Joint pain: an expert reveals the really effective remedy... not the one you think

Increasing joint pain is often seen as an inevitable consequence of aging. Difficulty bending over, difficulty moving around and limited movement are often the lot of the elderly. Yes, but not all.

Of course, physical capacities diminish with age, but age is not the explanatory factor; rather, it's something else, linked to the change in lifestyle habits associated with age and modern life. Which is why researchers say that the way we treat osteoarthritis is completely out of step with what the research clearly shows.

The best treatment

Osteoarthritis of the knee is not solved by a bottle of medicine, and rarely on an operating table. The most effective treatment requires some effort and costs very little: it's movement. Very few patients are guided towards the therapy recognized as effective in protecting their joints and reducing pain and discomfort.

A major European study (1) shows that less than 50% of people with osteoarthritis are offered exercise or physiotherapy by their primary medical resource. What's more, more than 60% of people who consult a doctor are offered a non-recommended treatment, and 40% are referred to a surgeon before a non-surgical option has even been tried.

Osteoarthritis is the most common arthritic condition, affecting almost 600 million people worldwide. According to the medical journal The Lancet (2), this number is set to approach one billion by 2050, due to a number of factors, including an ageing population, a more sedentary lifestyle and a worldwide trend towards overweight. So there's room for an effective solution.

Why movement?

Cartilage covers the contacting ends of our joints. It's a protective, resistant tissue, but it's not vascularized. No blood irrigates it, so it's the compression and expansion movements we make when we move that allow fluids to flow out and new nutrients to penetrate, as in a very rigid sponge.

The idea that cartilage wears out and doesn't renew itself is false. It can renew and repair itself, but only if it's active. It wears out, but it also repairs itself. Movement is therefore essential to its health and maintenance.

Osteoarthritis not only affects the cartilage, but also the bones, ligaments, surrounding muscles and even the nerves associated with the joint. So the recommended therapeutic exercises target all parts.

Muscle weakness is one of the earliest signs of osteoarthritis and facilitates its progression. It can be improved by resistance exercises.

Muscle (nerve) control can be improved by a program such as "Good Life with osteoArthritis: Denmark" (3), a physiotherapist-supervised program which not only demonstrates positive effects but also lasts, as it anchors exercise habits in participants. The effects not only strengthen cartilage and muscles, but also reduce inflammation, and limit the metabolic changes that accompany osteoarthritis.

Obesity is often associated with osteoarthritis; not only does it place an additional mechanical load on the joints, but it also causes high levels of inflammatory molecules in the blood, accelerating cartilage degradation (4). Regular physical activity can counter this degradation process in two ways: by limiting inflammation and cell damage, and by reducing excessive pressure on the joints in the medium term.

Exercise before surgery

Regular, specific physical activity helps to protect cartilage, strengthen joints as a whole and improve overall health. Before considering surgery, movement remains one of the most effective and least costly treatments.

• The more we move, the more our cartilage "breathes" and the less it degrades.
• The more we move, the stronger our muscles become, and with them our tendons and blood supply.
• The more we move, the lower the level of inflammatory molecules.
• The more we move, the less likely we are to put on weight.
• The more we move, the less our joints hurt, as cartilage gradually repairs itself.

It's all part of a virtuous circle that makes us want to keep moving, as the pain gradually subsides.

The idea of exercising when pain is part of everyday life indicates two things:

1. don't wait until osteoarthritis is too far advanced before changing your habits
2. ask for help and support to make gradual progress and avoid discouragement.

No drug cures osteoarthritis, and surgery can sometimes be the only solution in advanced cases, but it's a major operation and doesn't bring the hoped-for changes every time. It's better to trade pain for movement.

Illustration : Knee joint isolated - 2605167069

References

1- Guideline-based exercise management for hip and knee osteoarthritis: a cross-sectional comparison of healthcare professional and patient beliefs in Ireland
Toomey CM, Bhardwaj A, Browne J, Dowling I, Grealis S, Hayes P, Higgins N, Maguire D, O'Hora J, Rector J, Wood-Thornsbury A, Kennedy N. / BMJ Open. 2024
https://pmc.ncbi.nlm.nih.gov/articles/PMC11227783/

2- Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021 / The Lancet
https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00163-7/fulltext

3- Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide / Søren T. Skou and Ewa M. Roos
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1439-y

4- Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management / Rheum Dis Clin North Am
https://pmc.ncbi.nlm.nih.gov/articles/PMC2596954/

Osteoarthritis as a Whole Joint Disease / A Robin Poole
https://pmc.ncbi.nlm.nih.gov/articles/PMC3295952/

Do you have knee pain from osteoarthritis? You might not need surgery. Here's what to try instead / Belinda Lawford, Giovanni E. Ferreira, Joshua Zadro, Rana Hinman
https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779

The Best Medicine For Joint Pain Isn't What You Think, Expert Says
https://www.sciencealert.com/the-best-medicine-for-joint-pain-isnt-what-you-think-expert-says