Understanding Knee Arthritis: Damage vs Pain

It’s National Arthritis Week over in Ireland and I absolutely love their theme for this year: Every Movement Matters.

It’s really on point because people with arthritis tend to be afraid of moving or exercising.

For everyone else, it’s a good reminder that we should continue to stay active despite the COVID-19 lockdown around the world.

What is osteoarthritis?

Osteoarthritis is a joint disorder that is often characterised by pain and stiffness.

IT IS NOT A WEAR AND TEAR DISEASE.

What causes arthritis?

Arthritis, at it’s simplest definition, refers to a condition that involves joint inflammation. Symptoms of arthritis virtually always involve joint pain as well as joint stiffness.

There are more than a hundred types of arthritic conditions. Osteoarthritis and rheumatoid arthritis (RA) are the more common types of arthritis. Other diseases such as ankylosing spondylitis and gout are also considered arthritic conditions.

We still do not know what are the causes of arthritis.

In chronic inflammatory arthritis such as RA, psoriatic arthritis, and gout, the autoimmune system is involved. The immune system attacks the connective tissue around the joints, which typically leads to pain and swelling at the affected joints.

While the exact causes are unknown, cigarette smoking is strongly link to rheumatoid arthritis.

Osteoarthritis is considered a non-inflammatory arthrosis. Most people today still refer to osteoarthritis as a “wear and tear” condition.

However, research has repeatedly shown this is false. Obesity and previous joint injury are the strong risk factors linked to osteoarthritis.

It is SUPER important to remember that “wear and tear” is NOT the reason why people have osteoarthritis!

The devil is NOT in the damage

Most arthritis is diagnosed with blood tests, x-ray, or MRI. While imaging findings do confirm your diagnosis, it is not a life sentence to painful living.

In fact, many people with “joint damage” actually DO NOT experience pain.

(This is why the wear and tear narrative has been ousted to be archaic, pejorative, and inaccurate.)

Up to 14% of adults below 40 years old WITHOUT knee pain or any symptoms showed signs of osteoarthritis in their knees on MRIs.

This goes up to 43% for those above 40 years old!

That’s a lot right? Sure, you may have “arthritic knees” and your knees hurt. But that doesn’t mean it has to hurt / you can’t do anything about it!

We see the same type of “damaged” but pain-free joints relationship in the spine as well.

For adults in their 30s, 52% will show signs of disc degeneration and 9% would have facet degeneration in their spines. This goes up a whopping 88% (disc degeneration) and 50% (facet degeneration) for those in their 60s. Again, these individuals DO NOT have any pain or symptoms despite the osteoarthritic findings on their MRIs.

This is why the problem-based approach to pain management often fail to deliver satisfactory results.

Can knee arthritis be cured?

How has your general health and emotional well-being been looking?

This is probably one of the most important questions medical doctors and chiropractors alike should be asking.

Research shows that psychological and emotional factors may have a big role to play when it comes to painful knees!

Many people resigned to their pain because they think it’s “wear and tear” and that nothing could be done to help them feel better.

This is simply not true!

The severity of the “damage” on MRI findings correlates poorly with a patient’s pain experience. Their daily mood (e.g. happy vs. sad) as well as stress levels have a bigger part to play.

A study published last year put patients with osteoarthritis knees through a four-month marathon training. At the end of the study, the runners showed a partial reversal of their “knee degeneration”. How amazing is that?

Again, osteoarthritis is NOT a wear and tear condition. Running or any form of physical activities DO NOT “wear out” your knees.

What is the best treatment for arthritis?

Yes, you are right if you think this woman lived in pain.

This is a x-ray of a 57-year old teacher who suffered from knee pain. She had knee pain for most of her adult life due to an injury as a teenager.

Her knees showed signs of severe “degeneration” since her early 40s. She was also sedentary and overweight. She described her knee pain as 9/10.

This patient was put on the wait-list for a total knee replacement surgery.

While on the waiting list for knee surgery, she started to exercise under professional supervision. After a year, she described her pain as 1/10 and was subsequently removed from the wait list.

Exercise helps. Exercise is the best treatment for your arthritic pain. While that may seem counter-intuitive for most of us, research has repeatedly shown that it is the best approach to managing joint pain.

Exercise can help with improve fitness, help with self empowerment, improve your mood and mental well-being. It may also contribute to weight loss.

It’s really a win-win-win intervention.

When it comes to treatments for knee osteoarthritis, most people are familiar with pain medication, exercise, weight loss (for patients with BMI scores of 25 and above), and/or joint replacement options.

Rehabilitation exercise, such as the one mentioned in the case earlier, is starting to gain popularity as a treatment approach. However, most patients are still surprised to learn that they can exercise. A Cochrane review — the crème de la crème in health research — published in 2015 that exercise not only improves pain and physical function but also quality of life.

One of the treatment options that are is often mentioned in research literature but perhaps less known and arguably also less valued in Singapore is education.

Knee osteoarthritis patient education

In Sweden, a self-management education programme based on behaviour change principles was successfully implemented nation-wide. According a 2014 study, 94% of the 20,200 research participants rated the programme as good or very good.

The programme is straightforward and simple. It has three compulsory sessions:

Session 1:

• What is osteoarthritis?
• What are the available treatments?
• What do current treatment guidelines recommend?

Session 2:

• What are the exercises for osteoarthritis?
• Why is exercise in important?
• What are barriers to exercising?
• How can exercises be part of daily life?
• What are the self-management strategies that can be used to reduce pain and symptoms?

Session 3:

• What is like to live with osteoarthritis?
• What is the experience of non-surgical treatment for osteoarthritis like?

Sessions 1 and 2 of the programme are conducted by a physiotherapist while session 3 is led by a osteoarthritis communicator.

Most of us are probably not familiar with the concept of an osteoarthritis communicator. They are osteoarthritic patients who have gone through formal training to teach about what it means to live with the disorder.

While we don’t have such a robust program in Singapore patients with arthritic pain, evidence-based chiropractors and physiotherapists are more than equipped to deliver the other aspects of the education program.

Solution-focused coaching for long-term results

Square One Active Recovery is probably the only chiropractic clinic (or even physiotherapy clinic) in Singapore that promises that we will work towards making our own services redundant to you.

I am able to help over 80% of my clients achieve their recovery goals in 4 to 7 visits because of my commitment to getting people better.

Instead of a traditional exercise prescription approach, I offer long-term pain solutions by combining exercise, education, and coaching principles in my recovery approach.

It’s okay if you are unfit or unmotivated to exercise. I take physical fitness and behaviour change strategies into consideration when working with a client to deliver results.

Your next step

If you have been living with RA for a long period of time, you may want to consider seeking medical advice from a rheumatologist at Singapore General Hospital.

If you are open to approaching your pain relief management with a more holistic approach, book in for an appointment with us.

Living with arthritis is challenging. However, the treatment doesn’t have to stop at the joints affect.

Sure, it may affect the knee. Surgery, medication, or even a hyaluronic acid inject may help address the knee damage. However, that alone may not be enough to give you the quality of life you are after.

Arthritis has an impact on your daily activities. The best long-term solution is to look at the lifestyle changes you can make to manage the symptoms.

For example, good nutrition and physical therapy support may help with losing weight. That in turn may also help reduce pain as well as improve self-confidence and quality of life.

Book an appointment with us via the form below and discover the difference the right care can make.

Remember, #EveryMovementMatters.