Stable Health

For many years, age has been perceived to be a common contributing factor for the development of many different types of joint pain ranging from discomfort in your knees to your neck. To this day, majority of people put their achy, stiff joints down to “I’m just getting old” and tend to believe that this is something that “just happens” as we age. When we age, our outer appearance naturally starts to change. This predominantly happens over time and we notice changes in the appearance of our skin and hair. Similar types of transitions commence within our joints and bones.

What happens to our joints as we age?

Majority of our joints consist of a layer of protective hyaline cartilage surrounded by a joint capsule filled with synovial fluid. Both the cartilage and the synovial fluid protect joints, allowing them to move smoothly and prevent any friction between the articulating bones (1). As we start to age, gradually over time the cartilage between our joints starts to wear down. This is a normal process and more frequently occurs in our weight bearing joints such as knees, hips and lower back (2). Research has indicated that small amounts of wear and tear in people over the age of 50 doesn’t necessarily result in pain or limited movement (3,4). The most common symptom of this is occasional short-lived stiffness after a prolonged period of immobility, for example first thing in the morning when you get out of bed. However, there are certain risk factors that can predispose you to wear and tear at a faster rate and lead to the production of painful symptoms and the development of osteoarthritis (5,6,7).

So, is Age a significant risk factor for joint pain related to Osteoarthritis (OA)?

Naturally with age, we start to get changes within our joints where the cartilage slowly starts to wear down. But does this mean age is a risk factor for the painful symptoms associated with osteoarthritis? Research has established that majority of people that present with OA are between 60-80 (5). However, it has also been determined that age is not the primary risk factor for the development of painful symptoms. Studies has discovered that many elderly people who show signs of wear and tear on X-ray do not have significant clinical symptoms. Through this, researchers have deduced that painful OA is more so dependant on influences that happen earlier in life (8). Several risk factors that result in the development and advancement of OA include influences such as weight, trauma, genetics and knee alignment (9,10,11).

Risk Factors for Osteoarthritis (OA)

Although low-grade wear and tear in cartilage as we age is common, certain factors can speed up this process and result in painful symptoms such as joint swelling, difficulty weight bearing and reduced joint mobility.

Overweight and Obesity

Evidence from many trials has elaborated that people with increased body mass index (BMI) and obese individuals are at a significant risk for the development of osteoarthritis, particularly in weight bearing joints (9). 

Previous Joint Trauma

Previous trauma or injury to a joint such as a ligament tear, fracture or dislocation has been shown to result in the development of OA at a faster rate as compared to joints without any history of trauma (10).

Genetics and Malalignment

It has been established that some people have a genetic predisposition to OA, where studies have found that people with a strong familial history of OA increase their risk of development. Additionally, people with malalignments of the knee joint, where the angle of the articulating bones is slightly altered have been determined to have increased risk of OA (11,12).

Treatment interventions for osteoarthritis

Types of treatment modalities for OA frequently depend on what stage of wear your joint is at. The most common form of interventions for OA are:

Low impact exercise and weight loss

It is recommended that people with early stages of OA keep active and mobile through various types of low impact exercises and muscle strengthening. The National Institute of Clinical Excellence (NICE) guidelines additionally recommend that if you are overweight, weight loss is highly effective for reducing symptoms (13).

Physical or Manual Therapy

Conservative interventions such as physiotherapy, osteopathy and chiropractic have been shown to significantly reduce symptoms in people with varying degrees of OA such as knee, hip, lower back and neck (14,15,16).

Pharmaceutical Management

The National Institute for Clinical Excellence (NICE) guidelines additionally recommend pharmaceutical management for short-term symptom relieve from OA such as non-steroidal anti-inflammatory drugs and cortico-steroid injections (13).

So there is no excuse for why you have joint pain.

