What happens to the joint
Initially the spongy cartilage layer covering the end of the bones within a joint begins to thin and fray. As this happens, small cartilage flakes may break loose and float into the joint, and bone which normally does not take weight begins to do so. The result of these two changes in swelling within the joint, typically with prolonged weight bearing such as standing still for a long time or during jolting and jarring actions. The joint gives a characteristic ache and the swelling causes it to stiffen. The aching and stiffness tend to be worse in the morning and ease with gentle activity – people often say that when they get up it takes them ‘time to get going’. The pain and inflammation of OA causes the muscles to weaken and fail to support the joint placing an even greater stress on the joint structures.
Any additional stress imposed on a joint with OA should be avoided. Research has shown that being obese increases the risk of developing OA by 4.0 times in women and 4.8 times in men1. If you have even carried heavy shopping bags you will know the effect this can have on the knees and low back especially. Being just half a stone overweight is the same as carrying a big bag of potatoes. The difference is that you do not just carry this weight as you walk around a shops, but every minute of every day!
Because an arthritic joint often hurts and may be swollen, there is a natural tendency to rest it. In addition people are often cautious about exercise believing it to ‘wear out the joints’. In fact, resting an arthritic joint long term is actually one of the worse things you can do. Exercise helps to lubricate a joint, and strengthens the muscles surrounding it. If these muscles weaken, they can take less strain and in turn the arthritic joint has to take more. Strengthening muscle takes away stress on the joint by ‘deloading’ it. In other words the muscles take more strain so the joint has to take less.
At Norris Health we target arthritis using a combined therapy approach. Firstly we use acupuncture to dramatically reduce pain. Several research studies have confirmed its benefit, especially in the treatment of knee arthritis. In a study at the University Hospital Birmingham genuine acupuncture was compared to sham acupuncture and the genuine group had greater pain relief and reduction in stiffness which was maintained after the treatment finished 2.
A study at the University of Virginia analysed the results of 10 scientific trials representing acupuncture treatment in 1456 patients. Acupuncture was shown to be effective (statistically significant) for both pain and physical dysfunction with knee OA 3.
Physiotherapy is used to improve movements and reduce inflammation, and rehabilitation to re-strengthen the muscles supporting the joint. This treatment approach has been recommended by the National Institute of health and Clinical Excellence (NICE) and as such should be used by all GPs in the UK. View the official NICE document The care and management of arthritis in adults.
The results of combining therapies in this way is that their effects are greatly enhanced meaning a shorter, more effective treatment programme which is considerably more cost effective for the patient.
For more information on arthritis you can download a free booklet from the Arthritis Research Campaign (ARC).
- Felson, D (1997) Understanding the relationship between bodyweight and osteoarthritis. Clinical Rheumatology 11, 671-681.
- Jubb et al (2008) A blinded randomised trial of acupuncture compared with non-penetrating sham for the symptoms of osteoarthritis of the knee. Acupuncture in Medicine 26(2): 69-78
- Selfe, T and Taylor, A (2008) Acupuncture and osteoarthritis of the knee: a review of randomized controlled trials. Family and Community Health 31(3): 247-54.