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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Brain Food – by Dr. Lisa Mosconi
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We know that we should eat for brain health, but often that knowledge doesn’t go a lot further than “we should eat some nuts… but also not the wrong nuts, which would be bad”.
However, as Dr. Lisa Mosconi lays out for us, there’s a lot more than that!
This book is as much a treatise of brain health in the context of nutrition, as it is a “eat this and avoid that” guide.
Which is good, because our brains don’t exist in isolation, and nor do the nutrients that we consume. Put it this way:
We have a tendecy to think of our diets as a set of slider-bars, “ok, that’s 104% of my daily intake of fiber, I need another 10g protein and that’ll be at 100%, I’ve had 80% of the vitamin C that I need, and…”
Whereas in reality: much of what we eat interacts positively or negatively with other things, and thus needs to be kept in balance. And not only that, but other peri-nutritional factors play a big part too! From obvious things like hydration, to less obvious things like maintaining good gut microbiota, our brains rely on us to do a lot of things for them.
This book is very easy-reading, though a weakness is it doesn’t tend to summarise key ideas much, give cheat-sheets, that sort of thing. We recommend reading this book with a notebook to the side, to jot down things you want to attend to in your own dietary habits.
Bottom line: this is an excellent overview of brain health in the context of nutrition, and is more comprehensive than most “eat this for good brain health and avoid that” books.
Click here to check out “Brain Food” on Amazon and treat your brain like it deserves!
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Stop Self-Sabotage – by Dr. Judy Ho
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A lot of books of this genre identify one particular kind of self-sabotage, for example, they might pick one out of:
- Bad habits
- Limiting self-beliefs
- Poor goal-setting
- Procrastination
…etc, slap a quick fix on whatever they chose to focus on, and call it a day. Not so with Dr. Ho!
Here we have a much more comprehensive approach to tackling the problem of unintentional self-sabotage. With a multi-vector method, of which all angles can be improved simultaneously, it becomes much less like “whack-a-mole”… And much more like everything actually getting into order and staying that way.
The main approach here is CBT, but far beyond what most pop-psychology CBT books go for, with more techniques and resources.
On which note…
There are many great exercises that Dr. Ho recommends we do while reading… So you might want to get a nice notebook alongside this book if you don’t already have one! And what is more inspiring of optimism than a new notebook?
Bottom line: this is a great, well-organized guide to pruning the “why am I still doing this to myself?” aspects out of your life for a much more intentional, purposeful, effective way of living.
Click here to check it out on Amazon today, and stop sabotaging yourself!
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The Other Significant Others – by Rhaina Cohen
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As we get older, it’s a function of statistics that increasingly many of us are divorced or widowed. While some will—after whatever time seems right to them—get back into dating, what about those of us who decide that we won’t?
Rhaina Cohen explores the importance of friendship, mutual support, and (Platonic!) closeness and yes, even kinds of intimacy (for that too can be Platonic!) as we go on.
Even from a purely evolutionary approach, we are fundamentally social creatures, and while as individuals we may exist on a spectrum from reclusive to extroverted, we all thrive better when we at least have access to community and friends.
The style of the book is easy-reading and exploratory, and is very compelling as a call-to-arms for those who may wish to give/receive support to/from those with whom we are not necessarily sleeping.
Because at the end of the day, why should sex and/or romance be a required feature for legal protections? Aren’t we adults who can make our own decisions about whom we trust to care for us?
Bottom line: if you’re happily partnered and expect to pre-decease your partner, this book might not be directly important for you (it might for your partner, though). Everyone else? This book may be important at some point. That point might even be now already; only you know.
Click here to check out The Other Significant Others, and make your own choices in life!
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The Metabolism Reset Diet – by Alan Christianson
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The liver is an incredible organ that does a very important job, but what’s not generally talked about is how we can help it… Beyond the obvious “try to not poison it too much with alcohol, tobacco, etc”. But what can we do that’s actually positive for it?
That’s what Alan Christianson offers in this book.
