If you have osteoarthritis (OA), you know how involved (and, at times, overwhelming) a treatment plan can be. You may take medication to ease pain, apply topical creams over your painful joints, use hot and cold therapy to reduce swelling and pain, and change the way you eat. But even if you follow your doctor-recommended plan to the letter, you still may deal with pain and other OA symptoms. Though that can be frustrating, it could be that some of your everyday habits may be thwarting your good efforts and actually make your osteoarthritis symptoms worse.
Osteoarthritis is a progressive disease, which means it generally gets worse over time. It occurs when the protective cartilage that cushions the ends of bones gradually wears down. This can lead to changes in the bone; deterioration of the connective tissues that hold the joint together and attach muscle to bone; and inflammation of the joint lining. The resulting symptoms — pain, stiffness, swelling, and loss of flexibility in the joint — often develop slowly, and worsen over time.
Sometimes, however, OA symptoms can flare, either from an injury or a seemingly unrelated habit that puts more stress on your joints. Becoming aware of the latter is important so you can adjust your routine, take extra steps to protect your joints, and slow disease progression.
In addition to being aware of these potential triggers, it’s crucial to keep your doctor in the loop about any worsening symptoms, says Rajat Bhatt, MD, a rheumatologist at Prime Rheumatology PLLC in Richmond, Texas. They can help determine if the flare is related to a trigger or the result of a mechanical problem, and can help tweak your lifestyle or treatment plan to prevent further issues.
If you’ve been experience extra pain, stiffness, or swelling, here are nine things that could be making your osteoarthritis symptoms worse.
Trigger: You’re not exercising regularly
Because rest is often recommended after an injury, a lot of people think they have to take the same approach when dealing with joint pain from osteoarthritis. But exercise actually helps decrease joint pain and lowers the chance of disability due to osteoarthritis, according to a research review published in the Journal of Exercise Rehabilitation. The reason: “Low impact activity allows for better joint lubrication,” says Ryan J. Lingor, MD, sports medicine physician at the Hospital for Special Surgery in New York City. “It also strengthens muscles to help take unnecessary stress off the joints, decreases inflammation responsible for the progression of arthritis, and helps you maintain a healthy weight.”
That said, finding the right type of exercise is important to prevent further damage to the protective cartilage and joint. Try something low-impact, like walking, swimming, and bicycling, as well as something fun so you stick with it.
Before starting any new workouts, you should talk to your doctor. They may recommend seeing a physical or occupational therapist who can help you find activities that are best for you and determine at what level or pace you should do them.
Trigger: You started a too-intense workout regimen
It’s natural: You’re moving more and noticing the benefits, so you want to kick it up a notch. Unfortunately, excessive, vigorous workouts may increase arthritis symptoms and potentially hasten the progression of the disease, according to the Cleveland Clinic. Pushing yourself too hard, too fast can also be a detriment to your joints, adds Dr. Lingor. Instead, add intensity or volume a little bit at a time. Again, working with a physical or occupational therapist can ensure you don’t do too much too soon.
Trigger: You skip strength training
Strength exercises build strong muscles that help support, stabilize, and take some of the stress off worn-out joints. Think of your joints like a plant sapling or young tree, Karen Sutton, MD, Associate Attending Orthopedic Surgeon at the Hospital for Special Surgery in New York City, previously told CreakyJoints. Saplings need strings around them to help them grow straight and strong — just as joints need muscles and ligaments around them for support and stability. If you don’t have enough muscle, your joints can take more of a pounding during daily activities. But as muscles become engaged and grow stronger, they absorb some of the force, which takes pressure off weaker, worn-out joints. That shift can translate to a decrease in arthritis symptoms and improvement in day-to-day function.
You don’t have to own a weight machine or dumbbells to reap the benefits. Strength training can be done using your own body weight.
Trigger: You’re overweight
Extra weight puts extra pressure and stress on weight-bearing joints, such as the knees and hips, Dana DiRenzo, MD, MHS, instructor of medicine in the department of rheumatology at the Johns Hopkins University School of Medicine previously told CreakyJoints. How much more? According to the Johns Hopkins Arthritis Center, being only 10 pounds overweight increases the force on the knee by 30 to 60 pounds with each step. Additionally, the Mayo Clinic notes that fat tissue produces proteins that can cause harmful inflammation in and around your joints. But losing even a little weight can relieve some pressure, reduce your pain, and even slow the progression of OA. A 2017 study of overweight and obese adults who were either at risk for or had osteoarthritis found that those who lost weight over a four-year period significantly slowed down their rate of knee cartilage degeneration. The study also found that rates of OA progression were lower in those with more weight loss.
To start losing weight, Nilanjana Bose, MD, a rheumatologist in Houston, Texas, recommends following a Mediterranean-style diet, which focuses on vegetables, fruit, whole grains, and healthy fats. Not only does the heart-healthy, low-calorie diet help with weight loss, but Dr. Bose says it can help ease arthritis symptoms as well due to its emphasis on anti-inflammatory foods. Check out more expert-recommended tips to help you lose weight and improve arthritis symptoms.
Trigger: You compensate for pain
When you have arthritis in one joint, nearby muscles and joints have to work a little harder to pick up the slack, explains Dr. Lingor. “This compensation can contribute to pain or injury from extra stress in that new area.”