Age related joint pain can be caused by a variety of factors, which may be a result of “wear and tear” or something completely different. It is important to understand that there are several different types of therapeutic and self-management interventions that can help reduce your symptoms and get you back to feeling good! So, if you have been putting your joint pain down to “I’m just getting old” and you would like some advice please get in contact. Dr Curtis is an osteopath who specialises in treating and managing a wide variety of different joint and muscular problems. So, if you find yourself struggling with the dreaded “Tech Neck” and feel the need for professional advice, get in touch with the clinic to arrange an appointment.

References

1. Hansen, J. T. (2017). Netter’s Clinical Anatomy E-Book. Elsevier Health Sciences.

• Loeser, R. F., Hunter, D., & Ramirez, C. (2016). Pathogenesis of osteoarthritis. UpToDate. https://www. uptodate. com/contents/pathogenesis-of-osteoarthritis. Accessed January, 20.

• Cooper, C., Snow, S., McAlindon, T. E., Kellingray, S., Stuart, B., Coggon, D., & Dieppe, P. A. (2000). Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 43(5), 995-1000.

• Deshpande, B. R., Katz, J. N., Solomon, D. H., Yelin, E. H., Hunter, D. J., Messier, S. P., … & Losina, E. (2016). Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis care & research, 68(12), 1743-1750.

• Silverwood, V., Blagojevic-Bucknall, M., Jinks, C., Jordan, J. L., Protheroe, J., & Jordan, K. P. (2015). Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis and cartilage, 23(4), 507-515.

• Andriacchi, T. P., Favre, J., Erhart-Hledik, J. C., & Chu, C. R. (2015). A systems view of risk factors for knee osteoarthritis reveals insights into the pathogenesis of the disease. Annals of biomedical engineering, 43(2), 376-387.

• Musumeci, G., Aiello, F. C., Szychlinska, M. A., Di Rosa, M., Castrogiovanni, P., & Mobasheri, A. (2015). Osteoarthritis in the XXIst century: risk factors and behaviours that influence disease onset and progression. International journal of molecular sciences, 16(3), 6093-6112.

• National, C. G. C. U. (2014). Osteoarthritis: care and management in adults.

• Thijssen, E., van Caam, A., & van der Kraan, P. M. (2014). Obesity and osteoarthritis, more than just wear and tear: pivotal roles for inflamed adipose tissue and dyslipidaemia in obesity-induced osteoarthritis. Rheumatology, 54(4), 588-600.

1. Mastbergen, S. C., Wiegant, K., Beekhuizen, M., Kuchuk, N. O., Custers, R. J., Saris, D. B., … & Lafeber, F. P. (2016). Early evolving joint degeneration by cartilage trauma is primarily mechanically controlled. Osteoarthritis and Cartilage, 24, S359.

1. Warner, S. C., & Valdes, A. M. (2016). The genetics of osteoarthritis: A review. Journal of Functional Morphology and Kinesiology, 1(1), 140-153.

1. Nagamine, R. (2017). AB0814 Medial shift of the tibial articular surface should be taken into account for one factor of medial osteoarthritis of the knee.

1. National Collaborating Centre for Chronic Conditions (Great Britain), & National Institute for Clinical Excellence (Great Britain). (2008). Osteoarthritis: national clinical guidelines for care and management in adults. Royal College of Physicians.

1. Beumer, L., Wong, J., Warden, S. J., Kemp, J. L., Foster, P., & Crossley, K. M. (2015). Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis. Br J Sports Med, bjsports-2015.

1. Sampath, K. K., Mani, R., Miyamori, T., & Tumilty, S. (2016). The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis. Clinical rehabilitation, 30(12), 1141-1155.

1. Qinguang Xu, M. D., Bei Chen, M. D., Yueyi Wang, M. D., Xuezong Wang, M. D., & Dapeng Han, M. D. (2017). The effectiveness of manual therapy for relieving pain, stiffness, and dysfunction in knee osteoarthritis: A systematic review and meta-analysis. Pain physician, 20, 229-243.