Osteoarthritis: Pain, or Opportunity?

Saturday, May 22, 2021 - 13:00
low back pain, chronic pain, fibromyalgia, arthritis, health problems, knee pain, seniors, autoimmune

As an Ontario Registered Social Worker, ACE-Certified Health Coach, ACE-Certified Medical Exercise Specialist, ACE-Certified Personal Trainer, and an AAHFRP-Certified Post Rehabilitation Conditioning Specialist, and as a Subject Matter Expert (SME) for the American Council on Exercise, I help my clients define what their goals are. Goals are related to physical wellness, mental health, stress management, sleep problems, functionality in activities of daily living, and chronic pain/pain management.  I will help you feel better!

Using coaching techniques, counselling/psychotherapy strategies, and a wealth of knowledge, I help move you where you find yourself in the present, to where you wish to be in the future. Over the past 25 years, I have created a unique practice that combines registered social work, health coaching, medical exercise, and personal training. I am fascinated by the intersection of physical and mental health, and have been a pioneer in bridging the gap between these two realms.  I enable my clients to achieve successes they did not think possible.  I am based in Toronto, and work with clients locally as well as throughout Canada. Sessions happen in person, or virtually via FaceTime, Zoom or Skype.

Arthritis is accepted by most people as an inevitable consequence of the aging process.  With the remarkable improvements in health care, nutrition, and hygiene that have occurred in the last seventy years, people in first world countries are living longer than ever before.  This means that conditions which develop insidiously over a long life span, like arthritis and joint degeneration, were not seen on a large scale until recent years. Modern-day public health successes have lead to an epidemic of pain in middle-aged and older adults.

The incidence of osteoarthritis of the knee has also been influenced by participation in sports, as this condition often develops secondary to traumatic injuries such as ligament tears.  The proliferation of young women in the 1980s in injury-producing sports which were previously not widely available to females, such as basketball, soccer, softball, volleyball, and distance running, led to a dramatic increase in the number of women in the early 2000s being diagnosed with knee osteoarthritis. Osteoarthritis results from a degeneration of fluid inside joints, called synovial fluid, which acts a lubricant for the moving parts of joint, called articulating surfaces.  Synovial fluid plays much the same role in your joints that oil does in a car engine.  When this fluid decreases in quality and quantity, the articular cartilage which covers bones degenerates.  Cartilage does not contain pain receptors, and for this reason protects the bones inside joints.  When cartilage wears away, surfaces of bones – which contain pain receptors - begin to rub together.  This leads to a wearing away of these surfaces, creating pain and loss of mobility.

Some people are more likely to develop osteoarthritis than others.  Risk factors include:

  • Being overweight.  Being overweight leads to excessive force on the articular cartilage, specifically of the knee and hip.
  • Altered gait.  This leads to asymmetrical loading of joints, which increases the risk of joint degeration. Arthritis in one joint (eg, hip) can lead to altered gait patterns that cause excessive wear-and-tear on the knee(s).
  • Structural factors such as being bow-legged (varus) or knock-kneed (valgus).  Exercises to correct muscular imbalances that occur due to these factors can be highly beneficial.
  • Surgery on a joint involved in the exercise program.  The initial injury requiring surgical intervention in the vast majority of cases alters the structural integrity of the joint.  In addition, it used to be common for surgery to be performed on the knee for certain conditions that are best treated conservatively – in these cases, the surgery itself can be a catalyst the ensuing degeneration. More recent resears suggests that many orthopaedic surgeries are uncessary and actually lead to worse outcomes over time.
  • Discomfort and/or tightness the day following physical activity.  The breakdown of cartilage leads to the release of chemicals that irritate the synovial cells.  This leads to an increased production of synovial fluid that causes tightness, discomfort and sometimes swelling 10-14 hours after the offending activity.  This is called chemical synovitis, and is a main cause of the progression of osteoarthritis.
  • Risky exercises.  Full knee extension in a seated position puts tremendous pressure on the underside the patella (kneecap) and is to be avoided.  Deep squats are also a bad idea for the same reason. Any exercise performed without good alignment can lead to problems later on.

Exercise Specialist Recommendations: 

  • People with osteoarthritis usually self-limit their physical activity.  This is a mistake, because an appropriately designed exercise program can halt the progression of the condition, as well as restore function and mobility.  Moreover, limiting physical activity leads to the development of secondary problems such as cardiovascular disease, diabetes and hypertension.  Studies have demonstrated quite conclusively that a regular exercise program that involves cardiovascular exercise, strength training, and stretching, can create marked improvements in functional capacity, pain, and disability.
  • Get professional guidance!  I don’t usually begin a list of recommendations with this one, but in the case of osteoarthritis it is critical that an exercise program is designed properly to avoid further joint damage.  This can be a physiotherapist, chiropractor, or exercise specialist who has experience treating your specific condition.
  • Strengthen the lower body.  Restoring strength to the muscles that stabilize the hip and knee will remove pressure by providing stabilization so that the joint can function properly.  Excessive movement within a joint is usually caused directly by weakness in the surrounding muscles.  While the best case scenario is to maintain a high degree of strength through out the lifespan, thus avoiding the excessive movement that wears down joints, benefits can still be had later in the process of degeneration.
  • Do an extended warm up.  A long warm up – 10 minutes – of low level cardiovascular activity will ensure joint lubrication and increased elasticity of tissues.
  • Split up exercise sessions into smaller segments.  Multiple, shorter sessions per day may reduce joint pain.  As fitness level increases, longer sessions can be incorporated.
  • Try swimming or aqua-therapy.  Exercising in the water may be the best option for individuals who cannot tolerate land-based activities. Bear in mind that maintaining good alignment can be difficult in the water, so water-based exercise is not always a panacea.
  • Think of the future!  Doing risky exercises may not cause pain now, but may later on.  Deep squats and certain repeated overhead motions can compromise your joints in the future. Bear this in mind if you are in your 20s - don't perform exercises in a manner that will cause you issues in middle age.

The most important advice I can offer is to commit to prevention.  Staying strong and flexible throughout the lifespan results in fewer problems as we age!