A study published in the journal Arthritis and Rheumatology found people who develop knee pain associated with osteoarthritis often subsequently develop pain in other joints. Researchers concluded the heightened risk of pain likely occurs for many reasons including pain avoidance, pain sensitivity, and generalized OA.
This shows the importance of using as many tools as you can to manage OA in affected joints to avoid causing additional pain and problems in other areas.
Trigger: You don’t work on your flexibility
Flexibility exercises, such as yoga, tai chi, or Pilates, can improve joint mobility, reduce stiffness, and help prevent tightening of the tissues around the joint. Yoga has been found to be particularly beneficial for people with osteoarthritis. Not only can it help reduce stress, but a 2018 study of people with knee osteoarthritis found that after just one week of yoga therapy, patients reported a decrease in knee pain and stiffness, and significant improvement in mobility.
Working on your flexibility can also help with compensation. “You may not be aware of your own imbalances in strength and flexibility,” says Dr. Lingor. “This asymmetry may put extra stress on one side of the body resulting in injury. Doing exercise like yoga, Pilates, or tai chi can help make you more aware of and correct these imbalances.”
Trigger: You don’t use assistive devices
There is no shame in getting a little extra help, especially if it minimizes your osteoarthritis pain and makes everyday tasks a little easier to perform. Items like jar openers, long-handled tools, braces, and canes can all help support, stabilize, or take some pressure off affected joints. And though that may sound like an expensive investment, there are many household items that can be used to help with tasks. Check out some of these surprising items you can repurpose to use as assistive devices.
Trigger: You’re not sleeping well
Poor sleep is associated with more pain and higher levels of depression, as well as greater functional disability over time in people with OA, according to a study published in the journal Arthritis Care and Research. Lack of rest can also impact the way you respond to pain: “If you’re not sleeping well, it can exacerbate your perception of pain and make your tolerance worse,” explains Dr. Bose. Increased pain may then prevent you from going to sleep or lead to sleep disturbances, furthering a bad cycle, adds Dr. Bhatt.
Telling someone with arthritis to simply “sleep better” is not exactly helpful advice, as it can obviously be challenging and frustrating to get restful sleep when you’re in pain. Being aware of the impact that sleep problems can have on arthritis pain is a good first step. If you struggle getting the rest your body needs, check out some sleep tips arthritis patients swear by. Make sure you talk to your doctor about your sleep issues. They may be able to recommend changes in your medication timing to help encourage better sleep (such as avoiding taking steroids too close to bed) and help identify other medical problems that could be contributing to poor sleep.
Trigger: You hyper-focus on your pain
A negative mindset, like thinking your pain will never get better, may intensify pain and extend its duration, Robert Kerns, PhD, professor of psychiatry, neurology, and psychology at Yale University previously told CreakyJoints. That pattern of thinking is called pain catastrophizing — and the more you focus on your pain, says Dr. Bhatt, the worse the pain may get.
Of course, this doesn’t mean you have to hide your pain, slap on a smile, and be totally fine with having osteoarthritis. The pain — both physical and emotional — of having osteoarthritis is very real, and staying silent about it isn’t going to help you feel better either . Rather, you should talk to your doctor about any negative feelings you’re experiencing. They may be able to suggest coping strategies or refer you for to a provider for mental health care to help you better manage living with a chronic pain condition like OA .
What to Do if Your Osteoarthritis Symptoms Are Getting Worse
Talk to your doctor immediately about any new or worsening symptoms. They can assess the situation and determine if your treatment plan needs to be adjusted. You may need additional medication, a change in medication dose, or consider switching medications if your regimen is no longer controlling your symptoms well enough.
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Deepeshwar S, et al. Effect of Yoga Based Lifestyle Intervention on Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Frontiers in Psychiatry. May 8, 2018 doi: https://doi.org/10.3389/fpsyt.2018.00180.
Felson DT, et al. Multiple Nonspecific Sites of Joint Pain Outside the Knees Develop in Persons With Knee Pain. Arthritis and Rheumatology. September 2, 2016. doi: https://doi.org/10.1002/art.39848.
Gersing AS, et al. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology. May 2, 2017. doi: https://doi.org/10.1148/radiol.2017161005.
Interview with Nilanjana Bose, MD, rheumatologist in Houston, Texas
Interview with Rajat Bhatt, MD, rheumatologist at Prime Rheumatology PLLC in Richmond, Texas
Interview with Ryan J. Lingor, MD, sports medicine physician at Hospital for Special Surgery
Osteoarthritis. Cleveland Clinic. November 26, 2019. https://my.clevelandclinic.org/health/diseases/5599-osteoarthritis.
Osteoarthritis. MayoClinic. June 16, 2021. https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925.
Parmelee PA, et al. Sleep Disturbance in Osteoarthritis: Linkages with Pain, Disability and Depressive Symptoms. Arthritis Care and Research. March 2015. doi: https://doi.org/10.1002/acr.22459.
Role of Body Weight in Osteoarthritis. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/patient-corner/disease-management/role-of-body-weight-in-osteoarthritis/.
Villafañe JH. Exercise and osteoarthritis: an update. Journal of Exercise Rehabilitation. August 24, 2018. doi: https://doi.org/10.12965/jer.1836352.176.