Date: 15 July 2016
I had an accident when I was 18, which damaged the cartilage in my left knee. All they could do at the time was remove the cartilage. By the time I was 30, I had osteoarthritis, which I have now lived with for nearly fifty years. My knees and hips have been replaced, and I have pain in many other joints.
Despite this, I’ve enjoyed a full working life as a rheumatology research nurse, and didn’t want to retire, at age 74. After caring for my husband and then being bereaved, I wanted to keep busy. So I work as a volunteer research assistant with Mr Martin Stone, the surgeon who carried out my knee and hip replacements. I’ve also done work with Arthritis Research UK, to look at a dozen different preventative exercise programmes with a view to finding the best one to adopt in the UK.
Exercise rehabilitation programmes have been tried in places like Denmark, with the aim of helping to reduce the pain of arthritis through specialist exercise advice, and delay or avoid the need for joint replacement surgery. Some programmes we looked at didn’t have a proper evaluation. The one we chose to promote is called ESCAPE-pain - Enabling Self-management and Coping with Arthritic Pain through Exercise.
Typically programmes like this involve 12 sessions, in which participants learn about coping with their condition and undertake a tailored exercise programme. I myself haven’t taken part in a programme like this, as their main purpose is preventative, but andI’ve already had knee and hip replacements.
The physiotherapy I did have was quite limited. When I had my accident, the physios used to put weights on my ankles, to do exercises under load. In the Seventies, I had a bad flare up of arthritis, which was treated with steroid injections. Even when I had my knee replacement, I received intensive physiotherapy, but it was very brief - for only three to four days, before being discharged from hospital.
It was only in 2000, through work, that I realised exercise programmes could help people with arthritis. I’ve found walking in water very helpful for strengthening the quads, and have even built up to doing a 5km sponsored walk in water.
People with a lot of chronic arthritis pain tend to think, “I’d better sit still.” Or they might think a bit of leg raising, or doing stairs is a good thing - but these activities are likely to make it hurt without strengthening the muscles. Instead, they need the correct advice and reinforcement. It is not good enough to see a physiotherapist once and receive a sheet of exercises. You can’t be sure you are doing the exercises properly. It’s really important to have ongoing supervision. Twelve sessions in a programme is enough to ingrain the correct way to do the exercises into people.
Thinking about motivation and taking responsibility, unfortunately a lot of older people assume a pill will make them better, and that the doctor is in control. They don’t understand that they can help themselves. If people have explained to them properly what they need to do and why, then they will understand.
It has to be within the NHS and professionally led, so that people have confidence and take notice of the instructors. These days, hip and knee replacements only need three to four days in hospital. So you receive very intensive physiotherapy - when you are on painkillers or in discomfort. In my experience, there’s no proper physiotherapy follow up to check that you’re ok after you go home.
It’s up to you to ask your GP to be referred to physio - for which you wait six weeks. Instead, I think it would be better to have direct access to physiotherapy. It would take a burden off GP’s.
Given the huge scale of musculoskeletal pain, physios could have a much bigger role.
Christine shares her experience of physiotherapy after surgery and using exercise rehabilitation to help with arthritis.