In this article I intend to give a series of tips and recommendations and help solve some questions and doubts related to joint osteoarthritis, offering quality information and proven solutions to prevent and/or improve osteoarthritis. But, let us start at the beginning.
What is joint osteoarthritis and what are its causes?
Osteoarthritis is a degenerative pathology of the bones that begins with the gradual destruction or loss of articular cartilage, and that affects not only the cartilaginous joint surface but also the entire joint complex, ligaments, meniscus tendons.
Many of the recommendations that I give in this article can be used for joint osteoarthritis regardless of where it occurs, and although osteoarthritis can appear in different joints of the body, in this article I will focus on osteoarthritis of the knee and hip. Since, together with trapezio-metacarpal interphalangeal osteoarthritis, (joints of the hand) they constitute the vast majority of joint osteoarthritis suffered by the human being.
The function of articular cartilage is to cushion the forces at the ends of the bones and, as it is a material with a low coefficient of friction, it also allows the bones to move relative to each other, reducing wear on the joint.
But when the articular cartilage degenerates for different reasons, the friction between the ends of the bones increases, increasing the friction forces and starting the degeneration of the different structures of the joint. In more advanced cases, small pieces of cartilage are detached, which increases rubbing and friction, the menisci degenerate and all the peri-articular components are affected, such as the capsular joint muscles and tendons.
Sedentary lifestyle + overweight + lack of muscle strength-tone + lack of elasticity + mechanical-functional imbalance + metabolic imbalance = predisposition to joint osteoarthritis.
Among its main causes we can find the following:
- Obesity or weight gain: Fundamentally harmful when we are talking about osteoarthritis of the knee or hip.
- Sedentary life or lack of moderate-regular physical activity: Maintaining an active and dynamic life is possibly one of the most important factors to prevent joint osteoarthritis.
- Regular, moderate and non-aggressive physical activity from the point of view of the joints is indicated (in the context of a person over 50 years of age: swimming, cycling, elliptical trainer, easy running according to tolerance, adapted pilates yoga). physical therapy prevent joint osteoarthritis as it helps maintain a correct metabolic balance, increases growth factors and tissue regeneration, improves nutrient absorption, maintains adequate muscle tone (which improves muscle coverage), increases the pain threshold
- Lack of tone in the muscles: It would be a consequence of all of the above, the lack of correct muscle coverage makes the joint bear more load and weight and therefore deteriorate faster, producing osteoarthritis.
- Poor diet or nutritional imbalances: It is one of the key factors to understand the appearance of osteoarthritis in relatively young people (it develops later)
- Age: Like almost all diseases, the older you are, the more predisposed you are to suffer from joint osteoarthritis.
- Sex: As a general rule, women tend to have a greater predisposition to suffer from different types of joint osteoarthritis due to genetic and hormonal reasons.
- Trauma factors: Any major trauma resulting from an accident or fall that affects a joint and alters its normal mechanics can predispose said joint to more likely to suffer from osteoarthritis in the future. It must be differentiated from factors of the “repetitive micro-trauma” type that can occur in excessively repetitive activities of daily living, related to work and sports (performing certain sports in an excessive way such as competitive cycling, gymnastics rhythmic.)
- Postural alterations: Alterations in our biomechanics cause loads to be distributed incorrectly, and alterations in the alignment of the joint produce osteoarthritis, since it favors pressure in certain areas of the joint.
- Forced and maintained postures: These are some postures or repeated activities in joint positions that are excessively forced, which exert a very important pressure to suffer from osteoarthritis, an example may be the squatting position maintained related to specific work activities.
- Genetic factors: As in all diseases, there is always a genetic and/or hereditary component that makes you more susceptible to suffering from a disease.
Osteoarthritis is an affectation of the entire joint complex of the knee, therefore, it does not affect only and only the articular cartilage, it affects all the components of the joint, muscles, tendons, ligaments, menisci, joint capsule being able to reach become an osteoarthrosis etc.
Is the level of osteoarthritis equivalent to its severity?
Joint damage on x-rays does not indicate how much pain you should have. The person who has osteoarthritis, therefore, is not the only indicator that must be taken when assessing this joint disease globally. Knowing this is very important because on many occasions the pain is related to the associated periarticular elements such as tendons, (tendinopathies) tension, shortening or contracture of the related muscles and that gives mobility and coverage to said joint, ligamentous irritation of the joint in addition to the deterioration of the cartilage itself.
Knowing this is especially important, because they are a structure on which multiple therapeutic actions can be carried out by the physiotherapist and have a greater potential for regeneration than articular cartilage.
Osteoarthritis: can it be avoided?
The symptomatology and deterioration in the patient’s quality of life can vary considerably from person to person. As I have said before, sometimes significant deterioration is observed at the radiological level without significant or disabling pain. As we know, each person has a different tolerance to pain and a variable threshold for pain.
