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It’s 2am and you’ve been tossing and turning for hours. You’re so tired, but you just can’t sleep. You lay on your left side, but your neck hurts too much in that position. So you roll on to your back, but your lower back aches. You turn on to your right side, and success (!) that feels ok. But now your knees hurt, your brain’s counting down the hours until you have to get up for work, and you need to go to the toilet. Sigh.

Sound familiar? We’ve all experienced the dreaded ‘painsomnia’ – or insomnia caused by persistent pain.

Without the distractions of our daily activities, the dark of night can become a long, painful expanse of time. Even when we’re exhausted, sleep can be elusive. It might take longer to fall asleep, we can’t get comfortable, we wake frequently, or we just don’t get enough sleep. Or all of the above.

When you add anxiety about sleep into the mix, it becomes a vicious cycle. Poor sleep lowers your pain threshold which affects the quality of your sleep. Pain can affect your ability to be active – which affects your sleep quality and your pain levels. This can make you anxious or stressed – which again will affect how well you sleep and the amount of pain you experience.

And when you’re stuck in this cycle, exhausted and in pain, it affects your mood, your ability to concentrate and it’s very easy to become depressed. So it’s important that you act quickly as soon as you start having issues sleeping.

The good news is there are many things you can do to break the cycle. The not-so-good news is they may not work immediately. And they’ll require some effort on your part. But they’re all tried and true ways to develop good sleep habits and get the good night’s sleep you crave.

  • Acknowledge your painsomnia. Although it’s tempting to pull the covers over your head and ignore the problem, that won’t make it go away. Actually acknowledging the situation, and that there are things you can do to change it, is the first important step.
  • Develop a sleep routine. There’s a reason we do this with babies and small children – it works! As often as possible, go to bed and get up at the same time each day. Your body will become used to this routine and you’ll find it’s easier to fall asleep and stay asleep.
  • Manage your pain. You can’t have painsomnia if your pain is under control. Check out our A-Z pain management guide for simple, practical ways you can take control of your pain.
  • Try some relaxation techniques. There are as many ways to relax as there are stars in the night sky (well, almost) so there’s bound to be something that suits you. Try a warm bath before bed, reading (though nothing too engrossing!), deep breathing, listening to music, mindfulness, or visualisation. These techniques will help you become more relaxed so that when you go to sleep, you sleep well.
  • Exercise and be active during the day. As well as the many other benefits of regular exercise, it’ll help you fall asleep and stay asleep longer.
  • Don’t look at the clock. Constantly checking the time can make you anxious, which makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.
  • Manage your thoughts, all of the pesky voices in your head that are focusing on the things you need to do tomorrow, or the current state of the world, or the latest stress of the day. One way to deal with them is to write them down and get them out of your head. Put them down on paper and tell yourself you’ll deal with them tomorrow when you’re rested and have the brain power to deal with them.
  • Get out of bed. Don’t lie in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or breathing exercises and go back to bed when you feel more comfortable.
  • Avoid tech before bed. It’s easy to get caught up in news, social media and emails, and before you know it you’ve lost a few hours. Also the blue light on our devices suppresses the hormone (melatonin) that makes us sleepy at night, so be sure to stop screen use at least one hour before bed. That being said, there are some useful apps that may help you with your painsomnia – including sleep diaries, apps that provide soothing sounds to help block out other noises (like traffic or snoring), and apps that help you relax so you fall asleep more easily.
  • Consider cognitive behavioural therapy for insomnia (CBTI). This is a therapy that aims to challenge and change unhelpful ways of thinking about sleep. It also changes your behaviours when it comes to sleep. Find out more about CBTI in this article from the Mayo Clinic.
  • Evaluate your environment. What’s your bed like? Too hard, too soft or just right? Do you need to make some changes to your mattress, pillows and/or linen that will make your bed as comfortable as possible? Is there too much light or noise? Can you control that with simple fixes such as eye masks or earplugs? Is your room too hot? A slightly cool room is the best for a good night’s sleep. Consider all of these things as you take a long, hard look at your bedroom.
  • Get professional help. If pain is constantly keeping you awake at night, talk with your doctor about other things you can do to manage your pain and get some decent sleep.

Call our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available Monday to Thursday  between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

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12/Dec/2023

Our child has seen so many specialists and now they have been told to go to a kid’s physio. Are you thinking how will a physio help? Or how will this be any different to any other appointments we have? What do I tell my child they will be doing with them?

I am Nicole Pates, a Titled Paediatric Physiotherapist and director of Western Kids Health, a paediatric clinic in Perth Western Australia. I have been a Paediatric physio for over 13 years and these are the things I would like you to know about seeing a paediatric physio.

Children and teenagers, as we all know, are different from adults. Not just physically, but in all of their systems. Their brain is growing and their understanding of their body and how it works is constantly changing. Add into that school, friends and puberty and well, it can be a lot. Let alone managing chronic pain and fatigue on top of this. This is why it is important to work together with a physiotherapist who is experienced in working with kids and teens, who understands growth and development. You can search for a Titled or Specialist Paediatric Physiotherapist, who has undertaken extra study or experience in paediatrics, on the Australian Physio website https://choose.physio/find-a-physio

For families of children with persistent pain and / or fatigue, finding the right help can be tricky.  You can find a practitioner experienced in working in paediatric pain on the Australian Pain Society website  https://www.apsoc.org.au/Home/wcontent2/60

Once you have chosen a physiotherapist you will be *hopefully* be on your way to an appointment. You may be required to fill out some questionnaires or forms, prior to your initial appointment, depending on your reason for visiting the physiotherapist.

Typically, an initial appointment for children with chronic musculoskeletal / rheumatological conditions will be an hour or potentially more. For some families at Western Kids Health, we might sit down for 2 hours with not just physio but also OT and psychology. I encourage you to contact your chosen clinic to find out more about the first appointment. It is important to dress in clothes that are comfortable to move in and take a water bottle if needed.

Your physiotherapist may ask lots of questions in the first appointment. Not just about your child’s condition, symptoms, history, current team and limitations but also about their strengths, likes and future goals. Your physio will then watch how your child moves and plays, particularly the things they are having trouble with.

We love watching kids move and figuring out the different reasons as to why they might be having trouble or moving differently.

Being able to identify the activities that trigger your child’s symptoms, understanding their experience and watching how your child moves will enable your physio to work with you to formulate a plan. This plan should be collaborative and based around your child’s goals such as getting back to school, sport or hobbies. Having pain or fatigue can be so annoying and make moving and doing things difficult. But with chronic conditions, waiting for the pain or fatigue to go away before you get back into things can be an endless waiting game. Your physio will help you get back into doing things in a way that is meaningful, fun and supported.

Your physio may also provide education around:

  • Symptoms such as pain and fatigue and potential triggers / aggravators
  • Strategies on how to bring awareness to and strategies to minimise triggers and aggravators
  • Why your child may be experiencing pain.
  • How best support your child and their pain journey through supportive language in a progressive mindset

Your physio will also work hard to understand where your child’s physical function is at present and work out a plan to build on their activity level, strength, balance, movement control and most importantly, function over time. Your physio will support your child (and you!) with a plan for flare ups or set backs.

Other team members who your physio may recommend supporting you are

  • An Occupational Therapist, who assists your child to minimise the impact symptoms may have on sleep, school and relationships
  • A Dietician to understand your child’s nutrition needs whilst they are growing and create plans to support and meet these needs
  • A Psychologist to build coping skills and resilience and manage mental health symptoms such as low mood, stress or anxiety. This is important as often these symptoms are contributing to or exacerbating your child’s ability to engage in the physical rehab.

At Western Kids Health we run specialised groups in conjunction with the Arthritis & Osteoporosis Association of WA, including group hydrotherapy and strength and conditioning classes.

