Joint pain and osteoarthritis


Most people are likely to experience joint pain at some point in their lives. Playing sports or engaging in other strenuous activities can contribute to acute pain and inflammation from overuse of the joint.

While serious injuries are relatively uncommon, chronic joint pain may progress into a more severe hindrance over time.

It is older people who tend to develop osteoarthritis, with wear and tear of the joints being responsible for a lot of the damage. A number of degenerative changes can take place at the same time and one change can trigger further damage in a domino effect.

What is osteoarthritis (OA)?

A common cause of joint pain, such as knee pain or hip pain, is osteoarthritis (OA). OA is a degenerative disease, also described as “wear and tear,” which leads to loss of cartilage. It is also referred to as arthrosis, osteoarthrosis or OA and is a degenerative disease that causes the cartilage that protects the ends of your bones to wear down. This causes pain, swelling and problems with mobility.

OA is a chronic joint condition, and as it progresses, cartilage protecting the ends of the bones gradually breaks down, joint fluid loses its shock-absorbing qualities and bones may begin to rub against each other. This can cause pain, swelling and problems moving the joint.

Sometimes knee or hip pain caused by bursitis is confused with OA. There are some differentiators to be on the lookout for. Bursitis pain increases when pressure is put on the joint and can start sharply to gradually change to a dull ache. Osteoarthritis pain comes on gradually and gets worse over time. However, people with OA may also get bursitis.

What causes osteoarthritis?

There are several factors that can increase the risk of developing osteoarthritis and impact the rate at which OA progresses over time.

Overuse

The most general cause of joint osteoarthritis is "wear and tear", categorized by overuse of the joint, leading to increased load, or pressure, which further breaks down vital cartilage. However, this doesn't mean, that you should avoid any unnecessary movement. Moderate activity is important for OA patients, as it strengthens the muscles, stabilizes the joints and supports the nutrition of the cartilage.

Pre-existing conditions

Aside from current or historical injuries, certain pre-existing conditions can increase the likelihood of this condition appears. These include rheumatoid arthritis (RA), gout, and type 2 diabetes. The link between type 2 diabetes and OA is mainly due to weight gain, so following a healthy diet and reducing weight can contribute to an overall relief from the symptoms in this case.

Weight

Weight plays a large part in the management of osteoarthritis of the knee. We all know that the knee is a hard-working part of the body and is affected by the entire weight of the body; therefore, it is logical that the heavier you are, the more force is transmitted through your body to your knees, ankles and feet.

To address any concerns you may have about your weight and symptoms of osteoarthritis, you can refer to the NHS guidelines on maintaining a healthy weight and lifestyle. Such intervention could not only reduce the strain on your knees but also improve your health in other areas of your body.

Ageing

Unfortunately, our risk of developing osteoarthritis increases as we get older. Professionals often refer to this cause of osteoarthritis as 'wear and tear'. For some, arthritis is an unfortunate but natural part of the ageing process. Our knees are particularly susceptible to injury, as they are in constant use and weight-bearing. After a lifetime of activity, the cartilage can begin to degrade in places, leading to other painful conditions within the knee joint such as bone spurs.

 In later years, without regular exercise, the leg muscles may also weaken, which will put additional strain on the knee joints. This highlights the importance of taking a proactive approach to our health by maintaining good muscle strength to help reduce such risks as we age.

Genetic factors/family history

Genetics plays a huge part in many debilitating health conditions, with osteoarthritis of the knee no different. Scientists are yet to identify a specific gene as being one of the root causes of OA knee, but it is commonly accepted that there could be a number of genetic factors that may be the source of the issue.

One such factor is the genetic link in our DNA that runs in our families and is passed down to our children, leading to similar conditions in the next generation. Other research has shown that there is an inflammatory response within the body that involves cytokines present in the fatty deposits in the body, which can contribute to the body's response to the inflammation of osteoarthritis.

Previous injury to the knee

Once you have sustained an injury, regardless of which joint or muscle was affected, you are left with an inherent weakness in the injured area. This historic injury increases your chances of subsequent injury in the same area in the future. When we consider injuries to the knee, even a sports injury that occurred years before and from which you later recovered could increase your risk of developing osteoarthritis in later years.

