Osteoarthritis: All your burning questions answered by a physiotherapist (Part 2)

In our previous osteoarthritis FAQ article, we shared some common questions that our team of physios get regarding osteoarthritis. Osteoarthritis affects over 10% of adults and 20% of the elderly in Singapore. Some may relate osteoarthritis as a condition that mainly affects older people – however, there is an increasing number of cases where osteoarthritis has affected younger adults.

In this article, we answer some common questions and misconceptions that people may have when it comes to managing osteoarthritis and whether or not exercising is good or bad.

Isn’t walking/exercise bad for my joints?

No! While you may worry that exercising with OA could harm your joints and cause further pain and injury, research shows that people with OA can and should exercise. In fact, exercise is considered the most effective, non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.

Walking is a low impact exercise, which is free and easy to do. Walking has many benefits. As an aerobic exercise, it helps to improve circulation, improve blood pressure, and strengthen your heart. It also tones your muscles and builds bone density. 

It still doesn’t make sense to me that exercise is good for OA. More activity/exercise gives me more pain.

Is it difficult for you to believe that exercise is good for OA joints? Do you believe your OA joint is eventually going to wear out? Do you have trouble wrapping your head around how muscles can help a joint condition? What goes through your mind when you feel pain in your joints?

A common perception of OA is that it is a wear and tear condition. However, there are many studies to show that the amount of joint degeneration (“wear-and-tear”) shown on X-rays and MRI scans does not correlate to pain. One person may have significant joint changes shown on the imaging films with little or no pain, another can have mild joint changes but experience high levels of pain. This can seem confusing, especially if you believe that pain is caused by degeneration in your joint structures. One way of understanding this is to think of the joint changes as wrinkles on the inside, part of the changes that occur naturally with age.

What is pain?

First, let’s understand pain. Pain is your body’s way of protecting you from potential danger, but it does not always mean that you have injured your body tissues. One way of understanding the role of pain is that pain is a protective system to warn us of potential danger. However, what your pain system recognizes as “danger”, can be affected by many factors. How long you have been experiencing pain, what pain means to you, the feelings you had when you experienced the pain, and how you behave when you have pain, are just a few examples of contributing factors to your pain system becoming overprotective. Your mood, quality of sleep, overall health, and the list goes on!

In the previous article, [Osteoarthritis: All your burning questions answered by a physiotherapist (Part 1)] we mentioned that in osteoarthritis the joint cartilage becomes thinner and gets inflamed. What is important to know is that cartilage loves loading and can adapt. Cartilage gets its nutrients through compression and loading. Specialized cells (chondrocytes) that make collagen, and other materials that form the cartilage, react favourably to loading. So, movements and exercises which load your joints are actually helpful! Pain, when you move or exercise, can be because your pain system is over-protective. It does not mean that you are injuring or damaging the joint. Therefore, it is safe to exercise even if you feel sore, especially under the guidance of a healthcare professional.

What types of exercises are good for Osteoarthritis?

The following types of exercises are beneficial for people with OA.

1. Range of motion or flexibility exercises.
   • These include gentle stretching movements that take the joints through the full movement that they were designed to perform
2. Strengthening or resistance exercises
   • These exercises help to maintain and improve muscular strength. Strong muscles help to support and protect joints.
3. Aerobic or endurance exercises
   • These exercises help strengthen the heart and make the lungs work more efficiently. It builds stamina, which helps you to be able to increase the amount of time you are able to perform certain physical activities before tiring and feeling fatigued. Some examples include walking, cycling, swimming, or using the cross trainer machine.
4. Aquatic (water) exercises
   • Exercising in water is particularly helpful for people just beginning to exercise, as well as people who are overweight. The water buoyancy reduces the amount of weight borne by your joints and the water provides resistance to strengthen muscles. This has been shown to be especially helpful in relieving pain and improving function in people with hip and knee OA.

It is important to know that everyone’s condition is different, and your response to exercises will be different.  This means that the effect of different exercise types, levels of exercise intensity/resistance, exercise duration and session frequency will depend on the individual. That combination of exercises that work best for you may be very different to someone else even though you both have OA. Hence it is important that you consult with your healthcare team to design an exercise plan that is best for you.

How else can I help myself if I have Osteoarthritis?

Managing any chronic conditions you have well, will reduce your pain sensitivity and help with the joint pain you experience from Osteoarthritis.

It is important that you have a good understanding of what Osteoarthritis is and clarify any questions or beliefs you have with your healthcare team. Understanding how you respond to pain, and having an individualized, tailored treatment program will go a long way in helping you stay active and have a better quality of life.

Seek physiotherapy treatment

If you think you might be experiencing osteoarthritis or pain, contact us to speak with our team of physiotherapists. To find out more about knee pain or physiotherapy services that we provide, click on the links or speak to our team to find out more!