Hydrotherapy and physical conditioning for children with conditions like Juvenile Idiopathic Arthritis is safe and effective. Building strength through range is essential to keep your joints healthy. Your physio will work with you to help your child understand their body’s reactions and sensations as they try new activities. This will help your child build their capacity and understanding of body awareness. Your physio will help explore what movements and types of exercise work best for your child’s body, and most importantly making it fun!

You should see improvements over time with the right support and if you aren’t seeing those improvements, or your child isn’t reaching their goals, please discuss this with your therapy team.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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16/Nov/2023

Or how to manage fatigue

We all get tired. We overdo things and feel physically exhausted. It happens to us all. Usually after a night or two of good quality sleep the tiredness goes away and we’re back to our old selves.

But fatigue is different.

It’s an almost overwhelming physical and/or mental tiredness. And it usually takes more than a night’s sleep to resolve. It generally requires multiple strategies, working together, to help you get it under control.

Many people living with a musculoskeletal condition struggle with fatigue. It may be caused by a chronic lack of sleep, your medications, depression, your actual condition (e.g. rheumatoid arthritis, lupus, fibromyalgia) or just the very fact that you live with persistent pain.

Fatigue can make everyday activities difficult, and can get in the way of you doing the things you enjoy. The good news is there are many things you can do to manage fatigue and get on with life.

Exercise and being active. While this may sound like the last thing you should do when you’re feeling fatigued, exercise can actually boost your energy levels, help you sleep better, improve your mood, and it can help you manage your pain. If you’re starting an exercise program, start slowly, listen to your body and seek advice from qualified professionals. Gradually increase the amount and intensity of activity over time.

Take time out for you. Relaxation – both physical and mental – can help you manage your fatigue. I’m not just talking about finishing work and plonking down in front of the TV – though that may be one way you relax and wind down. I’m specifically referring to the deliberate letting go of the tension in your muscles and mind. There are so many ways to relax including deep breathing, visualisation, gardening, progressive muscle relaxation, listening to music, guided imagery, reading a book, taking a warm bubble bath, meditating, going for a walk. Choose whatever works for you. Now set aside a specific time every day to relax – and choose a time when you’re unlikely to be interrupted or distracted. Put it in your calendar – as you would any other important event – and practise, practise, practise. Surprisingly it takes time to become really good at relaxing, but it’s totally worth the effort. By using relaxation techniques, you can reduce stress and anxiety (which can make you feel fatigued), and feel more energised.

Eat a well-balanced diet. A healthy diet gives your body the energy and nutrients it needs to work properly, helps you maintain a healthy weight, protects you against other health conditions and is vital for a healthy immune system. Make sure you drink enough water, and try and limit the amount of caffeine and alcohol you consume.

And take a note out of the Scout’s handbook and ‘be prepared’. Consider making some healthy meals that you can freeze for the days when you’re not feeling so hot. You’ll then have some healthy options you can quickly plate up to ensure you’re eating well without having to use a lot of energy.

Get a good night’s sleep. Good quality sleep makes such a difference when you live with pain and fatigue. It can sometimes be difficult to achieve, but there are many things you can do to sleep well, that will decrease your fatigue and make you feel human again. Check out our blog on painsomnia for more info and tips.

Pace yourself. It’s an easy trap to fall into. On the days you feel great you do as much as possible – you push on and on and overdo it. Other days you avoid doing stuff because fatigue has sapped away all of your energy. By pacing yourself you can do the things you want to do by finding the right balance between rest and activity. Some tips for pacing yourself: plan your day, prioritise your activities (not everything is super important or has to be done immediately), break your jobs into smaller tasks, alternate physical jobs with less active ones, and ask for help if you need it.

Write lists and create habits. When you’re fatigued, remembering what you need at the shops, where you left your keys, if you’ve taken your meds or what your name is, can be a challenge. And when you’re constantly forgetting stuff, it can make you stress and worry about all the things you can’t remember. Meh – it’s a terrible cycle. So write it down. Write down the things you need at the supermarket as soon as you think of it –a notepad on the fridge is a really easy way to do this. Create habits around your everyday tasks – for example always put your keys in a bowl by the door or straight into your bag, put your meds in a pill organiser.

Be kind to yourself. Managing fatigue and developing new ways to pace yourself is a challenge. Like any new behaviour it takes time, effort and lots of practice. So be kind to yourself and be patient. You’ll get there. It may take some time, and there may be some stumbles along the way, but you will become an expert at listening to your body, pacing yourself and managing fatigue.

Talk with your doctor. Sometimes fatigue may be caused by medications you’re taking to manage your musculoskeletal condition. If you think your medications are the issue, talk with your doctor about alternatives that may be available.

Fatigue may also be caused by another health condition – including anaemia (not having enough healthy red blood cells to carry oxygen around your body), diabetes, high blood pressure, fibromyalgia and being overweight. If you’re not having any success getting your fatigue under control, your doctor may suggest looking into other potential causes.

So that’s fatigue…it can be difficult to live with, but there are lots of ways you can learn to manage it.

Tell us how you manage. We’d love to hear your top tips for dealing with fatigue.

FIRST WRITTEN AND PUBLISHED BY LISA BYWATERS IN OCTOBER  2020

Call our Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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21/Jun/2023

We all know regular exercise is essential for good health. It can improve the fitness of your heart and lungs, sleep quality, energy levels and mental wellbeing. And it can reduce your risk of developing conditions such as diabetes.

Exercise is also vital for the health of your bones.

Like muscle, bone is living tissue that responds to exercise by becoming stronger. People who exercise regularly have stronger bones and higher bone density than those who don’t. This reduces the risk of developing osteoporosis.

Exercise also increases your balance, coordination and flexibility, which improves your ability to prevent trips and falls. DYK, falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths? More than half of the hospitalisations were due to broken bones (fractures).(1)

Bones need exercise.

To understand why exercise is important for bone health, it helps to know how bones work.

Throughout your life, your bones are constantly changing. This is called ‘remodelling’. Bone cells called osteoblasts build new bone, while other bone cells (osteoclasts) break down and remove old bone. This process is controlled by hormones such as calcitonin, parathyroid hormone, oestrogen (in women), testosterone (in men), and vitamin D.

From birth to about 25, you build more bone than you lose. Your bones are not only getting bigger as you grow, but they’re also developing their density. This determines how strong they are.

From about 25 to 50, your bones break down and rebuild at about the same rate. They’re in a state of balance. This is when you’ve achieved your ‘peak bone mass’. Your bones are at their strongest.

After about 50, you break down more bone than you rebuild. While this means everyone will experience some bone loss as they age, it doesn’t mean everyone will develop osteoporosis.

Women commonly experience a period of rapid bone loss after menopause. This is due to a drop in oestrogen levels. It’s estimated that the average woman loses up to 10% of her bone mass in the first five years after menopause.(2)

For good bone health, exercise is vital for everyone – from the very young to the very old.

A combination of different exercises is best for bone health.

Different exercises challenge and strengthen your bones and muscles in different ways, so you should include the following in your exercise plan:

Weight-bearing exercises or activities where your body carries its own weight. These exercises put stress on your bones, making them stronger and denser. It also strengthens the muscles around your bones, providing support and reducing the risk of fractures. Weight-bearing exercises include brisk walking, climbing stairs, tennis, and netball.

High-impact exercises such as jogging, running, jumping, and skipping rope. They’re also weight-bearing exercises, but they place greater stress on the bones of the spine and legs as your feet hit the ground. This can provide more bone-strengthening benefits; however, these exercises aren’t suitable for everyone.

