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Jan 11, 2023

Redefining Osteoarthritis

Updated: Aug 10



Can imaging (e.g., x-ray) see how much pain I am in?

Although it would be amazing and a lot easier if scans such as X-Ray’s, CT scans, MRI, etc. could see our pain, they simply can’t. Pain is a subjective experience and is influenced by many, many factors that all interact in a complex way that can not be seen on a scan.


Unfortunately, osteoarthritic changes are a very common finding on scans for people with and … without pain. A study by Culvenor (1) and colleagues collected data from 5,397 scans of knees from people without pain and found osteoarthritic changes in 43% of adults over the age of 40. The severity of these changes may matter, with more severe changes often being more closely correlated with pain. However, even people that have severe OA on imaging may not experience any pain in 23.5-31% of cases (17).


Is Osteoarthritis just wear and tear caused by old age or excessive activity?

Yes, osteoarthritis is more common in the elderly and could be considered a normal part of aging. However, being physically active, playing sports, etc. does not increase the wear and tear and in fact may even be protective towards joint health. Less active people are at a higher risk of developing osteoarthritis then active people (2).


Will exercise not just worsen the wear and tear in my joint?

No, as discussed in a previous post osteoarthritis is not a wear-and-tear- condition but instead a more complex condition (4). Exercise has shown to decrease inflammation and maintain joint health (2-6). Although osteoarthritis involves numerous different structures in the joint it is cartilage that has traditionally received the most attention (13). Cartilage can adapt to load and becomes healthier (7). Cartilage doesn’t have a blood supply and receives it’s nutrients through load.


Studies have shown that long periods of not loading up the joint (e.g., going into space, post-surgery) results in thinning of the cartilage (8).


Another study followed a group of ultra-marathon runners and completed frequent MRI’s. This study actually found that the thickness of the cartilage increased over time (9).


Why does exercise hurt, if it is supposed to be good for the joint?

Pain sensitisation (overprotective/amplified system) (4). People with osteoarthritis (and often in other chronic pain conditions) have a reduced pain threshold at the joint but also throughout the body. In osteoarthritis the sensitisation is likely due to persistent inflammation. Sensitisation are changes to the ‘pain system’ that occur at the joint but also at the spinal cord and the brain (where we analyse and interpret nociceptive signals).


If you think of exercise as medicine, you need to ensure you are getting the right dose for it to be effective (5). But unlike medicine, exercise does not come with side effects (besides positive ones) and we can increase the dose over time to continue to see positive effects.


Getting the dosing right can be tricky and this might be when you seek advice from a health professional (e.g., physiotherapist, exercise physiologist).


There are also numerous different types of exercises to trial, for example, a recent review found that some lower impact modalities such as tai chi and yoga may be slightly more beneficial for OA in some people (11,12) However, activities such as running and walking do not progress osteoarthritis (14). More good news is that you don't need to spend numerous hours being physically active, 45 minutes/week has shown to have improvements (15). Anything is better then nothing (14)!


Will my osteoarthritis get worse over time?

Osteoarthritis does not need to continue to get worse, remember it is not ‘degenerative’. Joints can adapt and become healthier through regular progressive movements (3,5). Pain can improve or be managed through a range of interventions and lifestyle modifications.


Things you can do to manage osteoarthritis:

  1. Understand your condition, knowledge is power. This video as some great information: https://www.youtube.com/watch?v=qGQqs8y4v_M

  2. Remaining active including higher impact exercises/physical activities, as we have discussed above, movement and loading of the joint is critical in maintaining a healthy joint.

  3. Decreasing inflammation, exercise and physical activity can have an anti-inflammatory effect in the long-term5. Dietary changes can also help in decreasing inflammation, this can include consuming less processed foods.


From: Bunzli et al.,(10)


Ideally treatment approaches are personalized.

Research in OA has highlighted that there is significant variety in function, pain and treatment responses in people with OA (16). This is likely because as with all persist pain conditions, pain is influenced by numerous factors unique to the individual.


References

  1. Culvenor, A. G., Øiestad, B. E., Hart, H. F., Stefanik, J. J., Guermazi, A., & Crossley, K. M. (2018). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine, 53(20), 1268–1278. https://doi.org/10.1136/bjsports-2018-099257

  2. Bricca, A., Struglics, A., Larsson, S., Steultjens, M., Juhl, C. B., & Roos, E. M. (2018). Impact of exercise therapy on molecular biomarkers related to cartilage and inflammation in people at risk of, or with established, knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Arthritis Care & Research. https://doi.org/10.1002/acr.23786

  3. Rice, D., McNair, P., Huysmans, E., Letzen, J., & Finan, P. (2019). Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. Journal of Clinical Medicine, 8(11), 1769. https://doi.org/10.3390/jcm8111769

  4. You, T., Arsenis, N. C., Disanzo, B. L., & LaMonte, M. J. (2013). Effects of Exercise Training on Chronic Inflammation in Obesity. Sports Medicine, 43(4), 243–256. https://doi.org/10.1007/s40279-013-0023-3

