Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead
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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.
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What Doctors Feel – by Dr. Danielle Ofri
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This book discusses how feelings such as shame, fear, anger, empathy, and even love influence patient care. Dr. Ofri notes early on:
❝One might reasonably say, I don’t give a damn how my doctor feels as long as she gets me better. In straightforward medical cases, this line of thinking is probably valid. Doctors who are angry, nervous, jealous, burned out, terrified, or ashamed can usually still treat bronchitis or ankle sprains competently.
The problems arise when clinical situations are convoluted, unyielding, or overlaid with unexpected complications, medical errors, or psychological components. This is where factors other than clinical competency come into play.❞
~ Dr. Danielle Ofri
What then follows is very much a no-holds-barred account of the emotional side of medicine.
Not portraying doctors as heroes or martyrs, just as people. Indeed, she even talks about an early, abject failure of hers as a medical student, literally hiding from a patient who badly needed attention and to whom she had been assigned.
We learn not just about the mistakes of doctors, but also the mistakes of patients that lead to mistakes by doctors. For example, emphasizing the severity of your symptom(s) can sometimes be useful to ensure they get attention, but if your regular doctor has heard you rating every symptom always as a 10 every appointment for the past many years, then the end result is that they don’t have information to work from, and will—at best—become frustrated, which will not work out well for you.
Mostly, though, it’s about what goes on behind that calm collected professional exterior that most doctors show most of the time.
The style is a fascinating blend of well-researched science (there’s an extensive bibliography) and very human tales of suffering, compassion, hope, loss, isolation, connection, and more.
Bottom line: if you want to understand your doctor(s), then you want to read this book.
Click here to check out What Doctors Feel, and learn how emotions affect the practice of medicine!
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Nutrition To Combat Lymphedema & Lipedema
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Dr. Kelly Sturm is a rehab specialist (Doctor of Physical Therapy), and also a certified lymphedema therapist. Here’s what helps her patients with lymphedema and lipedema:
Don’t fan the flames
Lymphedema and lipedema are inflammatory lymphatic diseases affecting mostly women. As such, an anti-inflammatory diet will be important, but there are other factors too:
- Anti-inflammatory diet: this is to reduce the chronic inflammation associated with lymphatic diseases. This means eating plenty of fruit and vegetables, especially berries and leafy greens, and avoiding things like sugar, alcohol, caffeine, and processed foods. And of course, don’t smoke.
- Intermittent fasting: this also helps by giving the body a chance to correct itself; when the body isn’t digesting food, it has a lot more resources to devote to its favorite activity: maintenance. This results in lower inflammation, and better fat redistribution.
- Weight loss: not a bandwagon we often get on at 10almonds as it’s rarely the most important thing, but in this case it is of high importance (second only to dealing with the inflammation), as excess weight around the lymph nodes and vessels can lead to dysfunction and swelling. Thus, reducing the weight can ease that and allow the body to heal.
For more details on all of the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Eat To Beat Inflammation ← also some non-dietary advice in there too
- Ask Not What Your Lymphatic System Can Do For You…
- Lose Weight, But Healthily ← more useful than just trying to run a calorie deficit
Take care!
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Blind Spots – by Dr. Marty Makary
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From the time the US recommended not giving peanuts to infants for the first three years of life “in order to avoid peanut allergies” (whereupon non-exposure to peanuts early in life led to, instead, an increase in peanut allergies and anaphylactic incidents), to the time the US recommended not taking HRT on the strength of the claim that “HRT causes breast cancer” (whereupon the reduced popularity of HRT led to, instead, an increase in breast cancer incidence and mortality), to many other such incidents of very bad public advice being given on the strength of a single badly-misrepresented study (for each respective thing), Dr. Makary puts the spotlight on what went wrong.
This is important, because this is not just a book of outrage, exclaiming “how could this happen?!”, but rather instead, is a book of inquisition, asking “how did this happen?”, in such a way that we the reader can spot similar patterns going forwards.
Oftentimes, this is a simple matter of having a basic understanding of statistics, and checking sources to see if the dataset really supports what the headlines are claiming—and indeed, whether sometimes it suggests rather the opposite.
The style is a little on the sensationalist side, but it’s well-supported with sound arguments, good science, and clear mathematics.
Bottom line: if you’d like to improve your scientific literacy, this book is an excellent illustrative guide.
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Intuitive Eating – by Evelyn Tribole and Elyse Resch
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You may be given to wonder: if this is about intuitive eating, and an anti-diet approach, why a whole book?
There’s a clue in the other part of the title: “4th Edition”.
The reason there’s a 4th edition (and before it, a 3rd and 2nd edition) is because this book is very much full of science, and science begets more science, and the evidence just keeps on rolling in.
While neither author is a doctor, each has a sizeable portion of the alphabet after their name (more than a lot of doctors), and this is an incredibly well-evidenced book.
The basic premise from many studies is that restrictive dieting does not work well long-term for most people, and instead, better is to make use of our bodies’ own interoceptive feedback.
You see, intuitive eating is not “eat randomly”. We do not call a person “intuitive” because they speak or act randomly, do we? Same with diet.
Instead, the authors give us ten guiding principles (yes, still following the science) to allow us a consistent “finger on the pulse” of what our body has to say about what we have been eating, and what we should be eating.
Bottom line: if you want to be a lot more in tune with your body and thus better able to nourish it the way it needs, this book is literally on the syllabus for many nutritional science classes, and will stand you in very good stead!
