Treatment and pain relief for knee and hip osteoarthritis
If you have knee or hip osteoarthritis, there are many treatments available that can help you to stay active, reduce pain and prevent further degeneration. Embody Movement Exercise Physiologist Courtney Pointon explains.
More than 9% of Australians have osteoarthritis which can cause stiffness, difficulty moving and pain.[1] Fortunately, there is a lot you can do to manage and treat osteoarthritis to reduce the need for invasive treatments or surgery.
There are many different conditions that fit into the bracket of osteoarthritis (OA). So while the treatments outlined here cover a universally accepted approach based on research, the effectiveness will depend on the severity of your condition and how well you are able to adopt the recommended lifestyle changes.
What is osteoarthritis?
Osteoarthritis is a disease that affects the whole joint, wearing down the protective articular cartilage that provides cushioning between the bones.
While it is often referred to as a “wear and tear” disease that occurs due to use or overuse, Osteoarthritis is actually a joint disorder caused by ageing. One of the key risk factors is not being active enough as you age.
Osteoarthritis is the most common form of arthritis. It can damage any joint but most commonly affects the knees, hips, hands and spine.[2]
Signs and symptoms of osteoarthritis
Pain with weight-bearing and sometimes at rest
Stiffness, particularly in the morning.
Reduced range of movement.
Ret, hot and swollen
Fatigue and tiredness.
Knee and hip osteoarthritis present differently in each person. Some people will experience a deep ache in their hip, others will have pain more towards the back. Some people will have a really stiff knee which makes it difficult to move but it doesn’t cause any pain. Others have pain with no other symptoms.
The osteoarthritis treatment pyramid
The treatment pyramid is a globally accepted approach to the management and treatment of osteoarthritis, with three different levels of treatment, starting with the least invasive.
As you can see from the below image, the first line of treatment is education, exercise and weight control. This applies no matter where you are in your osteoarthritis journey.
First line of treatment: Education, exercise and weight control
Education, exercise and weight control have been the first line of treatment for all cases of osteoarthritis for 45 years as they are known to be highly effective.
Education
Education is all about understanding the condition, doing your research and learning about the actions you can take to ease pain, support your joints and keep your body moving.
Weight control
Weight control is an important aspect of OA treatment as we know that being overweight can put pressure on your joints, particularly knees and hips. Being a healthy weight will help to manage your OA as well as all the other benefits like cardiovascular and heart health.
The most common healthy weight measurement tool is Body Mass Index (this version from the Heart Foundation makes it easy to calculate). This measurement will give you an idea of whether your weight is in the healthy range. If it isn’t, losing weight may help improve your OA.
There is no specific diet for OA. We recommend any diet that you will stick to, whether it be a fasting diet, Michelle Bridges, calorie control diet, just choosing to eat better or cutting down on portion sizes. If you would like some support to lose weight, Embody Movement can refer you to a dietitian who belongs to the Sunshine Coast Women’s Health Collaborative, a network of our trusted allied health partners.
Exercise
Thirty minutes of moderate intensity daily is recommended. “Moderate intensity” means you feel a little bit puffed and need to take a breath every 3-4 words if you are talking.
Why is exercise important for osteoarthritis?
Cartilage needs appropriate load to be healthy.
It can improve joint range of movement.
It improves joint stability and function.
Normalised movement.
Improves joint confidence.
Exercise tips for knee and hip osteoarthritis
Aim for 30 minutes of moderate intensity exercise every day
Don’t do too much too soon – build up to the optimal amount and recommended loads over time
Ideally complete 2-3 strength training sessions per week (dedicated strength-building exercises, weights, Pilates)
Plus 3-4 cardiovascular sessions per week (walking, tennis etc.)
Land-based exercises are recommended over water-based exercises such as aqua aerobics. Studies show that the cartilage needs to be compacted/released/compacted/released to improve OA conditions and water-based exercises do not provide enough compaction to improve cartilage health.
Pain doesn’t equate to damage
Pain is not necessarily bad and does not automatically mean you are doing more damage. Pain is a normal part of your immune system response to changes in pressures and loads.
For the exercise to be effective, muscles need to be working and presented with some level of challenge. If the pain is 4 or less out of 10, we recommend continuing with awareness. Increased pain from exercise should be back to normal or pre-exercise levels within 48 hours.
For people who have a higher level of pain regularly, such as 6/10, we support you to continue at that rate while exercising without increasing the pain. That’s also where the second line of treatments kick in (see below).
Note that first-line treatments continue even for people who move up to the second and third lines of the treatment pyramid.
Second line of treatment: Pain relief, aids and passive treatment
Second line treatments cover pharmaceutical interventions, physical supports such as walking aids and passive treatment including massage and physiotherapy. They can help you deal with flare-ups and bring down pain levels to a low a return to exercise.
If you are regularly experiencing pain levels higher than 4/10, these treatments may be a necessary complement to first line treatments.
Physiotherapy: may include hands-on treatment, acupuncture, massage and the use of mobility aids. While these treatments will not improve arthritis because they do not change the load to the cartilage, they may reduce pain
Taping or braces: Because there is so much variation in taping technique and the types of braces that are available, it’s best to seek advice from a physiotherapist or allied health professional and see what works for you.
Orthotics: Again, try a few and see what works for you. We recommend trying over the counter orthotics first as studies show they are as effective as custom options.
Pain relief medication:
Paracetamol (eg. Panadol) offers weak pain relief but is generally considered safe.
Anti-inflammatories (eg. Nurofen, Advil, Voltaren) offer stronger inflammation relief but should only be used for one week at a time.
Opioids are not generally recommended for OA.
Cortisone injections can be helpful if you need rapid relief of symptoms but are not always recommended due to effects. They may offer 3-4 months of pain relief which can be used to build strength.
Hylauronic acid (synvics) supplementation to replace joint fluid will likely produce only minor short term benefits. There is a risk of infections and joint inflammation.
Last line of treatment: surgery
There are two types of surgery used in the treatment of osteoarthritis: arthroscope and total joint replacement.
Arthroscope (aka debridement or joint cleanup)
The is no evidence arthroscope is effective for knee OA compared to a placebo.[3] International OA guidelines now recommend against this procedure. Medicare no longer funds hip arthroscope for OA due to a lack of clinical evidence of its effectiveness.
Total joint replacement
Total joint replacements have their place in treatment for serious cases of OA. About 10% of knee and hip OA cases require joint replacement surgery. The success rates are around 80% for knee replacements and 95% for hip replacements.
Surgery is not a quick fix and involves a rehabilitation period of around 6-8 months for hip replacements and 12 months for knee replacements.
There are several different types of knee replacement surgery – they may replace all or part of the knee. If you are considering any kind of surgery for OA, it’s important to know the different types of surgery, the evidence behind what is being suggested and your options so you can be well informed before going ahead.
How Embody Movement can help
Here at Embody Movement, we work closely with many clients who have OA as well as those recovering from surgery.
Our Exercise Physiologists can develop a customised exercise program to support your joints that combine in-class activities as well as exercises you can do at home. Our Physiotherapists can provide additional pain relief, mobility and range of movement support.
Book an appointment with one of our Physiotherapists or Exercise Physiologist for advice and guidance tailored to your needs.
References
[1] Australian Institute of Health and Welfare, Osteoarthritis, last updated 25 August 2020.
[2] Mayo Clinic, Osteoarthritis, accessed 31 May 2021.
[3] David T Felson, Arthroscopy as a treatment for knee osteoarthritis, Best Practice and Research Clinical Rheumatology, Volume 24, Issue 1, February 2010, pages 47-50.