Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to updated treatment guidelines from the Australian Commission on Safety and Quality in Health Care.

So what is knee osteoarthritis and what are the best ways to manage it?

More than 2 million Australians have osteoarthritis

Osteoarthritis is the most common joint disease, affecting 2.1 million Australians. It costs the economy A$4.3 billion each year.

Osteoarthritis commonly affects the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles.

Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs.

Is it caused by ‘wear and tear’?

Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is not caused by “wear and tear”.

Research shows the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are not required to diagnose knee osteoarthritis or guide treatment decisions.

Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have shown this in people with osteoarthritis, and other common pain conditions such as back and shoulder pain.

This has led to a global call for a change in the way we think and communicate about osteoarthritis.

What’s the best way to manage osteoarthritis?

Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These include education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines.

Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.

Health professionals who use positive and reassuring language can improve people’s knowledge and beliefs about osteoarthritis and its management.

Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as paracetamol and anti-inflammatories and can prevent or delay the need for joint replacement surgery in the future.

Many types of exercise are effective for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you.

Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time.

Weight management is important for those who are overweight or obese. Weight loss can reduce knee pain and disability, particularly when combined with exercise. Losing as little as 5–10% of your body weight can be beneficial.

Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. Recommended medicines include paracetamol and non-steroidal anti-inflammatory drugs.

Opioids are not recommended. The risk of harm outweighs any potential benefits.

What about surgery?

People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement.

Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain.

However, high-quality research has shown arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis.

Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, 53,500 Australians had a knee replacement for their osteoarthritis.

Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management.

The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments.

I have knee osteoarthritis. What should I do?

The care standard links to free evidence-based resources to support people with osteoarthritis. These include:

• education, such as a decision aid and four-week online course
• self-directed online exercise and yoga programs
• weight management support
• pain management strategies, such as MyJointPain and painTRAINER.

If you have osteoarthritis, you can use the care standard to inform discussions with your health-care provider, and to make informed decisions about your care.

Belinda Lawford, Postdoctoral research fellow in physiotherapy, The University of Melbourne; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney, and Rana Hinman, Professor in Physiotherapy, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You’ve had a cold or the flu and your symptoms have begun to subside. Your nose has stopped dripping, your cough is clearing and your head and muscles no longer ache.

You’re ready to get off the couch. But is it too early to go for a run? Here’s what to consider when getting back to exercising after illness.

Exercise can boost your immune system – but not always

Exercise reduces the chance of getting respiratory infections by increasing your immune function and the ability to fight off viruses.

However, an acute bout of endurance exercise may temporarily increase your susceptibility to upper respiratory infections, such as colds and the flu, via the short-term suppression of your immune system. This is known as the “open window” theory.

A study from 2010 examined changes in trained cyclists’ immune systems up to eight hours after two-hour high-intensity cycling. It found important immune functions were suppressed, resulting in an increased rate of upper respiratory infections after the intense endurance exercise.

So, we have to be more careful after performing harder exercises than normal.

Can you exercise when you’re sick?

This depends on the severity of your symptoms and the intensity of exercise.

Mild to moderate exercise (reducing the intensity and length of workout) may be OK if your symptoms are a runny nose, nasal congestion, sneezing and minor sore throat, without a fever.

Exercise may help you feel better by opening your nasal passages and temporarily relieving nasal congestion.

However, if you try to exercise at your normal intensity when you are sick, you risk injury or more serious illness. So it’s important to listen to your body.

If your symptoms include chest congestion, a cough, upset stomach, fever, fatigue or widespread muscle aches, avoid exercising. Exercising when you have these symptoms may worsen the symptoms and prolong the recovery time.

If you’ve had the flu or another respiratory illness that caused a high fever, make sure your temperature is back to normal before getting back to exercise. Exercising raises your body temperature, so if you already have a fever, your temperature will become high quicker, which makes you sicker.

If you have COVID or other contagious illnesses, stay at home, rest and isolate yourself from others.

When you’re sick and feel weak, don’t force yourself to exercise. Focus instead on getting plenty of rest. This may actually shorten the time it takes to recover and resume your normal workout routine.

I’ve been sick for a few weeks. What has happened to my strength and fitness?

You may think taking two weeks off from training is disastrous, and worry you’ll lose the gains you’ve made in your previous workouts. But it could be just what the body needs.

It’s true that almost all training benefits are reversible to some degree. This means the physical fitness that you have built up over time can be lost without regular exercise.

To study the effects of de-training on our body functions, researchers have undertaken “bed rest” studies, where healthy volunteers spend up to 70 days in bed. They found that V̇O₂max (the maximum amount of oxygen a person can use during maximal exercise, which is a measure of aerobic fitness) declines 0.3–0.4% a day. And the higher pre-bed-rest V̇O₂max levels, the larger the declines.

In terms of skeletal muscles, upper thigh muscles become smaller by 2% after five days of bed rest, 5% at 14 days, and 12% at 35 days of bed rest.

Muscle strength declines more than muscle mass: knee extensor muscle strength gets weaker by 8% at five days, 12% at 14 days and more than 20% after around 35 days of bed rest.

This is why it feels harder to do the same exercises after resting for even five days.

But in bed rest studies, physical activities are strictly limited, and even standing up from a bed is prohibited during the whole length of a study. When we’re sick in bed, we have some physical activities such as sitting on a bed, standing up and walking to the toilet. These activities could reduce the rate of decreases in our physical functions compared with study participants.

How to ease back into exercise

Start with a lower-intensity workout initially, such as going for a walk instead of a run. Your first workout back should be light so you don’t get out of breath. Go low (intensity) and go slow.

Gradually increase the volume and intensity to the previous level. It may take the same number of days or weeks you rested to get back to where you were. If you were absent from an exercise routine for two weeks, for example, it may require two weeks for your fitness to return to the same level.

If you feel exhausted after exercising, take an extra day off before working out again. A day or two off from exercising shouldn’t affect your performance very much.

Ken Nosaka, Professor of Exercise and Sports Science, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.