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Arthritis and Physiotherapy - exercise, total knee replacements and stem cell therapy.

Updated: Sep 4, 2019

Arthritis and Physiotherapy Blog - Exercise, pain, total knee replacements, hip replacements and stem cell therapy.


About arthritis:


Arthritis is a common condition that affects around 10 million people in the UK. It is not a normal part of ageing, although it is very common and the main type is osteoarthritis, or OA. This blog is going to explain osteoarthritis symptoms, discuss physiotherapy, exercise and rehabilitation, joint replacements and modern stem cell therapy treatments.


Arthritis can occur in any joint in the body but commonly affects knees, hips, shoulders, the back and neck, fingers and thumbs. It commonly occurs from “wear and tear” (degeneration) of the joints over many years. This wearing of the joint can reduce the amount of cartilage and mean there is less space between the bones to move freely.


X-ray of Knee with Osteoarthritis

This can cause pain and inflammation in the joint and described typically as:


A dull ache, worse or stiff in the morning lasting no more than 30 minutes and eases gradually with movement.


What can arthritis cause?

  1. Pain

  2. Reduced movement in the joint

  3. Extra bone to form which further impairs movement, pain and function

  4. Reduced muscle strength (through pain stopping muscle function)

  5. Less joint capsule fluid is produced which lubricates the joint - this naturally decreases with age but is more pronounced in osteoarthritis

Bonus points:

  1. Joint swelling

  2. Inflammation chemicals making the joint further sensitive to pain

  3. Stiffening of the bone meaning forces through the joint are harder to disperse

The pain can be from uneven pressures or stresses on the joint where the cartilage has been reduced and more commonly from inflammation in the joint itself. The inflammation is thought to be from cartilage damage which aggravates the joint capsule and lining.


So what should you do?


Physiotherapy and exercise:



Exercise and physiotherapy are well proven to help with osteoarthritis. Physiotherapy can help:

  1. Strengthen the muscles and reduce the stresses on the joint which can in turn reduce pain and improve function. Stronger thigh (quadricep) muscles mean better function, less pain and reduces stresses going through the knee. This also applies to other joints.

  2. Provide movement exercises that reduce stiffness, inflammation and increase the amount of fluid in the joint as well as improving flexibility.

  3. Change the way your body moves through specific exercises to make the stresses exerted on your joint move evenly spread (biomechanics) to again reduce pain and improve function.

  4. A physiotherapist can help advise on the correct exercises, give advice to change daily activities and optimise your rehabilitation as much as possible.

  5. This should help but if you are still having issues, strengthening and improving muscle function means it will be easier to recover from any later surgery such as a joint replacement so it is not wasted

Please seek the advice of a physiotherapist about what exercises to do, good technique and exercises to avoid that could make the pain worse.


Please contact us if you have any questions or wish to book an appointment, or alternatively you can book online.


Medications:


There are two main options:

  1. Anti-inflammatories

  2. Pain relief

There are a number of options for anti-inflammatory medications such as non-steroidal anti inflammatories (NSAIDs) and pain medications.


I would strongly recommend seeking you doctor’s advice on pain relief and anti-inflammatories if you are struggling with pain and particularly if this affecting your daily life or hobbies.


Lifestyle and Diet:



Some of the risk factors mentioned above can help reduce the risk or help to reduce further degeneration of the joints:

  1. Reducing any excess weight will reduce the stress and forces going through the joints. For example, forces up to 3 times your bodyweight go through your knees when walking, up to 6 times when climbing stairs and up to 8 times when running.

  2. Changing your diet:

Reducing the amount of unrefined carbohydrates such as grains including bread, whole wheat pasta, brown rice and quinoa may be a possibility although they reduce other risks such as heart disease and better for weight management.


Increasing antioxidant foods such as spices, herbs and supplements.


Please see the nutrition journal article for more comprehensive details - it provides too much detail to add in here and supplements of Dragon’s blood from Peru and Indian supplements make interesting reading:


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841576/pdf/1475-2891-9-3.pdf


Other high anti-oxidant foods include berries, fruits, nuts, dark chocolate and vegetables.


Joint Replacements:


X-ray of a Total Knee Replacement

There are joint replacements most commonly total knee, total hip and total or reverse shoulder replacements if the pain and reduced function is too severe. However, in most cases physiotherapy is worth trying first for a number of reasons explained above.


If the pain is very severe, or after physiotherapy you wish to discuss surgical options such as joint replacements then you either need to speak to your GP who can refer to an orthopaedic consultant, or seek a private orthopaedic consultant’s opinion.


Stem Cell Therapy:


Embryonic Stem Cells

Stem cell therapy, or mesenchymal stem cell (MSC) treatment for osteoarthritis is very promising and exciting treatment, although a relatively new treatment option and hence less is known about its effectiveness long term. There is also little high quality evidence around at the moment because it is only just starting to develop momentum.


