At SSPC, arthritic pain is possibly the most common condition we encounter, and without doubt the most common question is “How can I reduce my pain”? Whilst traditionally the main management of joint arthritic pain has been rest and medication, we now know that’s definitely not the best advice for your pain. However it’s still not an easy question to answer, but here’s the choices you have:

  • Exercise. Without doubt, exercise needs to be at the forefront of your pain management strategy. These two concepts used to be inversely proportional – the greater the arthritic pain, the less exercise one did (or was told to do). Well, exercise and OA now need to be proportional – the more someone has OA, the more they need to exercise that arthritic joint – you just need to find the right type of exercise for your joint! The research is clear – appropriate and regular exercise does help reduce pain. Exercise also has the additional benefits of improving muscular strength, lubricating and moving joints, reducing stress and anxiety, and also helps improve sleep, which is important for healing. That’s where you probably need your Physiotherapist!
  • Weight Reduction: Losing even a kilo of weight will have a dramatic effect on lower limb arthritic conditions. One study showed that even losing half a kilogram can have a fourfold reduction in forces across the knee! Thousands of times we impact the ground every day, so you can appreciate how much less force is on our joints for every kilogram lost! Weight reduction isn’t always easy, but even slight changes to your diet can have a dramatic effect. Chris, our SSPC Dietitian, has some great strategies for those seeking an individualised approach to weight management.
  • Lifestyle Modifications: In reality, certain activities hurt certain joints. If you know what hurts and aggravates, it may not be necessary to stop that activity – there is often a way to compromise and continue activities that would normally hurt, as long as you know how to modify them. What we don’t always want you to do is necessarily completely avoid an activity – if you never do stairs because it hurts, you are sending your brain a consistent message that stairs are bad. When you next have to go up or down stairs, your pain can be extreme – not because the stairs present any more danger, but because your brain has gone into pain protection “over drive”! Find a way – ask your physio!
  • Take your medication as instructed. Whilst it is essential you listen to your medical specialist, and follow instructions on any advised pharmaceutical intervention, medication should rarely be your primary fight against your arthritis. Whilst pain is a warning sign for our body to avoid further damage, sometimes (and particularly in chronic conditions like OA) the body goes into a pain “over drive” – sending more and more protective pain signals just because the task you are doing is using your knee, NOT damaging it! Tasks become more painful, not because your OA has progressed or because the task presents any danger, but because your brain has become even more protective of your joint.  Unfortunately it is this pain protection “over drive” that leads to more disability, more stiffness, more weakness, and more pain. So pain medication is not just a band aid in this case, it helps control the brain’s overprotective tendencies, and enables you to keep moving and doing the exercises that will get you stronger and better.
  • Tape/Braces/Walking Aids/Orthotics etc: There is often a common thought that braces and supports should be avoided if possible. We often hear people say “I don’t want to become reliant on it” or “the brace will make my knee weak”. That’s actually not all true. If you do use a walking stick every single time you walk, then you may become overly reliant on it; if you put a brace on every single waking hour of the day it may become a security blanket; But with good education, none of the above should happen. Anything that helps ease your pain will help you to be more active – the more activity, the more strength and the less pain. So if it helps, don’t be afraid to use it – there’s no prizes for the bravest person!
  • Heat and cold. There’s not a lot of evidence we can provide for the use of heat and cold, but… we know it works well for some. At the end of the day, it’s whatever works best for you. Ice isn’t necessarily better than heat in the management of OA, or vice versa – give them both a try and see which helps you the most. Whatever you can do to reduce pain will help keep you moving, and that’s the critical thing!

The take home message from all of this is it doesn’t matter what works to ease your pain – whatever it takes, do it, and utilise this window of opportunity with reduced pain to work on the two most critical things: exercise and weight loss!

Anthony Lance

SSPC Physiotherapist