Joint pain and osteoarthritis


Many people tend to experience joint pain at some point in life. Severe pain and inflammation from excessive use of the joint may be a result of strenuous activities such as playing sport.

 While serious injuries are somewhat unusual, chronic joint pain may degenerate into a more severe impediment over time.

 Wear and tear of the joints account for a lot of the damage, especially in older people who are prone to suffering from osteoarthritis. Several degenerative changes may take place simultaneously, with a single change causing additional damage in a domino effect.

Osteoarthritis Knee Pain

Multiple osteophytes, definite or marked joint space narrowing, sclerosis and possible or definite bony deformity.

Osteoarthritis Hip Pain

OA of the hip usually presents as an ache in the front of the groin which may extend to the thigh.

What is osteoarthritis (OA)?

Osteoarthritis, commonly referred to as OA or arthrosis, is a common cause of joint pain, such as knee pain or hip pain. Also described as ‘wear and tear’, OA is a chronic degenerative condition that causes the protective fluid in the joint to lose its shock-absorbing abilities resulting in a loss of cartilage that protects the ends of the bones from wearing down. When the bones begin to rub against each other, this often causes pain, swelling and problems with mobility.

Hip or knee pain as a result of bursitis may sometimes be confused with OA. There are some differentiators to be on the lookout for. Bursitis pain increases when pressure is applied to the joint; this can start sharply and gradually change into a dull ache. In contrast, osteoarthritis pain comes on gradually and gets worse over time. Significantly, people with OA may also get bursitis.

What causes osteoarthritis?

There are several causes and risk factors that could increase the chance of developing osteoarthritis and impact the rate at which this debilitating condition progresses over time.

Overuse

‘Wear and tear’ is the most general cause of osteoarthritis, categorised by overuse of the joint, leading to increased load, or pressure, which further breaks down vital cartilage. However, this does not mean that you should avoid any unnecessary movement. Moderate physical activity is important for OA patients, in order to strengthen the muscles, stabilise the joints and support cartilage nutrition.

Pre-existing conditions

Besides current or historical injuries, certain pre-existing conditions may increase the probability of this condition manifesting. These include rheumatoid arthritis (RA), gout, and type 2 diabetes. The link between type 2 diabetes and OA is predominantly due to weight gain, so following a healthy diet and reducing weight may contribute to general relief from the symptoms in this case.

Weight

Weight plays a significant role in the management of osteoarthritis of the knee. The knee is a hard-working part of the body and is affected by the entire weight of the body. Accordingly, it is logical that the heavier you are, the more force is transmitted through your body to your knees, ankles and feet.

Maintaining a healthy weight and lifestyle addresses any concerns you may have about your weight and symptoms of osteoarthritis. Such action could not only reduce the strain on your knees but also improve your health in other areas of your body.

Ageing

Sadly, 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. Due to the fact that they are in constant use and weight-bearing, our knees are particularly susceptible to injury. After a lifetime of activity, the cartilage may begin to degrade in places, resulting in other painful conditions within the knee joint such as bone spurs.

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

Genetic factors/family history

Genetics plays a significant role in many debilitating health conditions including osteoarthritis of the knee. While scientists are yet to identify a specific gene as being one of the root causes of OA knee, it is generally agreed that there could be a number of genetic factors that may be the source of the issue.

Research suggests that the genetic link in our DNA that runs in our families and is passed down to our children, leads to similar conditions in the next generation. Additional research shows that the body's response to the inflammation of osteoarthritis may be due to an inflammatory response within the body that involves cytokines present in the fatty deposits in the body.

Previous injury to the knee

Any injury, regardless of which specific joint or muscle was affected, leaves you with an inherent weakness in the injured area. This previous injury increases your risk of subsequent injury in the same area in the future. When we take into account injuries to the knee, even a sports injury that occurred years before and from which you later recovered could increase your chance of developing osteoarthritis in later years.

Particular injuries to the knee are considered particularly damaging. For instance, it is believed that those who have suffered ligament injury, specifically anterior cruciate ligament (ACL) injuries, are far more likely to develop OA. Ligaments are the tough tissue bands 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 aim 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 may be diminished.

