Ross has knee osteoarthritis. About thirty years ago he had a nasty bicycle accident which resulted in surgery and six weeks in a cast. Recently, while travelling abroad, he started to feel pain in the knee again, often waking him at night and preventing him from walking too much during the day. On his return home, he sought several expert opinions and was diagnosed with osteoarthritis. It was supposed that this painful and debilitating condition possibly stemmed from the fall, all those years ago. After various clinical consults, he was ultimately recommended to have surgery by an orthopedic surgeon.
The Australian Commission on Safety and Quality in Health Care (2018) claim Osteoarthritis as the most common form of arthritis in Australia, affecting over 2million Australians. Over one-quarter relate to the knee. This degenerative knee disease is a chronic, progressively debilitating condition that affects the health of the knee joint and surrounding structures (Devji et al. 2017).
The main risk factors to developing knee osteoarthritis include; age (over 45), female gender, overweight/obesity, and prior joint injury… such as a bad fall off a bike 30 years ago.
Despite the growing evidence of the benefits of non-surgical and non-pharmacologic management of knee osteoarthritis such as weight loss (if required) and physical activity, recent studies suggest there is a general lack of exercise being recommended by health professionals as a form of treatment.
According to Dobson et al. (2016), what compounds the problem of exercises being ignored or underestimated as a viable treatment relates to ingrained beliefs and preconceived ideas... Many patients have no faith in non-clinical remedies. Many believe their condition will inevitably worsen and many give up trying or resign to surgery which is often ineffectual. Apparently, what helps convince patients to trust the process of 'conservative management strategies' is reinforcement by clinical professionals and evidence proving that it works… And what are ‘conservative management strategies’…EXERCISE, EXERCISE, and EXERCISE (Jenna Price 2020).
Ross has been physically active is whole life. Living inner city he didn't have a car and for many years rode his bike everywhere. He took up weight training in his forties and still works out on his original Lat pulldown machine. Ross took up yoga in his sixties and continues to follow along with a yoga program he recorded in the '90s on foxtel.
It wasn't until his travels last year, out of his regular exercise regime, that his knee started to bother him. On his return, he sought the advice of various doctors, none inquiring about his activity levels and none offering or recommending exercise as a viable treatment. In fact, Ross started to reduce his activities due to the pain and discomfort as he prepared for the potential prospect of surgery.
In our consultation, I gave Ross some basic exercises that took the knee joint through a good range of motion and that would help develop the muscles around the glutes and back as well as the knee. The plan was if he did have to have the surgery he would increase the chance of a full and speedy recovery. He was diligent in getting the exercises done and kept up his yoga every alternate day. Within three to four weeks, he found his pain was reduced. He was back to full mobility and canceled his doctor's appointments because he had other things to do. I have now developed a more comprehensive strength training program for him and added a couple of interval training sessions per week.
It seems clear from much scientific, clinical and anecdotal evidence, that clinicians and health care professionals could take a more proactive role in encouraging exercise as the first treatment for knee osteoarthritis and show their patients ways to incorporate exercise into their lives. If it's not their personal expertise then they could encourage and recommend their patients to seek out quality, effective physiotherapists, exercise therapists and sports physicians as the first point of call for specific strengthening and mobility programs, three to four days a week (Brignardello-Petersen et al. 2017).
David Hunter, the Professor, and Chair in rheumatology at the University of Sydney, suggests the focus of recovery should be on becoming active and to build strong muscles around the joint (Jenna Price 2020). Many activities can provide this kind of therapy such as resistance training, yoga, tai chi, walking, cycling, aquarobics, and Pilates… So, like Ross, their patients could find an activity they like and maintain, one that is enjoyable and feels like it is actually working then commit to doing it regularly.
REFERENCES
doi:10.1136/bmjopen-2017016114
doi:10.1136/bmjopen-2016-015587
Hi Dr John, yes it’s such an inexpensive option making it available to everyone.it puts individuals in control of their own health and recovery and all exercise has so many other health benefits. Considering this type debilitating condition often leads to immobility and forced isolation it can also affect mental health and exercise is so good for mental health.
Thank you Rose for this post. I totally agree with your thinking in relation to both the young and older athletes reconsidering surgery and choosing instead to do specific exercises to develop strength and flexibility around our joints, particularly knees and shoulders. Well done Ross!