Resistance training, also known as strength training, uses resistance or weights to strengthen your muscles by working them harder than you do in everyday life. The strong muscle contractions required to move a heavy weight place stress on the bone where the muscle attaches. When bone feels this strain repeatedly, it responds by becoming stronger. Resistance training uses equipment like free weights (e.g. dumbbells), gym machines, elastic resistance bands or your body weight (e.g. push-ups, squats).

Balance and flexibility exercises such as tai chi and yoga improve balance and mobility and can reduce your risk of falling. This is important for preventing fractures.

Before beginning an exercise program, speak with your health professional. Not all types of exercise are suitable for everyone. This is especially important if you have other health conditions, including osteoporosis. A physiotherapist or exercise physiologist can assist you with a safe exercise program that targets your specific needs and reduces your risk of injury.

Exercise must be regular and ongoing.

You need to exercise regularly to have a significant benefit, so you should choose activities you enjoy. This will make it easier to exercise consistently.

Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. This includes at least two sessions of strength training every week. However, when you’re just beginning, this can seem daunting.

That’s why it’s good to know you don’t have to do all your exercise in one session. For example, a 30-minute brisk walk can be broken up across your day into shorter, more achievable sessions, such as three 10-minute or six 5-minute walks.

You can do other things to make exercise a regular, ongoing activity.

Exercise with a group or a partner. This can improve your motivation to exercise and provides an opportunity for socialising with others.

Exercise SMART and set goals. A clear goal can motivate you to stay on track with your exercise program. But they must be realistic and specific to your abilities, needs, and health issuehttps://muscha.org/goals/s. So, ensure your goal is SMARTSpecific, Measurable, Achievable, Realistic and has a Timeframe.

For example, a good SMART goal for resistance training for stronger bones and muscles could be: “I will perform resistance exercises, such as lifting weights or using resistance bands, for 30 minutes, twice a week, for the next three months.”

This goal is Specific (focuses on resistance training), Measurable (30 minutes, twice a week), Achievable (realistic for most people), Relevant (aimed at improving bone and muscle strength), and has a Timeframe (three months).

Constantly evaluate your goals, adjust them as needed and reward yourself for your successes.

Add variety. Vary where you exercise and the type of exercise you do. Include recreational activities such as bushwalking or dancing. This will help keep your mind fresh and your motivation high. Find activities that are enjoyable to you so that you’ll be motivated to continue doing them.

Exercise within your capabilities. Often, people drop out of exercise programs because they exercise at a level beyond their current capabilities. Ensuring your exercise program suits your current abilities will decrease your risk of injury and increase your enjoyment and motivation to continue your exercise program.

Challenge yourself. Increase the intensity of your exercise as your fitness improves. It’ll make your exercise more interesting and also has greater health benefits.

Stop if you have pain. Don’t continue exercising if you experience pain or severe discomfort. Talk with your fitness professional for advice to ensure you’re not doing an exercise incorrectly.

Bone health doesn’t happen in a vacuum.

As well as exercise, you need to also to eat a nutritious diet with calcium-rich foods, get sufficient sun exposure for vitamin D, take medicines or supplements as prescribed by your doctor, quit smoking, and moderate your use of alcohol, caffeine, and salt intake, as they can impact bone density.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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References

(1) Falls. Australian Institute of Health and Welfare.
(2) Osteoporosis, Australasian Menopause Society


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18/May/2023

Do you have osteoarthritis in your knees? Does the pain sometimes interfere with your ability to be as quick or mobile as you’d like? If so, you’re not alone – it’s a big club!

Osteoarthritis (OA) is the most common type of arthritis, affecting 1 in 11 Australians. It can develop in any joint but commonly occurs in weight-bearing joints like your knees. And because it’s so common and causes lots of pain and distress, we’re all looking for effective treatments to manage the pain and keep moving.

The good news is there’s strong evidence about the most effective treatments for knee OA, those that aren’t effective, and those that don’t have enough evidence to support their use.

And yet, a recent study has shown an increasing number of people with OA are investigating some less effective treatments such as stem cells, platelet-rich plasma, and Botulinum toxin.

There are likely many reasons for this.

We’ve become much more familiar with searching online for information during the pandemic.

Information about the effectiveness (or not) of treatments isn’t always translated for consumers. And unfortunately, to access much of this information, you need access to journals and databases that are often behind a paywall.

Another problem is that it’s easy for anyone to create a video, blog, or social media post about the latest and greatest treatment without using current evidence. Their reasons for doing so can be many – from sharing personal experiences in the hopes of helping others to purely commercial gain. This info is everywhere online, easily accessible and often looks legitimate.

So you need to weigh any information carefully, be cautious and discuss your options with your doctor.

Here’s a snapshot of what we know works (or doesn’t) for knee OA

Staying active and exercising regularly

You had to know this was coming 😉. Research has repeatedly shown that exercise is key in managing knee OA (and other musculoskeletal conditions). A tailored exercise program developed by a physiotherapist or exercise physiologist can help reduce knee pain and improve knee function. If pain prevents you from exercising, you may find that warm water exercise is a good starting point. Warm water pools offer the comfort of warmth and the buoyancy of the water to ease the load on your joints.

Managing your weight

Being overweight or obese is directly related to the risk of developing knee OA. It’s also likely to speed up how quickly your OA develops or progresses. Evidence shows a relationship between weight loss and relief of symptoms such as pain and stiffness. But weight loss can be a long process for many people. And it’s challenging, especially when pain affects your ability to be as active as you’d like. However, it’s good to know that any weight loss can reduce your pain and increase your ability to exercise. So making small, achievable changes to your eating and exercise habits can bring big results. If you’d like to lose weight to improve your symptoms, your doctor and/or dietitian can assist you in losing weight safely.

Dealing with stress and your emotions

It’s natural to feel stress, anxiety and frustration when living with chronic pain. However, if you’re always fearful or worried about it, it can worsen your pain. That’s because pain isn’t just a physical sensation – it also involves your perceptions, feelings and thoughts.

The worse you think your pain will be, the worse it can feel. It can affect your sleep, and you become less active. These feelings, thoughts and behaviours can become a vicious cycle.

Talking with a family member, close friend, or a health professional about how you’re feeling can get it out in the open so you can start dealing with these feelings and hopefully break this cycle.

Strategies like breathing exercises, cognitive behavioural therapy (CBT), meditation, heat, and gentle activities like tai chi, walking, swimming, and cycling can also help you control your stress and anxiety.

What about medicines?

No medicine can affect the underlying disease process of OA. Still, combined with self-care and lifestyle changes, medicines may provide temporary pain relief and help you stay active.

There are a variety of medicines used in the management of knee OA, and each comes with varying degrees of evidence to support their use. They may be taken by mouth as a tablet or capsule (orally), applied directly to the skin in the form of gels and rubs (topical), or injected into the joint (intra-articular). Discuss the benefits and risks with your doctor if you’re interested in the following medicines.

Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. Nurofen, Celebrex, Voltaren). Depending on the dosage and other ingredients, NSAIDs are available over-the-counter or with a prescription. Oral NSAIDs are the preferred first-line drug treatment for OA and have been shown to reduce pain and symptoms in knee OA.

It’s important to note that NSAIDs are designed to be taken at low doses for short periods. Always talk to your doctor before starting NSAIDs, as they can cause harmful side effects, especially in older people.

Paracetamol (e.g. Panadol, Panamax). Research has shown that paracetamol provides only low-level pain relief and, in some cases, no pain relief compared to a placebo in knee OA. However, some people report that it helps reduce their pain so they can be more active. If you can’t take NSAIDs, they may also be an option. Before using paracetamol, talk with your GP to see if it’s appropriate.

Some medicines aren’t effective

Other medicines have been used for OA in the past that we now know aren’t effective and may have harmful side effects.

