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Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">updated treatment guidelines</a> from the Australian Commission on Safety and Quality in Health Care. So what is knee osteoarthritis and what are the best ways to manage it? <h2>More than 2 million Australians have osteoarthritis</h2> Osteoarthritis is the most common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. It <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">costs the economy</a> A$4.3 billion each year. Osteoarthritis commonly <a href="https://pubmed.ncbi.nlm.nih.gov/33560326/">affects</a> the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles. Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs. <h2>Is it caused by ‘wear and tear’?</h2> Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is <a href="https://pubmed.ncbi.nlm.nih.gov/31192807/">not caused by</a> “wear and tear”. <a href="https://pubmed.ncbi.nlm.nih.gov/21281726/">Research shows</a> the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">not required</a> to diagnose knee osteoarthritis or guide treatment decisions. Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have <a href="https://pubmed.ncbi.nlm.nih.gov/37795555/">shown this</a> in people with osteoarthritis, and other common pain conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545091/">back</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/33789444/">shoulder</a> pain. This has led to a global call for a <a href="https://pubmed.ncbi.nlm.nih.gov/38354847/">change in the way</a> we think and communicate about osteoarthritis. <h2>What’s the best way to manage osteoarthritis?</h2> Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">include</a> education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines. Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms. Health professionals who use positive and reassuring language <a href="https://pubmed.ncbi.nlm.nih.gov/35750241/">can improve</a> people’s knowledge and beliefs about osteoarthritis and its management. Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/36593092/">paracetamol and anti-inflammatories</a> and can <a href="https://pubmed.ncbi.nlm.nih.gov/26488691/">prevent or delay</a> the need for joint replacement surgery in the future. Many types of exercise <a href="https://pubmed.ncbi.nlm.nih.gov/30830561/">are effective</a> for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you. Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time. Weight management is important for those who are overweight or obese. Weight loss <a href="https://pubmed.ncbi.nlm.nih.gov/34843383/">can reduce knee pain and disability</a>, particularly when combined with exercise. Losing as little as 5–10% of your body weight <a href="https://pubmed.ncbi.nlm.nih.gov/36474793/">can be beneficial</a>. Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. <a href="https://pubmed.ncbi.nlm.nih.gov/33786837/">Recommended medicines</a> include paracetamol and non-steroidal anti-inflammatory drugs. Opioids are <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">not recommended</a>. The risk of harm outweighs any potential benefits. <h2>What about surgery?</h2> People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement. Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain. However, high-quality research <a href="https://pubmed.ncbi.nlm.nih.gov/24369076/">has shown</a> arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis. Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">53,500 Australians</a> had a knee replacement for their osteoarthritis. Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management. The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments. <h2>I have knee osteoarthritis. What should I do?</h2> The <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> links to free evidence-based resources to support people with osteoarthritis. These include: <ul> <li>education, such as a <a href="https://www.england.nhs.uk/wp-content/uploads/2023/07/making-a-decision-about-knee-osteoarthritis-v1.pdf.pdf">decision aid</a> and <a href="http://www.futurelearn.com/courses/taking-control-hip-and-knee-osteoarthritis">four-week online course</a></li> <li>self-directed <a href="https://healthsciences.unimelb.edu.au/departments/physiotherapy/chesm/patient-resources/my-knee-exercise">online exercise</a> and <a href="https://myjointyoga.com.au/">yoga</a> programs</li> <li><a href="https://www.gethealthynsw.com.au/program/standard-coaching/">weight management support</a></li> <li>pain management strategies, such as <a href="https://www.myjointpain.org.au/">MyJointPain</a> and <a href="http://www.paintrainer.org/">painTRAINER</a>.</li> </ul> If you have osteoarthritis, you can use the <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> to inform discussions with your health-care provider, and to make informed decisions about your care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236779/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, Postdoctoral research fellow in physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, Professor in Physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">original article</a>. </div>

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A bee-autiful new solution for osteoarthritis relief

