Episode 8: A-Z of Osteoarthritis with Dr JP Caneiro (part 2) (guest hosted by Jennifer Persaud)
Osteoarthritis is extremely common and there is a lot of new research in the area. In this weeks episode, we welcome Jennifer Persaud back from Arthritis and Osteoporosis Western Australia, as guest host. She asks our very own Dr JP Caneiro all the common questions you may have about joint pain.
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Episode Show Notes:
The paper Jennifer and JP were talking about:
Other helpful resources:
75% of people with eligible for knee replacement declined the operation at 12months:
Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, et al. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015;373(17):1597-606. https://doi.org/10.1056/nejmoa1505467
68% declined it at 24 months
Skou, S.T. et al. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials Osteoarthritis and Cartilage, Volume 26, Issue 9, 1170 – 1180: https://doi.org/10.1016/j.joca.2018.04.014
Exercise before knee replacement has better knee replacement outcomes:
Body weight reductions and knee pain
body logic physiotherapy empowering people to achieve better health welcome back to episode 8 of the empowered beyond pain podcast proudly brought to you by body logic physiotherapy in perth western australia this week we welcome back the award-winning jennifer passoud from arthritis and osteoporosis western australia as a guest host this is part two of three shorter episodes where she has a q a with dr jp canero last week we finished with jp sharing a common but unhelpful response to being told you have osteoarthritis so that’s where we’ll pick up again this week jp has a phd in musculoskeletal pain and is a specialist physiotherapist at body bodylogic physiotherapy he’s the lead author of a fantastic journal article which we’ve discussed before it was published in the british journal of sports medicine entitled three steps to changing the narrative about knee osteoarthritis care a call to action he published this in collaboration with several other leading researchers surgeons rheumatologists and musculoskeletal pain specialists the link for that paper and the associated infographic is on the show notes page which is www.bodylogic.physioforwardslash podcast today jennifer and jp discuss the call to action for therapists treating osteoarthritis self-management strategies for joint pain how structure is important but only one of a handful of considerations for those with joint pain and a quick reminder this episode was recorded a few weeks ago so please keep that in mind as some of the situations relating to the ongoing coronavirus pandemic have changed if you’re outdoors or being active kudos to you if you’re not and you’re driving perhaps you can park a bit further from your destination and walk in and if you’re doing neither of those things let us know what you are doing while listening via our social channels at ebp podcast on facebook instagram and twitter wherever you are in the over 60 countries across the world that tune in we hope you’re safe and healthy and remember to ask is there more to pain than damage so if i could if i could give you an example um you know let’s say i develop pain in my knee uh and i’m you know i’m 45 i’m 50 years old and i have functional limitation and i got an x-ray and the doctor told me that my you know to to make things simple he told me look it’s just a bit of wear and tear that’s normal but your joint is degenerating uh and you know you’ve got to be careful otherwise you’ll end up needing a knee replacement so basically the the message that is instilled in that in that conversation is that it’s a it’s a it’s a process that there’s nothing not much i can do about it’s a degeneration that is happening and there’s nothing i can do about it and i need to be careful and the more i load the joint the more i use it the more degeneration i would cause so immediately you can see that a person would have a sensible response not to use the leg because they’re thinking that if they use the leg they’re actually causing more just more stress on the joint and that can be problematic therefore exercise may not be the right thing to do so you can see that how one understands their condition and the beliefs that drive that can drive their behavior so they may become less socially active they may become less physically active in order to preserve that joint that because otherwise the only solution is to have a joint replacement so that whole person approach as you can see can can influence several levels of that of that person now the the contrary is also true because those factors can be targeted and if that person goes to understand that changes in a scan they are normal and they are normal part of aging and things such as meniscus tears cartilage degeneration cartilage thinning all these alterations that we see in a skin they’re quite common in people with no pain and and the prevalence of those changes are greater over the age of 40 which means that as you get older you’re more likely to have those changes but not necessarily having pain now if you stop using your leg or if you’re using your leg with caution and you are you know tensing your muscles so you’re trying to take the weight off the leg if you’re not as physically active if you’re not engaging in the things that you love you have a leg that is deconditioned you have biological changes uh in your body that can make that joint more sensitive and and therefore you you kind of you’re going towards the becoming more unable to do things whereas if you understand that other