Opioids. Opioids are powerful pain-relieving medicines. They’re effective at reducing acute pain (or the pain resulting from an injury or surgery), but evidence shows they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of knee OA.

Capsaicin. Capsaicin is the active ingredient in chilli peppers – it makes them ‘hot’. Capsaicin in creams and lotions has been used to help reduce OA pain, and some people report beneficial effects. However, evidence for its effectiveness in knee OA is low, and it’s generally not recommended. It also has side effects when applied, such as a burning sensation, which can take several uses to wear off.

Glucosamine and chondroitin. Studies have found no benefit from taking glucosamine and/or chondroitin for osteoarthritis.

The pointy end of the stick – intra-articular injections

Intra-articular injections are given directly into the knee joint. They include steroids, platelet-rich plasma, stem cells, hyaluronic acid and Botulinum toxin. Let’s look at them a bit more closely.

Corticosteroid injections. If you have persistent knee pain and haven’t had relief from oral medicines or other treatments (e.g. exercise, weight loss), your doctor may suggest a corticosteroid (steroid) injection. However, the duration of pain relief can vary from a few days to a few weeks, and the number of injections you can have is limited due to potential harm. There’s also emerging evidence that long-term use of these injections may cause OA to worsen in the affected joint.

Hyaluronic acid injections. The benefits of hyaluronic acid joint injections (also known as viscosupplementation or hyaluronan injections) are uncertain. Research findings have been inconsistent, and although some people find the treatment helpful, it can be expensive and isn’t generally recommended. The Australian Rheumatology Association states, “emerging evidence indicates that the effect of hyaluronic acid could be smaller than previously reported.”

Platelet-rich plasma (PRP) injections. Platelets are small cell fragments in the blood that help form blood clots to slow or stop bleeding and help wounds heal. PRP is a concentrated version of a person’s platelets injected into the affected joint. An Australian clinical trial led by researchers at the University of Melbourne, University of Sydney and Monash University has found that PRP was no better than a placebo at reducing symptoms in people with knee OA.

Stem cell injections. Despite being commercially available, there’s no evidence for using stem cell injections in treating knee OA. The International Society for Stem Cell Research and the Australian Rheumatology Association do not support using stem cell injections for osteoarthritis.

Botulinum toxin injections. The American College of Rheumatology/Arthritis Foundation Guidelines states that the small number of trials that have looked at the use of botulinum toxin in knee and hip OA ”suggest a lack of efficacy”.(1)

What about surgery?

Surgery may be an option for some people with knee OA when all non-surgical treatment options have failed, and knee pain and reduced function impact their quality of life. In this case, your doctor may refer you to an orthopaedic surgeon to discuss your options.

A total joint replacement of the knee is the most common type of surgery for knee OA. However, having an artificial knee means there will still be some limitations. An artificial knee won’t have the same sideways movement as a natural knee. It won’t bend fully, so getting down and up from kneeling is more likely to be challenging.

Arthroscopy is a surgical technique that involves the insertion of small surgical instruments, including a camera, into the knee. This allows the surgeon to examine the inside of the joint and cut, shave and remove material from the inside of the knee joint. “The Australian Government and most orthopaedic surgeons recommend against using arthroscopy for osteoarthritis of the knee. Research shows that doing an arthroscopy for this condition isn’t effective. Arthroscopy should only be used for knee OA if other treatments fail, such as losing weight, exercising and taking pain relievers.” (2)

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

References

(1) Kolasinski, S.L., et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology (2020).
(2) Arthroscopy, Healthdirect


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23/Apr/2023

How to keep up (or start) walking for health and pleasure when it’s cold outdoors

It’s not quite winter yet, but it sure feels like it!

And if you’re like me and love to get outdoors and walk, it can be a little tough staying motivated when it’s cold, wet and wintery. But there are things you can do to boost your motivation, stay active and even come to relish the experience of walking in colder weather.

But, I hear you ask, why would any sane person want to get off their warm, cosy couch, put aside the remote control and brave the elements??? Because exercise doesn’t take a break for the colder months 😐 and we need to engage in regular, consistent exercise year round.

And while it can be challenging at times, we all know how much better we feel after we hit the pool, go for a walk, or take part in an exercise class. Being active every day helps us manage our pain, get better quality sleep, and improve our mood. It also helps us manage our other health conditions. And it gets us out of the house so we can connect with others – our friends, teammates, gym buddies, and other people walking their dogs in the park.

Knowing all of that doesn’t make it easy though, so here are some strategies to help you get out there.

Timing is everything

Plan to go walk when your body has had a chance to loosen up. Do some stretches, or have a warm shower to relax your muscles and joints so you can walk more easily and with less pain. The Arthritis Foundation has some basic stretches you can use before you head out the door.

Dress for the weather

Your usual exercise gear may not cut it when it comes to walking in colder weather. You need to think layers. The clothes closest to your skin should draw moisture away from the skin (known as wicking) so your skin doesn’t stay damp. It should also dry quickly. Look on the labels for mention of wicking or polypropylene. Avoid cotton. When cotton clothes get wet, they stay wet, making you colder.

Next, add an insulating layer of fleece or wool to keep you warm. And finally, add a layer that will resist wind and rain. The beauty of layers is that you can take them off and put them back on if/when needed.

Choose bright colours so you’ll be seen through the fog and rain, even on the greyest days 👕👚🦺. And at the risk of losing my Melbournian status 😉, there’s something lovely about ditching the black clothes and wearing bright colours on a gloomy day.

There’s no such thing as bad weather, just the wrong clothing, so get yourself a sexy raincoat and live a little.“ Billy Connolly

Now accessorise!

I’m not talking bling here, 💎💍 though; like adding colour, bling can definitely brighten your day 😊. But I’m referring to appropriate socks and footwear. It’s best to wear walking shoes that are waterproof or dry quickly. And they need good traction – it can get very slippery out there! If you’ve got old shoes from last winter, check the soles to ensure they’re still ok.

It’s important to know that the walking shoes you wear in warmer months are unlikely to be suitable for walking in colder months. The tops of these shoes are generally a lightweight mesh that lets air in to keep your feet cool. Not what you need on a cold walk!

You also need to protect your extremities (this is a must if you have Raynaud’s). Wear gloves or mittens, a hat that covers your ears, a scarf, sunglasses and sunscreen. Even in the colder months, your skin can be damaged by the sun’s rays.

Oh, and depending on the length of the walk you’re planning, you might want to take a lightweight backpack or bag for your water bottle and to store any of the layers you remove.

Get a walking buddy

Having a buddy to walk with can be fun and boost your motivation on cold days. This could be your partner, kids, family, friend, neighbour, pet 🐕🐈, or a walking group.

Or go on your own

Sometimes you just need some time to yourself.

Be aware of the walking surfaces

Slips, trips and falls are enemies of anyone with a musculoskeletal condition. So we need to take care out there. Uneven surfaces, moss, wet leaves or mud on footpaths and trails, and slick tiles at the shopping centre can all be dangerous. So keep an eye on the surfaces. And check out this info from MyHealth.Alberta.ca for some tips to lower your risk of falling.

Explore new areas

Whenever you can, take the time to explore new walking paths, rail trails, parks, or neighbourhoods. It’s amazing what you discover when you go beyond your own backyard.

Always check BOM 💣

Visit the Bureau of Meteorology (BOM) or your weather channel of choice, and get the weather and rain forecast. This will help you dress appropriately and may also affect your timing. If you like walking in the rain, you may decide to head out regardless. But if you’re not a fan, the radar will give you an idea of when to go (just don’t forget your umbrella – just in case).

