Making a joint effort
CAN EXERCISE REALLY WORK BETTER THAN PAINKILLERS WHEN IT COMES TO MANAGING OSTEOARTHRITIS? KIM JONES ASKS THE EXPERTS
CHRONIC pain is a common symptom of osteoarthritis (OA), with one in three people living with the condition reporting a daily pain score of seven or above on a scale of one to 10.
So it came as a shock to many of them when NICE (the National Institute for Health and Care Excellence) recently issued draft guidelines stating that analgesics like paracetamol and strong opioids should no longer be prescribed.
Dr Paul Chrisp, director for the Centre for Guidelines at NICE explained: “This is because new evidence has shown there was little or no benefit to people’s quality of life, pain or psychological distress, and particularly in the case of strong opioids, there was evidence that they can cause harm in the longer term, including possible addiction.”
Instead, guidelines say doctors should first offer tailored therapeutic exercise to all OA patients (for example, local muscle strengthening and general aerobic fitness exercises).
OA affects an estimated 8.75million people over 45 in the UK and, according to the charity Versus Arthritis (versusarthritis.org), it’s the leading cause of pain and disability.
“It’s characterised by joint pain, swelling and reduced range of movement due to a breakdown of cartilage in the joints,” says Miriam Daurat, chartered physiotherapist at Our Health Hub (ourhealthhub. uk). “Common sites include the back, neck, hips, knees and hands.”
In a survey by Versus Arthritis, six in 10 people with osteoarthritis said the pain, joint stiffness and reduced mobility associated with the condition had a negative impact on their overall enjoyment of life.
For many people with OA, even a simple task such as putting on the kettle results in extreme pain. So is prescribed exercise a step too far?
“Due to pain levels, some people with osteoarthritis may be fearful or reluctant to engage in exercise,” recognises Disha Shah, a musculoskeletal physiotherapist at Ascenti (ascenti.co.uk) the UK’s biggest independent physio provider.
“This is completely normal, especially if you experience pain when doing everyday activities. But studies show that exercising will have many benefits, including helping to reduce pain and joint stiffness, weight loss, plus improved mood and self-esteem.”
It’s important to expect that exercise can be difficult to begin with, she adds, and in some cases joint pain may increase when you start a new regime.
“So take it steady and adjust your programme accordingly with the help of a professional such as a physiotherapist,” adds Disha.
So what sort of exercises are usually best for people with osteoarthritis?
“Everyone with OA is different so exercise that’s personalised to the individual, tailored to their activity levels and progression of their condition is best,” says Disha. “Generally, you should include flexibility, strengthening, aerobic and balance exercises.”
AND STRETCH
“As OA-associated stiffness is often worse in the mornings after waking, taking time to stretch and work through each affected joint range can have a really positive impact on approaching the day’s activities,” says Miriam.
KEEP STRONG
Disha says: “Strong muscles help to protect
the joints. Do gentle strengthening exercises at first – start low and go slow – then slowly progress by using light weights or elastic bands.
“Some good strength exercises include weight-bearing exercises like squats or lunges and wall pushups for strengthening the shoulder muscles without stressing the joints.”
Another great functional strengthening exercise is a “sit to stand” from a dining chair, adds Miriam. “Focus on slow, controlled movements on both standing and sitting. Building strength and control like this will also have the bonus of improving balance, which lowers the risk of falls.”
AEROBIC AND ENDURANCE EXERCISE
“Though aerobic exercises target the heart and lungs, they can have an impact on the joints and muscles as well,” says Disha.
“Things like walking, swimming, cycling, rowing, a low-impact dance class or even gardening improve your stamina and overall flexibility, as well as potentially helping you shed a few pounds. Pain can worsen with low mood, and aerobic exercise has the added advantage of releasing natural endorphins which help this.”
TAKE TO THE WATER
Try an aqua aerobics class. “Recent studies suggest that aquatic exercises are very useful in reducing joint stress and OA symptoms,” says Disha.
“The buoyancy helps the joints by relieving the pressure of your body weight on them, and alleviates the pain caused because of movement. So some exercises that might be difficult on land can be first practised in the pool and then transitioned into ground exercises.
“These are especially helpful for overweight individuals and people with significant pain-related inhibition. Aquatic exercise also helps build greater endurance as you can do a higher number of repetitions without aggravation of pain.
“A heated pool can also help soothe and make movement easier.”
EXERCISE TO AVOID
“High-intensity exercises like high impact aerobics, jumping, sports with sudden turns and stops, repetitive activities like deep squats or lunges, or running on hard, uneven terrain may aggravate symptoms,” says Disha.
“It’s good to take precautions to not overdo exercise in general. Also, if you experience a flare-up of symptoms, rest, let the inflammation settle down, and gradually rebuild your activity level.”
OA-associated stiffness is often worse in the mornings after waking physiotherapist, Miriam Daurat
Always check with a healthcare professional before starting a new exercise regime if you have OA