Arthritis is a big topic and there is no way I could cover it all so today I am just going to cover some of the basics to help you understand what is going on with your body.

First of all, it’s important to note that there are many types of arthritis. The two most common types are:

Degenerative arthritis, also known as osteoarthritis (OA for short)
Inflammatory arthritis such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis

Today we will be discussing osteoarthritis of the knee.

Here are the top five things you absolutely need to know about arthritis:

Arthritis is not a catastrophic diagnosis. You can continue to thrive and lead an active lifestyle with an arthritic knee and it’s not the end of the world.
Exercise is your best friend. Say this with me, three more times!
X-Ray findings are not proportionate to functionality or pain levels. Someone who describes “occasional stiffness” in their knee might have a “severe” x-ray, while a “mild” x-ray might belong to someone who describes unbearable pain that keeps them awake at night. X-rays do not give the whole picture!
Most knee pain from arthritis is from structures around the joint, and that pain can settle. It’s not the cartilage nor is it the outer compact bone causing the pain in your knee.
There are things you can do to slow the progression and maximize your function.

Let me say this loud and clear:

Maintaining an active lifestyle is one of the best things you can do if you have arthritis!

Let’s look at a classic scenario.

Meet Stacy. She’s 62 and tweaks her knee while out for a run. That weekend she goes away for a vacation with her family. They play golf, tennis, and even go kayaking! Now her knee is quite sore and even swollen. Stacy decides to rest for a few weeks figuring she just over-did it while away. But it’s still swollen two weeks later.

She goes to her doctor, who orders an x-ray. The x-ray uses technical terms like “osteophytes” and “joint space narrowing”. She is told she has arthritis in her knee. That night Stacy has company for dinner and a friend, let’s call him Gary, said he has the same thing! Gary says his knee is “bone on bone” (and demonstrates grinding with his knuckles together while making an awful scraping noise) because all his cartilage has “worn away” and that his friend Steve had to have a knee replacement and limped for months.

Now Stacy is devastated. She doesn’t want arthritis and she certainly doesn’t want a knee replacement. She feels doomed.

What happens next?

Option A: Stacy is scared and wants to protect her knee. So Stacy stops playing tennis and stops golfing, she hires someone to do her gardening and doesn’t even really walk the dog anymore because if running hurts than walking probably isn’t great either right? (I want you to know it hurts me deep down inside to type that). But when Stacy suddenly stops exercise and spends many hours per day sitting her knee gets stiffer and her muscles get weaker.

In her mind this has confirmed her worst fears that her knee is in awful shape (look how quickly it’s deteriorating!) and tries to protect it further by resting even more. This cycle of inactivity can is bad news bears.

It also doesn’t have to be this way.

Option B: Stacy doesn’t worry about Gary or his friend Steve because she knows nothing about their situations and her doctor didn’t mention surgery at all. Stacy’s knee is still a bit stiff and sore so she modifies her activities for a few weeks. Runs on the dyke become walks with the dog and she tries pickleball with a few friends instead of tennis. To her delight the knee pain improves! Her muscles have stayed strong from her modified activities and she still enjoyed her time out and about. Now Stacy is in a position to gradually rebuild and reintroduce activities she enjoys as she is able. (This scenario is a lot better if you ask me).

I will say it again: exercise is your best friend.

You are not wearing out the joint further by exercising. It is the most effective treatment for early and moderate knee OA (not to mention other health benefits). Exercise helps you maintain range of motion and strength. It is a lot easier to maintain strength and range than build it back up again after it has been lost.

Also, do not underestimate the benefits of exercise for the rest of your body. Many people who get an arthritis diagnosis self-impose activity restrictions and become more sedentary. This can have detrimental health benefits including increased risk of high cholesterol, heart disease and diabetes. Further, muscle weakness and joint stiffness can be contributing risk factors to falls. People with osteoarthritis experience 30% more falls than those without.

There is no use going too hard all day every day and being in extreme pain just for the sake of it but don’t stop all activity completely. You have to find a middle ground between activities that are challenging vs. aggravating (which is easier said than done). A physiotherapist can give you recommendations on which activities can be modified and help you figure out strength and range of motion exercises that are appropriate for you specifically.

Ok, so I hope you get it by now. If you have arthritis you should exercise. But let’s keep going, shall we? Let’s discuss why this diagnosis doesn’t have to be all doom and gloom.

What causes the pain in knee arthritis?

The cartilage that degenerates has no nerve endings nor does the hard compact bone beneath it. So they cannot be the source of the pain. So which structure is actually responsible?

The three main causes of knee pain associated with arthritis are:

Periosteum - the thin lining of tissue around the bone, it has nerve endings and supplies blood to the bone. If it tears it will hurt.
Synovitis - Synovium is the connective tissue lining of the joint itself. It can become inflamed and very painful. Synovitis can feel like joint tenderness or pain, swelling, and nodules (hard lumps).
Bone edema - This is more common in women who have underlying osteopenia or osteoporosis since the bones are already weaker. When stress on the bone increases, as is the case with arthritis, the deeper central layer of the bone can become swollen, which feels like a deep and intense ache.

Remember:

Not everyone with OA has these issues.
If you do experience pain from these structures it will likely settle down over a few weeks or months and your knee pain and function will return back to baseline. It’s not forever.
Like I mentioned above, the severity of an x-ray does not correlate with pain or disability.
Treatment should not be based off of the x-ray.
Do not let a bad x-ray be the reason you stop your favourite activity.
Do not let a bad x-ray make you afraid of feel doomed.
Please please please do not get surgery just because the x-ray is bad especially if everything else is great! (Disclaimer: obviously I am a physiotherapist and not your surgeon, so I’m not the one making calls on surgery. But if a surgeon is pushing for you to get surgery and you feel completely fine I would be asking why they feel it is necessary. They might have an excellent reason - that’s cool, making calls in grey areas is what they do all day every day so their opinion should be considered - I just don’t want you getting surgery because a friend of a friend had their knee done so you figure you might as well join the club).

The Arthritis Foundation provides a very general list of things you can do to slow down the arthritis progression and keep you are healthy and active as possible. These include:

Maintain a Healthy Weight: Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.
Control Blood Sugar: Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.
Maintain Range of Motion: Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help. Listen to your body and never push too hard.
Protect Joints: Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.
Relax: Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.
Choose a healthy lifestyle: Eating healthy food, not smoking, drinking in moderation and getting good sleep will help you to feel your best.

I really hope you feel slightly better about an arthritis diagnosis. This is something that can be managed.

If you have any questions about your arthritis or are looking for some specific suggestions to help your daily life please contact the clinic via email or phone us at ( 778) 630-8800. We look forward to meeting you!