Osteoarthritis is not something inevitable, something inherent or linked to age (you can be older without necessarily suffering from osteoarthritis, and being relatively young and suffering from it)
- Osteoarthritis symptoms can improve significantly with appropriate physiotherapeutic and comprehensive treatment.
- Maintaining toned muscle coverage can prevent the onset of osteoarthritis.
Stages or phases of osteoarthritis
The stages or phases in which osteoarthritis evolves and through which it passes are the following:
Loss of flexibility of the joint cartilage, in this phase there is a decrease in the thickness of the joint cartilage.
The wear of the cartilage will generate changes in the underlying bone. Areas of bone or cartilage widening may appear.
Release of small pieces of bone or cartilage that will float in the synovial fluid, (intra-articular mouse) being able to block the joint and circumvent the integrity of the cartilage, accelerating joint wear.
he joint capsule becomes inflamed, thus the increase in inflammatory cells and substances increases the process of bone disintegration, in this phase peri-articular ligamentous and tendon muscle involvement is also observed.
Bone destruction is accompanied by the following symptoms:
- Pain: Mainly it is an inflammatory pain generated by arthritis that accompanies osteoarthritis. It can be a diffuse pain throughout the joint but also a more specific pain in a specific point or area.
- Stiffness of the affected joint: The inflammation and destruction of the tissues will produce stiffness, especially morning stiffness and when the joint is cold after a period of rest.
- Loss of mobility in the joint: Produced by the destruction of tissues, by the formation of and by the release of particles in the joint space.
- Functional Impotence: Functional impotence is determined by the degree of involvement and by the affected joint, in each case of the knee the most common is going up-down stairs, pain when getting up after being a long time sitting-lying down, pain when being sitting with knees bent, pain at night.
Differences between osteoarthritis and arthritis
Many people do not know the differences between arthritis and osteoarthritis and what their main differences are. Basically, arthritis is an inflammation of the joint for any reason, overuse, trauma, infection, auto-immune osteoarthritis, on the other hand, is the degenerated state of the joint for various reasons, therefore osteoarthritis is always preceded by recurrent episodes of arthritis or joint inflammation.
Treatment and advice for joint osteoarthritis. What I can do…?
On many occasions, joint wear or osteoarthritis is spoken of as a degenerative and irreversible type of cartilage injury, for which little can be done. Many patients ask us what they can do to reduce their discomfort and how to avoid the progression of this common disease. From my point of view there are five major factors that can improve and prevent the osteoarthritic process;
- Physical exercise guidelines adapted and specific to each person.
- Avoid joint overloads and forced positions.
- Control body weight, being overweight is going to be a factor that can increase the signs and symptoms.
- A correct and specific diet for this type of ailment.
- Specific physiotherapy based on manual therapy and flexibility exercises.
What exercises can I do to improve osteoarthritis?
As for physical exercise, it is often said that it can be counterproductive because it can increase cartilage wear. In my opinion, this important issue needs to be clarified.
Obviously, if the state of joint degeneration has exceeded a limit, that is, a turning point has been exceeded in which the joint already hurts every time one moves, in that case we cannot perform moderate physical exercise such as convenient (walking, specific exercises in gymnastics) In these cases, other types of less aggressive exercises are more indicated, such as cycling, especially in the case of knee osteoarthritis, swimming;
In any case, physical exercise is always a good ally to prevent and improve joint osteoarthritis, since it stimulates metabolic processes of bone regeneration and strengthening, improves muscle tone, increases the volume and capacity of our tendons, and ultimately makes us lose weight. our joints have to bear less mechanical load.
There is also a wide range of specific exercises for each joint and depending on the degree of involvement. These exercises should be guided by a physical therapist to selectively enhance different types of muscle groups.
After light physical exercises, it is time to apply cold / cryotherapy to the joint, especially in case inflammation appears after physical activity.
Pharmacology: Is it good to take medication for osteoarthritis? Which?
If you have to take analgesic or anti-inflammatory medication, it is important to know that it is not convenient to take anti-inflammatory medications such as NSAIDs (Ibuprofen) systematically for a long time. This type of medication is indicated to avoid pain in the acute phases of the disease (phases of inflammation or arthritis) where it is difficult to rest and can help us get out of the vicious circle of pain-immobility-stiffness-atrophy-pain. However, they are not a good alternative to long-term medication and should be done responsibly.
However, in the event that we have to use a long-term analgesic drug to deal with the painful symptoms, the preferable option is Paracetamol, although among many people it may have a reputation for being a relatively mild analgesic, in many times it is the best option since it has fewer side effects.
Surgery and arthroscopy in osteoarthritis: When to opt for surgery?
It is important that you are well informed when making the decision to have surgery or not and what your options are:
Arthroscopy or joint “washes”
Arthroscopy or joint lavage for osteoarthritis is a surgical procedure that is performed relatively frequently to try to eliminate a patient’s pain if it persists after undergoing other conservative treatments. It is a surgical intervention where physiological serum is introduced to clean the synovial fluid of impurities in addition to actions associated with it to eliminate damaged structures such as the menisci (meniscectomy) or reconstruction of damaged ligaments. These interventions can be the preamble or the prelude to a much more invasive intervention such as the replacement of the joint with a prosthesis.
