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Osteoarthritis Self-Management

Osteoarthritis Self-Management

The first line of treatment for osteoarthritis (OA) involves a number of steps you can take on your own under the guidance and supervision of a healthcare professional. These include patient education, developing a self-management plan, therapeutic exercise, physical activity and weight management, if appropriate (HQO, Quality Standard: Osteoarthritis, 2018).

An important first step is to become educated about osteoarthritis and what you can do to manage symptoms on your own. This is referred to as “self-management”. You can learn ways to cope with arthritis symptoms and make lifestyle changes that may reduce pain and improve function and mood.

Lifestyle changes such as increasing physical activity/exercise and reducing excess weight can have the greatest effect on OA. Developing relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. For more information, visit the Arthritis Society’s free online arthritis self-management learning resources.

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Physical activity


Woman with osteoarthritis doing yogaA common misconception is that a painful joint requires rest. On the contrary, not enough movement can cause muscle weakness and worsening joint pain and stiffness. Light or moderate physical activity protects joints by strengthening the muscles around them, increasing blood flow to the joint and helping promote normal joint regeneration. Physical activity can also improve mood and lessen pain.

Physical activity is any movement that increases heart rate through activation of your muscles, while exercise is considered a structured, planned, repetitive and purposeful activity with the goal of improving or maintaining a component of physical fitness (source: Canadian Society for Exercise Physiology). An increase in physical activity, even in small increments, can help relieve arthritis symptoms and improve your daily function.

Physical activity strengthens the muscles and connective tissues around your joints, helping support joints that have been damaged by arthritis. Physical activity includes all those activities that you do as a part of everyday life – such as vacuuming the house, walking to work, even gardening. These kinds of activities can be very beneficial for your joints, and can help you maintain and improve your mobility.

Canadian 24-hour Movement Guidelines

The Canadian 24-hour Movement Guidelines are an evidence based set of general recommendations detailing appropriate levels of activity for people of different ages.

Exercise

People with osteoarthritis exercising by walkingExercise is physical activity that involves heavier, repetitive exertion, and is designed to improve or maintain physical fitness. Lifting weights, walking on a treadmill, taking a yoga class – these are the kinds of planned motions that we do specifically to improve our strength, endurance or flexibility. Being physically active can reduce pain and fatigue, improve mobility and overall fitness, and improve your state of mind by allowing you to actively participate in your own treatment. Participating in a properly designed exercise program is a great way to help alleviate the discomfort caused by arthritis.

Targeted exercise for your joints may have added benefit. A qualified therapist, such as a physiotherapist, can work with you to develop a progressive exercise program that is tailored to you.

There is conflicting evidence about the possibility of harm from high-impact exercise, such as running, soccer or tennis, so you will need to be your own judge about what activities your body can tolerate and consult with your doctor. You should be prepared to modify or swap out an activity if it worsens your joint symptoms. Joint rest is recommended when you are experiencing a flare of joint pain and/or your joint is swollen and hot. At these times, it is important to keep doing range of motion exercises.

What types of exercise are recommended for OA?

  • Therapeutic exercise

    Exercises that improve connections and response time between your brain and your muscles, increasing coordination to help the joint remain stable during activity and thus reduce risk of injury. Components include neuromuscular control (developing ‘muscle memory’ by training your joints and muscles to move in healthy patterns), strengthening your muscles, as well as improving balance and agility. A trained professional such as a physiotherapist can work with you to develop an appropriate therapeutic exercise program.

  • Range of motion exercise

    Range of motion, also called stretching or flexibility exercises are exercises that keep your joints moving, and can reduce pain and stiffness. To achieve the most benefit, these exercises should be done daily.

  • Strengthening exercise

    Exercises that maintain or increase muscle tone and protect your joints. These resistance-based exercises include weight-training movements done with a set of free weights, your own body weight, resistance bands or weight machines. For example, thigh (quadricep and hamstring muscles) strengthening is recommended for people with knee OA. The frequency of strengthening exercises should be discussed with your doctor or physiotherapist.

  • Endurance exercise

    Exercises that strengthen your heart, give you energy, control your weight and help improve your overall health. Examples include walking, swimming and cycling.

Tai Chi & Yoga

Activities like Tai Chi and Yoga that combine muscle strengthening, flexibility, and balance exercises can be beneficial in the management of OA. These exercises can also be meditative, promoting relaxation and increasing your capacity to cope.

  • Tai Chi: This ancient Chinese martial art is a combination of movements performed in a slow, focused manner. Though it has many variations and styles, Tai Chi is a low-impact exercise and is reminiscent of both yoga and meditation. Tai Chi could improve pain and physical function in some people as well as alleviate depression and contribute to health-related quality of life.

