brief overview of things that can help recovery + I Am Living With Osteoarthritis - Osteoarthritis Action Alliance + Tips for behaviour change – Apple Podcasts + Arthritis Web Seminar Series - YouTube). 

• Improving daily mood, stress, and sleep has a significant influence on your current and future joint symptoms (Does mood and coping affect my joint health–Joint Action – Apple Podcasts). Improving these factors is complex, but it is helpful for OA management and the prevention of symptomatic progression (Reframing pain for osteoarthri…–Joint Action – Apple Podcasts). 

• Be sceptical of “quick fixes” for OA management (Red Flag Rehab Narratives). Clinicians offering only “quick fixes” lack a comprehensive understanding of OA management, and their popularity is a common reason people do not live well with OA long-term, despite short-term promises.

• Make a flare-up plan. Pain flare-ups, where you feel confused and feel like “nothing is working,” will still occur and do not represent failure or increased need for surgery (Pain is complex - the overflowing cup analogy of pain + Knee Osteoarthritis - Triggers for Acute Flares + “I Don’t Know Why I’ve Got this Pain!” Allostasis as a Possible Explanatory Model). They can last for multiple days to weeks (The natural history of flare-ups: a daily diary study of patients with, or at high risk of, knee osteoarthritis). A realistic goal is to aim for decreased yearly frequency and life impact of your joint flare-ups. A joint pain flare-up is not a sign that your joint health is getting worse. Short-term joint flare-ups are common and normal (How to Manage an Osteoarthritis Flare-Up (Knee & Hip Pain Relief Tips). You should make a flare-up plan with your clinician, discussing 1) how to regress on exercise where needed, 2) what recovery tactics to prioritize to help your immune and nervous system recover to tolerate regular progressive movement again (5 key tips on managing flare-ups).  

  • Avoid hours of bed rest not related to sleep. This can worsen your OA symptoms and also increase your risk of other lifestyle-related diseases such as diabetes, cardiovascular disease, and worsening mental health. One or more of such conditions are predictive of OA becoming more symptomatic (Impact of self-reported comorbidity on physical and mental health status in early symptomatic osteoarthritis + All cause and disease specific mortality in patients with knee or hip osteoarthritis).

• Prevention is easier than management (The Remain in the Game App is Here! - Osteoarthritis Action Alliance + Can osteoarthritis be prevented – Apple Podcasts + Arthritis Seminar). Share this article with those you think are at risk of future symptomatic OA. 

Exercise for Joint Health:

• By far, progressive exercise is the best management option for pain relief for those with OA (Osteoarthritis Pain - PEER Pain Calculator + Overcoming fear of movement – Apple Podcasts). Most should seek help and guidance to start a weekly exercise routine for their joint health (Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis). Exercise benefits joint health, even when no weight loss is achieved (OA optimism - activity is good, but do you have to lose weight? + Evaluating the Effects of Exercise on Inflammation Markers in Musculoskeletal Pain). All modalities and intensities of exercise are safe when gradually increased over time, but “low-impact exercise” like cycling or swimming is often marketed as a good starting point. However, higher intensity exercise is safe for OA. 

  • Walking more than 6,000 steps per day protects long-term against developing walking limitations for people with or at risk of lower limb OA (Daily Walking and the Risk of Incident Functional Limitation in Knee Osteoarthritis: An Observational Study) 

  • Running for fun, within the Australian physical activity time guidelines, is very safe for the lower body joints and back health. The benefits of running vastly outweigh the risks. We have a whole article discussing concerns about running called “Running away from OA” that you can check out if you are concerned about running. 

  • Strength training is not harmful to the joints. It might be protective from OA (Optimizing resistance training for pain management in knee and hip osteoarthritis). More and more research is suggesting cartilage can adapt to stress and load, unlike what we used to think (Strength Training Is Associated With Less Knee Osteoarthritis).  

