Do you need to worry about that twinge in your knee or pain in your hip? Read our expert report to find out.
We all get aches and pains as we get older. For some of us, they may develop into osteoarthritis (OA). But there’s a lot you can do to help prevent or slow down its onset.
We spoke to Professor Philip Conaghan, spokesperson for Arthritis Research UK and professor of musculoskeletal medicine at the University of Leeds, about how to stay fit and active as the years go by. ‘The first time you notice pain when walking up and down stairs should be a “bingo moment”,’ advises Professor Conaghan. ‘This acts as an alert that your muscle strength needs improving so your joints work as they should.
‘We know that having strong thigh muscles (quadriceps) reduces knee pain by half, and that a strong grip reduces hand/wrist pain considerably, too.
‘It really is as simple as that. If you start off with pain in your knee, after a few months you’ll lose strength in your thigh muscles. A couple of years after that,
you’ll get shoulder pain (more likely to be tendonitis than osteoarthritis) as you’ve been “walking on your hands” (pushing yourself out of chairs and using stair rails to pull yourself up, instead of using your leg strength to propel you). You’ll also put strain on your back and hips. Before you know it, you have four painful joints.’
Exercise to improve muscle strength is essential. It doesn’t have to mean high-impact running – try walking as long as joints are not too painful – or aqua aerobics, or another water-based exercise such as walking laps in a pool. ‘When you’re stronger, try the cross-trainer,’ suggests Professor Conaghan. ‘Increase aerobic fitness and try Pilates for strong core muscles.’ Make exercise a daily habit for the best of both worlds – less pain and a body that works as it should.
How does arthritis begin?
Any joint that helps us walk upright is subject to damage. That means the knees, hips, lumbar and neck region of the spine. Our opposable thumbs also take a lot of strain.
Osteoarthritis is the process of joint failure, explains Professor Conaghan. ‘The cartilage and bone in joints becomes damaged and worn down. This is associated with secondary inflammation, which develops as a result of that damage.’ As for the causes of a condition that affects around eight million of us in the UK, genetics plays a part. It’s also more common in women, which may be due to hormonal differences. But injury and joint damage have a major impact, too.
‘Some injuries might have happened when you were 19, but you’re unlikely to recall these when you’re 65 or 70,’ says Professor Conaghan. ‘Elite athletes and footballers are more likely to damage their joints and therefore get arthritis.’ Weight is another important factor, and knees can suffer the most. Hardly surprising when the load on your knees is up to six times your body weight. ‘Add to this the loss of muscle strength through lack of exercise and sedentary jobs, and you have what I refer to as a total lifetime load on your joints,’ explains Professor Conaghan.
The relationship between joint damage and pain isn’t clear. ‘Sometimes you have a badly damaged joint that causes no pain but considerable stiffness; sometimes it’s both,’ he says. When pain or stiffness results in not using the affected limb, muscle weakness increases and your life becomes smaller. ‘You stop going out, sleep is disturbed and depression can set in,’ says Professor Conaghan. ‘It really can be a downward spiral for a lot of people.
‘Some osteoarthritis is probably inevitable as we age, but it doesn’t mean we have to accept the symptoms. There are many things we can do to manage them.’
Dealing with pain
For dealing with pain, anti-inflammatory creams containing ibuprofen or diclofenac are a good first option. ‘We think more and more that paracetamol is not effective,’ says Professor Conaghan. Next up the scale are non-steroidal anti-inflammatory drugs (NSAIDs). ‘However, these have side effects, such as dyspepsia and internal bleeding, so that means many people can’t take them. Naproxen is the safest in terms of avoiding heart attacks and stroke.’
Opioids such as co-codamol are top of the pain-relief medicine tree. ‘They help a bit, but again they have significant side effects, such as drowsiness and constipation,’ says Professor Conaghan. ‘Steroid injections into the joint may provide relief for up to six weeks. This can be useful as it allows a time window for you to start exercising and increase muscle strength, which in turn can lessen the pain and stiffness.’
Finally, a hip or knee joint replacement is effective, but it’s a big decision. ‘There’s no right point for this on the pain scale or damage shown on an X-ray,’ says Professor Conaghan. ‘It’s based on quality of life.’
For further information, visit arthritisresearchuk.org/osteoarthritis
3 ways to manage OsteoArthritis
1 Have strong muscles.
Thighs and forearms are most important. Test your thigh strength by getting out of a chair without pushing on the arms. Test your grip by opening a jar. If either causes you problems, get to work on your muscle strength.
2 Lose excess weight.
Shedding those pounds really does lighten the load on your hips and knees.
3 Exercise daily.
Try low-impact water-based routines. Once you’re stronger, move on to weight-resistance exercises and aerobic routines, such as Zumba. diets and supplements. There are no special diets or supplements that either cause or cure osteoarthritis, says Professor Conaghan. However, it makes sense to eat a healthy, balanced diet, rich in calcium, vitamin D and omega-3s (from oily fish such as salmon, left).
When it comes to supplements, the evidence is inconsistent. An Arthritis Research UK report on complementary medicines rated capsaicin (cayenne) top for providing effective relief from pain. Rosehip may also be helpful, but evidence is mixed for glucosamine hydrochloride and chondroitin.