  • Yoga: Numerous studies have shown the benefits of yoga for stress and anxiety. The practice of controlled breathing, simple meditation and stretching can improve a person’s state of mind and help them better manage pain. Regular yoga under the guidance of a certified instructor can also boost one’s general health and increase energy levels. (NOTE: In some cases, people living with arthritis should avoid strenuous yoga routines, such as Bikram and power yoga.)

Many low-impact exercise options can benefit people living with arthritis. For example, water therapy and swimming can help with pain and mobility. The resistance of the water can help strengthen your muscles while the buoyancy helps take some of the weight off painful joints. Consult your health-care provider to determine suitable exercises for you and your particular condition. For more information about arthritis, physical activity and exercise, visit our flourish articles on Exercise & Motion.

How much exercise is recommended for people with OA?

Any increase in your physical activity or exercise may help if you are not active. The right frequency, intensity, type and duration varies from person to person. A gradual increase in exercise is recommended, with an eventual target for adults of 150 minutes of moderate-to-vigorous intensity exercise per week, in sessions of 10 minutes or more (if tolerated). If you are not currently active, you are advised to start with light activities, such as walking, and attempt to increase your speed and/or distance over time.

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Protect your joints


While it’s important to keep your joints moving, it’s also important to avoid situations that put excessive stress or strain on your joints, as that can increase your risk of injury and make your joints deteriorate faster. Avoiding joint stress will also lead to less pain and help your joints work better, longer.

Techniques to protect your joints include:

  • Pace yourself

    Remember to alternate heavy or repeated tasks with lighter tasks. Taking a break reduces stress on painful joints and conserves energy by allowing weakened muscles to rest.

  • Keep joints aligned

    Positioning joints wisely promotes proper alignment and decreases excess stress. For example, squatting and kneeling may put extra stress on your hips or knees. When lifting or carrying heavy items, keep items at waist height and avoid carrying them up and down stairs. Avoid bending your back when lifting. Remember to ask for help when you need it.

  • Avoid excess joint stress

    Certain activities or occupations can place excessive stress on joints, such as hard labour, heavy lifting, repeated deep squats or repetitive movements. Avoid these higher-risk activities where possible.

  • See a physical or occupational therapist

    Talk to your doctor about seeing a physiotherapist who can customize your exercise program, or an occupational therapist who can advise you on assistive devices and adaptations for your home or workplace.

  • Use assistive devices

    Using appropriate tools and aids not only makes tasks easier, it helps to conserve your energy. Raise seat heights to decrease stress on hip and knee joints. Use a reacher to pick up items from the ground. Use a cane or walker to decrease stress on hip and knee joints.

    Visit our Assistive Devices Resource page to learn more about the different types of assistive devices that can make everyday tasks easier while minimizing joint pain and strain.

     

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Effective weight management


Healthy meal for osteoarthritis to manage weightJust as there is no single definition of a healthy body, there is no single definition of a healthy weight – it’s unique for each individual based on body composition, age, sex, lifestyle and other conditions. The best way to determine an appropriate weight for you is to consult with a healthcare professional.

Carrying excess weight increases the risk of developing OA in your load-bearing joints (knees, hips, ankles, spine, feet), and increases the rate at which these conditions progress. Excess weight has also been linked to OA of the hand, indicating that there is also a metabolic link to the disease, so achieving and maintaining a healthy weight is critical. To learn more about the effect of excess weight on osteoarthritis, visit our flourish article “Can Decreasing Weight Decrease Pain?

The good news is that, if you are overweight, losing even ten per cent of your body weight can help reduce strain on your knees and reduce pain. In fact, depending on the existing level of joint damage, losing weight may not only make you feel better, but could also delay or prevent the need for surgery.

There are a number of ways to achieve weight loss including healthy eating, exercise, and cognitive behavioural strategies. If you are having difficulty controlling your weight, you are advised to discuss these options with your healthcare provider.

Eating well

There is no conclusive evidence to suggest that what you eat can make arthritis either better or worse. However, being overweight can put excess strain on your joints. To work normally, your body needs food to supply energy, vitamins and minerals. Healthy eating will help you manage your weight and give you the energy to complete your daily activities, as well as promote a strong immune system and bone and tissue health.

Three ways to improve your nutrition include:

  • Limit saturated and trans fats

    A healthy diet should include modest amounts of unsaturated fats. Saturated and trans fats should be limited. Choosing the right amount and types of fats can help you achieve and maintain a healthy body weight and improve your overall health. Olive oil and cold-water fish such as salmon, trout or herring are examples of healthy choices.