Take your phone

It’s handy for listening to music, podcasts, and audiobooks and taking pics of the things you discover on your walk. It’s also essential for safety. Unfortunately, accidents can happen to us all, so stay safe and take your phone in case you need help. Or so you can call someone to pick you up if the weather becomes nasty!! 🚗🚓🚕

Add some mindfulness to your walk

Much of the pleasure of walking outdoors comes from enjoying the beauty of the changing seasons. So on your next walk, focus on your surroundings and how you feel. Try using the 5, 4, 3, 2, 1 method. For example:

  • What are 5 things you can see – e.g. the stripes on your gloves, the different hues of autumn leaves, a dog chasing a ball, fluffy clouds, ducks enjoying rain puddles.
  • What are 4 things you can physically feel: e.g. your feet on the ground, your partner’s hand, the wind on your face, the way your stride lengthens as you get into your rhythm.
  • What are 3 things you can hear: e.g. leaves crunching under your feet, children laughing, thunder in the distance.
  • What are 2 things you can smell: e.g. cut grass, rain coming.
  • What is 1 thing you can taste: e.g. your coffee traveller. ☕

Walk indoors

If you’re not a fan of exercising in cold and wet weather or you’re worried about slippery wet surfaces, walk indoors. Do laps of your home, hire/buy a treadmill, or walk briskly in your local shopping centre, gym or community centre.

Stay hydrated

Even though you may not be sweating as much as you would be on a hot day, your body is still losing water through your sweat and breathing. Take a water bottle with you and drink when you need to.

Set yourself a goal

If you’re still finding it hard to get motivated, set yourself a goal. It may be the ability to walk a certain distance without being out of breath or taking part in an upcoming fun run/walk. Choose something that matters to you, then create a SMART goal – that is, it’s Specific, Measurable, Achievable, Realistic and has a Timeframe. Read more about goal setting.

“Sunshine is delicious, rain is refreshing, wind braces us up, snow is exhilarating; there is really no such thing as bad weather, only different kinds of good weather.” John Ruskin

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265 or email (helpline@msk.org.au) or via Messenger.

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20/Apr/2023

DYK for many years it was believed that ancient Egyptian pharaohs Amenhotep (Amenophis) II, Ramses II (“The Great”), and his son Merenptah all had ankylosing spondylitis (AS)? In 2002, scientists examined X-rays of their mummies and found what they believed were radiological signs of AS. Cool story. And, if you have AS, it’s a mic drop moment. 🎤 Boom!

Unfortunately, this has now been debunked 😑 and the mummies show signs of a completely different condition. But let’s not let facts get in the way of a good story 😁. And let’s find out about AS.

Ankylosing spondylitis is an inflammatory arthritis that causes inflammation in the spine and the joints that connect the lower spine to the pelvis (sacroiliac joints). This inflammation causes back pain, stiffness and reduced mobility in the spine.

The good news is there are effective treatments for AS.

What causes it?

Ankylosing spondylitis is an autoimmune disease. That means it occurs as a result of a faulty immune system.

Instead of identifying foreign bodies (e.g. bacteria, viruses) and attacking them to keep you healthy, your immune system mistakenly targets healthy tissue in and around your joints, causing inflammation and pain.

We don’t know why this happens. Genes are thought to play a role. You’re more likely to get AS if your family has a history of it. Most people with AS have the gene called HLA-B27; however, this gene can also be found in people who don’t have AS.

Since this gene doesn’t automatically lead to the development of AS, scientists believe a complex mix of genes and environmental factors may be involved.

We used to think AS affected more men than women, but recent research suggests men and women are affected relatively equally. AS tends to develop in late teens and early adulthood.

Symptoms

The symptoms vary from person to person. The most common are:

  • Pain and stiffness in the back, buttocks or neck, often worse after waking or resting and relieved by exercise and movement.
  • Enthesitis, or inflammation and pain where tendons or ligaments connect to bone. Common areas for enthesitis are in the front of the chest where the ribs join the breast bone, the back of the heel (Achilles tendon) or underneath the foot.
  • Fatigue or extreme tiredness that doesn’t get better after sleep or rest.

Other symptoms can include:

In AS, due to chronic inflammation, new bone may grow around the joints in the spine. This can lead to permanent stiffness in the back and neck of some people with AS. In severe cases, the bones of the spine can fuse together; however, this can usually be prevented by starting appropriate treatment as early as possible.

Symptoms may change from day to day. At times your symptoms (e.g. pain, fatigue, inflammation) can become more intense. This is a flare. Flares can be unpredictable and seem to come out of nowhere.

Diagnosis

If you have ongoing back pain and stiffness or other symptoms of AS, it’s essential that you see your GP. Getting a diagnosis as soon as possible ensures treatment starts quickly. This will give you the best possible outcomes.

No single test can diagnose AS, so your doctor will use a combination of tests. They may include:

  • Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
  • A physical examination to assess joint tenderness, flexibility, and stiffness.
  • Genetic testing to look for the HLA-B27 gene.
  • Blood tests to check for inflammation.
  • Scans such as an X-ray and MRI (magnetic resonance imaging) to look for joint inflammation and damage.

Your GP will refer you to a rheumatologist if they think you have AS. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

Treatment

Ankylosing spondylitis is treated using a range of different treatments, including medicines, regular exercise and self-care.

Medicines

The two main types of medicines used to treat AS and help manage its symptoms are NSAIDs and targeted therapies:

Non-steroidal anti-inflammatory drugs (NSAIDs) are nearly always used as the first medicine to treat the pain, inflammation and stiffness of AS unless there’s a reason you can’t take them. Research shows that NSAIDs are very effective in managing symptoms of AS. Some people may need to take them regularly, while others will only take them as needed. This will depend on your symptoms and how you respond to the NSAID.

Your rheumatologist will discuss how often you should take NSAIDs and their long-term benefits and risks. There are many different types and brands; some are over-the-counter, while others are only available on prescription.

Targeted therapies are medicines that ‘target’ specific proteins in the immune system that produce inflammation. They include biological disease-modifying anti-rheumatic drugs (biologics), biosimilars and targeted synthetic disease-modifying anti-rheumatic drugs. These targeted treatments have dramatically improved the quality of life for people with AS who need more than NSAIDs to manage their condition.

Your rheumatologist will talk with you about using these medicines if you need more than NSAIDs to manage your condition or if you can’t take NSAIDs.

Exercise

This is the most important thing you can do to help manage your AS. Exercise can improve symptoms, including stiffness, pain, fatigue, breathing capacity and posture. It helps increase your flexibility and range of movement, so it’s easier to do many everyday tasks.

As soon as possible after receiving your diagnosis, you should ideally begin a personalised exercise program developed by a physio or exercise physiologist (EP) and aim to do some exercise every day. Being active is also essential for your overall health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

Self-care

As well as taking your medicines as prescribed and exercising regularly, there are other things you can do.

Learn about your condition. Understanding AS allows you to make informed decisions about your healthcare and actively manage it.

Manage your weight. Being overweight or obese increases inflammation throughout your body. This inflammation affects not only your joints but also blood vessels and insulin levels. This can increase your risk of chronic health conditions such as heart disease and diabetes. Losing weight is an important thing you can do to reduce your risk of these conditions and reduce your AS symptoms. Being overweight or obese also limits the effectiveness of some medicines used to treat AS. Losing weight can be challenging, so if you need to lose weight or advice on healthy eating, talk with your doctor or dietitian.

Learn ways to manage your pain. Pain is the most common symptom of AS, so it’s crucial to learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.

Work closely with your healthcare team. The best way to live well with AS is by working closely with the people in your healthcare team (e.g. GP, rheumatologist, physio). Keep them informed about how you’re doing and if you’ve experienced any changes in your symptoms or tried new medicines, complementary therapies, supplements or other treatments.

