Changing the paradigm: Exercise more for Osteoarthritis.
A staggering 1 in 11 Aussies currently have osteoarthritis (9.3%), a number that has risen by 35% since 2005 (AIHW, 2020).Significant pain, poor physical function and quality of life, the abuse of pain medication and the impending need for surgical replacement of the joint are all factors that emerge with people suffering from this disease. The right type of exercise program in the right dosage has been shown to deal with many of the symptoms faced with osteoarthritis. In this blog we will share a proven exercise regimen currently being used worldwide to treat the symptoms associate with hip and knee joint osteoarthritis, as a well as taking a brief look at what osteoarthritis actually is.
Osteoarthritis (OA) describes a common age-related disorder whereby abnormal progressive loss of cartilage occurs in one or more of your joints. Cartilage itself is found at the end of your bones and provides a friction free surface for your joint to move and operate optimally. Normal wear and tear as you age creates this cartilage loss naturally. However, poor alignment of a joint, poor strength and/or flexibility in the joint and poor sensory feedback from your nervous system can wear away this cartilage more rapidly. As osteoarthritis progresses, the space in between your joints narrows, making movement stiff and painful. In current medical practice, inevitably the final treatment is to receive a knee replacement surgery, where an artificial joint is replaced by the old joint in order to improve symptoms.
Example of osteoarthritis. Sourced from ( https://www.msk.org.au/osteoarthritis/ )
An example of a total hip replacement surgery. Sourced from https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
Because of the long process of degeneration in osteoarthritis over decades, preventative strategies to minimize progression can be far more helpful then in the case of other diseases in the body. A combination of education, specific exercise, and weight loss is recommended in evidence-based guidelines as first-line treatment and preventative strategy for those suffering with OA. The below pyramid outlines the strategies of how treatments should be administered to those with OA.
An example of appropriate treatment in order of importance. Sourced from https://gladaustralia.com.au/faq-for-people-with-oa/
What type of exercise: Neuromuscular training first, before strength!
Neuromuscular exercise training is a proven form of exercise therapy that improves pain, physical function and reduces further degeneration to those who are affected by osteoarthritis (Skou & Roos, 2017). Neuromuscular exercises for the lower extremities typically involve multiple joints and muscle groups performed in weight-bearing positions. Examples of neuromuscular exercises can be found here https://nemex.trekeducation.org/ . Issues with neuromuscular control can be found before OA begins and remain present in those suffering from OA:
- Significant past injuries of the hip and knee have been shown to reduce neuromuscular control to the effected joints and may create the onset of arthritis from poor alignment and loading through affected joints (Ageberg & Roos, 2015)
- People who suffer from osteoarthritis have been shown to have sensory dysfunction, lower limb muscular weakness, altered muscle activation patterns and reduced functional performance (Ageberg & Roos, 2015)
Strength training is also a very beneficial form of exercise therapy for those suffering from OA (Uthman et al., 2014). However, poor form and alignment from neuromuscular control can create more pain in your arthritic joints when undertaking strength training. Therefore, starting your program doing neuromuscular exercises and progressing to strength training later is a far more beneficial strategy.
How much exercise is needed to receive these benefits?
- Number of sessions per week: 2 sessions per week.
- Session duration: At least 60minutes for each session
- Duration of program: At least six weeks! We propose 3 months as a much better time frame for success in the program.
What benefits will I get from doing an osteoarthritis exercise program?
- A 30% reduction in the pain associated with arthritis. This pain reduction was shown to maintain at the 3 and 12 month mark meaning that the changes from the exercise program are not limited to the time that you participate in the program!!! (Skou & Roos, 2017)
- Reduce the need for taking pain medications such as anti-inflammatories, Panadol (or like products) and more intensive opioids (example endone, oxycontin etc.) (Skou & Roos, 2017)
- Improves function: When doing physical fitness testing, people undertaking an osteoarthritis specific program received far better results then their original tests pre program
- Less sick leave due to disease (Skou & Roos, 2017)
- The ability to extend the period of time before needing a joint replacement surgery for those with moderate to severe osteoarthritis (Skou et al., 2017)
Who can do the program?
Anyone with hip or knee joint osteoarthritis. This can span from mild osteoarthritis, to moderate to severe osteoarthritis (Skou & Roos, 2017). It has also been shown to be a beneficial pre-operative program for those people awaiting joint replacement surgery as it demonstrates a faster recovery post surgically (Skou et al., 2017)
The GLA:D program
This blog was used to create awareness regarding a very famous program in Scandinavia called the GLA:D (not a typo!) program. The program is a worldwide standardised program aimed at providing functional and symptomatic relief for people suffering from osteoarthritis. While the program is nationwide in Denmark where it originates from, it is still in its infancy in its Australian community. There are a number of GLAD practitioners throughout Australia including in our practice at Bespoke Health and Performance. For those wanting to find alternative, non-pharmacological or surgical strategies for their pain, it is highly suggested to undertake the program and find out for yourself.
References
Ageberg, E., & Roos, E. (2015). Neuromuscular Exercise as Treatment of Degenerative Knee Disease. Exercise And Sport Sciences Reviews, 43(1), 14-22. doi: 10.1249/jes.0000000000000030
AIHW. (2020). Osteoarthritis, Data – Australian Institute of Health and Welfare. Retrieved 19 January 2020, from https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/osteoarthritis/data
Skou, S., & Roos, E. (2017). Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskeletal Disorders, 18(1). doi: 10.1186/s12891-017-1439-y
Skou, S., Roos, E., Laursen, M., Rathleff, M., Arendt-Nielsen, L., Rasmussen, S., & Simonsen, O. (2017). Two year outcome from two parallel randomized trials on total knee replacement and non-surgical treatment of knee osteoarthritis. Osteoarthritis And Cartilage, 25, S35-S36. doi: 10.1016/j.joca.2017.02.071
Uthman, O., van der Windt, D., Jordan, J., Dziedzic, K., Healey, E., Peat, G., & Foster, N. (2014). Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis:. British Journal Of Sports Medicine, 48(21), 1579-1579. doi: 10.1136/bjsports-2014-5555rep