Welcome back to the blog! Osteoarthritis has been a bit of a passion project of mine over the last few months, learning and absorbing, finally attempting to disseminate what I believe to be the most up to date understandings around how the condition develops. I ran a webinar with BASRaT entitled “Osteoarthritis – Beyond Wear and Tear” and I have taken some of the questions from it and answered them below. For an in-depth read about Osteoarthritis you can get my “Osteoarthritis – Clinician Edition” as an EBook or Printed
The recurrent features are back with legend of the blog and music from Good Charlotte at the bottom of the page.
As usual feedback is greatly appreciated and any further reading for me please send it my way!
PLEASE REMEMBER – THIS BLOG IS NOT A REPLACEMENT FOR CLINICAL REASONING, IF YOU ARE UNSURE GET ADVICE
Legend of the Blog this week is Ollie Coburn who invited me to do the webinar with BASRaT and he gets through some seriously great work advocating for Sports Rehabbers and their place in the MSK landscape. Follow him on twitter HERE
Some questions about Osteoarthritis from the webinar that I thought I would try to answer:
“Is wearing joint supports during exercise likely to help?”
This will vary on a person-by-person basis. The supports or braces are unlikely to have an effect over the long term they are likely to help in the short term by providing a feeling of confidence in the joint to the wearer. A sort of joint hug, that increases the perception of stability. This may allow someone to complete higher intensity or longer duration exercises or a reduction in symptoms during/directly afterwards. We need to be careful that people do not feel dependent on the braces or supports and they are used for a specific reason.
There are some braces on the market which are suggested to offload the medial compartment of the knee specifically. I am unable at this time to comment on the effectiveness of these braces specifically related to the biomechanics of offloading the medial compartment during loading.
“Would this be classified as a disease of the immune system”
Osteoarthritis is a multifactorial disease, certainly of the whole joint but evidence is increasingly suggestive of relation to the whole person. The immune system is implicated in various parts of the process mostly in the inflammatory components. We have to consider the biopsychosocial nature of symptom development making this extremely complex but also the multifactorial nature of development where joint shape for example can cause Osteoarthritic changes in the joint.
“What do you think about Aquatic therapy/exercise for OA over land based therapy?”
There are a few things to consider here. I don’t think I have seen any research that says water based therapy or exercise is more or less effective than land based. There are some pros and cons to it though. You naturally offload weightbearing joints in the water due to buoyancy so for anyone really struggling with exercise due to pain this may be a good option. It might also be their preferred “environment” or method of exercise.
We do need to consider access, a pool is often more difficult to attend and more expensive than land based methods, it also much harder to load the joints in the water so we need to consider the specific goals of the exercise in each individual. Use some reasoning processes and the patients preferences in decision making.
“What is the evidence for supplements?”
When subjected to trials supplements don’t perform very well at all and don’t seem to provide a clinically meaningful improvement in symptoms. (a 2018 meta-analysis concluded there was low quality evidence that maybe they help in the short term*) There will always be some people who swear by them, having taken them and seeing a great improvement or stopped taking them and seen a drastic deterioration.
If people want to take supplements for their Osteoarthritis then there seems to be very little harm to them other than the financial cost. If they are well off enough that it does not affect their financial situation then it is their choice. I do not believe healthcare professionals should be recommending supplements and NICE guidance advises against recommending them.
*Liu X, Machado GC, Eyles JP, et alDietary supplements for treating osteoarthritis a systematic review and meta analysis British Journal of Sports Medicine 2018 52 167 175
I hope you have found these questions interesting and whet your appetite for more! Please take at my Osteoarthritis book for more and if you have your own questions, please do fire them at me using the contact form or on social media. Check out the courses page for upcoming events or use the contact form to contact me if you would like your department to book me!
Music Choice: Good Charlotte – “The River”
“I’ve seen enough now
To know that beautiful things don’t always stay that way
I’ve done enough now
To know this beautiful place isn’t everything they say”