Louise Chang, MD
Living with osteoarthritis is a long-term proposition. It’s your job to stay active and keep your joints healthy so that you can do the things you want and need to do, as independently as you can, for as long as you can.
“There’s nothing that I as a physician can do to slow the progression of osteoarthritis,” says Elinor Mody, MD, medical director of the Gretchen S. and Edward A. Fish Center for Women’s Health and co-director of the Center for Skin and Related Musculoskeletal Disease at Brigham and Women’s Hospital.
“And in the vast majority of cases, there’s nothing the patient can do that would make the disease get worse faster.”
So much of the time, you can manage your osteoarthritis on your own. But sometimes, you’ll need the guidance of a doctor or physical therapist to cope with pain, handle obstacles, and make sure you’re steering in the right direction. When should you seek help?
1. When you’re beginning an exercise program.
“The worst thing someone with osteoarthritis can do is nothing,” says Mody. “Exercise is particularly important for people with osteoarthritis. Muscle strengthening takes strain off the joints, and core strengthening has been shown to be very important in taking strain off the knee, preventing injury.”
You know how to walk, of course, and the trainer at the gym can show you how to use weight machines. But exercising when you have arthritis is a bit more complicated than it is for a healthy 25-year-old. To avoid injury and make the most of your exercise program, consult a doctor or physical therapist when you begin, to get a customized regimen that’s designed for your own individual needs and limitations.
2. When pain gets in the way.
Are you avoiding your weekly golf game or working in your beloved garden because it hurts too much to walk or bend? Then it’s time to see your doctor.
“When you’re having enough pain that it’s preventing you from doing what you need or want to do, it’s time to intervene,” says Mody. “Sometimes we can relieve the pain with cortisone or other medications, such as drugs that mimic the effect of chondroitin on cartilage."
Other ways to alleviate pain include:
In other cases, explains Mody, it may be time to talk about joint replacement surgery. “It’s important not to wait too long when that becomes necessary, because that can lead to muscle atrophy and joint contracture, and you may never really get back what you lost.”
3. When you need tools.
Much of the time, you can make your own changes to your home environment to stay as independent as possible and minimize your risk of injury. Get rid of throw rugs, put handles in the bathroom and a shower chair if necessary, and go minimalist in your decor, eliminating things like small occasional chairs and tables that block your path and giving yourself plenty of space to walk around.
But there’s a lot more that can be helpful to you. If you’re encountering a lot of difficulty managing independently at home, ask your physician for a physical/occupational therapy referral, or a home safety evaluation.
“They’re like MacGyver,” says Mody of occupational therapists. “If you have bad osteoarthritis of the hands, for example, they have assistive devices for things like doorknobs, jar lids, and writing with pens.”
4. When you’re de-feeted.
One of the biggest risks with osteoarthritis is a fall, and one of the biggest culprits in falling is bad footwear. Especially if arthritis has had an effect on the shape of your feet, you need customized shoes that will keep you comfortable andwell balanced.
“It used to be that arthritis patients had to wear these ugly orthopedic shoes,” says Mody. “Today, there’s no reason to be wearing uncomfortable, ugly or ill-fitting shoes. Talk to your doctor about meeting with a podiatrist. Life is too short to be wearing uncomfortable shoes!”
One of the biggest problems Mody sees is patients who wait too long to see their doctor as pain is limiting their life. “If you wait until you’ve lost a lot of muscle mass, or no longer have the range of motion you used to have, chances are you won’t get it back.”
So if you’re not sure whether you need to see your doctor, ask yourself these questions:
“These are all motions that require good rotation of the hip,” says Mody. “If you’re having trouble with them, you need to see your doctor. With the knee, people usually notice when they’ve lost range of motion there, so fortunately I haven’t seen a significant contracture of the knee in a long time.”
Then ask yourself one final question: Are you doing all the things you want to be doing? If not, is it because your arthritis is getting in the way? Then it’s time to see the doctor. “Our job as physicians is to have people live the longest, most fulfilled, happiest lives they can.”
SOURCE:Elinor Mody, MD, medical director, Gretchen S. and Edward A. Fish Center for Women’s Health; co-director, the Center for Skin and Related Musculoskeletal Disease, Brigham and Women’s Hospital, Boston.
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