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Getting Your Messy Life In Order
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Getting Your Messy Life In Order
We’ve touched on this before by recommending the book, but today we’re going to give an overview of the absolute most core essentials of the “Getting Things Done” method. If you’re unfamiliar, this will be enough to get you going. If you’re already familiar, this may be a handy reminder!
First, you’ll need:
- A big table
- A block of small memo paper squares—post-it note sized, but no need to be sticky.
- A block of A4 printer paper
- A big trash bag
Gathering everything
Gather up not just all your to-dos, but: all sources of to-dos, too, and anything else that otherwise needs “sorting”.
Put them all in one physical place—a dining room table may have enough room. You’ll need a lot of room because you’re going to empty our drawers of papers, unopened (or opened and set aside) mail. Little notes you made for yourself, things stuck on the fridge or memo boards. Think across all areas of your life, and anything you’re “supposed” to do, write it down on a piece of paper. No matter what area of your life, no matter how big or small.
Whether it’s “learn Chinese” or “take the trash out”, write it down, one item per piece of paper (hence the block of little memo squares).
Sorting everything
Everything you’ve gathered needs one of three things to happen:
- You need to take some action (put it in a “to do” pile)
- You may need it later sometime (put it in a “to file” pile)
- You don’t need it (put it in the big trash bag for disposal)
What happens next will soothe you
- Dispose of the things you put for disposal
- File the things for filing in a single alphabetical filing system. If you don’t have one, you’ll need to get one, so write that down and add it to the “to do” pile.
- You will now process your “to dos”
Processing the “to dos”
The pile you have left is now your “inbox”. It’s probably huge; later it’ll be smaller, maybe just a letter-tray on your desk.
Many of your “to dos” are actually not single action items, they’re projects. If something requires more than one step, it’s a project.
Take each item one-by-one. Do this in any order; you’re going to do this as quickly as possible! Now, ask yourself: is this a single-action item that I could do next, without having to do something else first?
- If yes: put it in a pile marked “next action”
- If no: put it in a pile marked “projects”.
Take a sheet of A4 paper and fold it in half. Write “Next Action” on it, and put your pile of next actions inside it.
Take a sheet of A4 paper per project and write the name of the project on it, for example “Learn Chinese”, or “Do taxes”. Put any actions relating to that project inside it.
Likely you don’t know yet what the first action will be, or else it’d be in your “Next Action” pile, so add an item to each project that says “Brainstorm project”.
Processing the “Next Action” pile
Again you want to do this as quickly as possible, in any order.
For each item, ask yourself “Do I care about this?” If the answer is no, ditch that item, and throw it out. That’s ok. Things change and maybe we no longer want or need to do something. No point in hanging onto it.
For each remaining item, ask yourself “can this be done in under 2 minutes?”.
- If yes, do it, now. Throw away the piece of paper for it when you’re done.
- If no, ask yourself:”could I usefully delegate this to someone else?” If the answer is yes, do so.
If you can’t delegate it, ask yourself: “When will be a good time to do this?” and schedule time for it. A specific, written-down, clock time on a specific calendar date. Input that into whatever you use for scheduling things. If you don’t already use something, just use the calendar app on whatever device you use most.
The mnemonic for the above process is “Do/Defer/Delegate/Ditch”
Processing projects:
If you don’t know where to start with a project, then figuring out where to start is your “Next Action” for that project. Brainstorm it, write down everything you’ll need to do, and anything that needs doing first.
The end result of this is:
- You will always, at any given time, have a complete (and accessible) view of everything you are “supposed” to do.
- You will always, at any given time, know what action you need to take next for a given project.
- You will always, when you designate “work time”, be able to get straight into a very efficient process of getting through your to-dos.
Keeping on top of things
- Whenever stuff “to do something with/about” comes to you, put it in your physical “inbox” place—as mentioned, a letter-tray on a desk should suffice.
- At the start of each working day, quickly process things as described above. This should be a small daily task.
- Once a week, do a weekly review to make sure you didn’t lose sight of something.
- Monthly, quarterly, and annual reviews can be a good practice too.
How to do those reviews? Topic for another day, perhaps.
Or:
Check out the website / Check out GTD apps / Check out the book
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Ageless – by Dr. Andrew Steele
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So, yet another book with “The new science of…” in the title; does this one deliver new science?
Actually, yes, this time! The author was originally a physicist before deciding that aging was the number one problem that needed solving, and switched tracks to computational biology, and pioneered a lot of research, some of the fruits of which can be found in this book, in amongst a more general history of the (very young!) field of biogerontology.
Downside: most of this is not very practical for the lay reader; most of it is explanations of how things happen on a cellular and/or genetic level, and how we learned that. A lot also pertains to what we can learn from animals that either age very slowly, or are biologically immortal (in other words, they can still be killed, but they don’t age and won’t die of anything age-related), or are immune to cancer—and how we might borrow those genes for gene therapy.
However, there are also chapters on such things as “running repairs”, “reprogramming aging”, and “how to live long enough to live even longer”.
The style is conversational pop science; in the prose, he simply states things without reference, but at the back, there are 40 pages of bibliography, indexed in the order in which they occurred and prefaced with the statement that he’s referencing in each case. It’s an odd way to do citations, but it works comfortably enough.
Bottom line: if you’d like to understand aging on the cellular level, and how we know what we know and what the likely future possibilities are, then this is a great book; it’s also simply very enjoyable to read, assuming you have an interest in the topic (as this reviewer does).
Click here to check out Ageless, and understand the science of getting older without getting old!
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