Damage to the ACL varies depending on the injury. Surgery is often required to either repair or replaces the ligament in grade 3 ruptures and tears. An ensuing period of intensive physiotherapy to rebuild the mobility and strength in the knee is also necessary. Following this type of injury, you can expect to be in recovery for many months while your body heals.

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

Sport

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

While it seems that osteoarthritis causes people to take less exercise because of concerns about experiencing sudden knee pain, exercise remains vital in the management of this condition. Research has shown that specific types of exercise are not only beneficial but can also aid recovery and build muscle strength.

Consider taking a short walk. Swimming 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

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

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

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

Many women experience difficulty with weight gain, especially after a pregnancy, which exacerbates the strain on their knees. Some women also struggle to lose weight after they have gone through menopause.

What symptoms are associated with osteoarthritis?

Listed below are the characteristic symptoms commonly reported by people who have been diagnosed with osteoarthritis (OA). It is essential that you consult your doctor about OA if you are experiencing any of these signs, particularly if you have previous knee or hip injuries.

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

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

Stiffness, in the affected joints, routinely after an extended period of rest or remaining still in one position. This symptom is usually most pronounced after waking up and getting out of bed, or perhaps a long car or aeroplane trip. Once you begin to move around this stiffness should gradually disappear, movement becoming 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. This could be due to an infection that would require immediate medical attention.

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

Lack of movement. Difficulty moving your joints freely and a decline in overall mobility may be the result of the cumulative effect of one or more of these symptoms. Increased inflexibility and inability to fully bend or straighten the joint may be symptoms that you’re suffering from osteoarthritis of the knee.

Given the stresses involved for a load-bearing joint – the need to support body weight and the twists and turns of movement – it is unsurprising that OA may affect the knee joint. However, other joints may also be directly, as well as indirectly, affected.

You may find that OA pain is deferred to other parts of the body. For example, OA in the hip might lead to pain in the knee, or OA in the spine might affect nerves causing numbness, pain or other symptoms in parts of the body to which those nerves connect. Walking may be very painful because of OA of the hip or knee. To deal with such discomfort the sufferer may develop a limp and painful sensations may be felt in the groin, thigh or buttocks – ranging from dull aches to piercing pain.

Grinding, grating or creaking. Moving the affected joints may cause a grating sensation or a crackling sound. This is known as ‘crepitus’ or ‘crepitation’, degeneration in the cartilage. This means the joint is no longer properly protected against impact or friction, leaving the bones to grind against each other. Significantly, without any additional symptoms, crepitus 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 begins to break down. X-rays or MRIs of joints may show small bone spurs, cracks or indentations. 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 might 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. Walking, running, bending or using the stairs may result in people with moderate OA experiencing pain. Extended periods of sitting or lying down commonly result in joint stiffness. 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
Intense pain and discomfort during everyday activities are symptomatic of severe OA. 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 dramatically and no longer reduces friction during movement.

Joint Replacement surgery is often the only feasible 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, it is important to consult with your doctor as soon as possible, as early osteoarthritis diagnosis and treatment means the outcome is often more successful.

Your doctor may ask you questions regarding the symptoms you are experiencing, such as knee or hip pain, and how they affect 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 conducive to show a joint effusion and injuries to ligaments and muscles, without radiation exposure.

Computer tomography (CT) is beneficial in highlighting bony structures for your physician and can be used to show even small fractures. For osteoarthritis, CT scans help evaluate bony alterations that may not be revealed 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 to, and changes in, 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 enhance activities of daily living.

How is OA treated?

There are two treatment options that are available in order to relieve your symptoms if you are suffering from osteoarthritis: non-surgical treatments and surgical treatments.

A combination of treatments may often be necessary in order to prevent the condition and symptoms from worsening and to permit you to live a life as near as possible before your osteoarthritis diagnosis.

The precise 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. By considering your individual circumstances, such as weight, physical activity, occupation and leisure activities, your GP will decide which treatments are advisable.

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, a patient may be required to undergo surgery to strengthen, repair or replace the affected joints. If surgery is the most suitable treatment, this course of action will only be taken if your GP has tried other treatments that have not been successful.