Now, usually when someone speaks of a “four week cleanse” as this book advertises on its front cover, it’s a lot of bunk. The liver cleanses itself, and the liver and kidneys between them (along with some other organs and processes) detoxify your body for you. No amount of celery juice will do that. However, this book does better than that:
What it’s about, is not really about trying to do a “detox” at all, so much as supporting your liver function by:
- Giving your liver what it needs to regenerate (mostly: protein)
- Not over-taxing your liver while it does so
The liver is a self-regenerating organ (the mythological story of Prometheus aside, here in real life it can regenerate up to 80% of itself, given the opportunity), so whatever the current state of your liver, it’s probably not too late to fix it.
Maybe you’ve been drinking a little too much, or maybe you’ve been taking some meds that have hobbled it a bit (some medications strain the liver rather), or maybe your diet hasn’t been great. Christianson invites you to draw a line under that, and move forwards:
The book gives an overview of the science involved, and explains about the liver’s role in metabolism (hence the promised weight loss benefits) and our dietary habits’ impact on liver function. This is about what we eat, and also about when we eat it, and how and when our body metabolizes that.
Christianson also provides meal ideas and recipes. If we’re honest (and we always are), the science/principles part of the book are worth a lot more than the meal-plan part of the book, though.
In short: a great book for understanding how the liver works and how we can help it do its job effectively.
Click here to check out “The Metabolism Reset Diet” on Amazon today!
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“Why Does It Hurt When I Have Sex?” (And What To Do About It)
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This is one that affects mostly women, with 43% of American women reporting such issues at some point. There’s a distribution curve to this, with higher incidence in younger and older women; younger while first figuring things out, and older with menopause-related body changes. But, it can happen at any time (and often not for obvious reasons!), so here’s what OB/GYN Dr. Jennifer Lincoln advises:
Many possibilities, but easily narrowed down
Common causes include:
- vaginal dryness, which itself can have many causes (half of which are “low estrogen levels” for various different reasons)
- muscular issues, which can be in response to anxiety, pain, and occur as a result of pelvic floor muscle tightening
- vulvar issues, ranging from skin disorders (e.g. lichen sclerosis or lichen planus) to nerve disorders (e.g. vestibulitis or vestibulodynia)
- uterine issues, including endometriosis, fibroids, or scar tissue if you had a surgery
- infections, of the STI variety, but bear in mind that some STIs such as herpes do not necessarily require direct sexual contact per se, and yeast infections definitely don’t. Some STIs are more serious than others, so getting things checked out is a good idea (don’t worry, clinics are discreet about this sort of thing)
- bowel issues, notwithstanding that we have been talking about vaginal sex here, it can’t be happy if its anatomical neighbors aren’t happy—so things like IBS, Crohn’s, or even just constipation, aren’t irrelevant
- trauma, of various kinds, affecting sexual experiences
That’s a lot of possibilities, so if there’s not something standing out as “yes, now that you mention it, it’s obviously that”, Dr. Lincoln recommends a full health evaluation and examination of medical history, as well as a targeted physical exam. That may not be fun, but at least, once it’s done, it’s done.
Treatments vary depending on the cause, of course, and there are many kinds of physical and psychological therapies, as well as surgeries for the uterine issues we mentioned.
Happily, many of the above things can be addressed with simpler and less invasive methods, including learning more about the relevant anatomy and physiology and how to use it (be not ashamed; most people never got meaningful education about this!)*, vulvar skin care (“gentle” is the watchword here), the difference a good lube can make, and estrogen supplementation—which if you’re not up for general HRT, can be a topical estrogen cream that alleviates sexual function issues without raising blood serum estradiol levels.
*10almonds tip: check out the recommended book “Come As You Are” in our links below; it has 400 pages of stuff most people never knew about anatomy and physiology down there; you can thank us later!
Meanwhile, for more on each of these, enjoy:
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Want to learn more?
You might also like to read:
- Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier? (counterintuitively, it’s the silicon! But do give it a quick read, because here be science)
- How To Avoid Urinary Tract Infections (may be relevant; always good to know)
- Come As You Are – by Dr. Emily Nagoski (book; if we could only recommend one book on responsible vagina ownership, this would be the one)
Take care!
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You’ve Got Questions? We’ve Got Answers!
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From Cucumbers To Kindles
Q: Where do I get cucumber extract?
