OUR LOVELY ISLAND is in the midst of a fitness revolution. Daily the number of people exercising on our streets, beaches and gyms seems to be increasing exponentially.
This is in keeping with global trends of improving health and prevention of chronic lifestyle diseases.
It is recommended that healthy adults engage in 20-30 minutes of moderately intense activity at least three to four days per week. Increased physical activity may however increase the risk of injury to the cartilage lining of our joints. This is especially true for high impact activities such as running.
Cartilage lost is never regained, much like our innocence. In young healthy active patients, joint replacement should be a last resort. Fortunately there are several options, which have been shown to be beneficial for the treatment of arthritis in the younger patient.
Exercise has been proven to be very effective at decreasing pain and improving mobility. Aerobic activity and muscle strengthening are important in the management of osteoarthritis. Low impact activities such as walking, elliptical machines, swimming and cycling are all excellent activities. Supervised physiotherapy and home exercise programs are also beneficial.
Bracing is another useful modality to decrease mechanical load across joint surfaces. It is especially helpful for cartilage loss that only affects part of the joint.
Bracing improves function by decreasing load across the affected part of the joint. Shoe inserts or orthoses can be designed to help offload the diseased portions of joints also.
Non-steroidal anti-inflammatory medications (NSAIDs) are indispensable in treating these patients. There has been no particular drug that has been proven to be more efficacious than others in the class. These medications can be harsh on the lining of the gastrointestinal tract and may result in bleeding and should be used as directed by your physician.
Intra-articular injections of various substances have used to treat osteoarthritis, especially of the knee, but also in the ankle and shoulder. Viscosupplementation with hyaluronic acid (Glucosamine and Chondroitin) has many theoretical benefits on joint health.
Hyaluronic acid has anti-inflammatory, anabolic, analgesic and chondroprotective potential. Intra-articular steroids are also very useful for short to medium term relief of joint pain and increase in mobility and function.
Platelet Rich Plasma (PRP) is another option used for injection into the joint. This product is produced by centrifuging the patient’s own blood and separating off the cells and growth factors important for inflammation and healing. Theoretically these substances are capable of directing healing and repair of the body’s tissues. This option is especially appealing for persons who prefer “natural” alternatives.
These are just a few of the options available for the non-surgical management of cartilage problems in younger patients.
Next: Surgical options for osteoarthritis.
Paul Adams is an orthopaedic surgeon with a fellowship in orthopaedic sports medicine.
