Arthritis & Joint Pain
Arthritis is one of the more common reasons people come to see me. It’s usually characterised by that feeling of stiffness and reduced ability to move as easily as we once could. It’s quite a misunderstood condition, often blamed on ‘wear and tear’ and accepted as a part of getting older. There’s more to arthritis than this, and thankfully there’s a lot you can do to help manage it.
What arthritis can feel like
Arthritis usually shows up in fairly common ways, such as:
- A deep ache in a joint that feels worse when you use it and easier when you rest
- Stiffness that’s often worse first thing in the morning and loosens off as you move
- Joints that feel stiff, creaky or grinding
- Inability to fully straighten your joints, so they sit slightly bent
- Stiffness and aching in the fingers, thumb or hand, worse when gripping or trying to open jars
- Joint pain that can flare up for a few days or weeks and then settle down again
- Occasional swelling, or feeling of swelling, in the joints
- Reduced range of motion that’s noticeable when doing the gardening, climbing stairs, or other activities
There are different types of arthritis, with some overlapping symptoms. Finding out which kind you have is important as they are managed differently.
Why arthritis happens
The most common type of arthritis is osteoarthritis, the one usually associated with ‘wear and tear’, though this is a bit of a misleading phrase.
Our joints have smooth cartilage at the ends of our bones and a tiny amount of fluid to help lubricate and nourish it. When we move, the joint acts like a pump, squeezing out waste and bringing in nutrients. In osteoarthritis, these smooth surfaces do break down, but ‘wear and tear’, or the more alarming ‘bone on bone’, can cause fear and make people use their joints less, on the assumption that more ‘wear’ means more ‘tear’1. Movement keeps our joints healthy and it is important this process is maintained, even when there are signs of arthritis.
It also isn’t just down to our age, or overusing our joints. It’s better understood now that our general health and low-grade inflammation play a big part in arthritis, as much as ‘wear’ over time. Research has even shown runners have a lower incidence of osteoarthritis in their knees than non-runners2. It’s also thought this inflammation may also be a factor in overweight people, rather than simply the extra load through the joints3,4,5.
This is reassuring as it means a lot of arthritis can be managed through lifestyle and by keeping our joints moving.
Inflammatory arthritis – Rheumatoid Arthritis and others
Inflammatory arthritis is caused by the immune system going into overdrive and mistakenly attacking its own joints.
The most common of this type is rheumatoid arthritis, but there are others in the same family: psoriatic arthritis (linked to skin conditions), axial spondyloarthritis (or ankylosing spondylitis) and gout. These conditions need managing medically by a GP and usually a rheumatologist. You will most likely be prescribed medications to help manage them.
I have less ability to help with these conditions, and patients often have periods of flare-ups and remission. I can still help with the pain, discomfort and some of the stiffness they cause. It’s just that the management is quite different from osteoarthritis.
The telltale signs of inflammatory arthritis are:
- Morning stiffness lasting much longer than 30 minutes6
- Typically it will feel worse at rest and better with movement
- Several joints at a time are typically affected and usually on both sides of the body
- It can often involve the smaller joints of the hands, wrists and feet
- It can come with a general feeling of being unwell, tired, run down, or lethargic
This isn’t an exhaustive list and if I suspect you may be suffering from an inflammatory arthritis, I’ll refer you to your GP for investigations so you can get the right diagnosis and medication management.
How I assess and treat arthritis
Assessment
My assessment follows the same full process I use with every patient. For assessing arthritis I will:
- Ask about when it started, which joints are affected, when the stiffness occurs, what makes it worse or better and how it’s interrupting your day-to-day activities.
- Check for any signs of inflammatory conditions that require a GP referral
- Assess your joints thoroughly to see how they move, where they’re limited and what the muscles around the joints are doing in compensation
- Look at your other joints (e.g. the hip and ankle if you’re complaining of knee stiffness) to see how your body is working and moving overall
Treatment
Once we’ve determined if it’s osteoarthritis and that I can help, we’ll put a treatment plan in place that usually consists of:
- Hands-on manual therapy to ease any pain, reduce stiffness, address any muscle guarding or compensation and improve your quality of movement
- Advice on any lifestyle changes that would help with managing your arthritis
- Specific exercises that will help maintain the necessary movement and mobility in the joints to keep them healthy
It’s a combination of these that gets the best outcomes. While I can’t fix your arthritis, I can help get your joints working well and keep them that way as much as possible.
