Well, as the title might lead you think, you might be expecting information about anti-inflammatories, herbal supplements, acetaminophen, and other things you can put in your mouth and swallow. Unfortunately, you aren’t really going to find that in this blog, and if you want the video below where Dr. Trenholm goes through the myriad of non-surgical treatment options for OA (osteoarthritis), of which oral medications and injection therapies are but a small part. In fact, those therapies are only effective in controlling the pain and stiffness associated with OA so that you can do the treatments that actually work in the long run.
The reality is that OA is a chronic and progressive degenerative joint disease characterized by the breakdown of cartilage and changes in bone structure. Non-operative conservative management options aim to reduce pain, improve function, and enhance the quality of life for those affected.
While we can’t turn back time and reverse the degenerative changes that have occurred in a joint with OA, treatments and rehabilitation can certainly slow down, and in some cases even halt, that progression.
There have been a number of studies over the last number of years looking at various treatment, lifestyle, and rehab interventions to see what are the most effective. We will review these briefly below, but for a more in depth explanation, kick back and watch the community engagement session that Dr. Trenholm led in the winter of 203.
Scientific evidence supports several conservative treatment modalities:
Physiotherapy: Structured exercise programs, focusing on strength, flexibility, and aerobic conditioning, have shown significant benefits in reducing pain and improving joint function. Evidence suggests that both supervised and home-based exercise regimens can be effective.
The major issue with OA is two fold:
asymmetric loading over the joint surface
uncontrolled speed/velocity at which loads are applied
The key with physiotherapy or exercise based rehab plans are that they are [1] progressive (increased repetitions, increased loading weights, and increased instability over time), [2] consistently done (a minimum of 5 days a week), and [3] targetted to the biomechanical asymmetries or deficiencies that your joint is experiencing.
Weight Management: For obese patients, weight loss has been associated with substantial improvements in knee OA symptoms. Reducing body mass can alleviate stress on weight-bearing joints, leading to decreased pain and enhanced mobility.
Like the old saying goes, “a little dab’ll do ya”. It doesn’t take much weight loss to make a huge impact on your knees. Why? Well your body weight is going through a very small joint surface area, which means that all of the weight of your body is tunneling through a small area. Just standing in place, your knees are experiencing 2-3 times your body weight! So if you lose 10lbs, your knees are feeling the effects of a 20-30lb weight loss.
Assistive Devices: The use of braces, orthotics, and canes can aid in joint protection and functional mobility. These devices are particularly useful for patients with knee and hip OA.
Current evidence suggests that bracing can be beneficial for individuals with knee osteoarthritis, particularly in reducing pain and improving function. Unloader braces, designed to shift weight away from the affected compartment of the knee, have shown effectiveness in alleviating symptoms and may delay the need for surgical intervention.
Studies indicate that while some patients experience significant improvements, results can vary based on factors like severity of osteoarthritis, patient compliance, and the type of brace used. Overall, bracing can be considered a useful non-surgical option for managing knee osteoarthritis, often used alongside physical therapy and lifestyle modifications.
Education and Self-Management: Patient education regarding OA and its management can empower individuals to actively engage in their care. Self-management strategies, including pain coping techniques and lifestyle modifications, have shown positive outcomes.
The key during the rehab process is not to solely focus on pain reduction. This is because people will live at the limits of the amount of pain they will tolerate in order to regain their level of functional capacity … a.k.a. doing the things that they need to and love to do like walking, gardening, playing with grandkids, going to work, and so on.
So early on, rather than focussing on pain improvements, look for functional improvements. Pain improvements will come later.
Pharmacological Options: Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used to manage pain. Topical NSAIDs have also been effective for localized pain relief with reduced systemic side effects.
However, the important point here is that NSAIDs or acetaminophen are only useful in controlling pain. That’s it.
But, if pain is controlled, then you will more likely engage in weight loss efforts as well as physical activity which have more robust effects on altering the progression of OA
Intra-articular Injections: There are two main injection methods that have been well studied with respect to osteoarthritis
Corticosteroid injections can provide temporary relief of inflammation and pain. In my opinion, and how I convey the effect to patients, is that it is like putting 1000 Advils right where it counts. The risk of systemic side effects is low, but there are real risks with respect to the joint becoming infected since we are putting a hole in the skin. Additionally, a condition called avascular necrosis can happen in the hip, regardless of where the injection is, as a result of interruption of blood flow to this area (the risk is about 1 in 50000)
Additionally, hyaluronic acid injections (viscosupplementation) are a newer injectable therapy which acts to stimulate the chondrocytes (cartilage cells) in joints to make more synovial fluid. This will thereby increase the distribution of forces throughout the joint which will result in less pain, and improved function of the joint. The effectiveness varies among individuals, with some experiencing significant benefits, while others may see minimal improvement. While some studies show positive results, others indicate limited long-term benefits compared to other treatments like physical therapy or NSAIDs. Overall, viscosupplementation may be a viable option for patients who have not found relief from other conservative treatments, but it's often viewed as a complementary approach rather than a standalone solution.
Overall, the evidence supports a multidisciplinary approach combining physical therapy, weight management, pharmacologic treatment, and patient education to effectively manage osteoarthritis conservatively.