  5. Skou, S. T., Pedersen, B. K., Abbott, J. H., Patterson, B., & Barton, C. (2018). Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy, 48(6), 439–447. https://doi.org/10.2519/jospt.2018.7877

  6. Nicklas, B. J. (2005). Behavioural treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training. Canadian Medical Association Journal, 172(9), 1199–1209. https://doi.org/10.1503/cmaj.1040769

  7. Bricca, A., Juhl, C. B., Steultjens, M., & Roos, E. M. (2016). Impact of daily exercise dose on knee joint cartilage thickness in healthy animals – a meta-analysis of published randomized control trials. Osteoarthritis and Cartilage, 24, S404. https://doi.org/10.1016/j.joca.2016.01.731

  8. Eckstein, F., Hudelmaier, M., & Putz, R. (2006). The effects of exercise on human articular cartilage. Journal of Anatomy, 208(4), 491–512. https://doi.org/10.1111/j.1469-7580.2006.00546.x

  9. Schütz, U., Ehrhardt, M., Göd, S., Billich, C., Beer, M., & Trattnig, S. (2020). A mobile MRI field study of the biochemical cartilage reaction of the knee joint during a 4,486 km transcontinental multistage ultra-marathon using T2* mapping. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-64994-2

  10. Bunzli, S., Taylor, N. F., O'Brien, P., Wallis, J. A., Caneiro, J. P., Woodward-Kron, R., Hunter, D. J., Choong, P. F., Dowsey, M. M., & Shields, N. (2023). Broken Machines or Active Bodies? Part 1. Ways of Talking About Health and Why It Matters. The Journal of orthopaedic and sports physical therapy, 0(5), 1–3. https://doi.org/10.2519/jospt.2023.11879

  11. de-la-Casa-Almeida, M., Villar-Alises, O., Rodríguez Sánchez-Laulhé, P., Martinez-Calderon, J., & Matias-Soto, J. (2024). Mind-body exercises for osteoarthritis: an overview of systematic reviews including 32 meta-analyses. Disability and rehabilitation, 46(9), 1699–1707. https://doi.org/10.1080/09638288.2023.2203951

  12. Martinez-Calderon, J., Cano-García, F. J., García-Muñoz, C., Rufo-Barbero, C., Matias-Soto, J., & Infante-Cano, M. (2024). How can clinicians enhance self-efficacy beliefs in osteoarthritis? An overview of systematic reviews with meta-analysis. Clinical rheumatology, 43(5), 1435–1446. https://doi.org/10.1007/s10067-024-06943-2

  13. Brandt, K. D., Radin, E. L., Dieppe, P. A., & van de Putte, L. (2006). Yet more evidence that osteoarthritis is not a cartilage disease. Annals of the rheumatic diseases, 65(10), 1261–1264. https://doi.org/10.1136/ard.2006.058347

  14. Huffman, K. F., Ambrose, K. R., Nelson, A. E., Allen, K. D., Golightly, Y. M., & Callahan, L. F. (2024). The Critical Role of Physical Activity and Weight Management in Knee and Hip Osteoarthritis: A Narrative Review. The Journal of rheumatology, 51(3), 224–233. https://doi.org/10.3899/jrheum.2023-0819

  15. Dunlop, D. D., Song, J., Lee, J., Gilbert, A. L., Semanik, P. A., Ehrlich-Jones, L., Pellegrini, C. A., Pinto, D., Ainsworth, B., & Chang, R. W. (2017). Physical Activity Minimum Threshold Predicting Improved Function in Adults With Lower-Extremity Symptoms. Arthritis care & research, 69(4), 475–483. https://doi.org/10.1002/acr.23181

  16. Radojčić, M. R., Arden, N. K., Yang, X., Strauss, V. Y., Birrell, F., Cooper, C., Kluzek, S., & VIDEO Trial Investigators (2020). Pain trajectory defines knee osteoarthritis subgroups: a prospective observational study. Pain, 161(12), 2841–2851. https://doi.org/10.1097/j.pain.0000000000001975

  17. Son, K. M., Hong, J. I., Kim, D. H., Jang, D. G., Crema, M. D., & Kim, H. A. (2020). Absence of pain in subjects with advanced radiographic knee osteoarthritis. BMC musculoskeletal disorders, 21(1), 640. https://doi.org/10.1186/s12891-020-03647-x


This blog’s ideas and references were largely inspired from the excellent talk by Tasha Stanton1 at the San Diego Pain Summit.

  1. Stanton, T. (2022). Rethinking Osteoarthritis – Is It More Than Just The Joint? [Review of Rethinking Osteoarthritis – Is It More Than Just The Joint?]. In San Diego Pain Summit. https://www.youtube.com/watch?v=qGQqs8y4v_M


If you are dealing with osteoarthritis or other persistent pain conditions and you want more reliable information, please visit the below:


The team at Adapt Movement are based in Geraldton but also offer telehealth services. If you do want to receive the most up to date treatment for osteoarthritis we are here to help.



This blog was written by Samuel Bulten


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