Q) I've developed osteoarthritis in my hips (and thumb joints and knees to a lesser extent) so I can no longer go for walks or dig my garden.
I've been told it's caused by wear and tear but that trying to keep walking will do no further damage – this doesn't make sense to me.
I used to walk every day for at least 30 minutes and longer at weekends (river and parks) and coastal walking on holiday. I also work out in a gym three times a week and took up T'ai chi four years ago. In other words I'm much more fit and active than most 65-year-old women (I'm 5'7" and eight stone, and still working).
Is walking (which hurts at every step) really not going to make things worse through more wear and tear? Is it possible to sign up for the trials of the gene/cartilage research I've read about? Or the caterpillar fungus research?
Diana (Summer 2015)
A) I'm pinning my colours to the mast here: from now on I'm taking a zero-tolerance position on the phrase 'wear and tear' – so let's hear no more of it (from doctors as well as everyone else)! It's a horrible term and makes people think of progressive, inevitable destruction of their joints, which doesn’t fit with what we know is happening in joints that are affected by osteoarthritis.
Our joints aren't machine parts that simply wear out. They're dynamic tissues that are constantly responding to the stresses and strains that we put through them.
There's a continuous process of 'wear and repair' happening in our joints. But some circumstances tip the balance more towards wear in the joint rather than repair. For example, injury or muscle weakness around the joint, which in turn leads to pain and the changes seen in the joint in osteoarthritis.
Addressing problems like muscle weakness or abnormal load passing through the joint can help to bring the balance back towards the repair process. In summary – for most people osteoarthritis isn't an inevitably progressive thing and can be modified by looking for and addressing the problems that tip the balance from wear to repair in the joints.
Being advised to exercise when it hurts to do so is difficult advice to swallow if we think about osteoarthritis as wear and tear. But it's not a question that exercise will merely cause more wear to the joint. Movement will help to:
- prevent stiffness
- keep the joint moving through its full range
- keep the muscles strong around the joint.
In turn, this will help to prevent symptoms getting worse.
It's great that you're trying to keep as active as possible – working out at the gym and T'ai chi is much more likely to be helping your hips than harming them. And I'm sure you would be having a lot more problems with your joints were it not for the exercise you have been doing for many years. Some input from a physiotherapist may lead to some improvement in your symptoms and give some guidance on other types of exercises that will be beneficial for you.
I’d also be interested in where you're experiencing pain when you walk – is the pain felt in your groin? In which case it might be coming from the hip joint itself.
If the pain is felt on the outside of your hip, at the side of the leg, it may be caused by a condition known as greater trochanteric pain syndrome (also known as trochanteric bursitis). This is associated with hip osteoarthritis but can respond well to an injection of steroid and local anaesthetic combined with some specific exercises.
Editor's note: Visit our current clinical trials to find out which trials are recruiting.
This answer was provided by Dr Tom Margham for the Summer 2015 edition of our magazine, Arthritis Today, and was correct at the time of publication.
Send your questions for Dr Tom Margham to firstname.lastname@example.org
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