Non-surgical osteoarthritis treatment options
Knee braces

Explore Unloader knee braces

Traditionally knee braces have been known to be rather uncomfortable to wear because they were very big and bulky. However, in recent years there have been significant advances in the design and development of efficient and comfortable models. 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 imperative to determine whether the condition is unicompartmental, i.e. just one side of the knee is affected, whether the condition affects both sides of the knee, or whether it is the patella (knee cap) that is affected.

For patients with unicompartmental knee osteoarthritis – valgus or varus knee conditions – it may be beneficial to wear an unloading brace. An unloading knee brace functions by relieving the pressure off those areas worst affected by osteoarthritis; 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 challenging for sufferers to kneel down or climb stairs. The root cause here is where the patella sits, in the trochlear groove, where the articular cartilage underside starts to wear down, causing inflammation. If the wear and tear become severe, the bone can even become exposed, causing chronic pain as the bones move across the rough surface of the trochlear groove. In such cases, patellofemoral osteoarthritis bracing may be used to attempt to realign the patella over the femur bone.

Whichever type of brace you require, it is important to try out various braces to get the style that fits perfectly. We always recommend working with a clinical professional to select a suitable brace. Once you have the brace fitted professionally it will provide you with the opportunity to test it in a controlled environment before wearing it out and about.

While many people find their symptoms can be helped greatly by wearing a brace, with osteoarthritis treatments options should not be looked at in isolation. Other osteoarthritis knee treatments, such as following a nutrition plan or exercise regimen are also important to consider alongside the use of a brace.

Suitable footwear for helping osteoarthritis

While osteoarthritis in the foot may affect any of the joints, it is the big toes that are most commonly affected, due to the fact that these are more prone to pressure and wear and tear from walking. Toes may become stiff and rigid over time from this pressure; walking may become difficult. Selecting the most suitable footwear can help those with osteoarthritis in the foot, knee or hips. Selecting footwear that has good shock absorbency that provides the body with support and minimises pressure on the joints is recommended. The correct shoe selection may help reduce inflammation and pain in the entire body, especially when used in conjunction with other treatment plans.

Exercises

The fact that osteoarthritis may be a debilitating and painful condition leads many people to try to limit their physical 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. While it may appear challenging initially, 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 important to exercise gently and only take activities at your own pace. The advice of your GP, physiotherapist or specialist is essential before any exercise regimen is undertaken.

Due to the fact that stronger muscles are required to support damaged joints, muscle strengthening exercises are very important. If the muscles encompassing the affected joints are strong it means there is decreased pressure and a decreased demand on the joint itself. When a joint is inflamed, swollen or painful, it may seem like a difficult task but a medical professional can help plan a suitable muscle strengthening regimen.

Gentle stretching exercises move the joint affected with osteoarthritis through a full range of motion exercises in order to enhance mobility. The flexibility of the knee is principally seen to be bending and stretching of the knee. However, it is also important to consider the connection of the knee to the hip and to the ankle. Exercises that concentrate on moving both the ankles and the hips smoothly in circular motions may have a real positive impact, specifically when carried out every day.

Engaging in aerobic exercise when you are suffering from symptoms of osteoarthritis might seem especially daunting but aerobic exercise is beneficial for several reasons. Aerobic or endurance exercises are beneficial for the heart and lungs, increasing stamina and reducing fatigue. Increasing the calories the body burns, aerobic exercises may be effective in helping weight loss or maintaining a healthy weight. This may be helpful for those suffering from osteoarthritis because excess weight can aggravate inflammation and pain in the knees. By releasing hormones, such as endorphins, which are known to be ‘happy hormones’, aerobic exercises may improve your mood and aid in 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. Besides lowering blood pressure, improving circulation and reducing the risk of heart disease by strengthening the heart, walking may also tone the muscles that support joints and may lower the risk of bone fractures by slowing bone mass loss.

For those who are just starting an exercise regimen and those who are overweight or trying to lose weight, aquatic exercises may be an ideal starting point. Aquatic exercises do not require any swimming; they are simply performed in water. The buoyancy may help reduce joint pressure from the weight of the body and the water provides resistance for the muscles because they are moving so they become stronger.

Patients should really see the benefits from committing to an exercise regimen that has been planned by a medical professional, specifically 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. 

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.