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6 Golden Rules for Osteoarthritis

Osteoarthritis (OA) is an incredibly common condition that can affect anyone, but is usually more prevalent in people over the age of 40, or with previous joint injuries. The joints may feel stiff, make clicking or grating noises, and can become aggravated with activity. Source: Arthritis Australia

Osteoarthritis myths

It is a condition that sparks a lot of anxiety and fear, because for eons we’ve been told scary stories about this musculoskeletal boogeyman. You’ve probably heard it’s a “wear and tear” condition, along with other scary descriptors such as “bone on bone”, “degeneration”, “bone spurs”, etc. But those descriptions are both inaccurate and inappropriate. For the majority of people living with osteoarthritis, they are able to do just that; go on living! It may seem counterintuitive, but exercise and movement is perhaps the greatest medicine available for your stiff and sore joints.

Okay, not the boogeyman, what is it?

In OA the joint space does become narrower, as the cartilage that lines the bone becomes thinner. But it isn’t load and exercise that “wear and tears” the cartilage, in fact osteoarthritis is often less common in runners! Research shows us now that rather than just mechanical load on the joint (i.e. running, skiing, tennis, basketball, etc), it is caused primarily by a biological process (involving hormones, chemicals, proteins, etc).

Why does it hurt?

knee pain

All right, I can hear what you’re saying; “who cares why it happens, it still hurts when I use it!”, so allow me to explain. Understanding your pain is the key to reintroducing exercise in a safe and helpful way. The origin of your pain isn’t the cartilage itself – it doesn’t have any of the nerve endings that sense and transmit pain. It’s not the bone either – again, no nerve endings! Pain is an incredibly tricky phenomena that is best explained to you by a health professional with knowledge of your specific circumstances, I highly recommend talking to any of the Osteopaths or Myotherapists at Peninsula Osteopathy + Allied Health. Pain doesn’t indicate the level of change within the joint. Pain does not equal damage. Have you ever had a papercut? Ouch! Stubbed your toe on the coffee table? Stepped on a runaway Lego block? You get my point… Pain is an alarm, warning you of the potential for danger, but it’s not an alarm you’d rely on daily to get out of bed.

There are three main structural origins of pain in OA. Firstly, the periosteum, a thin tissue that covers the bone like Gladwrap. Second, the synovium, the tissue that encapsulates the joint, like a balloon. And lastly, inflammation and oedema, this is the influx of chemicals and hormones designed to heal the area. All three of these can contribute to pain in varying amounts, but there are other pain factors to address with your health practitioner, such as; sleep, stress, diet, mood, activity levels, comorbidities, and more!

What can I do about it?

After an OA diagnosis, people often try to minimise the “damage” by reducing their exercise, walking less and even ceasing the leisure activities they love most. But what you’re really sacrificing is your cardiovascular health, mood, mental wellbeing, bone density, muscular strength, and increasing your risk of a variety of chronic conditions. Exercise can improve the metabolic factors associated with your condition and allow you to move more efficiently. A progressive reintroduction to exercise, guided by a health professional, can improve your osteoarthritis and reduce your risk of other conditions.

6 Golden Rules

1. Talk to a health professional
The Osteopaths and Myotherapists at Peninsula Osteopathy + Allied Health can provide a thorough assessment of your condition, function, mobility, and strength. They can accurately diagnose your condition and answer any questions you may have about it. They can help to address lifestyle factors that may be contributing to your pain. They can provide expert manual therapy to ease the aches and pains associated with your condition. And they can help guide a progressive and individualised plan to get you up and moving!

2. Reconsider your X-Rays
X-Rays, MRIs and other images are useful tools for identifying sinister conditions, however it can often be alarming to see the different changes to our body on an image. Unfortunately, findings on imaging often correlate very poorly to pain and function1. People with no pain can have drastic irregularities on their images, and others in great pain can show next to nothing! Talk to your practitioner about what your images mean for you.

3. Aerobic exercise
This type of exercise involves raising the heart rate and is where a lot of the cardiovascular health benefits come from. Start small, doing a little more than you currently do, and gradually increasing it – under the guidance of your health professional. Walking, jogging, swimming, and cycling are great aerobic activities, but the best exercise is the one you enjoy doing. Maybe you used to play tennis, or maybe you want to get into golf, there is no shortage of ways to raise your heart rate and get moving.