Living with osteoarthritis can be a daily struggle, marked by pain, stiffness and limited mobility. For the millions of Australians affected each year, finding an effective and safe treatment is crucial – especially one without the unpleasant side effects so common to conventional treatments. That’s where <a href="https://www.raydel.com.au/shop" target="_blank" rel="noopener">Abexol</a> steps in: a new, naturally derived solution that is making waves in the health community thanks to a very surprising ingredient: Beeswax alcohols! Abexol was originally discovered during a study into gastrointestinal issues. Participants in the study not only experienced relief from stomach issues, but also noticed a marked decrease in joint pain. It was this lucky discovery that led researchers to explore Abexol’s dual benefits for joint and gastrointestinal health. <h2>The bee-nefits of Abexol</h2> Recently registered with the Therapeutic Goods Administration (TGA), Abexol is poised to revolutionise the way we approach osteoarthritis management. That’s because traditional treatments often come with a host of gastrointestinal side effects, including nausea, diarrhoea, heartburn and gastritis just to name a few. Abexol, on the other hand, offers a unique solution by protecting the gastrointestinal tract and improving gut health, all while addressing joint pain at the same time – making it a truly holistic approach to such a widespread issue among Aussie seniors. It’s worth noting that a lot of traditional osteoarthritis treatments are also fish-based, such as glucosamine, chondroitin, or fish oils. For people with fish allergies, this is obviously a huge problem. Abexol provides a safe, non-fish-derived alternative, effectively managing arthritis pain and inflammation without the risk of allergic reactions. Abexol is also rich in powerful antioxidants that shield the body’s cells from damage caused by free radicals. These harmful molecules can arise from normal metabolic processes or external sources like pollution and smoking. By neutralising free radicals, antioxidants help reduce the risk of developing chronic diseases. <img src="https://oversixtydev.blob.core.windows.net/media/2024/07/RAYDEL-Abexol2_1280.jpg" alt="" width="1280" height="716" /> Abexol’s high bioavailability also ensures that the body can absorb it without issue. As the only beeswax-alcohols-based product registered by the TGA for treating mild arthritis and osteoarthritis while supporting stomach health, Abexol could well be the game-changer you have been searching for. According to Sarah Munnik, the Australian Market Access and Development Manager of Abexol, “Beeswax and derivatives of beeswax have been known to have great medicinal benefits, and have been used for hundreds of years across continents such as Africa, South America and Asia. “Ninety per-cent of our customers that have tried Abexol have loved it and have found that it’s either really helped to improve their joint pain and stiffness or supported their digestion and relieved gastric discomfort.” Abexol’s natural composition, lack of side effects and additional gastroprotective benefits clearly make it a standout choice. So embrace the future of osteoarthritis management with Abexol and get ready to step into a life of greater comfort and freedom. For more information, head to <a href="https://www.raydel.com.au/shop" target="_blank" rel="noopener">https://www.raydel.com.au/shop</a> – and don’t forget to take advantage of our special Over60 offer by entering the discount code Over60 for 15% off your purchase! Images: Shutterstock | Supplied This is a sponsored article produced in partnership with Raydel.

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Researchers puzzled by results of anti-inflammatory medications for osteoarthritis

