National Post (National Edition)
`Motion is lotion' can pay off
Movement is key therapy for osteoarthritis
Your knees ache, your neck cracks or maybe there's a twinge in your hip. If you're suffering from painful joints, you're not alone. Genetics, obesity and prior injury can predispose someone to joint pain, but arthritis is by far the most common cause, and more than 54 million Americans experience some form of it, according to the Centers for Disease Control and Prevention.
Osteoarthritis is the most common type, and it happens when the cartilage in the joint breaks down and the surrounding bone develops inflammation. Osteoarthritis becomes more common with age, but you don't have to just grit your teeth and suffer through it, says Jason McDougall, a professor at Dalhousie University in Halifax who specializes in arthritis and pain research.
An array of strategies are available for treating joint pain, ranging from physical therapy to pain medications, injections and surgery, but one of the most effective ways to manage joint discomfort is one that can seem counterintuitive: Keep moving.
If you're feeling pain in your joints, you might be inclined to lay off them, but that's one of the worst things you can do, says A. Lynn Millar, a physical therapist and fellow emeritus at the American College of Sports Medicine.
It's a vicious cycle — it hurts, so you stop moving the area that's painful, but “immobilization actually causes deterioration in the joints,” Millar says. Hence the saying among physical therapists, “Motion is lotion.” Movement brings nutrients to the joints and keeps them healthy, Millar says. “Everyone wants a magic bullet,” she says, and physical activity is the closest thing we have.
Even if you've had an X-ray or MRI that shows arthritic changes in your joint, that shouldn't dissuade you from exercising. “Your structure isn't your destiny,” says Greg Lehman, a Toronto-based physiotherapist, chiropractor and clinical educator in physiotherapy.
Turns out, the findings on an imaging test aren't a good indicator of pain, he says. Imagine going to a ski area and finding all the people 50 and older who were skiing enjoying themselves. Lehman says that if you gave these skiers a scan of their knees and hips, the “vast majority of them” would have structural changes in their knee and hips without even knowing about it.
For a 2012 study, researchers took MRIs of the knees of 710 people 50 and older and found that nearly 90 per cent had at least one feature of osteoarthritis on the MRI, irrespective of whether they had knee pain.
Joint pain is complicated, and it's not just about bones and ligaments, but also how your nervous system is interpreting the signals it's receiving. Chemical mediators, such as enzymes and neuropeptides, released into the joint when someone has arthritis can sensitize the nerve endings around it to make them more active than normal. “These signals are translated by the brain as pain,” McDougall says.
Most people with joint pain respond well to physical therapy and an activity program, Lehman says, and studies have shown that exercise programs can reduce pain and increase physical function for people with osteoarthritis in their hips.
Low impact activities such as swimming, biking, walking or using an elliptical trainer can be gentle ways to move your joints, but even something as high impact as running can be fine for people who can tolerate it, Millar says.
A study that followed nearly 500 runners over a period of 14 years found that “there was no progressive increase in musculoskeletal pain in older adults who participated in regular vigorous exercise, including running, compared with those who did not.” Arthritis does not progress any faster in people who run than in people who don't, Millar says, and people with arthritis who are regular runners report less pain and maintain function longer than people who don't run.
Strength training can also help by building up the muscles around the joint so they're better able to deal with the force coming through the joints. You don't have to lift heavy weights to reap benefits, Millar says. Even doing some simple leg lifts or bending and straightening your legs can yield benefits for your knees and hips, for instance.
If you're carrying extra weight, losing even as little as a single pound can make a noticeable difference.
Research has shown that one pound of weight on the body equates to four pounds of weight across your knee, says Antonia Chen, an orthopedic surgeon at Brigham and Women's Hospital in Boston. “I tell my patients to celebrate losing one pound. Even one pound is four pounds off your joint and it will make you feel better.”
Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen are the go-to medications for managing arthritic pain, but they're no panacea.
“Most of the time, they work for a little bit, and then they stop working,” says Ali Guermazi, a professor of radiology and medicine at Boston University School of Medicine. They also have side effects such as internal bleeding, especially when taken long-term, Guermazi says. For people who cannot take NSAIDs because of side effects, acetaminophen (Tylenol) can also be an option. In severe cases, opioids may be used short term, but they aren't a great option and should be carefully managed because of addiction risk, Guermazi says.
When pain meds aren't helping, corticosteroid injections to the joint are sometimes used, but they're not without risks. Although they can offer relief for many patients, they can also damage the cartilage in the joint, Chen says.
With cannabis legalized in Canada and many parts of the U.S., cannabinoids are becoming another option for treating pain. McDougall's group has studied the use of cannabinoids for controlling joint pain.
Tetrahydrocannabinol, or THC, the cannabinoid responsible for marijuana's famous high, also has anti-inflammatory properties, studies have found.
When all else fails, joint replacement surgery is a final option.
“The recommendation is that you should try to put it off as long as possible,” McDougall says. Although a joint replacement can be life-changing in a good way for some patients, it's not a magical cure.
Chen says that it's important to have realistic expectations for the surgery: “It's not like you get the joint replacement and you're up and jumping around. It can take up to one full year to recover.”
Glucosamine and chondroitin sulphate supplements are another popular joint pain treatment she tells her patients to skip. The evidence that they help is so slim, she says, that in 2013 the AAOS put out a statement that said, “don't use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.” The supplements “do not provide relief for patients.”
There's no way around it — exercise remains the bedrock for joint health. “If your knees are sore, it doesn't always mean you should stop what you're doing,” Lehman says.
Doing the activities you love can be therapeutic, not just mechanically and biologically for the joint, he says, but because you're moving again and that can be emotionally and psychologically healing, too.
YOUR STRUCTURE ISN'T YOUR DESTINY.