4. Resistance exercise and balance
Moving your body against resistance and trying not to fall over. There are many bodyweight exercises that can achieve this, and with the addition of a few resistance bands or small weights, you’d never have to step foot in a gym if you didn’t want to. Again, speak to a health professional to learn which exercises will suit you, how to do them, and how often.

5. Diet and lifestyle
Familiarising yourself with Australia’s Dietary Guidelines can help guide you on the types of foods you should be eating on a regular basis. Diet and metabolism affects the hormonal and chemical processes that can increase joint pain and other health conditions. The odd Tim-Tam won’t hurt, you’d be shocked to see the food cupboard in the POAH tea room, but eating well as regularly as possible will go a long way to your health.

6. Don’t let pain rule you
If you wait for pain to dissipate completely before you begin exercising, you might never exercise. It is normal to feel some discomfort after increasing your activity levels, if your pain levels are tolerable and stable – within 3-4/10 – you shouldn’t fear continuing your exercise regime.

References
Guermazi, A., Niu, J., Hayashi, D., Roemer, F. W., Englund, M., Neogi, T., … & Felson, D. T. (2012). Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). Bmj, 345.

3 Tips to Get You Started on Your Running Journey

The coronavirus pandemic of 2020 has changed our lives dramatically. It has stopped us from seeing friends and family, made us change our hygiene habits (maybe for the better?) and significantly changed our routines and day-to-day existence.

With gyms closed and outdoor activities limited, I wanted a easy, quick and affordable way to fit exercise into my day.

And so like that, I took up running!

Now I am no expert, that is one thing I am sure of, but I can definitely impart some tips and tricks that I have put in place to keep me motivated and committed to the cause, because to be honest, running in itself is pretty boring.

What keeps me coming back is the post-run endorphin hit that you get with any exercise, what a great way to start the day!

For all the beginner runners out there, this is what I have incorporated to keep me going.

Set Goals

Probably the easiest and most effective tip towards achieving your goals is to create them in the first place! Too many times I have seen clients and patients (and of course me personally!) start exercise classes or rehabilitation programs with vague and ambiguous end points.

“Get fit”, “get stronger”, “improve flexibility”, “increase my core strength” are some common ones that get bandied around. The problem with these is that they aren’t specific enough.

One great way to create clarity with goal setting is to use the S.M.A.R.T acronym. SMART goals are specific, measurable, achievable, relevant and time-orientated. If we take running as our example to create a SMART goal, it might look something like this:

I want to run 21kms continuously, by the start of next year (6months time).

This goal is specific (21kms continuously), it is measurable (we can track progress via measuring Km’s ran), it is achievable (yours may be different based off your level of fitness/experience), it is relevant and has a date attached to it. From this we can work backwards and put a plan in place to reach this goal.

Track your progress

There is now an abundance of ways that we can do this with modern technology – from phone apps all the way up to top of the range wearable watches. If you are a beginner like me, using a phone app would be the best place to start. I have been using the RunKeeper app from Asics. It’s free and has all the features needed to give you the right amount of information and feedback.

Measuring and tracking your progress over time creates buy-in, tells you how you are tracking towards your goals and can create that little extra bit of incentive to stay with the process when the last thing you feel like doing is going out and exercising.

On the flip side, try not to get too bogged down on the day-to-day progress and running times/splits/Km’s ran. Being sick, tired, fatigued from work, dehydrated, stressed etc. are all factors that can influence your run. As long as the overall trend is a positive one, it’s ok to feel crappy from time to time.

Injury Prevention – Warm-up, work on your weaknesses & manage loads

Avoiding any significant disruptions or prolonged time-off from running is going give you the best chance at reaching your goals. As an Osteopath, I could write a whole blog post on this topic alone! (Maybe I will?).

Injury prevention doesn’t mean spending every other day in the gym or getting weekly massages – as nice as that may be!

