/ Arthritis - Any advice?

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csw on 20 Aug 2013
Not sure if this is in the right forum, apologies if not. Anyway, for a long time I've had a slightly arthritic right knee. It's never been a problem as far as walking with a pack goes, but it did curtail my running - However in the last 18 months or so it's got dramatically worse and now both knees and one hip are affected. I had a bit of a wake up call yesterday walking down from the East face of Tryfan which took about three hours and was quite painful. It occurred to me that unless there's a way to deal with this, it could mean the end of long routes on high crags, which was a scary thought.

Anyway, so far conversations with my GP have pretty much centred on pain management, and it must be said that a handful of codeine certainly makes descent easier, but I'm not sure I'd want to be leading on it. Does anyone have any suggestions about managing arthritis in a climbing context?
Gus - on 20 Aug 2013
In reply to csw:

Glucosamine, chondroitin, fish oil are all worth looking into.

There's also the option of adjusting your diet towards the "anti inflammatory" recommended diet which basically involves cutting out wheat, gluten, dairy etc, this will also help with weight control.

It's also worth investing in some trekking poles to keep those big crag days going, along with good sturdy footwear.

Lastly, a good physio or chiropractor may be able to get you a bit more movement and make you more comfortable.

Keep at it, don't give up, and push on!!!!!!
deanr - on 20 Aug 2013
In reply to csw: Cut out tomatoes and mushroom
Dauphin - on 20 Aug 2013
In reply to csw:
Get refered to a Rheumatologist.

D
jon on 20 Aug 2013
In reply to csw:

The hip, while painful, isn't really a problem in the long run as replacements are fantastic. Knee replacements however aren't anywhere near as successful yet and don't have the same longevity (though I suppose if someone goes from not being able to walk to being able to, then that is a success). So maintaining your own knee for as long as possible is essential. I suppose it all depends on how far along the line you are with your arthritis. Mrs J's right knee has no cartilage at all (the result of a skiing accident/ligament damage 25 years ago that was never treated). For four years now she has injections of a lubricant direct into the joint (3 injections, twice a year). She's able to do everything - without pain - except run (she's a very active trekking guide and a climber) and is in a far better and happier state than four years ago. I know from other people that have tried it that it doesn't work for everybody but it's certainly worth considering.
http://orthopedics.about.com/cs/treatment/a/synvisc.htm
duchessofmalfi - on 20 Aug 2013
Take the pain killers and carry on exercising:

Brufen or Diclofenic (prescription) or if you can't take them a COX-2 inhibitor (prescription and some health concerns- discuss with GP / specialist clinic and you may find some milage in discussing usage patterns, you might get a greater willingness to prescribe for occasional use to facilitate exercise than for everyday use to manage moderate pain). Much depends on your GP - if you haven't got a sympathetic one won't don't be fobbed off.

Glucosamine I think helps but probably not enough to keep going now you have an actual problem - I think this helps with injuries and long term trends but won't make a big difference on a long climb / walk as you've described.

Other people swear by walking poles to tame descents and definitely consider adapting other kit (boots / rucksac / weight).

Giving up leads to poor fitness and weight gain which really doesn't help.
Rog Wilko on 20 Aug 2013
In reply to csw: My doctor said "Try getting younger." Ho,ho!
ripper - on 20 Aug 2013
In reply to csw: I have osteoarthritis in my fingers (visible signs in the knuckles nearest the tips, nothing much in the way of pain yet). When I told my GP I'm a climber and I work on a keyboard, she replied: "you might want to think about stopping both of those things". yeah thanks doc, really helpful. I'm on glucosamine&chondroitin, omega 3, eat lots of ginger and cinnamon, but don't really know if it's helping...

Sir Ranulph Fiennes swears that cider vinegar has pretty much cured his symptoms - normally I'd dismiss that as old wives' hogwash but, well, he is Sir Ranulph Fiennes...

I'm interested in this anti-inflammatory diet that somebody mentioned - not heard of that before. and what was that about cutting out tomato and mushroom - why?
csw on 20 Aug 2013
In reply to csw:

I could definitely pay more attention to my diet, not least because at the moment there's too much of it. Interesting about the tomatoes and mushrooms - I wonder what that might be about. my partner yesterday mentioned that someone she knew had had great results from cutting marmite out of their diet - Which I have to say would be a wrench in my case.

Anyway, thanks for your replies, they've given me some starting points - I guess we'll see what happens next....
tallsteve - on 20 Aug 2013
In reply to csw:

I too have arthritis in one knee since falling out of a tree when 16. Was told I'd have a false knee by the time I was 35. Still going with the same one.