There is evidence to show that these treatments can reduce pain, improve function and possibly increase cartilage volume. There is also some evidence to show it can help with rotator cuff injuries in the shoulder, but again this is of low quality and new evidence.


So what is it?

Stem cell therapy uses stem cells from the bone marrow to repair your own cartilage. They use your own body’s cells and inject or implant them into the joint.


There is currently no evidence on physiotherapy or rehabilitation programs following stem cell therapy and regenerative rehabilitation may become a whole new field.


However, it has been shown that weight bearing can change how the cartilage restructures, which may affect the outcome of treatment.


It is important to note it has not yet been clinically approved and therefore research is still being investigated before it may be made widely available but this remains an exciting prospect for joint pain and osteoarthritis at present.


I hope you enjoyed reading.


Please visit my other blogs and book online or contact us for an appointment or consultation.


Kind regards,


Daniel Leers (BSc Hons, MChem, mCSP, HCPC)





Bibliography:


Arthritis Foundation. (2019). Osteoarthritis Exercise | Exercising with Osteoarthritis. Retrieved 26 August 2019, from https://www.arthritis.org/living-with-arthritis/exercise/benefits/osteoarthritis-exercise.php


Ashkavand, Z., Malekinejad, H., & Vishwanath, B. (2013). The pathophysiology of osteoarthritis. Journal Of Pharmacy Research7(1), 132-138. doi: 10.1016/j.jopr.2013.01.008


Barfoot, J. (2019). Stem Cell Therapy & Treatment - Diseases and Conditions. Retrieved 26 August 2019, from https://www.eurostemcell.org/what-diseases-and-conditions-can-be-treated-stem-cells


Carlsen, M., Halvorsen, B., Holte, K., Bøhn, S., Dragland, S., & Sampson, L. et al. (2010). The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutrition Journal9(1). doi: 10.1186/1475-2891-9-3


Corleone, J. (2019). A List of Unrefined Carbohydrates | Livestrong.com. Retrieved 26 August 2019, from https://www.livestrong.com/article/312342-a-list-of-unrefined-carbohydrates/


Costigan, P., Deluzio, K., & Wyss, U. (2002). Knee and hip kinetics during normal stair climbing. Gait & Posture16(1), 31-37. doi: 10.1016/s0966-6362(01)00201-6


Eustace, C. (2019). Does Inflammation Play a Role in Osteoarthritis?. Retrieved 26 August 2019, from https://www.verywellhealth.com/osteoarthritis-and-inflammation-2552229


Fransen, M., McConnell, S., Harmer, A., Van der Esch, M., Simic, M., & Bennell, K. (2015). Exercise for osteoarthritis of the knee. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd004376.pub3


Fransen, M., McConnell, S., Hernandez-Molina, G., & Reichenbach, S. (2014). Exercise for osteoarthritis of the hip. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd007912.pub2


Iijima, H., Isho, T., Kuroki, H., Takahashi, M., & Aoyama, T. (2018). Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: a meta-analysis toward the establishment of effective regenerative rehabilitation. Npj Regenerative Medicine3(1). doi: 10.1038/s41536-018-0041-8


Kessler, M., Glaser, C., Tittel, S., Reiser, M., & Imhoff, A. (2006). Volume Changes in the Menisci and Articular Cartilage of Runners. The American Journal Of Sports Medicine34(5), 832-836. doi: 10.1177/0363546505282622


Liu, F., Meng, Q., Yin, H., & Yan, Z. (2019). Stem cells in rotator cuff injuries and reconstructions: A systematic review and meta-analysis. Current Stem Cell Research & Therapy14. doi: 10.2174/1574888x14666190617143952


Miller, R. (2018). Knee Exercises for Arthritis. Retrieved 26 August 2019, from https://www.arthritis-health.com/treatment/exercise/knee-exercises-arthritis


Osteoarthritis. (2019). Retrieved 26 August 2019, from https://www.physio-pedia.com/Osteoarthritis


Østerås, N., Kjeken, I., Smedslund, G., Moe, R., Slatkowsky-Christensen, B., Uhlig, T., & Hagen, K. (2017). Exercise for hand osteoarthritis. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd010388.pub2


Recommendations | Osteoarthritis: care and management | Guidance | NICE. (2014). Retrieved 26 August 2019, from https://www.nice.org.uk/guidance/cg177/chapter/1-Recommendations#diagnosis-2


Vaishya, R., Pariyo, G., Agarwal, A., & Vijay, V. (2016). Non-operative management of osteoarthritis of the knee joint. Journal Of Clinical Orthopaedics And Trauma7(3), 170-176. doi: 10.1016/j.jcot.2016.05.005


Versus Arthritis. (2019). Arthritis. Retrieved 26 August 2019, from https://www.versusarthritis.org/about-arthritis/conditions/arthritis/

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