  • Separate from exercise, returning to the active leisure you enjoy is essential to help you cope with the OA of your joints (OA Optimism - physical activity and poking into pain). You might have pain and stiffness, but you do not need to suffer and not participate in activities you enjoy. This can also include returning to sport. The benefits of sport, such as bone health and mortality, outweigh the risks, so sports participation of some weekly amount should be encouraged for everyone (Health Benefits of Different Sports: a Systematic Review and Meta-Analysis of Longitudinal and Intervention Studies Including 2.6 Million Adult Participants t + Sport and longevity: an observational study of international athletes). Sometimes it takes some time to improve total exposure to sports or your valued active activities. At the same time as gradually increasing sports participation from a tolerable level, you use structured and less wonderfully chaotic exercise options, like strength training, to help build up your tolerance again, until you find the “goldilocks zone” of tolerable weekly exercise, which does move over time based on your life events and your increased fitness and strength (Dosing for Osteoarthritis). 

  • Any active activity does not have to be pain-free to have pain-relieving effects (Association of Pain During Exercise With Exercise‐Induced Hypoalgesia in People With Knee Osteoarthritis + Exercise-induced pain and analgesia? Underlying mechanisms). 

Guidelines for physiotherapists on what to offer people seeking exercise education for OA (Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis).

Weight management advice:

• Multiple studies show weight loss, especially when 10% of your current bodyweight is reduced over 2 years, can be very helpful for improving OA symptoms and slowing down symptomatic OA progression (Weight loss: the treatment of choice?  + Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis + Effect of weight reduction in obese patients + Top tips for losing weight – Apple Podcasts + Losing weight and osteoarthritis– why and how? - Joint Action). 

• Weight loss protects from the perceived need for joint replacement (Weight loss is associated with reduced risk of knee and hip replacement).

• Fat loss surgery has been shown to be helpful for OA (Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis).

• Weight loss has been shown to improve joint health on imaging rather than just slow down progression (Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage).

• Weight loss is more helpful when combined with exercise, rather than through dietary changes alone (Diet-induced weight loss alone or combined with exercise).

• Weight loss can also be helpful in “normal weight” people (Is calorie restriction beneficial for normal-weight individuals?). Gaining muscle and strength can be helpful for an underweight individual with OA, despite increasing body weight (Role of skeletal muscle in the pathophysiology and management of knee osteoarthritis).

• If your clinician does not speak to you about the benefit of weight loss for your OA, or increasing muscle mass if you are underweight, find another clinician  (Weight Management - Osteoarthritis Action Alliance).

• Nutrition quality can matter when you have a healthy body weight for your joint health (Food as medicine for osteoarthritis - practical tips, research spotlights and what the future holds + Behavioral Interventions to Manage Obesity and Osteoarthritis). 

• Be careful of over-promising supplements for joint health. When people with joint pain are offered outdated management options that are no better than placebo, harmful, or expensive, it is not surprising that many are dissatisfied or disillusioned with current medical practice and seek “alternative” options. Realise that they are called “alternative” as they have not been proven by high-quality science to be effective, and often appear helpful when really something else has changed, coinicidence or not, to improve your joint symptoms (Leeches, honey bees and snakeoil – Apple Podcasts + Should I take this supplement – Apple Podcasts + Alternative Medicine and Common Errors of Reasoning | Semantic Scholar + Why do ineffective treatments seem helpful?).

(Food as medicine for osteoarthritis - practical tips, research spotlights and what the future holds)

What are the “smaller rocks” for OA management?

• Medication/Injection: 

  • Most over-the-counter medications like paracetamol work no better than a placebo for OA pain (Pain Calculator).

  • NSAIDs like Nurofen have small benefits, similar to opioids (Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis), but don’t prioritize them over exercise of any intensity (Pain Calculator). Where possible, use topical creams (Topical NSAIDs | Science-Based Medicine) to receive equal benefits to oral forms, without the potential side effects of persistent use (Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis + What anti-inflammatory should I take for my osteoarthritis? – Apple Podcasts + Non-steroidal anti-inflammatory drugs in football - a "Keeping SCORE" approach to judicious use).