factors can influence tissue sensitivity and you learn that actually using the leg and developing strength in the leg and keeping your muscles relaxed and and engaging in activities that you enjoy and targeting you know making sure you’re sleeping well that you uh you’re eating well and adopting healthy uh lifestyle choices and that can influence your pain you know immediately you have you can take charge of this and despite the changes in your knee you can have an impact on your levels of pain and disability so that whole person approach can get you in trouble but it can get you out of trouble okay thank you so what you’re saying is you’re not discounting any one particular system but that all of those systems all work together to complement one another and so that we have to think of the person in a holistic manner to treat and if i could add just to the sensation perception that you you mentioned before so as clinicians we can test sensation so we can poke in the joint and we can test if it’s sensitive or not um and the the person’s perception is how they interpret that sensation so we have patients that you know complain of knee pain and when you go and you touch where they’re hurting is actually not on the joint line is on the you know soft tissue attaching to the joint line it’s on the muscle on the surrounding is on the kneecap um and they’re really concerned about what they’ve what it was found on the x-ray of their knee but pain is actually not on the knee it’s on the surroundings of the knee but their interpretation is that you know it’s a dangerous message coming from my knee and a probably a good example here is that some patients can be quite sensitive and they can say look it i only have pain that you know my pain is seven out of ten uh and it’s quite bothersome and you can have patients that have pain that is two out of ten and it’s just as bothersome so the the level of the sensation it may be less than another person but the perception is that it’s way worse it’s like you’re living by the you know on a busy road and you know i may live there and be completely distressed by the noise of all the cars and you can be my neighbor and not even realize their cars around you so that that that interchange you know it just comes back to say that pain as any other um physical or or sensations or estates uh it’s individual it’s unique it’s a unique experience okay thank you for clarifying that and now you you talked about the importance of communication um in the arts at your last um last response um and i’m just interested in your paper that was published last month you um called for action from permissions and there were three main themes around the actions you were calling for them to respond to can you just give a summary of what those three points were yeah sure so probably the first thing is what we’ve been discussing so far takes us to that first step which is changing the message and the message is the message that we deliver to patients so it’s very common and that’s the way i was trained uh you know a couple of years ago going through uni when you know if you have pain it means that it’s there is a structural change and the pain is equal the damage in your joint uh and the change in the message is that pain in knee osteoarthritis is not solely related to the structure of the knee and just making a real really clear here at this point is that we’re not discounting what happens in the knee joint you you’re actually considering that but you’re considering that not as the center of the person’s paying experience but one of several factors that may influence someone’s paying experience so the message that we’re trying to promote the clinicians to promote is to say hey you’ve got some changes in your knee but you also have all these other factors that can influence how sensitive that knee can get and so it’s moving more towards an approach where looks at all potential factors to that individual so it’s not everyone that has stress in their life it’s not everyone that has sleep problems it’s not everyone that is socially isolated but there are some people that have those very factors so that’s kind of the step number one which is attending to factors that can be uh related to a person’s overall health basically the second step which is a consequence of that is a change in treatment focus and in physiotherapy for instance there was uh traditionally we’ll be looking at trying to you know change what happens in the knee joint and and getting the muscles strong around the knee and really focusing on the knee whereas the treatment that we’re seeing these days that are following guidelines and following contemporary evidence is to look at all those factors to that particular individual and target factors that are modifiable to say look you’re not using when you use that leg because you’re afraid of putting weight on it you’re really tensing the muscles around it so let’s say my wrist is my is my sore knee and i’m afraid of using this because my understanding is that the more i use it the more damage i’ll create in that wrist or that knee so in order to protect it i try not to move it and the only way our body can do that is by tensing the muscles around it and it’s quite often that we see patients with knee pain that walk with a really stiff walk and they don’t engage their leg properly they look it’s almost like they lose their shock absorption in that leg and they’re clenching that and they’re creating a lot of stress around that name so that’s a very clear biological component where you have sensitivity on the joint and you have muscles compressing