Managing delayed surgery for arthritis

DISCLAIMER: while registered as non-practicing, I cannot give osteopathic advice. This post is intended to be informative, not instructive.

Operations considered non-urgent would normally take a while to come through, but with additional delays due to the pandemic, waiting times are even longer. Even during lockdown, when you can’t necessarily see your manual therapist, there are things you can do to manage your symptoms.

Hip replacement diagram

Osteoarthritis Basics

Osteoarthritis can affect any cartilaginous joint. Most of the joints in the body come under this classification.

Cartilage has a very poor blood supply, but it is still living tissue. This means that it still needs to receive nutrients and get rid of waste products. It does this via the fluid in the joint. You can imagine your cartilage as a sponge: squashing all of the cartilage will push out the waste, and releasing it will allow the nutrients in.

If you don’t use the full range of the joint, some of the cartilage won’t get the fluid transfer it needs, and its health will deteriorate. This can make the joint feel crunchy, or give a sensation of “catching”. This is a bit of a vicious cycle, as you won’t want to move through an uncomfortable range.

If you want to know more about how arthritis works, have a read of my main osteoarthritis blog post.

My Typical Management Strategy

NHS guidelines include exercise and manual therapy for managing arthritis. Research supports the efficacy of these too.

Think about the sponge analogy: injured cartilage is still living cartilage. I wouldn’t claim to be able to cure arthritis, but I have had patients coming in with walking sticks and frames who find they can walk unaided after a few weeks’ treatment. There are a few aims with my treatment and exercise plans:

  1. Relax muscles that are restricting joint movement
  2. Encourage the body to use the restricted range again
  3. Work on compensation issues
Postural changes with osteoarthritis

Using the hip as an example, where typically the hip ends up flexed, and the “elderly posture” develops as a result, my generic plan would be to:

  1. Relax hip flexors (quadriceps, deep abdominal wall) with massage and stretches
  2. Encourage hip extension during treatment and with exercises such as lunges
  3. Look at strengthening muscles that have been held stretched eg glutes, work on back and neck mobility (if not self resolving)

Managing Without Manual Therapy

The good news is that exercise is just as good, if not better, than manual therapy alone!

Exercising into a painful range can be tricky. Although I describe arthritis and my management strategy in quite mechanical terms, everything comes back to the nervous system. Stretching muscles is less about “lengthening” and more about teaching the brain that this movement is safe.

So although you want to work through that uncomfortable range and get the cartilage pumping again, you don’t want to do too much too soon and give your subconscious a reason to keep trying to protect the area.

A so called good, beneficial and safe exercise can be risky, harmful or ineffective if its loaded inappropriately […] Rehab is placing tissues under loads it can withstand and progressing as it adapts!

Adam Meakins

The Return-To-Sports Program suggests that exercises that cause less than 2/10 pain can be repeated daily, as it should not cause enough discomfort the next day to warrant a rest day. As the tissue heals, more exercise should be possible within the <2/10 range.

Prehab

Good habits will see you through lockdown and beyond! Rehabilitation after surgery is already considered an important part of recovery, but pre-habilitation is important too. Typically, if the area surrounding a joint is in good condition before surgery, we can expect better outcomes.

Pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement.

Wallis et al, 2011

In Summary

Although delays to your surgery are inconvenient, they don’t need to be devastating. Getting and staying as active as is comfortable have been shown to improve function and pain while waiting for the operation, and to improve the outcome of surgery. A good level of activity is also a good strategy to help keep your other joints healthy.

Share

Leave a Reply