  • Injections: 

    • Corticosteroid injections might be helpful for some in the short term (average relief is between 2 to 8 weeks) (Pain Calculator). But, multiple use in one year has negative effects on the joint (Osteoarthritis debate series: steroid injections, harmful or helpful?), which many clinicians might have blamed previously on beliefs of “inevitable worsening,” however we know now that is not true. 

    • OA is one of the only consistent conditions where platelet-rich plasma (PRP) or platelet-poor-plasma injection is more helpful than a placebo, without long-term joint harms that corticosteroids have (Platelet-rich plasma injection…–Joint Action – Apple Podcasts + Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritisl). However, watch out for profit-rich-placebo marketing of the “best” dosage or type of PRP as this is not clear yet (Risks of PRP injections).

    • Hyaluronic acid and other "lubricant" based injections have limited evidence to support confidence in their use (Osteoarthritis Pain - PEER Pain Calculator + Care for an oil change? – Apple Podcasts).

    • Be aware of the placebo effects of injections. We have seen placebo injections (saline solution only) do just as well as exercise for those with OA (Exercise and education versus saline injections for knee osteoarthritis).

• Manual therapy or “hands on” options (including massage, needling, cupping, hot/cold modalities, electromodalities).

  • As manual therapy does not cause tissue change, it is only helpful for pain modification, just like pain medication, with stronger pain relief effects when you expect it (“The Dark Side of Musculoskeletal Care”: Why Do Ineffective Techniques Seem to Work? A Comprehensive Review of Complementary and Alternative Therapies + What manual therapy can and can’t do with Dr Mark Bishop). Manual therapy should be used to increase exposure to activities that improve your joint health, like exercise and good sleep (Assessing Reactive Approaches to Pain w/ Marc Surdyka + The E3 Rehab Podcast: 149. High vs Low Value Care w/ Josh Zadro + Evidence review for the clinical and cost effectiveness of manual therapy for the management of osteoarthritis). Be careful of reliance on manual therapy like muscle massage as the “only option” for pain relief  (Integrated manual therapies: IASP taskforce viewpoint). Exercise offers similar effects to pain relief for a joint flare-up (especially when expectations are optimistic) while offering substantially more health benefits additional to pain relief compared to touch-based, non-active options. This is despite the sell many desperate clinicians offer to desperate clients seeking “strong short term pain relief” with pessimistic views about self-managing a joint pain flare-up (Unraveling the Mechanisms of Manual Therapy: Modeling an Approach).

    
    

Is surgery inevitable for OA?

• Arguments to have surgery focus on when you are unable to do the strategies you need to improve your OA, despite best care management for multiple months, due to joint function related lowered quality of life and sleep (When should I get my knee joint replaced? Insights from experts). Another important consideration for seeking surgery is when considering your long term long-term health as when you are unable to meet the Australian Physical Activity guidelines after months to years of up-to-date joint health management, a continued sedentary lifestyle has worse risks than the risk of surgery. Prior to surgery though all should be aware that:

  • Evidence-based lifestyle management including exercise can prevent most from ever needing joint surgery. Joint surgery has been predicted to be not be needed for 80% of those with symptomatic OA who receive up-to-date high-quality non-surgical management advice (What can be done to avoid knee replacements? - Joint Action). 

  • OA does not inevitably worsen significantly when managed well. Joint surgery is not inevitable and should become less common as non-surgical exercise and lifestyle-based management become more popular (Osteoarthritis101 with Surgeon - Empowered Beyond Pain - YouTube). 

  • Many joint surgeries for ligament or as a “clean up” do not have strong evidence to be protective of future OA development (Knee debridement for arthritis must end + Why ‘Useless’ Surgery Is Still Popular - The New York Times + Arthroscopy, past time to stop – Apple Podcasts + Surgery: the Ultimate Placebo - Ian Harris).

