Arthritis is common. About one in four Americans have it — more than 54 million people, according to statistics from the Centers for Disease Control and Prevention. If you’re one of them, it might be a small comfort knowing that you’re not alone but the bottom line is arthritis is painful and can be limiting.
Osteoarthritis — the most common form of arthritis — can cause not only pain but aching, stiffness and swelling in any joint. It most commonly affects the hips, knees, fingers, feet and shoulders. Osteoarthritis results from the grinding that occurs between the joints when shock-absorbing cartilage wears down over many years or from joint injury or infection.
As a result, osteoarthritis can be frustrating to live with because it can affect your ability to work and even participate in activities you enjoy.
If you have been diagnosed with arthritis, you might have learned about the potential of joint replacement surgery for hips, knees and shoulders. Although it can be highly effective in reducing pain and increasing mobility, doctors always attempt to maximize the benefits of conservative treatment before recommending surgery. Additionally, replacements can vary widely on how long they last (from two to 20-plus years).
So what can you do before resorting to surgery? Here are some tips from the experts.
OTC Pain Relief
The first line of treatment for arthritis pain is typically over-the-counter analgesics like Tylenol and NSAIDs (nonsteroidal anti-inflammatory drugs) like Advil or Motrin for help with pain and swelling, Some people find relief in topical, over-the-counter creams that have ingredients including capsaicin, menthol and lidocaine. They work to essentially distract the user from the pain by irritating nerve endings with a cooling or warming sensation, according to information from the Arthritis Foundation.
While more large-scale studies need to be done to determine their effectiveness, some patients find relief in alternative treatments like acupuncture, using anti-inflammatories like turmeric (curcumin) in food or supplements, as well as anti-inflammatory teas like willow bark and ginger, or even taking glucosamine or chondroitin supplements. Before undergoing any alternative treatment, it’s important to pass it by your doctor to make sure the treatments won’t interfere with any medications you’re taking.
The number one thing that people diagnosed with arthritis can do to help is to lose weight, according to Thomas Vikoren, MD, fellowship-trained orthopedic surgeon and president of Bucks County Orthopedic Specialists, part of Doylestown Health.
“I know it’s hard to do, but it legitimately helps a lot of people feel better,” says Dr. Vikoren.
In fact, one study published in the journal Arthritis & Rheumatism found that for people with knee osteoarthritis, losing one pound of weight resulted in four pounds of pressure being removed from knees.
“The pressure on the joint is a multiple of a person’s weight,” explains Dr. Vikoren. Less pressure equals less pain and damage to the joints, he adds. “Maintaining a healthy weight is one of the best ways to limit the speed of arthritis getting worse.”
While being overweight can worsen arthritis, regular exercise may be the answer for both weight loss and pain reduction. It may seem counterintuitive to exercise when you’re in pain, but the right kind of exercise can be done safely and be very beneficial. Exercise keeps the joint moving and lubricated helping to maintain mobility and strengthen the muscles around the joint at the same time, notes physical therapist Mona Dunlap, MS, PT, CLT-LANA, who is clinical manager of The Clark Outpatient Rehabilitation Center at Doylestown Hospital.
Low- or no-impact, less aggravating exercise could include swimming, biking, walking or using the elliptical machine. “These machines are advisable over a treadmill to decrease impact on the joint,” adds Mona.
When the above strategies aren’t helpful on their own or in combination, physical therapy is often the next step. The purpose of physical therapy is to strengthen the muscles around the joint to stabilize it and encourage mobility without causing more damage to the joint.
Physical therapists will devise a treatment plan that could include resistance training, strengthening exercises and stretching. In order to be most effective, patients will need to carry over what’s learned in therapy at home. It's important to note, however, that many doctors recommend delaying surgery for three months after a cortisone injection to minimize the risks of complications at the surgery site.
To help with pain and inflammation, another option is corticosteroid injections. A doctor administers the injection to the joint and relief can last between one and three months. It's important to note, however, that many doctors recommend delaying surgery for three months after a cortisone injection to minimize the risks of complications at the surgery site.
Another type of injection available for the knee involves hyaluronic acid, which is a natural lubricant. Also called viscosupplementation, these injections are intended to mimic and boost the joint’s hyaluronic acid that diminishes with osteoarthritis. A doctor administers these injections usually in a series over a month.
Time for Joint Replacement?
Often over time, despite best efforts, treatments may stop working as well, pain increases and mobility decreases. When that happens, joint replacement may be the only solution. But it’s important to know when is the right time.
“There is a sweet spot for joint replacement. If you wait too long, you can lose too much mobility and create a limp that becomes a habit, which is not only hard to break after surgery, but also can cause pain in other joints of the body. It makes it much harder to get all of that back post operatively and fully rehab the knee,” says Mona.
Dr. Vikoren adds that one indicator for joint replacement is when you’re no longer able to maintain physical fitness. “When people are seeing a decline in their ability to do things like walking for recreation or maintaining a healthy weight because their ability to exercise is limited, it’s time to consider a replacement.”
- For more ideas on arthritis management, visit the Arthritis Foundation.
About Clark Outpatient Rehabilitation Center
The Clark Outpatient Rehabilitation Center offers physical, occupational, and speech therapies as well as hand therapy, lymphedema therapy, and pelvic floor rehabilitation, and programming for neurological impairments with ample space. Its location within steps of Doylestown Hospital—and convenient parking—on the health system’s flagship campus is in careful consideration of facilitating patient access to these popular and critical services.