Certain injuries to the knee are considered particularly damaging; for example, it is believed that those who have suffered ligament injury, specifically anterior cruciate ligament (ACL) injuries, are far more likely to experience OA due to the nature of the injury. Ligaments are tough bands of tissue that connect bones within the body and stabilise the joints. The ACL is one of four ligaments within the knee joint and is located at the front, with its main being to prevent your knee from moving forward beyond your tibia (shinbone). It is the ACL that enables you to walk, run and jump. Without this ligament, your stability can be compromised.

Damage to the ACL will vary depending on the injury; however, in grade 3 ruptures and tears, surgery is often required to either repair or replace the ligament. This will be followed by a period of intensive physiotherapy to rebuild the mobility and strength in the knee. Following this type of injury, you can expect to be in recovery for many months while your body heals.

Due to the potential risk of developing further problems in the knee joint, effective rehabilitation after an accident or operation involving the knee is critical, along with an emphasis on rebuilding the strength in the affected joints and muscles. Following a recovery protocol after an injury will go a long way towards minimising your risk of further injury to your knee or having future OA problems.

Sport

Sport has always been associated with injuries to the body in one form or another. Some sports have a higher risk of musculoskeletal injuries than others, especially high-impact or contact sports such as running, football or tennis. This is because the more force that is applied through the joint, the greater the strain; in turn, this can increase the risk of cartilage degradation and damage. To reduce the risk of developing osteoarthritis in the future, it is vital to pay close attention to any sporting injuries that occur and to take the appropriate remedial action.

It seems that osteoarthritis causes people to take less exercise, as they are concerned about experiencing sudden knee pain; however, exercise is vital in the management of this condition. Researchers have found that certain types of exercise are not only beneficial but can also aid recovery and build muscle strength.

To build muscle strength, you might like to consider taking a short walk or going swimming, which is especially recommended due to the water's warmth and buoyancy. Tai chi or yoga, with their gentle controlled stretches, have been a popular form of gentle muscle-strengthening exercise for centuries.

Gender

It seems that women are more at risk of developing osteoarthritis than men due to a number of factors. One major factor is the female hormone oestrogen. This hormone has a number of roles within a female body and one of its little-known roles is the protection of the cartilage in the joints to allow more movement and flexibility.

This is particularly evident in younger women, whose bodies are designed to adapt for childbirth. Women also tend to have wider hips than men, which places a different directional load on their knees and can lead to additional strain on the joint. 

When oestrogen levels naturally decline following menopause, the protection that this hormone provided also drops. This leaves older women more susceptible to osteoarthritis in their joints.

Many women struggle with weight gain, especially after a pregnancy, which contributes to further strain on their knees. Some women also experience difficulties losing weight after they have gone through menopause.

What symptoms are associated with osteoarthritis?

Listed below are the symptoms commonly reported by people who have been diagnosed with osteoarthritis (OA). If you are experiencing any of these symptoms, especially if you have previously injured your knee or hip, it is important that you talk to your doctor about OA.

Pain or discomfort in your joints that may reduce mobility, making it difficult to get up and out of chairs, use the stairs, or walk long distances. The pain may be deferred, or even appear in other areas of your body, such as back pain, which could be caused by osteoarthritis.

Swelling can occur in the affected joint in two different forms. Hard swelling presents as bony or knobbly lumps or spurs that grow upon and around the joints and is caused by osteophytes. Soft swelling is caused by the joint lining becoming thicker and extra fluid inside the joint itself. Conversely, this swelling can make the muscles appear thin and wasted. The weakening of the muscle or stability of the joint can cause the joint to give way.

Stiffness, usually after a prolonged period of rest or being still in one position, you may experience stiffness in the affected joints. Stiffness is usually most pronounced after waking up and getting out of bed, or perhaps a long car or plane journey. This stiffness should dissipate once you start moving around and movement becomes easier with light activity. The stiffness is caused by friction between the bones and for those suffering OA of the knee, swelling in the joint.

