What you can do for yourself to help
The Pain of Arthritis and More
We recently hosted a group of physiotherapists from the Complex Pain Program at St. Paul’s Hospital. It was an interesting evening discussing their program which is often a last resort for individuals suffering with chronic pain. Many individuals joining because of diseases associated with one of the many forms of arthritis.
Pain is an unpleasant sensory experience from the brain. For those that suffer from chronic pain I’m sure you can relate to the unpleasant component and may share in a well known fact known from those of us who have worked with individuals that suffer from chronic pain that you “don’t feel heard.”
There are over 100 types of Arthritis – arthr- meaning joint and -itis meaning inflammation, all the types of arthritis are a form of joint inflammation.
1 in 5 Canadians live with arthritis and 1 in 2 adults over 65 have arthritis
There is no cure for arthritis
There are two categories of arthritis:
- Osteoarthritis (OA) is the result of the body’s failed attempt to repair damaged joint tissues. We think of this as the “wear and tear” or degenerative arthritis. It leads to the breakdown of cartilage (elastic material that covers and protects the ends of bones) resulting in bone on bone contact that causes pain, stiffness, swelling, and reduced range of motion. This is the most common type or arthritis that people get as they age.
- Inflammatory Arthritis is different from OA as the source of joint damage comes from inflammation. Inflammatory arthritis includes every form of arthritis except for OA, and is mostly caused by autoimmune diseases characterized by inflammation of the joints and other tissues and organs within the body. Within this, Rheumatoid Arthritis (RA), Ankylosing Spondylitis, and Psoriatic Arthritis are the most common. With these autoimmune diseases the body’s immune system starts to attack the healthy tissues, and results in pain, stiffness, restricted mobility, fatigue, and damage to the joints. People of all ages can get these, and it’s not just limited to older adults.
An important point to mention here is that there is a crossover with arthritic symptoms and chronic pain. From my recent inservice with the complex pain physios from St. Pauls Hospital my notes read: Arthritis treatment – wear and repair /motion is lotion.1 in 5 Canadians suffer from chronic pain, making this an important point to touch on. Direct from my emails with Sarah Brothwick: “Websites I refer to are the Arthritis Society www.arthritis.ca and Pain BC www.painbc.ca. The Arthritis Society in particular offers a lot of online education as well as in person education sessions. People In Pain BC www.pipain.com is a network of support groups in local communities I also refer to a lot. They are not specific to arthritis but are more about chronic pain in general, but because a large component of arthritis pain is from chronic pain, is very applicable and relevant.”
There are connections between pain, arthritis pain, chronic pain and emotions.
Like it or not the more I have the opportunity to share through the blog and radio show the more the message seems to be the same….we are all dealing with stress in a stressful world and navigating it is challenging for us all. Chronic pain and chronic stress and chronic everything – with no disrespect here but rather a respectful “I got you, cause I got it too.”
From the book, “The Happiness Advantage” author Shawn Achor states: While many of us, thankfully, live lives free of serious trauma, we all experience adversity of one kind or another at some point in our lives. Mistakes. Obstacles. Failure. Disappointment. Suffering. We have many words to describe the degrees of hardship that can befall us in our personal and professional lives. And yet with every setback comes an opportunity for growth that we can teach ourselves to see and take advantage of. (-1)
If there is no cure for arthritis how can you improve your pain levels?
A change in the way of thinking about Osteoarthritis is that although wear and tear is a component and a natural result of aging, bigger triggers include: obesity, eating the wrong foods, stress, injury and lack of complete rehabilitation, and lack of exercise. This from the book “Healing Arthritis” where author Susan Blum states “the ultimate goal is to shift your body on the deepest level toward resiliency and vibrant health.”
Improving Your Nutrition
The goal of treatment for arthritis is to control pain, minimize damage to joints, and maintain a person’s quality of life. Some treatments include supplements and prescription medications to improve pain levels and modify the disease. Less invasive treatments that help improve quality of life and joint health are our nutrition changes and exercise. In extreme cases joint replacement or resurfacing surgery would be considered.
“Inflammaging” is related to age related chronic inflammation. Another quote from Blum’s book: “With each passing birthday, low grade systemic and local inflammation occur, triggered partly by age related increases in visceral (abdominal) fat and a decrease in muscle mass.”
Did you catch the part about eating the wrong foods? This opens a bigger conversation on the theories we acquire many diseases and the state of your GUT HEALTH. Looking to include foods in your nutrition that are probiotic and anti-inflammatory, and reduce or eliminate the refined and inflammatory foods would be worthwhile. Another win for taking responsibility for yourself by forming positive nutritional habits. Last months blog “Time To Step Up Your Spring Nutritional Habits,” focused on replacing or scaling poor nutritional habits with ones that will produce results over the long term. Think of nutrition and exercise being the two pillars that will produce the best results, rather than one or the other.
Can exercise help?