Use aids and equipment. Supports such as long-handled shoehorns, reachers and canes can reduce joint strain and make life easier, especially if your condition has reduced your flexibility and mobility. An occupational therapist can advise you on aids, equipment and home modifications.

Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about how to deal with this.

Manage stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.

Practise mindfulness. Regularly practising mindfulness meditation can improve your mood, relieve stress, improve sleep, improve mental health and reduce pain.

Eat a healthy, balanced diet. While there’s no specific diet for AS, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other health problems, such as diabetes and heart disease.

Quit smoking. Smoking cigarettes harms your general health, negatively affects your bone health, and increases inflammation.

Seek support from others. You might find it helpful to contact the Ankylosing Spondylitis Australia or the Ankylosing Spondylitis Group of Victoria and speak to others who have AS and know what you’re going through.

Complications

Some people with AS develop an eye problem called iritis or uveitis, which causes a painful red eye with blurred vision and sensitivity to light.

If you develop eye symptoms, you’ll need to quickly get your eye checked and treated by an ophthalmologist. Treatment is usually with prescription eye drops, which reduce the chance of permanent eye damage.

Understanding this risk and knowing what signs to be alert for can reduce the risk of eye damage. Ask your GP or rheumatologist what you should do if you develop any eye symptoms.

One last thing

If you think ankylosing spondylitis sounds like a dinosaur, you’re not far wrong. There was a dinosaur called an ankylosaurus. So, what you’ve lost in ancient pharaohs, you’ve gained with a very impressive dinosaur 🐉 😉.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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22/Feb/2023

Note: I’ve been listening to great music while writing this article. I’ve embedded some links so you can share the love 💛.

Bored with your usual exercise program? Why not follow David Bowie’s advice and “put on your red shoes and dance the blues”?

Dancing is a fun, expressive and social form of exercise. It’s also a great way to meet new people.

There are many dance styles to try – from salsa to hip hop, ballroom or belly dancing. Or you can shake your tail feather around the house when a great song comes on the radio.

Why you should be dancing

If you’re like me, the idea of dancing, especially in public, is terrifying. I’m uncoordinated, clumsy and have never felt comfortable or natural moving to music. My partner is changing that, one ‘box step’ at a time. Not the unco, clumsy part – he’s not a miracle worker 😂. But becoming more comfortable just dancing. You see, he’ll literally dance at the drop of a hat. At home, in his coffee shop, in the supermarket. It makes him happy.

And when he’s happy, I want to join in on that happiness.

So that’s a key reason to dance – happiness 😊.

It’s also a very social activity. Joining a dance class or going to clubs is an opportunity for you and your friends to have a fun, physical outing. And you may make new friends. What’s not to love about that? 💜

Gonna make you sweat (Everybody dance now): Dancing is exercise

The Australian physical activity guidelines recommend that adults be active most days of the week, preferably every day.

That means that each week, adults should do either:

  • 2.5 to 5 hours of moderate intensity physical activity – e.g. a brisk walk, golf, mowing the lawn or swimming. Moderate intensity means you can talk comfortably but not sing.
  • 1.25 to 2.5 hours of vigorous intensity physical activity – e.g. jogging, aerobics, fast cycling, soccer or netball. Vigorous intensity means you can only say a few words without gasping for breath.
  • an equivalent combination of moderate and vigorous activities. (1)

So dancing – at a moderate or vigorous intensity – is a fun and creative way to contribute to your weekly dose of exercise.

Everybody dance: Other health benefits

Chic put it so well in their song, “Dancing helps relieve the pain, soothes your mind, makes you happy again. Listen to those dancing feet. Close your eyes and let go.“ But don’t just take the word of those disco legends… dancing:

  • improves the health of your heart and lungs
  • improves circulation of blood and synovial fluid through joints
  • relieves pain and stiffness
  • reduces fatigue
  • helps you sleep better
  • improves strength, endurance and stamina
  • improves balance, coordination and flexibility
  • helps keep bones strong and prevent falls
  • lowers stress levels and improves your mood
  • helps you maintain a healthy body weight or lose weight when combined with a weight-loss eating plan
  • builds self-confidence
  • improves brain health and cognitive functions
  • nurtures your creative side and allows you to express yourself
  • improves overall health and fitness.

Dance, dance: Getting started

OK, if I’ve sold you on dancing, it’s time to get started. And a good way to do that is to think about the different dancing styles and ask yourself…

  • What style appeals to me?
  • What do I want to get out of dancing? For example, do I want to:
    • meet new people?
    • get fit?
    • improve my balance and coordination?
    • get involved in competitions?
  • Do I want to dance on my own or with a partner?

Thinking about these things can help you choose the style that best meets your needs.

You also need to be conscious of the physical demands of the dance style. For example, if there’s a lot of jumping or moves that put significant pressure on joints, it may not be suitable if you have arthritis in your hips, knees or feet. That being said, there are so many styles to choose from, including:

Once you’ve picked a style, as you would before starting any new exercise program, you need to consider your fitness level and other health issues. If it’s been a while since you’ve been active, talk with your doctor before you start.

Flashdance: What to wear?

Your clothing needs to be comfortable and allow you to move freely. But you don’t want any trailing sleeves and long skirts. They’ll be a trip hazard. So leave your inner Stevie Nicks at home, at least until you’re a more proficient dancer 😁.

As far as shoes go, some dance styles, like tap, require special shoes. But for the most part, when starting out, you can generally wear shoes you already have. Just make sure they’re flexible, comfortable and provide good support. And it’s best to start in low shoes that allow you to move smoothly and safely across the floor.

Other tips for a safe(ty) dance

Dancing is exercise, so start slowly and learn good technique. You should also:

  • Consider getting family or friends involved. It’s fun to explore new experiences, like dance classes or groups with others, especially if you’re a little nervous or find it difficult to get motivated on your own.
  • Warm up before you start. Don’t just ‘lose yourself to dance’. Give your body time to loosen up and get ready for some exertion.
  • Drink enough water and stay hydrated – before, during and after dancing.
  • Take breaks, and rest when you need to. It’s easy to get caught up and overdo it, especially when you’re having a good time. So listen to your body and take regular breaks.
  • If you feel unusual pain, stop that move or dance sequence, and get advice from your dance instructor, physiotherapist or exercise physiologist. You may be overextending a joint or moving in a way that’s not great for your musculoskeletal condition. So safety first.
  • Cool down when you finish.
  • Have a wonderful time!

Dance hall days: Finding a place to dance

  • Start at home if you’re nervous about going public with your dance moves. Put some music on, and go for it. Make sure you have plenty of space and there are no slip or trip hazards (e.g. rugs, pets). Other safety issues such as talking with your doc, wearing appropriate clothing and footwear, warming up, cooling down and hydrating still apply.
  • Check out some online groups and classes. There’s so much available online. This has been a positive of the pandemic – an enormous growth in good online resources. You’re sure to find something that suits you. If you’re looking for inspiration, YouTube and TikTok have some great dance content. Just watch them carefully and evaluate them as you would any other online health content. Our article Online exercise – look before you leap provides a list of things to consider before starting any online exercise (including dance).
  • Visit websites of local community houses and clubs as they often provide dance classes as part of their exercise offerings.
  • Dance schools and studios often provide more formal dance training. This may be of particular interest if you want to perfect your dance technique, enter competitions or learn a style unavailable in your local community.
  • Hit a club or pub. And if you’re groaning about a late night (which I do regularly), many venues have afternoon music and dance sessions or dinner dances. You just have to keep an eye on local venues.
  • No Lights, No Lycra. This a place for people to come and dance freely in a friendly, non-threatening, drug and alcohol-free atmosphere. It happens in a dimly lit room with the lights low so people can truly dance without worrying about what they look like. No Lights, No Lycra events happen all over the world. You can find your closest venue here.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

More dance tunes to get you in the mood!

