Osteoarthritis: Oh it's just wear and tear!

I see a lot of people with osteoarthritis (OA) in a variety of joints, particularly the hips, knees and spine. It is very likely that their GP will have told them "Oh it's just normal wear and tear". I have numerous GP friends and I am not sure whether they say this. As a profession, it is these sorts of what seem innocuous, throw away comments from GP's that potentially cause a lot of distress and worry. So much so, by the time they see us, they fear that their joints are crumbling and they're causing all sorts of harm inside. They fear their joints are wearing away. In fact, I try and reassure my clients that it is the opposite!

Let's take a look at the image to the left that compares a normal joint to one that has gone through the arthritic changes in a simplified, non-daunting way.

The first thing that I try and reassure my clients is that arthritic changes are a normal part of aging that will happen to us all.

Secondly, I describe how all joints have a space between the bones known as joint space. We need this space for the bones to move, in order to allow us to move. What happens in arthritic changes is that the smooth layer on the edge of the bones called cartilage does wear away. This is the only wear and tear that is truly going on inside your joint. What actually happens is this cartilage layer is replaced with osteophytes (bony spurs). These spurs start to take up this joint space, making the space narrower, which makes moving our bones harder. This is what causes the pain and the crepitus (noises) you hear. This is evident in the image, above right. I hopefully complete my reassurance by saying, effectively your bones have got thicker and stronger! Therefore no tearing or crumbling is occurring!

I go on to advise my clients that this is why on an X-ray, your bones look whiter because they are thicker and stronger.

OA can only officially be diagnosed by the use of X-ray. I then try to make light of the situation by saying that their knee (or whatever joint is effected) is technically stronger than my own!

It is becoming more and more apparent that a large proportion of our treatment times are being used to reassure our clients following these not innocuous, but insidious comments as they put the fear of our Lord in a lot of our patients and clients. One thing we know that helps with pain management for OA joints is exercise. By strengthening the muscles around the affected joint, and keeping the joint moving with gentle exercise, thus reducing the loads the joint has to withstand when weight-bearing.

"Move it or lose it!"

Of course other strategies are used too in the management of OA. For example; additional advice, heat and analgesia (pain relief) but the key element is exercise. Sadly, this almost becomes counter-intuitive with sufferers because they perceive movement with wear and tear is putting them at risk of doing more harm, fearing pieces of bone are going to chip off with the noises they hear!

GP's, Consultants, fellow clinicians, stop calling this wear and tear and spend those few minutes explaining to your patients what OA really is. Not to make our lives easier, but for the well-being of your patients!