Muscle bulk is your best friend. Strong legs less pain. Insist on seeing a specialist - I was sent 3 years ago to a specialist ostea physio. She gave me exercises to lengthen my shortening leg tendons and strengthen key muscle groups. I now just suffer dull aches on descent, and am a little slower than most.

It depends on the causes what you should do. Be insistent with the doc and get an expert to assess you.
Simon Caldwell - on 20 Aug 2013
In reply to tallsteve:
> Muscle bulk is your best friend.

+1 on that.
Also, keep active if you can, for most people lack of movement makes things worse.
Glucosamine and the like have failed to show any benefits in the trials that have been done, but there haven't been that many. Take it by all means, some people claim it helps. I used to, but haven't got any worse since I stopped about 4 years ago.

For a few ideas/inspiration have a look here
http://www.mudsweatandtears.co.uk/2012/03/27/natural-movement-for-mountain-runners/
hokkyokusei - on 20 Aug 2013
In reply to csw:

When I was diagnosed with artritis I was told to lose weight and get fitter. I did and it has worked to an extent. In the beginning I took a lot of pain killers, particularly diclofenac, but now I only take them when it's really bad.

Poles also help on the steep descents when carrying a lot of weight.
Karl Wooffindin - on 20 Aug 2013
In reply to csw:

I find the diclofenac helps but i have to be careful and just roll with the punches, if i am on a bad day then i try and take it steady, it's all about finding a balance.

As said above - get referred to the Rheumatology dept by your GP and see what help they can offer.
silo - on 20 Aug 2013
In reply to csw: Serrapeptase check it out it will change your life!
maisie on 20 Aug 2013
In reply to csw:

Actually, a whole bunch of trials have failed to demonstrate any benefit with glucosamine or chondroitin, but don't let that stop you from taking them - just don't buy the cheapest stuff. However, EFA (omega) supplementation is proven to slow onset of osteoarthritis and associated pain; a number of proprietary supplements are available, but it's worth researching hemp oil.

Weight control is very important - not only is fat pro-inflammatory, but every extra ounce you carry is an ounce of pain. I don't personally subscribe to the anti-inflammatory diet theory, but as someone said, at the very least it might help with weight control.

Regularity of exercise is critical - try to avoid sporadic exertion, and in particular weekend exercise syndrome.

Be careful - and very well informed - about using selective Cox-2 inhibitors for pain relief; as an extreme example, look up vioxx. Preferential Cox-2s like Meloxicam can be useful, but tend to be used more in veterinary medicine. Pre-exercise pain relief works MUCH better than post.

Take a multi-modal approach to pain relief - consider non-drug adjuncts like acupuncture or magnets. They may work for you, they may not. But if you try to go drug-free, only persevere if your pain is completely ablated without painkillers; otherwise, use some medicine wisely.

Lastly, do listen to your body: it does have limits to its longevity and endurance. If, after all of the above, it still hurts to come off Tryfan (certainly wrecked my knees last month), you might need to adjust your goals.

Martin (logged in OH's account)
GeoffRadcliffe - on 20 Aug 2013
In reply to jon: That's amazing. My knees aren't great and seem to have got a lot worse in the last year. If Synvisc can help it certainly seems worth a try as it doesn't seem to have any bad side effects. I hope Hilary continues to do what she does. All the best.
csw on 21 Aug 2013
In reply to csw:

Once again, thanks for all your contributions. I'm a lot better informed than I was this morning - all I was sure of then was that denial didn't seem to be working anymore...
sao - on 21 Aug 2013
In reply to csw:
I have an inflammatory arthritis (something not too dissimilar to Rheumatoid), so I know a bit about what you're experiencing.

Have you been given a diagnosis of some sort of osteoarthritis, and he's ruled out an inflammatory disease? I agree with the people above it might be worth getting referred to a Rheumatologist. XRays and MRIs are also worth discussing with your GP to see what bone and soft-tissue damage is in there, they can also test your blood for any signs of raised inflammation. There's some genetic markers for Rheumatoid they can detect, but there's lots of other inflammatory forms that there's no conclusive test (if it's early it might not show up yet as bone damage), so they'll make a diagnosis based on a history, which is why it's a tricky one to diagnose between inflammatory and mechanical (OA) types.

Have a look at the arthritis research website:
www.arthritisresearchuk.org/arthritis-information/complementary-and-alternative-medicines/cam-report.aspx

for their report on alternative medicines. There's some good information on there.

Poles & strengthening exercises (Pilates / Yoga) are a life-saver.

I take a cox-2 inhibitor - for me, I find it's really well tolerated, much better than long-term use of diclofenac. These are anti-imflammatory though, so I'm not sure if they'd be of use in osteoarthritis. However, OA isn't a side of arthritis I know much about. The arthritis research site is really good if you've not already come across it.