Redness and warmth of the skin over the affected joint may become red and warm. This could be due to an infection which would require immediate medical attention.

The buckling or locking up of the joint when OA is moderate to advanced you may find that it feels like the knee gives way, or buckles. This happens when uneven grooves in the damaged cartilage become detached and stuck in the joint.

Lack of movement, the cumulative effect of one or more of these symptoms can result in difficulty moving your joints freely and a decline in overall mobility. If you’re suffering from osteoarthritis knee symptoms, this may result in you being more inflexible and unable to fully bend or straighten the joint.

It is no surprise that the knee joint can be affected by OA, given the stresses involved for a load-bearing joint: the need to support body weight and the twists and turns of movement. However, other joints can also be directly as well as indirectly affected.

You may find that OA pain is referred to other parts of the body, for example OA in the hip could lead to pain in the knee, or OA in the spine could affect nerves causing numbness, pain or other symptoms in parts of the body to which those nerves connect. OA of the hip or knee can make walking very painful. To accommodate the discomfort the sufferer may develop a limp and painful sensations may be felt in the groin, thigh or buttocks. Again ranging from dull aches to piercing pain.

Grinding, grating or creaking you may find that there is a grating sensation or a crackling sound when you move the affected joints. This is known as crepitus or crepitation. Crepitus is due to degeneration in the cartilage, meaning the joint is no longer properly protected against impact or friction leaving the bones to grind against each other. It is worth noting that crepitus without any other symptoms, is not something to be concerned about.

How are stages of OA classified?

OA stages can be classified from x-ray evaluation in the Kellgren Lawrence grades KL 0 - KL 4:

  • KL 0: No radiographic features of osteoarthritis
  • KL 1: Possible joint space narrowing and osteophyte formation
  • KL 2: Definite osteophyte formation with possible joint space narrowing
  • KL 3: Multiple osteophytes, definite joint space narrowing, sclerosis and possible bony deformity
  • KL 4: Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity

A more common description of the stages of osteoarthritis is mild, moderate and severe OA (stages 2 - 4).

1. Mild Osteoarthritis
At this stage, the surface of the joint cartilage is beginning to breakdown and x-rays or MRIs of joints may show small bone spurs, cracks or indentations forming. Patients with mild OA may experience pain or discomfort after a long day of walking. Wearing an ultra-lightweight brace like Unloader One X or Unloader Hip could help prevent further breakdown while easing mild joint pain.

2. Moderate Osteoarthritis
At this stage, the joint cartilage has broken down to the point that the bones are more frequently rubbing together. People with moderate OA may experience pain while walking, running, bending or using the stairs. Joint stiffness is commonly experienced after long periods of sitting or lying down. Inflammation of the joints is also reported following more strenuous activities.

Wearing a brace, such as Unloader One X or Unloader Hip, could help delay the need for total joint replacement surgery.

3. Severe Osteoarthritis
Severe OA is characterized by great pain and discomfort during everyday activities. By this stage, the joint space between bones is significantly reduced because the cartilage is nearly gone, causing the bones to rub and grate against each other. The synovial fluid, which provides lubrication for joints, has decreased drastically and no longer reduces friction during movement.

Joint Replacement surgery is often the only viable treatment option for people who are diagnosed with severe osteoarthritis. However, it is important to maintain a healthy weight and lifestyle to avoid complications during surgery. Wearing an Unloader One X knee brace can help you to maintain a healthy lifestyle and manage your weight, making yourself a better surgical candidate.

How is OA diagnosed?

Only a trained medical professional can accurately and effectively diagnose osteoarthritis. If you are experiencing chronic knee or hip pain and think it may be due to osteoarthritis, it is best to speak with your doctor as soon as possible.

Your doctor may ask you questions regarding the symptoms you are experiencing, such as knee or hip pain, and their impact on your daily function. Your doctor may also perform a physical examination of the affected joint(s), or even take X-Rays to help verify the diagnosis. This process may be repeated over time to better monitor the progression of the disease. Additional diagnostics could include further ultrasound, CT and MRI scans.