  • Reduce sugar intake

    Sugar contains “empty” calories and has no nutritional value. This includes honey and syrup as well as white, brown, cane and raw sugar. Limit or avoid adding sugar to drinks and cereals. Although artificial sweeteners contain fewer calories, it is best to get used to food being less sweet. Use dried, unsweetened fruit like raisins, cherries or dates to sweeten cereals since they provide vitamins, minerals and fibre.

  • Eat more vegetables and fruit

    Vegetables and fruit should make up the largest component of your diet. Keep in mind that the sweetest fruits have high sugar content so it is best not to overdo it. Try to have at least one vegetable or fruit at every meal and while snacking. Besides being an excellent source of energy, vegetables and fruit boost your fibre intake, which helps with digestion and weight management. They are also loaded with antioxidants, which help boost the immune system and may help maintain healthy cartilage.

Supplements

Supplements are consumable products designed to be added to (not replace) your diet, to help you get the proper nutrition your body needs. It is always important to consult your doctor if you decide to take supplements as they may interact with medications or may contain ingredients not listed on the label.

  • Vitamin D

    Low vitamin D may contribute to worsening of osteoarthritis. Vitamin D can be obtained through sun-exposure, vitamin D rich foods, or supplements. Vitamin D is also important to maintain healthy bones.

  • Glucosamine and chondroitin

    These substances are found in our joints and help keep the cartilage healthy. Clinical research has not found a clear or consistent benefit from the use of glucosamine or chondroitin sulphate supplements for osteoarthritis. If you are interested in trying these supplements, talk to your healthcare provider: a trial may be reasonable to see if there is any benefit.

  • Turmeric

    Turmeric is a bright yellow spice that is often found in curry powder and is used in many traditional cuisines. It may be a part of your existing diet, or you may be aware of turmeric supplements. Scientific research indicates that turmeric may offer several health benefits. A 2016 systematic review examined data from eight randomized clinical trials that investigated the effectiveness of turmeric and curcumin extracts for treating symptoms of osteoarthritis. The authors concluded that there is some evidence to suggest that taking curcumin each day for 8-12 weeks can help reduce joint pain and inflammation due to arthritis, particularly osteoarthritis. The results also indicated that curcumin extracts might be as effective as taking NSAIDs, such as ibuprofen and diclofenac. If using turmeric supplements, look for ones that contain piperine, which helps with the absorption of curcumin, or use alongside with black pepper. Be aware that high doses or long-term use of turmeric may cause gastrointestinal problems.

Other supplements are often advertised for OA (e.g. avocado-soybean unsaponifiables), but there is not enough research to offer any recommendation regarding their use.

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Heat and cold


HeatIcon of osteoarthritis heat therapy

Taking a hot shower and using warm packs are great ways to help reduce pain and stiffness. Always use a protective barrier, such as a towel, between the warm pack and your skin.

Heat is ideal for:

  • Relieving pain
  • Relieving muscle spasms and tightness
  • Enhancing range of motion

IMPORTANT: Do not use heat on an already inflamed joint, as it can make symptoms worse.

ColdIcon of osteoarthritis cold therapy

Using a commercial cold pack or a homemade one (from ice cubes, a damp face cloth or a bag of frozen vegetables) can be helpful to provide short-term relief from inflammation. Always use a protective barrier, such as a towel, between the cold pack and your skin.

Cold is ideal for:

  • Swelling
  • Decreasing pain
  • Constricting blood flow to an inflamed joint

For more information about using heat or cold, visit the Strategies and Techniques section of our Managing Chronic Pain Learning Guide.

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Relaxation and coping skills


Woman with osteoarthritis meditatingDeveloping relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. Relaxing the muscles around a sore joint reduces pain. There are many ways to relax. Try meditation or deep breathing exercises. Listen to music or relaxation tapes. Imagine or visualize a pleasant and restful acivity, such as lying on a beach.

For more information about relaxation and coping skills, visit the Strategies and Techniques for Managing Chronic Pain section of our Managing Chronic Pain online guide.

 

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Discover More


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This osteoarthritis resource was reviewed in February 2021 with expert advice from:

Dr. Sarah E. Ward, MD, FRCSC
Orthopaedic Surgeon, Division of Orthopaedic Surgery
St. Michael’s Hospital
Assistant Professor, Department of Surgery
University of Toronto

Members of the Canadian Arthritis Patient Alliance Steering Committee, including:

  • Linda Wilhelm
  • Janet Gunderson
  • Therese Lane
  • Louise Crane

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This resource was made possible through unrestricted educational grants from:

Arthritis alliance of Canada
Pfizer