If you’ve got joint pain or stiffness that’s holding you back, let’s put a plan together to help.
What to expect
I can’t reverse the changes in joints as a result of arthritis, and it’s important to be up front about that. We’ll manage the condition by reducing discomfort, improving your quality of movement and keeping you active to help your joints stay healthy. Exercise is the best recommendation for arthritis but it’s not a magic cure. The evidence shows that it isn’t any more effective for pain relief than over-the-counter painkillers, though it does have fewer side effects7. Exercise also helps keep your joints moving and nourished, which is key to managing your arthritis.
You will have variable days with arthritis. Some people will go many days, weeks or months without much problem, but setbacks are entirely normal and expected where things feel more stiff or uncomfortable. It’s common for arthritis to come and go like this and doesn’t mean more damage has been done.
My job is to help you find the level of exercise and movement that works for you, and how to increase or decrease this as needed based on how well you’re managing at any given time.
Most arthritis, while disruptive to daily life, is not serious. There are a few symptoms that would require you to get checked out by your GP or NHS 111 before seeing me:
- Severe pain and swelling in a joint that started suddenly
- The skin around the joint is red, hot or swollen
- Joint pain with high or low temperature, or feeling hot, cold or shivery
These are very uncommon but do need to be assessed, so if you’re in doubt, it’s always better to get it looked at.
Sources: NHS — Arthritis
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about arthritis
Osteopathy can help with managing and reducing pain, and improving movement and function. What I do specifically will depend on what joints are affected and how they’re affecting you day-to-day. I’ll assess you first and then let you know if I can help and what we’ll do about it. If I can’t help, I’ll refer you to someone who can.
Not entirely. Age and ‘wear and tear’ often get blamed more than they should. Osteoarthritis is complex and also influenced by our general health and low-grade inflammation. Regular use of our joints, rather than avoiding movement, is important for maintaining their overall health and function.
A scan is usually not needed for arthritis and it is often diagnosed without one. The changes seen on a scan do not always match the level of pain or disability. Many joints in those without any complaints will look arthritic on a scan, and there are those with painful joints that show very little. This lack of strong correlation means scanning risks causing unnecessary worry or fear. If there is lots of pain and limitation in function then a scan may be done as part of a surgical opinion for joint replacement.
There is weak evidence for exercise making arthritis worse. Joints need movement to stay healthy, so even though it seems counterintuitive, maintaining an active lifestyle is key to managing the condition. The joint may be slightly aggravated in the beginning. This isn’t a sign of harm and should settle. The important thing is to find a level of exercise and movement that works for you and your joints.
Most people do not need a joint replacement and if you have arthritis, it is certainly not a guarantee that you will end up needing one. Joint replacements are typically reserved for when conservative approaches haven’t worked and quality of life is significantly affected. They can be really beneficial under these circumstances. If this is something that might be right for you, we can discuss this and I can help with a referral.
Unfortunately, we cannot reverse arthritis that has already occurred. Instead, it is about managing the condition by keeping you moving and active, maintaining your current joint health, and slowing its progression where we can, so that your quality of life doesn’t suffer.
Osteopathy can help with the aches, stiffness and pain caused by rheumatoid arthritis in conjunction with regular medical care and not as a replacement. Since this condition is driven by the immune system, it needs managing with medication and under the care of a rheumatologist. My aim will be to help you with pain and range of movement so you can maintain an active lifestyle and carry on your daily activities.
Very often I can help with arthritis in the thumb, hand or fingers. Arthritis in these joints is very common and can affect our grip and fine movements like opening jars, often getting in the way of daily life. The approach is much the same as any other joint. The aim is to reduce pain, stiffness and give you advice and exercises so you can maintain your mobility as much as possible.
Does this all sound familiar?
Let’s take a look.
If you’re suffering with joint pain or stiffness that is affecting your daily life, let’s figure out where it’s coming from and what can be done about it.