  • Complete satisfaction with the benefits of surgery are often not met, despite joint replacement often being more helpful than harmful (Patients' Expectations Impact Their Satisfaction +  What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis?).

  • Surgery is often offered too quickly due to outdated beliefs common in medical professions where long term harm of bad advice takes years to be noticed, or harmful words are not governed against. Unfortunately, this problem is not less common among “experts” or “specialist” with more years of experience (General practitioners’ views on managing knee osteoarthritis + Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty + The Relationship between Clinical Experience and Quality of Health Care).

  • Evidence-based lifestyle management will still be encouraged post-surgery to maintain the health of your joint. Stopping seeking high-quality education, maintaining a healthy weight or exercising because “I am getting surgery anyways” will likely make your recovery from joint surgery and future joint function worse then it could be (Knee Replacement Rehab (Education | Myths | Stretching & Strengthening Exercises). 

So overall, if we all were to have medical scans, most people would have the joint finding equivalent to wrinkles and grey hair. It is important to know that these signs of “radiographic” OA often do not reflect what causes an OA flare-up, or symptomatic OA. Joint pain cannot be visualised, but unfortunately, many still assume that the natural structural changes which are seen in scans are the cause of symptomatic change. Increasingly however, health professionals are becoming trained to understand that symptomatic OA is an ‘all body’ condition resulting from numerous possible contributing risk factors. These result in an immune response in the joint or joints where the flare-up has occurred, resulting in the symptoms that lead to the individual seeking healthcare. We now know reducing the severity of OA flare-ups ideally involves reduction of the contributors to a flare-up rather than just attempting to ‘repair’ the ‘grumpy’ structure. The biggest beneficial impacts on OA in any joint come from exercise, nutrition, good sleep, reduced mental stress, improving movement confidence, reaching and maintaining a healthy weight. The information provided should have expanded on this summary statement and at Method Health we will spend time to help you understand your personal complexities to best manage all these factors that affect your joint health.

Check out these resources for more about managing specific sites of OA:

Knee

• Knee Osteoarthritis (OA)

• Knee Osteoarthritis - E3 Rehab + The E3 Rehab Podcast: 170. Knee Osteoarthritis - The Clinical Care Standard w/ Ilana Ackerman

• Patellofemoral osteoarthritis – Apple Podcasts 

• Surgery advice:

  • Total Knee Replacement Rehab w/ Chris Hughen and Marc Surdyka

  • Knee Replacement Rehab (Education | Myths | Stretching & Strengthening Exercises)

  • NHS England » Decision support tool: making a decision about knee osteoarthritis

Hip

• Hip Osteoarthritis - E3 Rehab + Total Hip Replacement - E3 Rehab + Doctor of Physical Therapy Answers Your 10 Most Common Questions About Hip Osteoarthritis

• The E3 Rehab Podcast: 44. Hip Osteoarthritis & Total Hip Replacements (Top 5 Tips) w/ Mehmet Gem

• What are the best exercises for hip osteoarthritis?

• Surgery advice:

  • NHS England » Decision support tool: making a decision about hip osteoarthritis

    
    

Ankle/Feet/Big Toe

• Understanding the cause of Ankle OA 

  
  

Shoulder

• Glenohumeral Osteoarthritis: Disease Burden, Current Understanding, and Gaps in Knowledge and Treatment

  
  

Wrist/Hand/Finger/Thumb

• The Effectiveness of Exercise-Based Rehabilitation in People With Hand Osteoarthritis

• Osteoarthritis (OA) of the hand and wrist

  
  

Elbow

• Elbow Physiotherapy - YouTube

  
  

Neck

• Exercises for Neck and Shoulder Pain - E3 Rehab

• Patients’ beliefs about diagnosis and treatment of cervical spondylosis with radiculopathy

• The effect of neck-specific exercise and prescribed physical activity on headache and dizziness

• Association between Cervical Spondylosis and Migraine: A Nationwide Retrospective Cohort Study