Researchers in the US are calling for a re-evaluation of the way some well known painkillers are prescribed after research showed they may actually lead to a worsening of inflammation over time in osteoarthritis-affected knee joints. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and naproxen are designed to reduce inflammation for the estimated 2.2 million Australians suffering from the sometimes debilitating effects of osteoarthritis. Osteoarthritis is a degenerative condition affecting joints in the body – most commonly hips, knees, ankles, spine and hands – which results from the degradation of cartilage on the ends of bones within the joints. As the cartilage wears away, the bones rub together resulting in swelling, pain and restricted movement. To combat this pain and swelling, NSAIDs are commonly prescribed, however the long-term impact of this type of medication is unclear, including its effect on the progression of the condition. “To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis,” said the study’s lead author, Johanna Luitjens, from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “NSAIDs are frequently used to treat pain, but it is still an open discussion of how NSAID use influences outcomes for osteoarthritis patients. Surprisingly the report says: “…the impact of NSAIDs on synovitis, or the inflammation of the membrane lining the joint, has never been analysed using MRI-based structural biomarkers.” The study compared 793 participants with moderate to severe osteoarthritis of the knee who did not use NSAIDs, with 277 patients who received sustained treatment with NSAIDs for more than a year. Each patient underwent Magnetic Resonance Imaging (MRI) scans of the joint, which were then repeated after four years. The researchers were able to assess the images for indications of inflammation and arthritis progression including cartilage thickness and composition. The data showed the group using NSAIDs, had worse joint inflammation and cartilage quality than those not using NSAIDs, at the time of the initial MRI scan. And the follow-up imaging showed the conditions had worsened for the NSAID group. “In this large group of participants, we were able to show that there were no protective mechanisms from NSAIDs in reducing inflammation or slowing down progression of osteoarthritis of the knee joint,” said Luitjens. According to Luitjens, the common practice of prescribing NSAIDs for osteoarthritis should be revisited as there doesn’t appear to be any evidence they have a positive impact on joint inflammation nor do they slow or prevent synovitis or degenerative changes in the joint. There is also a possibility that NSAIDs simply mask the pain. Despite adjusting the study’s model for individual levels of patient physical activity, “patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis,” said Luitjens. Luitjens hopes future studies will better characterise NSAIDs and their impact on osteoarthritic inflammation. With one in three people over the age of 75 in Australia suffering from osteoarthritis and an estimated one in 10 women and one in 16 men set to develop it in the future, unlocking treatment options for this crippling condition is an imperative. This article originally appeared on <a href="https://cosmosmagazine.com/science/osteoarthritis-puzzled-antiinflammatory/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Clare Kenyon. Image: Shutterstock

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Exercise and knee osteoarthritis: helpful or harmful?