Good luck!
smuffy on 21 Aug 2013
In reply to csw: Have a look at your diet. Theres is now a wealth of information supporting how certain food types can affect arthritis.
a lakeland climber on 21 Aug 2013
In reply to csw:

I've an arthritic hip, the pain varies from slight twinges to severe pain. I take ibufren as and when necessary.

In this order:

1. Lose weight.
2. See a physio - I went private rather than through my GP.
3. Keep moving
4. Get a referral to a specialist - if it's bad then you should be offered this anyway from your GP

ALC
Dauphin - on 21 Aug 2013
In reply to silo:

Can you refer me to some well controlled double blinded studies for that one. What I've read so far is WooWoo.

D
sdgreen - on 23 Aug 2013
In reply to csw: The book 'A Doctors Home Cure for Arthritis' (Campbell) recommends cutting out 4 things: Processed Sugar, Flour (all types), Alcohol & something else I can't remember. I'd add Dairy & Processed Fats to that. Look at 'The diet Solution Program' (Isabel De Los Rios) which is basically a diet for life not just a fad to lose weight. The idea being to cut out processed foods from your life. Cutting out those things would definitely help with general health & may help reduce inflammation.
csw on 23 Aug 2013
In reply to csw:

Well - I have to do something, but the thought of cutting out cheese and flour - I'm assuming pasta is going to be included there - is a pretty scary one - Still, they say the important things in life are always simple and the simple things are always hard - Let's see what happens......
ryan_d - on 23 Aug 2013
In reply to csw: I'm an occupational therapist with a strong background in ortho, worked with lots of good docs and physio, and had my fair share of knee issues.

Your arthritis is most likely osteo rather than rheumatoid, so the anti-inflammatory diet will have some benefits, but I suspect it won't fix your problem- highly effective in rheumatoid though (in case you don't know and excuse me if I'm telling you to suck eggs, but rheumatoid is an autoimmune disease and usually affects the smaller joints ie hands and feet, but can cause problems in knees etc and OA is wear and tear- Yours sounds more like OA, but you need to get this confirmed).

Best advice i can give is to reiterate some of the above and try to keep your weight down, lighten your pack as much as you can, strengthen your upper legs, especially the muscles around the knee with lots of squats, lots of core work to stabilise your knee and try to improve your flexibility. Thats always been the advice I've seen given and it worked for me.

Hope this helps.

Ryan
csw on 23 Aug 2013
In reply to ryan_d:

Thanks - I'm pretty sure it's osteo - I mean it was mentioned by my GP, so that's what it is unless I'm misremembering.

I had thought about squats, but I was afraid they'd just grind the joint down more - I take it that's not a danger?
ripper - on 23 Aug 2013
In reply to ryan_d:
> (In reply to csw) I'm an occupational therapist with a strong background in ortho, >
>
> Ryan

Hi Ryan - any advice for OA of the fingers (inc. early signs of Heberden's Nodes)? knees and everywhere else seems fine. any tips would be welcome

chev1n - on 23 Aug 2013
In reply to jon:

the hip while painful isnt really a problem as hip replacements are fantastic - I have had arthritis in my hip for some time and although I am very active it is getting worse.
I would like some advice on hip replacemnts. I do some yoga and although I am getting on a bit suppleness or lack of it prevents me from climbing the way I used to. I still have aspirations to climb hard and push myself. I can also still run, swim and cycle although I cannot do these like I used to

I know people who are worse than me. I have a friend who comes on conservation weekends and has had a hip replacement and walks even slower than me. non climber. I also have a climbing friend who climbs no harder than severe. Both these guys have had replacements

what I dont want to do is make things worse and ruin my climbing potential for good

any advice would be really great

thanks D
tattoo2005 - on 23 Aug 2013
In reply to csw: I have had problems with my knees and work in orthopaedics in our local hospital. I have had steroid injections in my knees which have worked really well for me and I now use poles when I am hiking up and down the mountains up here in Scotland, definitely well worth buying. Have you been formally diagnosed with arthritis? If you haven't seen anyone in a hospital setting it might be worth asking your GP to refer you to orthopaedics in the first instance, I have found my work colleagues very helpful indeed.
The Reaper on 23 Aug 2013
In reply to csw: Don't worry about hip replacements. If you are suffering from osteo-arthritis then at least you have this option. I have had two and I can genuinely say they have been "life changing". Four years ago (after experiencing steadily deteriorating hip joints over 10 years) I had given up cycling because of the pain, was taking two days to recover from a moderate climbing session, couldn't walk more than a couple of miles and was on high doses of diclofenac just to get through the day. Now, I'm cycling ~100km a week and climbing as hard as I ever have - one of my replacements has made me even more flexible I reckon.