These songs will have you cutting the sleeves off your jumpers to make leg warmers (à la Flashdance) in no time 😅.

Reference

  1. Australian Government, Department of Health and Aged Care. Physical activity guidelines: For adults (18-64 years) 

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13/Oct/2022

We get asked this question a lot! But unfortunately, it’s not a simple ‘yes’ or ‘no’ answer.

Arthritis is a general term used to describe over 150 different conditions. The more accurate name for them is musculoskeletal conditions, as they affect the muscles, bones and/or joints.

They include osteoarthritis, back pain, rheumatoid arthritis, fibromyalgia, gout, polymyalgia rheumatica, lupus, osteoporosis and ankylosing spondylitis.

Around 7 million Australians live with a musculoskeletal condition, including kids. So can you avoid becoming one of them?

Maybe? Not really? It depends? 🙄

Because there are many different types of musculoskeletal conditions, the answer depends on various factors.

For conditions like rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, and lupus, we don’t really know their cause. Without knowing the cause, it’s hard to prevent something from occurring.

What we do know is that they’re autoimmune conditions. That means they occur due to a malfunctioning immune system. Instead of attacking germs and other foreign bodies, the immune system targets joints and healthy tissue, causing ongoing inflammation and pain. We don’t know why this happens, but scientists believe that a complex mix of genes and environmental factors is involved.

At this stage, we can’t change a person’s genetics to prevent them from developing an autoimmune type of arthritis, or conditions like osteoporosis and Paget’s disease, which are also linked to genetics. Many musculoskeletal conditions also become more common as you get older and are more common in women.

Other health issues, such as diabetes, kidney disease, coeliac disease, and even other musculoskeletal conditions 😫, can also increase your risk of developing a musculoskeletal condition. For example, chronic kidney disease can increase your chance of developing gout, and rheumatoid arthritis increases your risk of developing osteoporosis and fibromyalgia.

So that’s the bad news.

The good news is there are things you can do to reduce your risk of developing a musculoskeletal condition. Or, if you develop one, reduce its impact and severity.

Maintain a healthy weight

Excess body weight puts more pressure on your joints and increases the stress on cartilage, especially in weight-bearing joints like your hips, knees, and back. For every kilo of excess weight you carry, an additional load of 4kgs is put on your knee joints.

In addition to putting added stress on joints, fat releases molecules that increase inflammation throughout your body, including your joints. Being at a healthy weight reduces this risk.

Being overweight or obese is strongly linked to developing osteoarthritis (OA), most often in the knees. Hand OA is also more common in people who are overweight.

Back pain and inflammatory conditions such as gout, rheumatoid arthritis, and psoriatic arthritis have also been linked to being overweight.

If you have a musculoskeletal condition, maintaining a healthy weight, or losing weight if you’re overweight, can decrease your pain, allow you to become more active, and decrease your risk of developing other health problems like heart disease and diabetes.

Quit smoking

As well as the obvious links to cancer and lung disease, smoking’s linked to back pain, neck pain, rheumatoid arthritis and osteoporosis. Smoking also causes fatigue and slower healing, which can make pain worse. And it can make some medications less effective.

So quitting smoking has many health benefits. Within weeks of quitting, you’ll breathe easier and have more energy, making it easier to exercise and do your day-to-day activities. Find out more about the impact of smoking and ways to quit for good.

Stay active and exercise regularly

Regular exercise is vital for overall good health and keeps you fit, independent and mobile. Being active helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as osteoporosis, heart disease, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

Having strong muscles is also essential to reduce your risk of falls.

Look after your mental health

Mental health conditions can increase the likelihood of developing some musculoskeletal conditions. For example, people with depression are at greater risk of developing chronic back pain. And living with a painful musculoskeletal condition can have a significant impact on mental health.

If you’re living with anxiety, depression, or another mental health condition and feel that you’re not coping well, it’s important to seek help as soon as possible. This will ensure you don’t prolong your illness and worsen your symptoms. It becomes harder and harder to climb out of a depressive episode the longer you wait. Similarly, the longer you put off seeking help for anxiety, the more anxious you may become about taking that first step.

There are many different types of treatment options available for mental health conditions. The important thing is to find the right treatment and health professional that works for you. With the proper treatment and support, they can be managed effectively.

Get enough calcium and vitamin D

Calcium and vitamin D are essential to building strong, dense bones when you’re young and keeping them strong and healthy as you age.

Getting enough calcium each day will reduce your risk of bone loss, low bone density, and osteoporosis.

Calcium is found in many foods, including dairy foods, sardines and salmon, almonds, tofu, baked beans, and green leafy vegetables.

Vitamin D is also essential for strong bones, muscles and overall health. The sun is the best natural source of vitamin D, but it can be found in some foods.
If you’re unable to get enough calcium or vitamin D through your diet or safe sun exposure, talk about calcium and/or vitamin D supplements with your doctor.

Protect your joints

Joint injuries increase your risk of getting OA. People who’ve injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint. So it’s important to protect against injury by:

  • maintaining good muscle strength
  • warming up and cooling down whenever you exercise or play sport
  • using larger, stronger joints or parts of the body for activities, for example, carrying heavy shopping bags on your forearms, rather than the small joints in your fingers
  • using proper technique when exercising, for example, when using weights at the gym or when playing sports, especially those that involve repetitive motions such as tennis or golf
  • maintaining a healthy weight
  • avoiding staying in one position for extended periods
  • seeking medical care quickly if you injure a joint.

Drink alcohol in moderation

Excessive alcohol consumption contributes to bone loss and weakened bones, increasing your risk of osteoporosis. For people with gout, drinking too much alcohol, especially beer, can increase your risk of a painful attack.

It can also affect your sleep, interact with medicines, and affect your mental health. To find out more about the risks of drinking too much alcohol and how you can reduce your alcohol intake, read ‘Should I take a break from booze?’.

Manage stress

While stress on its own is unlikely to cause someone to develop a musculoskeletal condition, chronic stress or a stressful event may be a contributing factor, especially with conditions such as fibromyalgia and back pain.

It can also cause issues with sleep, mood, increase pain, and make you more prone to flares if you have a musculoskeletal condition. It can then become a cycle of stress, poor sleep, pain and more stress. And this can be a difficult cycle to break.

But there are things you can do to deal with stress. Try relaxation techniques such as meditation, breathing exercises and visualisation, and avoid caffeine, alcohol and cigarettes.

Talk to someone – whether it’s a family member, friend or mental health professional, about what’s stressing you out so you can deal with it.

Talk with your doctor

If you’ve been experiencing joint or muscle pain, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly, reducing the risk of joint damage and other complications.

Final word

While at this moment in time, we can’t absolutely 100% prevent ourselves from getting a musculoskeletal condition, the good news is that early diagnosis and treatment will give you the best outcomes.

Treatments for many of these conditions have come a long way in recent years, and most people live busy, active lives with musculoskeletal conditions. 😊

Call our Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


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13/Oct/2022

Osteoarthritis is the most common form of arthritis. And because of this, I think it’s often dismissed, and its effects underestimated.

I mean, how often have you heard people say, ‘it’s just wear and tear’, ‘we’ll all get it eventually’, or my personal favourite ‘it’s just a bit of arthritis’ 😤? These offhand comments trivialise the considerable pain and disability that osteoarthritis (OA) causes many Australians.

If you have OA or know someone who does, you know it can significantly impact every aspect of life. Symptoms such as persistent pain, fatigue, stiff and swollen joints, weakened muscles, anxiety, depression, and sleep problems can affect a person’s ability to be as involved in social, community and work activities as they might like.

So, no, it’s not ‘just’ arthritis.

Let’s look at what it is.

What is osteoarthritis?

