Osteoarthritis (OA) is a chronic, degenerative condition the involves the surface cartilage in the joint wearing away, leading to low grade inflammation in the joint capsule and lining and over time an overgrowth of bone. In people with OA these changes can cause pain, swelling, and problems moving the joint. These symptoms can worsen over time. The knee is one particular joint that is most commonly affected by osteoarthritis. OA can affect any joint including large ones such as the knee or hip, and smaller ones such as the joints of the fingers or neck.
OA is a chronic disease. As there is no cure, but you can manage your disease and also your symptoms. People who properly manage their OA slow down the progression of the disease, sustain an active and healthy lifestyle, and reduce the need for surgery. Rest, recovery and sleep play an integral role in the daily care of osteoarthritis. This article will review and guide you through some useful changes you can be making.
Keys to effectively managing osteoarthritis:
Rest Recovery and Sleep
Bracing and Supports
Viscosupplementation – Other Injection Therapies
Rest, Recovery and Sleep
Managing your OA is about understanding what your body is telling you. As the disease progresses, you’ll become more aware of what activities in your routine help your symptoms, or make them worse. Like every new years resolution, big lifestyle shifts are hard to keep. Set your goals small and find that consistency. For additional tips, see Gillian Thomas’ suggestions making small change to your Diet and Nutrition. The approach is applicable to all areas of OA management.
Rest is a key component in the management of osteoarthritis. Listening to your body and resting when appropriate will help lower the chances that a flare up (rapid onset of worse than normal symptoms) will keep you down for long periods of time. If you notice, pain, swelling, or increased heat around the affected joint, it may be time to take a break. This means that you’re non-weight bearing if your hips or knees have OA or that you’re not typing if your fingers or wrist are the area of concern. Often, breaking up a task into smaller parts with short breaks works well. Joint sparing positions when working also helps- and are another way to rest the arthritic joint. An example would be using a stool rather than kneeling, if kneeling bothers the OA in the knees. Rest needs to balanced. Too much rest and the joints become stiff and sore, similar to what happens overnight and the joints may feel stiff until gently moved a few times.
Talk to your doctor or medical team about assistive mobility devices such as braces, canes, walking poles Arthritis friendly kitchen utensils are helpful for sore hands, and long handled gardening tools reduce the amount of bending and kneeling necessary. There may be other devices that can help you “rest” your joint while not interfering with your busy schedule.
Managing your symptoms is key to staying ahead of osteoarthritis. In previous posts we talked about the importance of exercise and diet to slow down the progression of OA. Routine recovery will be an important part in facilitating your on-going exercise and overall well being. Find below a handful of recovery techniques:
Soft tissue therapies have been heavily studied and proven to beneficial for people suffering from OA. Seeing a trained professional who can provide soft tissue treatments to the affected areas can reduce pain and improve joint mobility. Physiotherapists, chiropractors, and massage therapists are all qualified to provide manual therapy. Despite the benefits, passive manual therapy along is not enough for sustained relief. Patients need to take advantage of less pain and improved function of the affected joint to exercise: strengthen the muscles that support the joint. This will help reduce pain and improve function that lasts over time.
Research established that regular use of ice on a daily basis can reduce overall pain. While icing a sore joint may relieve pain for a short while it does not seem to alter the long-term path of OA. However when people have less pain they are often more able to exercise and do remedial exercises.
There are 4 stages of osteoarthritis, each with increasing levels of pain, swelling, and other symptoms. For people who experience flares up when strengthening on land, hydrotherapy is a great way to reduce the impact on the joint. Passive hydrotherapy, such as sitting in a hot tub can also help muscles around the arthritic joint relax. Getting in the water will reduce the weight being carried by joints. This will make strengthening easier. Take a look at our post on Physical Activities for Hip and Knee Osteoarthritis to learn more about exercises in the water. The goal of hydrotherapy is to recover strength and transition back to land based exercise when appropriate.
Several studies demonstrate that acupuncture can alleviate pain and improve function in individuals who have knee osteoarthritis. During an acupuncture appointment, very thin needles are inserted into the skin at very precise points on the body. A medically trained professional may attach a small electrode to the acupuncture needle to cause target muscle stimulation. Acupuncture may be very effective when a joint is swollen and inflamed. Traditionally trained Acupuncturists use many acupuncture points throughout the body, aiming to restore energy flow and healing environment, in addition to reducing pain and swelling.
Talk to your sport medicine doctor and family physician about medications that could help with the symptoms of osteoarthritis. Creams and gels applied to the skin may reduce pain by stimulating other nerve pathways that create a sense of heat or cold; by delivering anti- inflammatory medication through the skin to the joint or by blocking specific nerve fibres that carry pain signals. These products are safer than medications by mouth for most people, but need frequent application many times a day, which can be difficult to schedule. Other medications are taken by mouth.
These may be gentle painkillers such as acetaminophen, anti- inflammatory drugs such as ibuprofen, or pain modulating medications such as duloxetine and nortriptyline, which act on the pain centres in the brain. Strong painkillers such as narcotics may rarely be prescribed, but should be considered a last resort only once all else has failed, due to their many side effects.
Studies have shown that half of people suffering from OA have a hard time falling asleep. Quality of sleep has been determined to impact the amount of pain one will feel the next day. Some suggest that a lack of sleep can trigger increased inflammation. Others also believe that being tired will make people with OA more sensitive to feeling pain.
A routine bedtime plan can help: Bedtime should be the same each night. All electronics and screens should be turned off about 1 hr before. Personal grooming, some stretching and gentle mat exercises done on the bed are ways of winding down and preparing for sleep. Minimal noise and light helps the brain turn off- the use of ear plugs and eye shades may be needed.
In some cases applying a topical medicated cream, or applying ice or heat if this is preferred also reduces pain as one settles into bed. Herbal teas may be relaxing and soothing and can also assist falling asleep. A comfortable mattress, a few extra pillows to support sore knees and covers that keep the temperature neither too hot nor too cold can make a difference too.
The management of OA is from top to bottom: Exercise, diet, rest, recovery, and sleep. People with OA benefit from managing their day to accommodate their disease, one step at a time, to find the perfect recipe that works for them.