Taking into account my experience, bibliography in this regard and different types of studies that confirm it, arthroscopy that is aimed at trying to eliminate the painful condition without there being other symptoms such as joint block or instability due to ligamentous rupture, do not usually have good results, and may until the pain worsens.
However, it is usual that in addition to pain there is a time of joint blockage due to involvement of the meniscus or intra-articular mouse (a piece of meniscus and another “floats” inside the joint and is arranged in the inter-articular line and blocks the joint) in In these cases, arthroscopy is performed to remove the affected meniscus or structure that blocks the joint or to restore the integrity of a damaged ligament, and therefore has very good results.
Joint replacement for a knee or hip prosthesis
There are different surgical alternatives to alleviate the consequences of joint osteoarthritis, especially used in cases of hip and knee osteoarthritis, are joint prostheses that partially or totally replace the joint.
When should I decide to have surgery and put on a prosthesis?
In general terms, it is important to emphasize that pain and impact on quality of life is the most important factor in making the decision to opt for surgery based on the replacement of the joint for a total or partial knee/hip prosthesis (the most common)
The symptoms of osteoarthritis can improve a lot without the need for surgery, so before making that decision, I recommend that you do everything possible to reverse this situation with the indications that I comment on in this article and with the advice of a specialist physiotherapist.
It must be taken into account that, on many occasions when suffering from osteoarthritis, there may be structures such as the muscles, tendons and ligaments that surround the joint that are partially responsible for the patient’s pain and that can be successfully addressed directly by the physiotherapist with massage, electrotherapy, specific stretching, selective and progressive potentiation.
Finally, if you do not get pain relief and you have carried out all the indications and recommendations, it will clearly be a failure of the conservative treatment for osteoarthritis. If pain and disability make it very difficult for you to carry out your activities of daily living (ADL), it forces you to self-medicate and consequently lose health and quality of life, the most appropriate thing to do is to opt for the surgical option. joint replacement for one of a prosthesis that replaces the cartilage (the most common knee and hip prostheses)
This aspect should be assessed by the specialist and by the person suffering from the disease.
Food to prevent or improve in case of joint osteoarthritis
To improve the health of our bones and joints, foods such as raw nuts (especially walnuts), fish and legumes are recommended. Today we have much healthier alternatives than conventional animal milk such as soy milk or juice, rice, oatmeal, or almonds. Alternating the consumption of these 4 vegetable products together with a balanced diet is for me the best alternative to animal milk.
In addition to this, legumes have a high content of calcium and phosphorus, and above all, they provide a calcium that is absorbed more efficiently than that from animal milk, minerals such as potassium and magnesium are also important, which are very abundant in fruits like plantain and banana.
Is animal milk and dairy products really good for our bones? What is true about it?
Some health professionals, as well as the media, recommend us to consume milk of animal origin, since it provides us with calcium and has a high nutritional value. But, on the other hand, there is more and more talk about lactose -free milk, casein -free milk, skimmed milk in relation to this, I want to share some advice and some reflections to try to shed light on this issue in relation to osteoarthritis, and thus be able to contribute to improving and prolonging the life of our bones and joints.
Milk is a product with high nutritional value, but on the other hand, it contains many substances that can cause irritation or food intolerances, we must bear in mind that we are the only living being that regularly consumes milk from another animal, it is a food that on an evolutionary scale it has been introduced into the human diet very recently , and we are still in a process of genetic and evolutionary adaptation, which is why there are certain societies (more intolerant in Eastern societies since it was introduced even later) and within them certain people who tolerate this product differently.
Therefore, animal milk is a food that may not be well absorbed by our digestive system (the best known is called lactose intolerance) but in addition to lactose, animal milk contains many other proteins that, due to their origin, are foreign
For this reason, our digestive system not only does NOT absorb them correctly, but in certain types of more susceptible people, it can be identified as an external aggressor agent and generate food intolerances, for all these reasons, the long-term consumption of milk in certain people It does NOT benefit your bone health but can acidify your metabolism and over time demineralize your bones.
For people who tolerate this food correctly, it can be a good option if consumed in moderation. People who are intolerant know it immediately since, as the word itself says, they do not “tolerate” this food and immediately after eating it they feel the symptoms of stomach and intestinal discomfort, however, for all those people who have a small intolerance or intestinal irritability and who consume milk on a daily basis and in large quantities, it is not recommended to consume this product.
Finally, it is important to highlight that hip and knee prostheses have a certain useful life (they vary according to the type and according to each case, but they are usually around 10-15 years) since once the useful life time has elapsed, it is necessary to intervene again to replace a second prosthesis. Therefore, this option must be carefully evaluated in people between 40-60 years of age.