As we know, OA is the most common form of arthritis. It’s most likely to develop in people over 45, but it can also occur in younger people. It frequently affects weight-bearing joints, such as the knees, hips, feet, and spine. The joints of the hands, including the thumbs, are also commonly affected.

While it was once thought to be an inevitable part of ageing, resulting from a lifetime of wear and tear on joints, we now know it’s a complex condition and may occur due to many factors.

Osteoarthritis and your joints osteoarthritis

To understand how OA affects your body, it’s helpful to know a little about your joints.

Joints are places where bones meet. Bones, muscles, ligaments and tendons work together so you can twist, bend and move about.

Covering the ends of your bones is a thin layer of tissue called cartilage. It provides a slippery cushion that absorbs shocks, helps your joints move smoothly and prevents bones from rubbing against each other.

Around most of your joints is a tough capsule that holds your bones in place. The inside of the capsule is lined with synovial membrane, which produces synovial fluid. This fluid lubricates and nourishes the cartilage and other structures in the joint.

With OA, the cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float in the synovial fluid. Because the cartilage no longer has a smooth surface, the joint becomes stiff and painful to move.

Eventually, the cartilage can break down so much that it no longer cushions the two bones. Your body tries to repair this damage by creating extra bone. These are bone spurs (or osteophytes). Bone spurs don’t always cause symptoms but can sometimes cause pain and restrict joint movement.

OA causes and risk factors

Many things can increase your chances of developing OA, including:

  • your age – people over 45 are more at risk
  • being overweight or obese
  • your genetics – the genes you inherit can play a role in developing OA
  • other conditions – such as rheumatoid arthritis and gout, can cause damage to your joints and lead to OA
  • gender – 3 in 5 people who have OA are women
  • repetitive movements associated with your job or occupation (e.g. constant kneeling, squatting, lifting heavy loads)
  • significant injury, surgery, damage or overuse of a joint.

Signs and symptoms

The symptoms of OA can vary from person to person. Some of the more common symptoms include:

  • joint pain, stiffness and swelling (inflammation)
  • grinding, rubbing or crunching sensation (crepitus)
  • muscle weakness.

These symptoms can sometimes worsen, especially when you feel stressed, upset, overdo things, or don’t get enough sleep. This is called a flare or flare-up.

Diagnosing OA

If you’ve been experiencing joint pain, it’s essential you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. This will give you the best possible outcomes.

To diagnose your condition, your doctor will do some exams or tests. They may include:

  • Your medical history. Your doctor will ask you about your symptoms, family history and other health issues.
  • Physical examination. Your doctor will look for swelling in and around the joint and test your joint’s range of movement. They’ll also feel and listen for grinding, rubbing or creaking in the joint.

Imaging (e.g. x-rays, ultrasound or MRI) and blood tests aren’t routinely used to diagnose OA. However, they may sometimes be needed if there’s uncertainty around your diagnosis.

Treating OA

There’s no cure for osteoarthritis; however, your symptoms can be effectively managed with exercise, weight management, medicines, and self-care.

Exercise

Because of the old ‘wear and tear’ myth, many people are worried that exercising joints with OA will cause more joint damage. But regular exercise can actually help reduce some of your symptoms (e.g. pain, stiffness) and improve your joint mobility and strength. It will also move synovial fluid through the joint, providing essential nutrients and removing waste.

Exercises that move your joints through their range of movement will also help maintain joint flexibility; this is often lost due to OA. Strengthening the muscles around your joints is also important. The stronger they are, the more weight they can take. This will help support and protect your joints.

An exercise program that promotes muscle strength, joint flexibility, improved balance and coordination, and general fitness will give you the best results. Start exercising slowly and gradually increase the time and intensity of your exercise sessions over weeks and months. A physiotherapist or exercise physiologist can help you work out an exercise program that’s right for you.

Weight management

Being overweight or obese increases your risk of developing OA and the severity of your condition. The additional weight also increases pressure on your joints, especially your weight-bearing joints (e.g. hips, knees, feet), which is likely to cause further pain and damage.

The amount of overall fat you carry is also significant because fat releases molecules that contribute to low but persistent levels of inflammation across your whole body. This, in turn, increases the level of inflammation in the joints affected by OA.

For these reasons, maintaining a healthy weight is essential if you have OA. Your doctor or dietitian can advise you on safe weight-loss strategies if you need to lose weight.

Weight loss can be a long process for many people. It’s challenging, especially when pain affects your ability to be as active as you’d like. But it’s good to know that any weight loss can reduce your pain and increase your ability to exercise. So making small, achievable changes to your eating and exercise habits can bring big results. It just takes time, commitment, and support.

Medicines

No medicines can affect the underlying disease process of OA, but combined with exercise, weight management, and self-care, medicines may provide temporary pain relief and help you stay active.

The most commonly used medicines for OA are:

  • Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. ibuprofen). These medicines are available over-the-counter and with a prescription, depending on their dosage and other ingredients. They come in tablet/capsule form (oral NSAIDs) or as a gel or rub applied directly to the skin (topical). It’s important to note that oral NSAIDs are designed to be taken at low doses for short periods. Always talk with your doctor before starting NSAIDs, as they can have side effects.
  • Paracetamol. Research has shown that paracetamol provides only low-level pain relief for osteoarthritis. However, some people report that it helps reduce their pain so they can be more active. For this reason, it’s worth discussing a trial of paracetamol with your GP to see if it‘s appropriate for you.
  • Corticosteroid (steroid) injections may be helpful for people who haven’t found relief from other treatments (e.g. exercise, weight loss) or other medicines. Corticosteroid injections into a joint can provide short-term pain relief; however, the number of injections you can have each year is limited due to potential harm.

Note: Opioids are powerful pain-relieving medicines that effectively reduce acute pain (or the pain resulting from an injury or surgery). In the past, they were prescribed to treat pain associated with conditions like osteoarthritis; however, there’s strong evidence that they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of OA. Read the Choosing Wisely Australia resource ‘5 Questions to ask about using opioids for back pain or osteoarthritis’ for more info.

Self-care

There are many other things you can do to reduce the impact of your symptoms, including:

  • Learning about your condition. Understanding OA and how it affects you means you can make informed decisions about your healthcare and actively manage it.
  • Learning ways to manage your pain. Pain is the most common symptom of osteoarthritis, so it’s crucial to learn to manage it effectively. Read our A-Z guide for managing pain for more information.
  • Working closely with your healthcare team. The best way to live well with OA is by working closely with the people in your healthcare team (e.g. GP, physio) and keeping them informed about how you’re doing and alerting them to any changes.
  • Protecting your joints. Supports such as walking aids, specialised cooking utensils, ergonomic computer equipment and long-handled shoehorns can reduce joint strain and make life easier. An occupational therapist can advise you on aids, equipment and home modifications. You can also check out our range of aids in our online shop.
  • Taping, knee braces and orthotics may be helpful if you have OA in your knees or feet. A physiotherapist or podiatrist can advise you on these.
  • Improving sleep quality. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have osteoarthritis and chronic pain can be challenging. If you’re having problems sleeping, talk with your doctor about ways you can address this.
  • Managing stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.
  • Eating a healthy, balanced diet. While there’s no specific diet for OA, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other medical problems, such as diabetes and heart disease.

Surgery

In most cases, surgery isn’t required for people with osteoarthritis. However, surgery may be an option if all non-surgical treatment options have been unsuccessful and you’re still experiencing significant pain and loss of function.

The most common surgery for osteoarthritis is a joint replacement. When considering surgery, you should be informed about what it involves, the rehabilitation process, and its potential benefits and risks.

Note: An arthroscopy isn’t recommended to treat knee OA. Evidence shows it’s not effective in improving OA knee pain or function.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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