Unpacking Osteoarthritis, a prevalent yet often misunderstood joint pain condition affecting millions worldwide.
Unpacking Osteoarthritis, a prevalent yet often misunderstood joint pain condition affecting millions worldwide.
Get-Fit Guy is hosted by Kevin Don. A transcript is available at Simplecast.
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Hi and welcome back to Get Fit Guy, Kevin Don here. This week I want to chat a bit about joint health. It is not a surprise that everyone who listens to my show intentionally is a human and that humans are mortal. Therefore, it is reasonable to assume that the listeners would like to figure out ways to extend the quality of the time we spend alive. One of the most common emails I receive, that isn’t a hate mail is people asking about osteoarthritis.
So let’s have a chat (also known to some listeners as a lecture) about that this week. Osteoarthritis is a Greek word (apologies to listeners that don’t like foreign words-such a pedant) and means inflammation of the bones and joints. It beats out things like bursitis and gout to take top spot as the most common joint condition globally. Inside our joints, we have a cushioned layer of cartilage and osteoarthritis occurs when this layer is worn out faster than we can repair it. There is also an inflammatory aspect to the condition. In the United States, 40% of adult males and 47% of adult females will develop it and the average age of diagnosis is 55.
So, what can we do about it? As someone who, in his 30’s, was already showing signs of osteoarthritis in scans in my left hip socket, I can assure you that it is painful and frustrating and that looking for pain relief is something I spend a bit of time on. Now, in the U.S. the first line treatment for this is Tylenol, or acetaminophen. I have never found this to work for me (although if you listen to this podcast, you will know that anecdotal evidence can get in the bin). The studies show that it is more effective than placebo, but, unfortunately, this was not at a level found to be clinically significant. In fact, on a scale of 0-100, Tylenol only scored 3 points higher than a sugar pill. Clinical significance starts at a 10 point gap. So, if a straight up analgesic doesn’t work (sorry, there I go with the Greek words again) and we know that osteoarthritis is inflammatory, what about an anti-inflammatory like ibuprofen (Advil)? Well, because they are really bad for you. Up to 30% of users develop stomach ulcers and they increase the risk of a cardiac event to the point of an extra heart attack per 200 users a year. Scary stuff. So, given this information, would you really keep at it with the pill popping for pain relief? I should note here that topical gels have similar efficacy to oral anti-inflammatories and do not have the same kind of absorption in the system. Therefore, they do not increase the incidence of stomach issues or cardiovascular issues more than placebo.
What about injections? I have had some corticosteroid injections in my knee for pain from tendon damage from too many kicks in martial arts. This does not mean, by the way, that martial arts cause knee issues, just that I developed a knee issue myself. Saying otherwise would be an inductive argument. I did find that I had significant pain relief for about 10 weeks and then I needed surgery. These injections increase the deterioration and in fact, you can only have 3 injections into a body part in a year because of the tissue damage.
So, with pills and injections out the window, most people seem to end up with some surgery. Now, the question here is: if you had really bad pain, would you go see your local faith healer or voodoo priest? If the answer is no, then perhaps you would avoid arthroscopic surgery also. The reason I say this is that in a 2013 study, 146 patients were randomised into 2 groups: one that received arthroscopic surgery and one that had their knee cut open and a surgeon ‘pretend’ to do surgery. I won’t get into the ethical considerations here, because I know at least one listener who would rather stick toothpicks under his nails than hear me talk about philosophy again. But anyway, the fake surgery patients recovered and showed the same improvements that the patients who had a real procedure did. Just before anyone emails me in to say their surgery worked. I’m not saying it doesn’t. It just doesn’t work better than a surgeon pretending to give you surgery.
So, we have covered pharmaceutical stuff, but what about things you could do yourself at home? Like losing weight, or doing some movement or changing your diet? Studies conducted on twins showed that some of the osteoarthritis risk is genetic, but there are other things we can do to mitigate non-genetic risk. Probably a reduction in obesity levels and lowering overall of BMI could be the biggest, most impactful thing you could do. This correlates nicely (although please remember that correlation is not causation) with the fact that hunter gatherers, both contemporary and those we have examined skeletal remains of, show up to 5 times less incidence of osteoarthritis than more modern, sedentary lifestyles account for. Knee osteoarthritis is 3 times less prevalent in people with a BMI of under 25. I would like to note here that this won’t be a full picture. My BMI is 28.4, so I am overweight, but also I am not sure anyone would say I was carrying significant body fat, so we do need to look at body composition and whether or not it was circumference also. Because the reverse is also true that being overweight due to muscle mass does not also mean you are healthy, although muscle and bone density skew BMI somewhat. As I have said before, this is a 10-15 minute podcast. It’s not called lengthy and boring tips, it’s called quick and dirty tips, therefore I simply cannot cover all the nuance. So, let’s just leave it at: losing weight and reducing BMI will have a positive impact on osteoarthritis.
Which brings me to exercise. Well, studies on the efficacy of movement and exercise for pain management in patients with osteoarthritis have been so conclusive, that future studies have been deemed pointless. Pretty watertight and of significant weight as evidence that is. You may have heard me mention two weeks ago in the episode about 10,000 steps, that intensity there makes a big difference. I would note that in terms of osteoarthritis results, that intensity did not make any difference. What did was dose frequency. Exercise performed at least 3 times a week showed greater efficacy than training less than that. As I have said before, ‘use it or lose it’. And it appears that regular exercise will indeed be more useful than irregular. I’d have said most people could have worked that out though.
Because I will be asked, I will note that the best way to get your joints moving is to move them. Someone emailed me to say that walking was great for joint health. Really? If you can explain to me how walking is good for your shoulder joints or wrists, I’m all ears. Remember that we have a couple of universally indisputable rules with training, one being the SAID principle (Specific Adaptation to Imposed Demand). If you don’t ever take your elbows through as close to a full range as you possibly can, then what do you think will be the effect on your elbows? The body doesn’t work like an item, in the sense that you don’t put your elbows in the cupboard and don’t use them and bring them out 70 years later and they are brand new. Nope. So, make sure that you take your joints through a controlled range and make sure you Involve loaded movement. Sometimes it must be like groundhog day for listeners, but I can’t change the rules just to keep the podcast exciting.
In a couple of weeks time, I will cover CARS, or Controlled Articular Rotations and how these can help joint health, so make sure you stay tuned in. As always, thank you for listening and send any fun emails to me at getfitguy@quickanddirtytips.com and you too can be denounced on the show. That’s a joke, I will only do that if I don’t like the email.
Get-Fit Guy is a Quick and Dirty Tips podcast. Thanks to the team at Quick and Dirty Tips Morgan Christianson, Holly Hutchings, the director of podcasts Brannan Goetschius, and Davina Tomlin. I’m your host, Kevin Don. If you have a question for me, leave me a voicemail at 510-353-3104 or send me an email at
getfitguy@quickanddirtytips.com
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