It's all about attitude; I'm guessing the two people you know maybe don't really want to push it too much. I followed a rigorous exercise/physio regime after both my operations and was back on the bike after six weeks, climbing regularly after three months. I was constantly surprised at what I could achieve and haven't looked back.
jon on 23 Aug 2013
In reply to chev1n:

There are several threads on here about this, including one from me when I was trying to decide what type to have (and indeed whether to have it done! Do a search for 'hip replacement'.

Briefly though, at first I wanted a re-surfacing but here in France they don't do it so eventually I went for a THR. It was done in Lyon on 22 November 2010. I was climbing at Buis les Baronnies six weeks later on the 8 January - with the surgeon's blessing. I was back to my regular climbing standard within another six weeks. Now I'm 100% unaware that I've got a replacement. It's absolutely fantastic. You won't regret it and you certainly won't make things worse. They will get worse if you do nothing.

A few thoughts:

It's very difficult to force yourself to go into a hospital and submit yourself to a fairly major (though everyday) operation when you are still relatively mobile (albeit with pain). However, having the op while your muscles are still in good nick hugely reduces the recovery time. If you wait till you can hardly walk then your muscles are going to be in a bad state and getting them back to a normal state will take months instead of weeks.

I don't know about the UK, but I was given a type of hip that is more and more frequently used in France for active people. It's called a double mobility hip and is just about impossible to dislocate which is obviously quite important for a climber. Google 'hanche double mobilité.

Physio is the other key to a quick recovery. It will give you back your ability to make high steps and will prevent you from limping.

csw on 24 Aug 2013
In reply to jon:

Don't mean to keep bumping this, but it's very encouraging to read - once again thanks to everyone for your advice.
paul mitchell - on 25 Aug 2013
In reply to csw: Have suffered arthritis from being a small child.
Now it is getting bad in most joints.As a child it was my hip.

I think diet and yoga are the best answers to arthritis.
Try cutting out refined foods,dairy products,white sugar,chocolate,tea,coffee,alcohol and red meat.

Makes for a pretty boring life.I find my joints are less painful if I follow the above regime,but now it seems the arthritis is here to stay.

Jumping off hundreds or thousands of times onto bouldering mats will not do hips and knees much good;nor will campus board training or one arm pull up training.

Try flax seed oil and cod liver oil.
paul mitchell - on 25 Aug 2013
In reply to csw: Clearly,campussing and one arm training refer to screwing up arm and shoulder joints...
csw on 25 Aug 2013
In reply to paul mitchell:

Yeah - I suspect running in boots with a rucksack on my back might have played a part in destroying my knees. They've been this bad before though and gone into remission, for want of a better word, so I'm hoping that some improvement is still possible.
jon on 25 Aug 2013
In reply to csw:

> They've been this bad before though and gone into remission

That's absolutely typical of arthritis, going through periods calm and then flaring up.
LeeWood - on 25 Aug 2013
In reply to csw: Check out diet recovery from the perspective 'acid -alkali'. Reference to the net pH values which result in your body's tissues. The bottom line is this: health problems thrive in acid conditions, while recovery is inevitable in alkali. One of the easiest ways to emphasise alkali content is to eat exclusively raw food. I have personal experience of recovery through this, but with minor problems. Prevention is better than cure.
csw on 25 Aug 2013
In reply to LeeWood:

I'll check that out - thanks
Tall Clare - on 25 Aug 2013
In reply to paul mitchell:
>
>
> I think diet and yoga are the best answers to arthritis.
> Try cutting out refined foods,dairy products,white sugar,chocolate,tea,coffee,alcohol and red meat.
>
>

Not sure how much truth there is in it but I've heard that cutting out wheat can help too.
Jamie B - on 26 Aug 2013
In reply to csw:

One word - cycling!
csw on 26 Aug 2013
In reply to csw:

So - let's see if I have this right: Cutting out wheat, tomatoes and cheese [dairy] is going to help.....

Can anyone see a way to sneak lasagne past that? I think I'm going to cry :(

Seriously though, thanks....
ads.ukclimbing.com
Tall Clare - on 26 Aug 2013
In reply to csw:

I guess the only solace is that if it helps to reduce the symptoms of arthritis then it's worth a try? My brother's taken a similar diet-based approach (in his case ultra low saturated fat began plus fish) to address the onset of multiple sclerosis.
csw on 26 Aug 2013
In reply to Tall Clare:

Sorry to hear about your brother :( - and yes, definitely worth a try, just typical of me to leave things 'til the last possible minute, and to want my cake and eat it too - or in this case not....

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