There are a few simple strategies that you can do to limit your chance of getting hurt:

Warm-up

A 5-10minute warm-up prior to going for your run may help to limit the chance of an injury occurring in the first place or speed-up your recovery post-run. Your warm-up should consist of some flexibility-based and strength-based movements that target all the parts of the body that you will be using during the run. Common stretches and exercises in a warm include dynamic stretching (think leg swings, trunk twists etc.), strength-based exercises (squats, lunges, single leg exercises) and neuromuscular exercises (high knees, butt flicks, grapevines etc.).

Make your legs and trunk resilient and adaptable

Another way to prevent injuries from slowing you down is to build your bodies capacity to be resilient against running, this can be done by increasing the strength in your leg and trunk muscles. Going through a systematic and thorough musculoskeletal assessment with your trusted health professional will help identify areas of weakness and then will allow you to put in place strategies to adjust accordingly. At Peninsula Osteopathy & Allied Health, a common running assessment may include things like testing the range-of-motion and strength in your ankles, knees, hips and spine. From this we can then give you exercises and hands-on treatment to improve these deficits.

Manage your loads

I.e don’t do too much but don’t do too little. Maybe the biggest cause of injuries in any training program is increasing your loads too quickly. This is because your body doesn’t have the capacity to deal with the loads and stresses you are putting it under. Again, another topic that we could dive deeply into with various guidelines and protocols, but for beginner runners (like me) splitting your running program into 2 week blocks and not increasing your overall running load by more than approximately 10% each block can limit the chance of any flare-ups. A multitude of factors can contribute to overall ‘load’; running distance, speed, elevation and amount of rest can all be altered to make runs easier or more difficult. Tracking your progress via an app or watch gives you more data to make informed decisions and prevent any excessive fluctuations in load.

Should you have any questions or wish to know more about a warm-up or how to reduce your chance of injury during running, give the clinic a call to speak to one of our experienced Osteopaths, Myotherapists or Exercise Physiologists on 5253 2345.

3 TOP TIPS FOR YOUR HIPS

Hip Anatomy and Impingement syndrome:

The hip joint forms a solid connection between the lower limb and pelvic girdle, thus meaning it is designed for stability and weight-bearing rather than to offer a large range of mobility. The joint is a ball and socket joint formed between the thigh-bone (Femur) and the pelvis (acetabulum) and gains its stability from large supporting ligaments and muscles.

In the healthy hip joint the femoral head is able to glide smoothly within the socket of the acetabulum however this can be impaired in patients who suffer from femoral acetabula impingement syndrome (FAI). Hip impingement or FAI is a condition in which the structure of the hip joint become modified causing an impaired capability of the femoral head to move freely and smoothly within its socket. Typically this will present as stiffness or tightness of the thigh, hip or groin, poor ability to flex the hip past a right angle and pain in the groin or front of the hip when flexing the knee towards the chest, running/cycling or sitting for periods of time.

FAI commonly arises from high impact sports or exercises that involve a large amount of jumping, changing direction and recurrent movement of the hip joint outside its normal range (such as football, dancing and golf) placing excessive and abnormal load through the hip joint. The stress of ongoing excessive load can lead to either a thickening of the femoral neck (CAM lesion) or deepening of the hip socket (PINCER lesion), or a combination of both which over time can result in damage to the cartilage of the hip joint.

In other cases FAI can be present from birth and be largely asymptomatic until later in life.

What are my treatment options?

In some cases surgical intervention may be required for successful treatment of FAI however there are many conservative measures that can be taken to improve hip functionality and reduce symptoms associated with FAI.
Osteopathic treatment may be able to assist in reducing symptoms of FAI. It is not uncommon with FAI for the muscles of the hip, pelvis and lower back to become tight acting on further limiting the range of motion available at the hip joint. Treatment of soft tissue massage and muscle stretching techniques can be used to help relax and lengthen these muscles, assist in reducing inflammation and ultimately reducing pain.

Exercise based rehab focused around promoting hip mobility may also assist in the ongoing management and reduction of symptoms – Here we have provided you with 3 of our favorite at home stretches and exercises to give a try!

1. Kneeling hip flexor stretch

2. Pelvic bridges

3. Hip adduction stretch (Frog stretch)

If you are currently suffering from hip or groin pain and would like further personalised advice on treatment and management options feel free to contact the clinic today to discuss whether Osteopathy or Exercise Physiology may be able to get you back into what you love doing!