HOW TO PREVENT CANCERS

by Cathy Johnson

Most of us don't think about our joints until they cause us pain. But knowing a bit about your joints and how to look after them will help you keep moving.

ur joints allow us carry out a myriad of everyday activities – so when they play up, it can be devastating.

Here are five important things to remember about keeping joints healthy.

Throbbing knees, aching hips and sore ankles become more common as we age. Very often, worn cartilage is involved.

It's easy to assume a lifetime of activity is to blame; that with every movement our limbs make, we are literally wearing the cartilage in our joints away. But the idea our joints are like light bulbs or car tyres with a limited number of "uses" before their lifetime expires is simply untrue, says rheumatologist Professor Patrick McNeil.

Plenty of older people who've been active all their lives never develop osteoarthritis, he points out. And this misguided view can lead to people avoiding exercise, which has an important role in keeping joints healthy.

"I think it's a myth to make the general statement that exercise is bad for your joints or actually wears your joints out," McNeil says. "There's no evidence for that."

Exercise doesn't just help keep joints healthy; it's one of the best treatments for joints that are already damaged. While it's natural that when joints hurt, you want to avoid moving them, the movement actually performs an important job. Cartilage is living tissue but it has no arteries to deliver blood to it. Instead it relies on movement of the joint to create a pumping action that circulates fluid containing oxygen and nutrients.

Exercise also:

decreases pain.helps maintain the mobility and flexibility of joints.improves muscle strength, which can help hold joints in their correct alignment, taking pressure off sore spots.

Regular exercise can also help you maintain a healthy weight, reducing stress on joints. And of course it has enormous general health benefits. The bottom line? It's much better to be physically active than to hold back because of your joints.

Generally speaking, your joints will let you know if your exercise is causing harm. But if you have been diagnosed with joint damage, or have pain that suggests damage, it's possible the wrong sort of exercise could make your arthritis worse. (Some discomfort in an affected joint is normal but substantial increased pain or swelling during or after activity may be a sign you need to modify your program.)

"If you have osteoarthritis in weight-bearing joints such as the hips, knees and lower spine for instance, high impact exercise like running can certainly aggravate symptoms and it's probable it might accelerate progression [of the damage to the joints], although I think that's still an open question," says McNeil.

"In those cases, I'd probably recommend a lower impact exercise such as swimming or bike riding that puts less stress on the affected joints."

An exercise physiologist or physiotherapist can help you work out how to change your exercise regime to minimise joint pain.

People with arthritis often take anti-inflammatory medicines, also known as non-steroidal anti-inflammatories (NSAIDs), to help relieve pain. However, these medications can cause many side effects – some of which may be serious or life-threatening, such as an increased risk of stroke and internal bleeding.

When you're taking an NSAID, always use it cautiously and for the shortest time possible. If you need to use these medicines for a long time (for example, to manage the symptoms of arthritis when other therapies don't offer relief), make sure you see your doctor regularly.

Pain specialist and rheumatologist Associate Professor Milton Cohen says anti-inflammatories are overused in Australia, especially for osteoarthritis.

Though its name ends in 'itis' (which means inflammation), this is misnomer as osteoarthritis involves only low-grade inflammation, says Cohen.

NSAIDs should be more closely targeted to genuinely inflammatory conditions – the classic signs of which are swelling, redness and warmth of affected tissue.

For people with chronic pain, including pain associated with osteoarthritis, Cohen advocates simpler painkillers (such as paracetamol) combined with non-drug approaches. Non-drug strategies include changing the way the painful body part is used (where possible), and optimising sleep, diet and exercise.

Anti-inflammatories are best kept in reserve to use intermittently, says Cohen, as a "passport to activity" such as a weekly game of golf.

Do your joints pop or snap? Or do they make more of a creaking, rubbing or grinding sound?

Noisy joints might be alarming, but not all noises are signs of a problem requiring medical attention. For instance, any movement that causes a sudden change in joint volume can make a cracking sound, says Deakin University pain specialist Dr Michael Vagg. (The noise you get when you crack your knuckles is one example. Long-term evidence has shown this habit to be harmless.)

It's thought these some noises come from sudden pressure and volume changes in the fluid-filled sac in joints, he says. This pulls some dissolved gases out of the fluid solution to form unstable bubbles that pop to make the snapping sound.

But rubbing or grinding noises, known as "crepitus", can be a sign of damaged cartilage, which can create rough surfaces (and even leave parts of bone exposed). Such surfaces can creak and grind when rubbed against each other. This is osteoarthritis and the noise is most common in the knee and the neck. And it can progress. But there's little you can do to prevent further cartilage deterioration and confusingly, it doesn't always correlate well with the pain a person feels. However, some forms of painful crepitus might be helped by physiotherapy to correct muscle weaknesses affecting the stability of joints.

If in doubt about your noisy joints, ask your doctor or physiotherapist to check them out.

Published 14/11/2013