that joint and they can engage in habits which many times are completely non-conscious that can perpetuate that sensitivity but in addition to that they are really concerned about their leg and they they stop doing their the activities they enjoy so let’s say they used to bike ride every day or every couple of days and they are no longer doing that and they are now not sleeping very well because they are less physically active and they are so they don’t sleep very well that out as the chemistry in their body that deconditions that leg and when they put weight on the leg they stress it and they may be carrying a little bit more weight and we know that if you have changes in your body weight that can influence inflammatory processes as well so for that example patients we we gotta look at it and go on it if we look at your name one of the things that you’re doing is that your habits are not very helpful so let’s change that let’s see if we can relax those muscles put some white helpful weight on that joint and develop the muscles around it to support the joint so you feel confident in using that and probably the first step to do to doing that is to understand that actually loading the joint is healthy for it it just needs to be graduated in a way that your joint can adapt and that tends to reduce sensitivity now if we go beyond your knee you’re not sleeping well one of the reasons for that is because you’re not exercising enough and cycling is a great way of getting some movement through that joint you know it’s low impact it builds up your muscles and it’s something that you used to do regularly so your body and your knee is probably craving for that again so let’s get back to that and you put on some weight so how about we look at how much you’re eating and that gets your sleep better which also affects your weight so we kind of the treatment is going more towards a holistic approach looking at several factors that may impact someone’s overall health but also their knee and a really important thing for patients with neo-white is that as we mentioned before several of these patients will have many co-morbidities so they may have cardiovascular disease they may have respiratory disease they may have diabetes and keeping themselves active with a healthy weight is so important so we going and seeing the physio for instance it’s it’s more than just getting exercise for the knee it’s about developing an active healthy lifestyle that enables them to be healthier and feeling better about their knee and the third step is again a consequence of this is empowering the patient to have a a sensible understanding of their condition so before we use the example of someone that is afraid of using their leg because they think that putting weight on the knee is going to cause more damage and now after the the experience they had with the with the clinician they may understand that actually putting some weight on that joint is actually really healthy and really important and they can use that they develop strategies to use that leg better they have an understanding that other factors can influence their pain they have an understanding that acting having a healthy lifestyle is important for them so my job as a physio is to help the person make sense of why their knee sore and what are the things they can do to alleviate that but also how can we bridge the gap between where they are and where they want to be so what are their goals you know are there ghosts to be able to play with their grandkids to lift their grandkids to ride their bike to walk every day with their wife or whatever it is and can we bridge that gap and create a plan but that plan is an active plan and a plan that the patient is in charge so the third step is coaching patients to put them in charge of this condition which if we go back to your early question around you know patients that have been you know they’re isolated because of coping 19 heavy and active self-management plan is a it’s imperative in times like this so the end of another episode we hope you found it empowering and have some clear ideas to work on my key take-homes were despite having pain in the knee we now understand it’s not just the knee that contributes to the pain that osteoarthritis is a whole person condition even with advanced osteoarthritic changes you can still improve pain and function without surgery load and impact which is a form of load is actually helpful for our joints if it started appropriately and progressed gradually with adequate recovery and finally treatment for osteoarthritis is a great opportunity to reflect on your overall lifestyle and a chance to perhaps change a few things that help your overall health next week is part three of having jennifer from arthritis and osteoporosis western australia as a guest host and i share a favourite study of mine relating to guessing the slope of a hill when you’re alone compared to when you’re with a close friend as always show notes including relevant infographics and references can be found at www.bodylogic.physio forward slash podcast and we can be contacted via twitter until next time remember to ask is there more to pain than damage [Music] please note what you heard on this episode of empowered beyond pain is strictly for information purposes only and does not substitute individualized care from a trusted and licensed health professional if you would like individualised high-value care for your pain sports or pelvic health problem head to the body logic website and make an appointment fee music generously provided by ferven and cash English (auto-generated)