Dr Christian Barton is a physiotherapist and researcher based in Melbourne. Many of the patients I see have been given bad advice that makes their pain worse, not better. Helen, an accountant, is a perfect example. My heart sunk as Helen told me her story a year ago. Two years earlier, she had fallen at work and fractured her knee cap. After two months in a splint, the knee cap had healed. Helen attempted to start exercising again, but the knee still hurt. An MRI requested by a specialist diagnosed Helen with knee osteoarthritis. Doctors and specialists told her painful exercise would damage her knee more – she needed to be careful. Within a couple of years Helen would need a joint replacement. Helen now did very little physical activity, had gained 12kg, and was depressed. Before the injury, she would regularly paddle board, run, and box. Now she sat on the couch eating chocolate, fearful that her knee was becoming more damaged. Inappropriate advice is common Advice to rest and avoid pain is commonly provided to people with knee and other joint pains. This advice is often wrong, and harmful. Inactivity and rest makes pain and osteoarthritis worse, not better in the longer term. Our joints need movement and exercise to stimulate repair and keep them strong. There is undisputable evidence that staying active and regular participation in exercise is safe and will help improve pain, and a person’s quality of life. This is true for knee osteoarthritis, low back pain and almost any other painful condition I regularly see as a physiotherapist. Educating people with pain is essential Educating Helen about the importance of exercise and dispelling common myths is a big challenge I often face. She needed to exercise to help her pain and the rest of her health and well-being. Helen asked a common and important question – what about the pain, and associated damage? I explained to Helen that pain and damage reported on and MRI or XRay are poorly related. Pain is actually our brain’s response to a perceived threat, which motivates us to be protective. One of the biggest problems we see in people with long standing pain like Helen’s is that factors unrelated to damage begin to drive and increase this perceived threat. Modern neuroscience’s understanding of pain tells us pain is influenced by fear, anxiety, stress, changes in mood, and poor sleep. All of these factors were contributing to Helen’s pain. As a result, she had become over protective. If someone is told their joint is damaged and ‘wearing out’ like Helen’s was, they begin worrying about exercising it. This then means simple movements like getting out of a chair and walking begin to hurt, even though there is very little stress on the joint, and certainly no damage occurring. But Helen had become completely disabled by fear, stopped exercising, and her condition had become much worse. We had to get her moving. Helen is not alone Knee osteoarthritis affects 2.2 million Australians. The condition costs our health system $2.1 billion per year, mostly for surgical interventions, like joint replacement surgery. This surgery helps in the right person, but in most (2/3) cases, completion of an exercise program supervised by a physiotherapist will delay the need for joint replacement surgeries by at least two years. Some people will never need surgery if they stay active. A big problem we have in Australia though is many people are told to rest when they have pain, not stay active. A large general practice database tells us less than 4 per cent of people with knee osteoarthritis seeking care are referred for support to help them exercise. They are more commonly encouraged to take pain killers, which do not help in the long term, or referred to a surgeon. Frequently, people then end up less active, become depressed, put on weight and increase their risk of other chronic diseases like heart disease and diabetes. Exercise and regular physical activity is also the key to treating these conditions Where is Helen now I talked to Helen two weeks ago, about a year on from when I first saw her. That morning she had completed leg strengthening exercises, jumping and hopping exercises, and a 1.5km run. Her journey had not been easy. Following our first long discussion about pain and exercise, she started with some exercises at home, and then completed a 6-week supervised group exercise program with a physiotherapist. With improved confidence, she joined a gym and started to regain her life. She had been exercise at least 2-3 times per week since this time. One of the things she was enjoying most was playing one on one basketball against her son again. Her smile as she told me this was incredibly uplifting and why I love what I do. Dr Christian Barton and Helen were both guests on Insight on SBS, which explores the role of exercise in treating chronic illness.

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30 foods scientifically proven to beat arthritis

According to the <a href="https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/arthritis-musculoskeletal-conditions/overview" target="_blank">Australian Institute of Health and Welfare</a>, 30 per cent of us suffer arthritis and other musculoskeletal conditions – that’s almost 7 million people! And while there’s no way to cure it entirely, certain diet and lifestyle changes can ease the pain and even stop it worsening. A review of scientific studies on arthritis from KIIT University in India has identified the 30 foods from eight food groups that could hold the key to slowing down arthritis. How many are in your diet? <ol> <li>Fruits – Dried plums, grapefruit, grapes, blueberries, pomegranate, mango, bananas, peaches and apples.</li> <li>Whole grains and cereals – Wheat, rice, oats, corn, rye, barley, millets, sorghum and canary seed.</li> <li>Oils – Olive oil, fish oil and borage seed oil.</li> <li>Dairy – Yoghurt (curd).</li> <li>Legumes – Black soybean, black gram.</li> <li>Herbs – Sallaki and ashwagandha.</li> <li>Spices – Ginger and turmeric.</li> <li>Tea – Green tea and basil (tulsi) tea.</li> </ol> “Regular consumption of specific dietary fibres, vegetables, fruits and spices, as well as the elimination of components that cause inflammation and damage, can help patients to manage the effects of rheumatoid arthritis,” study author Dr Bhawna Gupta said. “Incorporating probiotics into the diet can also reduce the progression and symptoms of this disease. “Patients suffering from rheumatoid arthritis should switch from omnivorous diets, drinking alcohol and smoking to Mediterranean, vegan, elemental or elimination diets, as advised by their doctor or dietician.” Tell us in the comments below, do you suffer from arthritis? What lifestyle changes have you made to treat it?

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Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead

A bee-autiful new solution for osteoarthritis relief

Researchers puzzled by results of anti-inflammatory medications for osteoarthritis

Exercise and knee osteoarthritis: helpful or harmful?

30 foods scientifically proven to beat arthritis

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