Ultimate guide to beating pain of arthritis
FREE PULLOUT INSIDE
PAIN is the most common reason for a GP appointment — not surprisingly, given that up to a half of all Britons live with daily pain. Following the advice of pain specialist and sufferer Dr Helena Miranda on Saturday, today the Mail launches a series of essential expert guides to tackling common problems — back pain, migraine, headache and, here, arthritis — to help stop pain ruling your life.
Osteoarthritis need not be the end of the world — or a stellar tennis career. in January, after years of pain, three-time Grand slam tennis champion andy Murray had surgery to ‘resurface’ his hip joint that had been damaged by osteoarthritis.
By June, he was back on court, taking the Queen’s doubles title — not a bad result for an operation many associate with old age and decreasing mobility.
osteoarthritis occurs when the cartilage that protects our joints breaks down. the body’s attempts to repair the damage can make it worse, as the synovium — the capsule containing the joint — thickens and produces more lubricating synovial fluid, in turn causing inflammation. as part of this attempt at repair, extra bone may grow at the joint’s edge, distorting it. the result: stiffness and pain.
in the UK, an estimated nine million people have osteoarthritis, which most commonly hits the joints that take most strain — more than two million over-45s have it in their hips, and five million in their knees — but it can affect any joint, from the fingers to the toes.
age-related ‘wear and tear’ is clearly a factor, but the exact cause of osteoarthritis remains unclear. injuries may play a part, and there is evidence the condition is inherited. Women suffer more than men, thought to be due to the drop in oestrogen during the menopause.
While not many of us punish our joints in quite the same way as andy Murray, punish them we do — being overweight increases the risk of arthritis by at least four times.
every additional pound of weight increases the load on each knee by four pounds, with every step wearing down the cartilage. there is also evidence that fat cells release chemicals that cause inflammation.
and sedentary lifestyles don’t help, as a lack of exercise weakens the muscles and ligaments that support joints.
the good news is that, although there is no cure for osteoarthritis, there is much that can combat it — and the pain it causes.
WHAT TO DO IF IT’S EARLY DAYS
there are two things you can do to avoid osteoarthritis or keep it at bay once joints start to stiffen and feel painful: stay active and watch your weight. ‘staying mobile and maintaining good muscle strength is the best way to keep osteoarthritis at bay,’ says Professor Philip Conaghan, a consultant rheumatologist at Leeds teaching hospitals Nhs trust, who led the National institute for health and Care excellence’s latest review of treatment guidelines.
it’s a myth that exercise can lead to osteoarthritis by wearing down joints (unless you’re an elite athlete with a punishing regimen). in fact, joints supported by weak muscles are more susceptible to arthritis. tellingly, the average body mass index (BMi) of hip surgery patients in the UK in 2016 was 28.8 (overweight). and with an average BMi of 31, many of those who had a knee replaced were obese.
But even when osteoarthritis has set in, it’s not too late to do something about it.
STEPS TO AVOID THE SURGEON
BUILD YOUR STRENGTH iN his Nhs clinic, Professor Conaghan sees patients with knee, hip and other joint pain aged from about 40 to 75, ‘and among them muscle weakness is almost universal’, he says.
his advice is simple: ‘First get strong, then get fit. Just telling people to walk round the block is a bad starting point — because they are weak, they can’t walk at a brisk pace and they’re not getting any benefit.
‘But once they’ve built up some muscle strength, they can start on aerobic fitness, such as on an exercise bike or cross trainer, or swimming. Walking laps in a swimming pool is a fabulous exercise for weak people.’
and exercise really will help, with overwhelming evidence that it ‘significantly reduces pain and improves function, performance and quality of life in people with knee and hip osteoarthritis’, as a review in the journal annals of Physical and rehabilitation Medicine said this year.
one of the most effective methods of preventing arthritis and pain is maintaining strong thigh muscles, according to research which measured the strength of quadriceps muscles (at the front of the thigh) in 488 elderly people.
the researchers, writing in the journal Knee surgery, sports traumatology, arthroscopy last year, found that weak thigh muscles were directly linked to arthritis in the knee.
exercise works because joints depend on a network of supporting muscles and other
tissue, explains Professor Conaghan. ‘A lot of joint pain actually comes from the tendons and structures around the joint, where the tendons attach to bone,’ he says.
Tendons start to hurt when the weak muscles they are attached to leave them bearing an unfair share of the load.
Sensible recreational exercise protects the joints, adds Martyn Porter, a consultant orthopaedic surgeon and medical director of the National Joint Registry, which keeps records of replacement procedures.
‘People who exercise carefully and effectively are often those who don’t get arthritis,’ he says. ‘These are people who are 60 or 70, who have exercised over their lifetime, eat well, and have good muscle strength.’
BUT IT’S NEVER TOO LATE
ANY exercise that strengthens the quadriceps will help protect knees and hips. Cycling and swimming work well, without putting too much strain on the joints. The gluteus muscles that support the hip joints can be strengthened by simple leg raises when lying on your side and back.
Most people with knee problems find their pain starts to improve as their muscles grow stronger, says Professor Conaghan. ‘Most knees will not require a joint replacement — only about 15 per cent of patients end up going for surgery,’ he adds.
With hips, exercise is still beneficial, but not as much. ‘Hips don’t respond as well to muscle strengthening as other joints do,’ says Professor Conaghan. ‘But it should always be tried first.’
CAN SPECIAL INSOLES HELP?
THERE is an array of expensive insoles designed to combat the pain of knee arthritis. But you’d probably be better off investing in a regular pair of comfy shoes, says Professor Conaghan.
‘The evidence that insoles help knee pain is not good,’ he says. ‘I generally recommend wearing a thick-soled shoe, something that gives you a bit of shock absorption.’
The theory behind lateral wedge insoles, which slightly raise either the inside or the outside of the foot, altering the alignment of the thigh bone and the shin bone, is that altering the load on the knee reduces pain and improves the function of the joint.
But study after study has failed to find any evidence that they are effective.
Cushioned or lateral wedge insoles are also sometimes prescribed to relieve symptoms of hip arthritis — despite the National Institute for Health and Care excellence acknowledging ‘a paucity’ of trials showing any benefit.