A Quick Snapshot:
When somebody refers to the term “arthritis” they’re most likely talking about the most common form: Osteoarthritis (OA). It’s characterised by the breakdown of cartilage that covers the ends of the bones within the joint, this cartilage acts as a kind of buffer and shock absorber for the joint. It most commonly affects the hands, spine and joints such as hips, knees and ankles.
This form of arthritis is commonly miscommunicated as “wear and tear” as we age, leading to joint pain and stiffness. Fun fact: there is more arthritis today than ever, yet we’re more inactive than ever. Should we really be calling it “wear and tear”…? Let’s look at the top 5 myths associated with this kind of arthritis today.
Osteoarthritis is a chronic and progressive disease characterized by loss of the cartilage that covers and protects the ends of the bones where they meet at a joint. Without this protective coating, bone rubs against bone, causing irritation and inflammation. The result is pain and stiffness in the joint and often pain in the muscles and ligaments that surround it.
What Are The Numbers?
- 1 in 5 Australians (22%) over 45 currently have osteoarthritis.
- 2.1x more likely to have poor health.
- 1 in 5 Australians with OA have high or very high psychological stress.
- Over 1 in 2 Australians with OA have moderate to very severe pain.
Myth Number 1: We Can Rely On Scan Results
Much like any scan results, they can’t be used alone to diagnose OA. A scan can visibly show signs of OA development, but it does a terrible job of predicting the level of pain or functional disability regardless of how mild or severe the arthritis may appear on imaging.
To give you an idea of how confusing this can be, consider the following results from a systematic literature review:
When patients had knee pain:
- Anywhere between 15-75% had visible OA signs on scans.
When OA was found on scans:
- Anywhere between 15-81% had pain symptoms.
Long story short: Anywhere between 4-14% of healthy, uninjured and non-painful knees will show signs of OA when scanned in young adults. This number jumps to 19-43% in adults over age 40. Scan results are a really poor way of figuring out how bad and disabling somebody’s OA will be.
A study from 2020 showed that scan abnormalities were found in 97% of otherwise healthy, uninjured people. 30% had meniscus tears, 57% had cartilage damage, as well as many other findings including tendon damage, bone marrow abnormalities and partial ligament ruptures.
Myth Number 2: Rest Is Best
Exercise and movement may be the last thing you want to do when your joints are stiff and achy. However, exercise is a crucial part of the OA management plan. Not only that, it is the number one intervention when it comes to prevention and management! When you spend prolonged periods of time resting or becoming inactive, your joints will feel stiffer and the surrounding muscles will actually become weaker over time, increasing the pressure placed on the joint itself.
The key part is finding the most comfortable, safe and tolerable starting point (that’s where we come in). The basic components of the exercise prescription are activities that improve flexibility, muscle strength, and endurance. The specifics will depend on various factors, including which joints are involved, how severe the pain is, how fit you are, and whether you have other medical conditions.
Myth Number 3: You Should Avoid Exercise
As just mentioned, exercise is not dangerous. Safe, graded exposure to painful activities can actually help reduce pain by improving your strength, capacity and tolerance. If there’s one osteoarthritis treatment an individual with osteoarthritis should do every day, it’s exercise.
Regular exercise strengthens muscles and improves flexibility and balance. It not only helps ease pain and stiffness but also improves overall health. It’s also good for your mood and for staving off other conditions prevalent in older age. We can’t downplay the effect on your mental health when you find ways to stay regularly active and engaged in life.
Coincidentally, it’s been found that those who take part in regular distance running actually showed lower levels of OA than their more inactive counterparts. Interesting, right!
Lack of exercise may contribute directly to osteoarthritis, especially by causing the atrophy of supportive and shock-absorbing muscles, such as those surrounding the knee.
Myth Number 4: Surgery Is The Only Option
We’re looking at a big problem over the next 6-7 years in Australia when it comes to the burden of arthritis-related surgeries, the most common of which include total knee replacement (TKR) and total hip replacement (THR).
Based on the current predictions, the number of these surgeries is expected to grow by 276% and 208% respectively by the year 2030. This is going to cost the Australian healthcare system ~$5.32 billion annually. Based on this study “if surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings.”
Unfortunately, surgery isn’t the only answer. In fact, 20% of people who undergo joint replacement surgery due to severe pain still report having severe pain 5 years after surgery. The joint replacement options are usually recommended for people who have undergone at least 12 weeks of non-surgical management (rehab) with limited to no success.
One of the most interesting approaches I’ve seen an orthopaedic surgeon take was to have a client go through a “mock surgery” by completing the post-surgical rehab process prior to having an actual operation. There’s no harm in this approach as you’ll be completing the rehab either way, but chances are you may not need the surgery after completing the full graded-exposure exercise rehab.
Myth Number 5: The More It Hurts, The Worse It is
Myth number 1 explained why we can’t rely on scan findings when it comes to explaining pain or level of functional impact. They just don’t correlate very well! Let’s look at a few other real-life examples of when the pain/damage level does not match up.
These are incredibly painful! Yet, they’re not life-threatening and the level of tissue damage is minimal and will heal within a couple of days most likely.
How many times have you first noticed a bruise in the mirror? Or had a partner pointed one out to you? A bruise is an obvious sign of tissue damage yet all too often we have no idea they’re even there or how we got it! They can be completely painless.
When you’ve been sunburnt, how incredibly painful is it when you need to have a shower or you feel your clothes rubbing across it? Whilst yes, sunburn is a sign of skin tissue damage, the clothes and water are not making the damage any worse, but the level of sensitivity and pain can still be very severe!
Action Steps: What To Do Now..?
Here are a few things we want you to keep in mind after reading this article:
- If you’ve been told you have arthritis on a scan, yet feel no pain or limitations in movement then ignore it and stop worrying! 97% of people show these sorts of things on completely normal, healthy joints.
- If you have painful, confirmed OA by diagnosis and find yourself avoiding all kinds of activity, it’s time to find yourself a health professional who will help you find ways to start getting active in a safe and tolerable way.
- Pain around your joints can be due to different things, not necessarily arthritis. If you’re experiencing pain it’s a good idea to see a health professional to get to the bottom of it.
- You should be trying to do everything possible before considering getting any form of joint replacement surgery (because they are no guarantee of success). If you haven’t committed and completed at least 3 months of rehab-based treatment then it shouldn’t be considered.
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Sources (For Those Interested…)
Horga, L.M., Hirschmann, A.C., Henckel, J. et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol 49, 1099–1107 (2020). https://doi.org/10.1007/s00256-020-03394-z
Culvenor, A. G., Øiestad, B. E., Hart, H. F., Stefanik, J. J., Guermazi, A., & Crossley, K. M. (2019). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British journal of sports medicine, 53(20), 1268–1278. https://doi.org/10.1136/bjsports-2018-099257
Heidari B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian journal of internal medicine, 2(2), 205–212.
Ackerman, I.N., Bohensky, M.A., Zomer, E. et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 20, 90 (2019). https://doi.org/10.1186/s12891-019-2411-9