Physiotherapist Sarah Brothwick who specializes in working with inflammatory arthritis states, “Exercise is definitely a big component of self-managing arthritis, but people have to find something that will work for them and at a suitable level.” If we want to put on muscle mass we need to be doing some form of strength training.
I feel this is currently a hot topic in our industry as many health practitioners can play a role in pain management. In keeping with each practitioners scope of practice I ask, “Is rehab training or is training rehab?” (A famous quote and lecture series from Charlie Weingroff.) My scope as a personal trainer includes assessment and exercise prescription that is appropriate for the level of the individual. Including exercises that are effective or corrective in nature is competency and mastery of the “art and science” of being a master trainer. I do not have manual skills to adjust or manipulate, or fancy machines, or the ability to prescribe supplements or medications. The training plan I give you is all natural and can be part of your overall plan.
Exercise can be an effective way to reduce long-term symptoms. The American Centre for Disease Control recommends that people with arthritis follow the general physical activity guidelines for adults or older adults. There is no evidence that activity will progress the condition. In fact Dr. David Olson of Edgemont Chiropractic recently explained to me that our joints need to be stimulated to repair and there are many studies that support this. In fact a sedentary lifestyle, not increased activity increase the of hip and knee arthritis by over 10%. Olson states, “the cartilage needs loading and unloading for it’s nutritional health.”
We tend to move less when we are in pain. Unfortunately, the less we move, the less we become capable of moving. Move it or lose it! “Why do you lose mobility? Because your brain doesn’t want you to move. Why doesn’t your brain want you to move? Because you stopped moving.” – stopchasingpain.com
Below you can find a joint routine that can be completed everyday to keep your joints moving because motion is lotion!
Osteoarthritic knees and hips will benefit from low impact exercises that stretch and strengthen the muscles which support and move those joints. Exercises may include:
- Shallow squats that can become deeper over time as the knee joints become stronger
- Quad and hip flexor stretching
- Hip hinging exercises, such as in glute bridges or deadlifts that strengthen the hips (the hips are the powerhouse of the body and can help to protect your knees!)
- Hamstring stretching and strengthening exercises
And as always, strengthening the core will provide benefits to the limbs – if your core is not up to the task of stabilizing your body, your body will look to the various joints to do extra work! A strong core lets you accomplish more with your limbs.
Another benefit of exercise is resultant weight loss. Excess body weight creates more stress on arthritic joints. Exercise aimed at weight loss can provide long-term ease and relief of pain and swelling. According to a 2005 study, one pound of body weight can create 4 pounds of pressure on the knees. So if you lose even just 10 pounds, you’ve lightened the load on your knees by 40 pounds! Losing weight is not only a product of increased exercise but more importantly nutrition.
The positive mental health benefits of exercise have also been well researched. I had a laugh when I came across an article from the Business Insider that researchers from Yale and Oxford that say “exercise makes you happier than money!” Ok well another spin is that exercise is more important to your mental health than your economic status.
What else can you do?
Mindfulness activities (reading and meditation), support groups, and counselling. Focus on activities that you enjoy and monitor the intensity with your pain levels. Gardening for example is a great way to move and relax at the same time. Use pain flare ups as a guide to modifying the intensify of your activity. I suggest always working within your capacity and being aware of where your tolerance levels are. Sometimes this takes practice! The benefits will show with consistency when you make movement a lifestyle.
Inform, Instruct, Inspire @ it’s time! Fitness Results
Written by: Sheila Hamilton and Jessica Pastro Copyright April 2019
Email from Physiotherapist Sarah Borthwick who specializes in inflammatory arthritis. Thank you for providing me with some excellent resources!
Chronic pain contacts at St Paul’s Complex Pain Program:
Keri Fuchko: tel:604-806-9028, Kfcuchko@providencehealth.bc.ca
Sarah Hearne: Kfcuchko@providencehealth.bc.ca
Book: Healing Arthritis: Author Susan Blum Copyright 2017 – Thanks to Linda D for sending this book my way!
Book:The Happiness Advantage : Author Shawn Anchor (-1) P. 111
“Fitness For Mental Health” The Globe and Mail (Ontario Edition) 8 Apr 2019 PAUL LANDINI
JOSPT PERSPECTIVES FOR PATIENTS Running and Osteoarthritis Does Recreational or Competitive Running Increase the Risk?
J Orthop Sports Phys Ther 2017;47(6):391. doi:10.2519/jospt.2017.0505
Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative Grace H. Lo1,2 & Sarra M. Musa1 & Jeffrey B. Driban3 & Andrea M. Kriska4 & Timothy E. McAlindon3 & Richard B. Souza5 & Nancy J. Petersen1 & Kristi L. Storti6 & Charles B. Eaton7 & Marc C. Hochberg8 & Rebecca D. Jackson9 & C. Kent Kwoh10 & Michael C. Nevitt11 & Maria E. Suarez-Almazor12 Received: 17 November 2017 / Revised: 10 April 2018 /Accepted: 20 April 2018 # International League of Associations for Rheumatology (ILAR) 2018