Top 10 tips for managing osteoarthritis

by Martin Kidd, Clinical Lead, Southern Community Orthopaedic Triage Service (SCOTS), Health NZ Southern

Osteoarthritis (OA) is a condition of the joints. It is characterised, among other things, by degenerative changes in joint cartilage, inflammation of the joint lining, thickening of the joint capsule, pain, and a decrease in the normal function of the joint. As we age, the process of regeneration is gradually overtaken by degeneration throughout our body: as we age, we see it every time we look in the mirror. 

In some cases, and in some parts of our body, such as weight-bearing joints, degeneration occurs more quickly than we can compensate for, be it due to previous trauma, genetics, body type or whatever reason. So, we present to our health professional looking for some strategies to help us manage our symptoms. 

1. Re-calibrate

Your engine is different now. You probably can’t fire on all the cylinders you used to. We have supported 1500 people with OA through the SCOTS programme, yet we have not cured a single one. Two out of three of them report that they have made significant functional gains with less pain. Sure, they have strengthened muscles, improved balance and may be more flexible, but much of the improvement comes down to a shift in attitude: “OK, this is me. How can I make the best of what I have? My glass is half full, as it were.”

2. Grieve

Before you can move on, you might recognise the following stages that you go through. First, denial: this can’t happen to me, I am too young, I have too much to do, I am only just retired, it’s not fair! Then you might become angry: it’s NOT fair! Then, you bargain: well, what if I did this, or that, maybe my knee would get better. Finally, acceptance: OK, this is me, so what should/can I do to help myself. It is good to grieve for something you lose. For some, the process is a quick one, for others it takes time. That’s OK.

3. Support

Whether you live with someone or alone, your journey with OA will not succeed without support. You may need to make changes in your life because you have OA. These changes may affect those around you. If you are changing your expectations of yourself by recalibrating, then those within your circle of influence will need to as well. Be honest with them so they can be a tailwind. Don’t forget non-human support, e.g. a shoe-horn, a walking stick, and the new Arthritis NZ website. Every bit of support counts, because there will be times when the journey is hard.

4. Motivation

To help me here, I refer to the book So What Happens Now by AEM Kidd, where the author describes the importance of motivation better than I: 

“As a child, spending time on a simple activity that you enjoyed was the only motivation you needed: playing with your trucks, your dolls, painting, dancing, singing or reading. Your motivation was purely intrinsic. Only when someone else offered a reward for you to do an activity, such as a gold star or a grade or a prize, that motivation changed. This is called extrinsic motivation. To get the best out of your recovery plan it is a good idea to tap into what will work for you. Finding someone who can motivate you in a scheduled manner: an app, a physiotherapist, a community worker, can help you establish a routine: this is extrinsic. Then, reflect on how you can maintain this through activities you love and enjoy. Ask yourself “Why do I want to achieve this goal?” Then put the word “because” next to it. For example, I want to walk without support because I want to walk my dog (which I love) with confidence.” P. 43. 

Tap into your intrinsic motivation and work out your why. Be realistic with your goals and relate them to what is important to you. 

5. Nutrition

Food defines culture. Food is integral to social engagement. Food is fuel. Food, in a nutshell, is important. Making good food choices can profoundly influence our journey with OA. One of the most influential and modifiable OA risk factors is body weight. Not only does increased weight increase the load through some joints, but obesity also creates a low-grade systemic (whole-body) inflammatory environment that worsens OA*. Keep weight management simple, making one change at a time. Start with looking at portion sizes: a serving of red meat no bigger than your palm, a serving of carbohydrates no bigger than your fist, a serving of fresh vegetables the size of two open hands. Maybe try eating your main meal off a small plate. Include protein with every meal: it will fill you up and prevent snacking later on. Make nutrition changes small and sustainable. If you want to lose weight, aim for a 1kg change, achieve it (yay!), then reset and aim for another 1kg.

6. Medication

We are lucky at SCOTS to have the services of the School of Pharmacy clinic and its lead clinician, Emma Smith. I have heard her presentation many times and the messages are consistent. The better a medication is at removing pain, the more side effects it has. If there were a single ideal pain reliever, we would use it all the time. There isn’t. However, it is a good idea to understand risks and benefits of different types of analgesia (pain relief medication). Whether you use opioids such as codeine or tramadol, non-steroidal anti-inflammatories like Voltaren, Brufen or Celebrex, or you use paracetamol, you should ask for and understand side effects. The best place to go for this information is your local pharmacist. Bring them out from behind their counter and have them explain exactly what this or that does and what side effects there are. Spoiler alert: The medication with the fewest side effects is paracetamol.

7. Incidental exercise

Every bit counts. Park half a block further away from your destination. Bring in less firewood each time so you can do it more often. Walk to the letter box by going all the way around the house. There are many ways you can mindfully increase exercise outside of the formal exercise programmes or gym and pool sessions you might be part of. 

8. Pacing

Give yourself permission to slow down. Break down tasks into smaller chunks. For example, clean one room a day rather than the whole house in one go. Maybe leave the weeding of that garden section to another day, or mow only part of the lawn. Even in New Zealand, where some outdoor activities are so weather-dependent and we feel we need to make the most of rain-free days, it is OK to slow down and leave things for another day. Pacing needs practice, especially if we are the “bull at a gate” type of person. Remember, do no more on a “good” day and no less on a “bad” day. 

9. Belonging

OA can be very socially isolating. Moving hurts and it is sometimes just easier to stay put. After all, you’ve got your telly and your books and craft, your phone and your computer. You have your groceries delivered. Why go out when it hurts so much? Well, if the SCOTS participants over the years have told us anything, it is the value of the group, being able to share a journey with others in the same direction. Whether it is a formal programme like SCOTS or Steady As You Go, or less structured like a few of you in the pool together, place a high value on making the effort to get out to spend time with others who share your journey with OA. They will teach you more and support you more sustainably than any health professional. Your story also has value and should be shared with others. 

10. Self-advocacy

Be proactive. Ask questions and seek answers. Of your GP, your physiotherapist, your pharmacist, your health coach, your friends. There are many thousands of folks with OA in New Zealand, but you are the only one with your special blend of symptoms, personality and motivation. Therefore, any question that you have is valuable and important. Go ask it.