An ultrasound is helpful to view a joint effusion and injuries to ligaments and muscles, without radiation exposure.

Computer tomography (CT) illustrates bony structures very well for your physician and can be used to show even small fractures. For osteoarthritis, CT scans help evaluate bony alterations that may not show clearly on x-rays.

Magnetic resonance imaging (MRI) also works without radiation. MRI's show detailed sectional images of tissue, which is especially useful for ligament and meniscal injuries or injuries/ changes of the joint cartilage.

If you do receive a diagnosis of OA, do not lose hope! There are a number of options available to treat your condition, including our Unloader knee braces, clinically proven to relieve OA pain, and the Unloader Hip brace, proven to improve activities of daily living.

How is OA treated?

If you are suffering from osteoarthritis there are several treatment options that are available for you to try in order to relieve your symptoms. There are two types of treatments: non-surgical treatments and surgical treatments.

It is often the case that a combination of treatments is required in order to prevent the condition and symptoms from worsening and to allow you to live a life as near as possible before your osteoarthritis diagnosis.

The exact course and combination of treatments you will receive for your osteoarthritis will be determined by several factors, including the affected joints in the body, the specific symptoms you are experiencing and the severity of the symptoms. Your GP will decide which treatments are suitable by also considering your individual circumstances, such as your weight, physical activity, occupation and your leisure activities.

The long term aim of treatment is to protect the joint cartilage from further damage to postpone the need for surgery for as long as possible. In some cases, it may be necessary for a patient to have surgery to strengthen, repair or replace the affected joints. It may be that surgery is the most suitable treatment but this course of action will only be taken if your GP has tried other treatments and they have not been successful.

Non-surgical osteoarthritis treatment options
Knee braces

Explore Unloader knee braces

Traditionally knee braces could be quite uncomfortable to wear as they were very big and bulky, however over recent years there have been huge advances in design and efficient and comfortable models have been developed. Knee braces are not all the same so it is vital to have an accurate diagnosis of the condition before attempting to use a knee brace. It is necessary to ascertain if the condition is unicompartmental, i.e. just one side of the knee is affected, if the condition affects both sides of the knee, or if it is the patella (knee cap) that is affected.

For patients with unicompartmental knee osteoarthritis, that is valgus or varus knee conditions, it may be beneficial to wear an unloading brace. An unloading knee brace works by taking the pressure off of the areas worst affected by the osteoarthritis and the braces are able to apply corrective forces to the area. Both improve knee stability and proprioception, which is the sense of body position and self-movement.

If the patella (knee cap) is affected by osteoarthritis it causes pain in the very front of the knee, making it difficult and painful for sufferers to kneel down or climb stairs. In this situation, the root cause is where the patella sits, in the trochlear groove, the articular cartilage underside starts to wear down, causing inflammation. If the wear and tear become severe, the bone can even become exposed, causing severe pain as the bones move across the rough surface of the trochlear groove. In this situation, patellofemoral osteoarthritis bracing can be used to attempt to realign the patella over the femur bone.

Whichever type of brace you require, it is also important to consider the style and fit so it is vital to try out various braces to get one that fits perfectly. We would always recommend working with a clinical professional to select the appropriate brace. This means you can have the brace fitted professionally and it will provide you with the opportunity to try out the brace in a controlled environment before wearing it out and about.

Many people find their symptoms can be helped greatly by wearing a brace but with osteoarthritis treatments, options should not be looked at in isolation. It is important to consider the use of a brace alongside other osteoarthritis knee treatment, such as following a nutrition plan or exercise regime.

Suitable footwear for helping osteoarthritis

Osteoarthritis in the foot can affect any of the joints in the foot, but it is the big toes that are most commonly affected, as these are more susceptible to pressure and wear and tear from walking. Toes can become stiff and rigid over time from this pressure and walking may become difficult. Choosing the most suitable footwear can help those with osteoarthritis in the foot and those with osteoarthritis in the knee or hips. It is advisable to choose footwear that has good shock absorbency, provides the body with support and minimises pressure on the joints. The correct type of shoe can help reduce inflammation and pain in the whole body, especially when used alongside other treatment plans.

