We all know ageing brings in various changes in everyone’s body. Commonest is greying of hair. Greying is visible to eyes and in today’s world we have kind of accepted that premature greying is real. Few people enjoy no or little greying till the age of 50 or sometimes more, whereas few keep struggling with that as early as 20s or in some cases even before. When it comes to joint pains, specially knee, hip, ankle and other large joints we usually don’t think that it may be a start of osteoarthritis which is also age related change.
Osteoarthritis is the normal wear and tear of the joint and is one of the senile changes inside the joint, similar to greying of hair, only difference being greying is painless whereas joint changes are in most of the cases painful. Now, if someone complains of knee pains at 65, we know for a fact that it is a natural thing to expect at that age. But we need to be cautious and aware of the early onset of this change which is on the rise. Usually people may have a history of trauma, accident, fracture or ligament tear which may be the trigger for early onset of arthritis. But there is a considerable group of population in whom we may get to see early changes in joint line similar to osteoarthritis as early as 35- 40 years of age.
The reasons to these are usually joint destruction due to improper usage or overuse of the joints, muscle weakness leading to increase in joint loading, posture abuse ie. Overuse of certain postures, accelerated aging pertaining to poor lifestyle, etc.
The commonest manifestation as we know is pain, restricted movement with or without swelling. A simple visit to a physiotherapist can help you know whether your journey towards osteoarthritis has already begun or not.
Simple test to check-
Meet your physiotherapist- he or she will check the joint movement and presence of crepitus in passive range of motion which strengthens the suspicion.
Weight bearing x-ray- your physiotherapist may order an x-ray in weight bearing position. Joints of lower extremity are better visualized on a x-ray in standing (weight bearing) position. Weight bearing x-rays have been a choice of investigation among physiotherapists as it reveals the actual joint space in functional position.
Prevention of early onset
Avoid joint abuse- examples are walking/jogging on incorrect surfaces. You should always consult a physiotherapist before you begin a new workout regime even if you don’t have any pre-existing issues of bone and joints. Physiotherapists are movement scientists who are specially trained to understand biomechanics that is joint-loading, effects of surface contact and torque generated by each muscle around specific joints (spinal joints, weight bearing joints, etc.)
Selecting correct footwear- always show your footwear to your physiotherapist before you start using the same. They will tell you if this footwear is suitable for your height, weight and foot structure. A lot depends on the anatomy of foot arches. Not all footwears are for everyone ex. Generally people think, a flat footwear is the best one and heels are bad. Whereas in reality a flat footwear with a half inch of heel raise is more ergonomic for the knee joint, hip joint and spine. It also helps to keep the center of gravity and line of gravity of the adult human body just anterior to S2. If the center of gravity shifts more anteriorly it would change the torque generated by the para-spinal muscles and as a result will lead to anterior pelvic tilt which in turn would lead to tightening of hip flexors and anterior abdominal muscle wall laxity.
Weight training- many people have this belief that lifting weights is an excellent exercise when it comes to bone and joint health. True!! As weight bearing exercises decreases chances of osteoporosis. But, how much weights to use, which form of weight bearing exercises to perform in order to max out the benefits of weight training needs to be looked at. A qualified physiotherapist is specifically trained to calculate and assess the load-bearing and length-tension relationship of each muscle of the human body. So it’s worth discussing the same with your physiotherapist. Incorrect weight bearing or techniques may damage the joint rather than benefiting the individual.
Stretching exercises/eccentric muscle loading- Recent studies have shown that stretching exercises with proper and calculated hold time and range of various muscles have similar benefits like strength or resistance training. Whoa!! Problem solved! For women who are hesitant/who can’t or shouldn’t lift weights can actually do customized and tailored whole body stretching exercises after learning it properly under guidance of an experienced physiotherapist and bingo!! Work out done right.
Joint preserving exercises- once a person has started with osteoarthritis it can’t be reversed and the journey is progressive, just like grey hairs can’t become black again. But slowing down the progression and minimizing the effects of existing damage is possible. There are certain exercises which tune your muscles to reduce the load on the bone and joint. Yes, it is possible! Our body is a machine and works on the principal of mechanics. So reducing the load on the joints by muscle training lessens wear and tear of the joint and thereby helps in increasing joint life.
How much ever costly implant is put after a joint replacement, one cannot duplicate a natural joint’s function and mobility. So in an individual’s best interest joint preservation and thereby increasing function and life of a natural joint is a matter of smart choice.
So next time your knee gives out a crackling sound visit an experienced physiotherapist who will evaluate your joint and other factors affecting it and help you preserve your joints to ensure longevity and functional range of the joint in question. Surgical options do help with pain reduction but conservative management is in the best interest of a person with osteoarthritis. Once joint is worn off to an extent that is interfering with the person’s day to day activities that is the time conservative approach and management won’t work, and the person needs an artificial joint.
Early evaluation in cases of doubt should be considered as joint can preserved, movements can be restored and disease progression can be limited. This article was submitted to increase awareness around early osteoarthritis in women and men.
World Arthritis Day is observed on October 12th each year to build awareness. Though osteoarthritis is a change that comes in with aging, but early onset should and must be prevented. Nothing can replace the effect of scientifically carved out joint preservation exercises.