A: You can buy it from BulkSupplements.com (who, despite their name, start at 100g packs)
Alternatively: you want it as a topical ointment (for skin health) rather than as a dietary supplement (for bone and joint health), you can extract it yourself! No, it’s not “just juice cucumbers”, but it’s also not too tricky.
Click Here For A Quick How-To Guide!
Q: Tips for reading more and managing time for it?
A: We talked about this a little bit in yesterday’s edition, so you may have seen that, but aside from that:
- If you don’t already have one, consider getting a Kindle or similar e-reader. They’re very convenient, and also very light and ergonomic—no more wrist strain as can occur with physical books. No more eye-strain, either!
- Consider making reading a specific part of your daily routine. A chapter before bed can be a nice wind-down, for instance! What’s important is it’s a part of your day that’ll always, or at least almost always, allow you to do a little reading.
- If you drive, walk, run, or similar each day, a lot of people find that’s a great time to listen to an audiobook. Please be safe, though!
- If your lifestyle permits such, a “reading retreat” can be a wonderful vacation! Even if you only “retreat” to your bedroom, the point is that it’s a weekend (or more!) that you block off from all other commitments, and curl up with the book(s) of your choice.
Q: Any study tips as we approach exam season? A lot of the productivity stuff is based on working life, but I can’t be the only student!
A: We’ve got you covered:
- Be passionate about your subject! We know of no greater study tip than that.
- Find a willing person and lecture them on your subject. When one teaches, two learn!
- Your mileage may vary depending on your subject, but, find a way of studying that’s fun to you!
- If you can get past papers, get as many as you can, and use those as your “last minute” studying in the week before your exam(s). This will prime you for answering exam-style questions (and leverage state-dependent memory). As a bonus, it’ll also help ease any anxiety, because by the time of your exam it’ll be “same old, same old”!
Q: Energy drinks for biohacking, yea or nay?
A: This is definitely one of those “the dose makes the poison” things!
- Caffeine, in and of itself, can be healthy in moderation for most people.
- Taurine has assorted benefits at safe dosages:
- Other ingredients often have health benefits too.
But… The generally agreed safe dose of taurine is around 3g/day for most people; a standard Red Bull contains 1g.
That math would be simple, but… if you eat meat (including poultry or fish), that can also contain 10–950mg per 100g. For example, tuna is at the high end of that scale, with a standard 12oz (340g) tin already containing up to 3.23g of taurine!
And sweetened carbonated beverages in general have so many health issues that it’d take us a full article to cover them.
Short version? Enjoy in moderation if you must, but there are definitely better ways of getting the benefits they may offer.
Q: Best morning routine?
A: The best morning routine is whatever makes you feel most ready to take on your day!
This one’s going to vary a lot—one person’s morning run could be another person’s morning coffee and newspaper, for example.
In a nutshell, though, ask yourself these questions:
- How long does it take me to fully wake up in the morning, and what helps or hinders that?
- When I get out of bed, what do I really need before I can take on my day?
- If I could have the perfect morning, what would it look like?
- What can evening me do, to look after morning me’s best interests? (Semi-prepare breakfast ready? Lay out clothes ready? Running shoes? To-Do list?)
Q: I’m curious how much of these things you actually use yourselves, and are there any disagreements in the team? In a lot of places things can get pretty heated when it’s paleo vs vegan / health benefits of tea/coffee vs caffeine-abstainers / you need this much sleep vs rise and grinders, etc?
A: We are indeed genuinely enthusiastic about health and productivity, and that definitely includes our own! We may or may not all do everything, but between us, we probably have it all covered. As for disagreements, we’ve not done a survey, but if you take an evidence-based approach, any conflict will tend to be minimized. Plus, sometimes you can have the best of both!
- You could have a vegan paleo diet (you’d better love coconut if you do, though!
- There is decaffeinated coffee and tea (your taste may vary)
- You can get plenty of sleep and rise early (so long as an “early to bed, early to rise” schedule suits you!)
Interesting note: humans are social creatures on an evolutionary level. Evolution has resulted in half of us being “night owls” and the other half “morning larks”, the better to keep each other safe while sleeping. Alas, modern life doesn’t always allow us to have the sleep schedule that’d suit each of us best individually!
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