Dear Colin: My doctor diagnosed me with osteoarthritis of both hips and prescribed a pain medication that seems to help, but I’m worried about addiction and side effects. My doctor tells me that walking is OK, but I need to limit activity to avoid stressing my hip joints. Being that I’m only 63 years old and in reasonably good health, I’m not ready to “throw in the towel” yet with playing tennis or golf with my husband. I also don’t want to spend the rest of my life on pain medication. Any advice? Because I’m not directly involved with your care, I’ll provide general guidelines that apply to most with osteoarthritis. Your doctor probably prescribed a “COX-2 inhibitor” as your pain medication, which is a special class of nonsteroidal anti-inflammatory drugs designed to reduce joint pain and swelling from osteoarthritis. This medication can effectively lower inflammation by blocking prostaglandin production (prostaglandins arise from tissue damage, causing pain and swelling). COX-2 inhibitors were never meant to be continued for extended periods, because they can cause serious side effects (such as cardiovascular problems), yet they continue to be widely prescribed that way. Dr. Jeff Katz, medical director for Zoomcare in Oregon, says, “While pain medication can be crucial to short-term management of OA-related pain and other conditions, it’s supposed to be short-term. In other words, a plan to initiate pain medication should be accompanied with a plan to stop in order to avoid potentially serious side effects as well as addiction.” I couldn’t agree more. Pain medications only treat the symptoms associated with osteoarthritis; they do not address the cause of pain. The key to successfully treating osteoarthritis: lower joint forces associated with activity to minimize pain and swelling. Instead of promoting a sedentary lifestyle that’s guaranteed to decrease overall function and open the door to serious debilitating diseases (depression, obesity, diabetes), research shows real promise with careful strengthening of the hip and thigh muscles along with purposeful stretching, although a defined arthritis protocol has yet to be established (Arthritis Care & Research 2010). How does strengthening and stretching decrease pain associated with osteoarthritis? Strong muscles are the best shock absorbers for joints, so by strengthening key muscles that cross the hip (thighs and hips), joint forces decline, and pain and swelling are better controlled. Stretching is also critical because it helps maintain a healthy range of motion to better distribute forces over a greater joint contact area. Endurance exercise (such as walking) is also important to keep body fat down while improving cardiovascular health, but it’s not effective for strength or flexibility so it’s only one piece of an effective plan in effectively dealing with osteoarthritis. The standing hamstring stretch/hip strengthening exercise can be an effective pain modulator for hip osteoarthritis. It simultaneously stretches one side’s hip and hamstring muscles while boosting strength and balance on the other side. The key, however, is to find the right height to place one foot up so you’re able to completely straighten both knees. Hold each side for one to three minutes daily, working up to an intensity level of 7 out of 10 (i.e., “difficult”). The overwhelming factor, however, when it comes to dealing with chronic problems like osteoarthritis is adopting a positive attitude that’s rooted in taking charge of your health. There’s no better medication than that.
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