Exercises

Osteoarthritis can be a debilitating and painful condition and many people experience stiffness, so they try to limit their activity. However, mild to moderate exercise can be one of the most effective and important treatments for osteoarthritis, whatever a person’s age or fitness level. It may seem challenging at first but by combining exercises designed to increase general fitness levels with specific muscle strengthening training, many people see an improvement in their symptoms as their fitness and strength increases. It is essential to exercise gently and only take activities at your own pace. Any exercise regime should be undertaken on the advice of your GP, physiotherapist or specialist.

Muscle strengthening exercises are very important as stronger muscles are required to support damaged joints. If the muscles surrounding the affected joints are strong it means there are less pressure and less demand on the joint itself. When a joint is inflamed, swollen or painful, it can seem like a difficult task but a medical professional can help devise a suitable regime.

Gentle stretching exercises, or range of motion exercises, move the joint affected with osteoarthritis through a full range of motion in order to improve movement. The flexibility of the knee is predominantly seen to be bending and stretching of the knee but it is important to also consider the connection of the knee to the hip and to the ankle, so exercises that focus on moving both the ankles and the hips smoothly in circular motions can have a real positive impact, especially when carried out every day.

Undertaking aerobic exercise when you are suffering from symptoms of osteoarthritis can be especially daunting but aerobic exercise is valuable for several reasons. Aerobic or endurance exercises are beneficial for the heart and lungs, build stamina and can reduce fatigue. Increasing the calories the body burns, aerobic exercises can be effective in helping lose weight or maintain a healthy weight. This can be helpful for those suffering from osteoarthritis as carrying excess weight can exacerbate inflammation and pain in the knees. Releasing hormones, such as endorphins, which are known to be ‘happy hormones’, aerobic exercises can improve your mood and aid a better night’s sleep, which will make you feel better overall.

Walking is a great exercise as it’s relatively easy on the joints and it’s free. As well as lowering blood pressure, improving circulation and reducing the risk of heart disease by strengthening the heart, walking can also tone the muscles that support joints and can lower the risk of bone fractures by slowing bone mass loss.

Aquatic exercises can be an ideal starting point for those who are just beginning an exercise regime and those who are overweight or trying to lose weight may also find exercising in water beneficially. Aquatic exercises do not require any swimming. They are simply performed in water as the buoyancy can help reduce the pressure on joints from the weight of the body and the water provides resistance for the muscles as they are moving so they become stronger.

Patients should really see the benefits from sticking to an exercise regime that has been planned by a medical professional, especially if used in conjunction with other forms of treatment such as a knee brace or nutrition plan.

What steps should I follow to get an Unloader brace?


1. Visit your doctor to get a prescription

First, you will need to visit your doctor for a confirmed diagnosis of osteoarthritis (OA). Consider printing or emailing a copy of our Useful information guideline when preparing for your doctor’s appointment.  This will assist you to document the history of your ailments and the types of symptoms you experience before you meet your doctor.  If you are diagnosed with OA, the doctor will refer you to an Orthotist.

2. Find an orthotist

Once you have a prescription for an Unloader brace, you need to contact an orthotist in your area who can fit you. Your doctor may have a recommendation or referral. Alternatively, you can contact us to find an orthotist near you. It is always advisable to use a qualified practitioner for initial fittings. Speak to your orthotist about the Unloader brace 7-Day trial.

3. Check costs prior to making a commitment

Once you have located a suitable orthotist, consult him/her in terms of total cost, which will include the actual brace and professional fitting fee.

4. Get fitted properly

A good fit is essential for comfort and effective OA pain relief; thus, an Unloader-Brace-Test will be performed. The orthotist will ensure that a) the brace is fitted correctly, and b) you know how to use it to best effect before you leave. It is advisable to bring a pair of shorts to the fitting so that the orthotist can fit the brace correctly.

How to get a brace

Please contact us if you have any questions, if you would like us to refer you to an Unloader expertise centre in your area. We will respond to you within 24-hours.