Degenerative Joint Disease: Climbing & Descending Stairs
Synopsis: One of the main issues people with DJD experience is difficulties with climbing or descending stairs.1
Author: Thomas C. Weiss Contact: Disabled World
Many people who are in mid-life or their senior years have been diagnosed with degenerative joint disease, something this writer certainly understands from a personal perspective. 'Degenerative Joint Disease (DJD),' is synonymous with, 'Osteoarthritis (OA),' and people with DJD or OA find their hips and knees are affected. One of the main issues people with DJD experience is difficulties with climbing or descending stairs.
Degenerative joint disease, also known as Osteoarthritis (OA). degenerative arthritis, and osteoarthritis, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting usually the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. The main symptom is pain, causing loss of ability and often stiffness. The pain experienced is generally described as a sharp ache or a burning sensation in the associated muscles and tendons.
People in their fifties or sixties frequently develop bony nodules over the small joints of their fingers that are usually painless. The nodules are markers of degenerative joint disease, promising the potential of joint involvement in other parts of the person's body. While nobody knows what constitutes genetic risk factors for the development of DJD, a large number of people who have experienced trauma to large weight-bearing joints through activities such as:
- Car accidents
- Football injuries
will lose cartilage over time. Cartilage serves as a protective tissue between adjacent long bones. When cartilage is lost through injury or surgery, it cannot be readily replaced. The consequences for people who develop pain, decreased range of motion and stiffness in their affected joints is DJD - a distinctive rheumatologic diagnosis, commonly lacking in inflammation, redness, warmth and swelling.
Knee and hip involvement are typical in people with DJD, especially in their fifties and sixties. People often times complain of pain while walking, descending or climbing stairs and will avoid activities that make discomfort and stiffness even worse. Rheumatologists often advocate quadriceps strengthening for people with DJD of the knee, arguing that muscle building will decrease stresses on joints that are affected. Weight loss is a crucial part of therapy for people with established degenerative joint disease (DJD). Many people feel that things such as non-steroidals, dietary supplements and glucosamine help.
The Trouble with Stairs
I have DJD in my feet, ankles and knees. After doing too much physical activity, my hip or hips may become very sore and achy. For some people with DJD, descending stairs is difficult. For me, it is going up the stairs that truly hurts.
The majority of doctors recommend exercising on flat surfaces, to include water aerobics and riding a bicycle. Climbing stairs has cardiovascular benefits, although it might be hard for a person with established DJD who has weak hamstrings and quadriceps. Due to this, it may be helpful to build strength first with resistance exercises and save stair climbing until a later time.
Interestingly, people who undergo joint replacement such as hip or knee replacement surgery are often times pleased with their ability to climb stairs, walk for extended periods of time, or enjoy aerobic activities without experiencing pain. Bear in mind that pain relief is the number one indication for joint replacement surgery - particularly in people who are unable to tolerate non-steroidals or opiate analgesic medications. Personally, medications like Vicodin or Tramadol simply make me dopey; I am left to wonder how many people have gone through the medications and side-effects as I have. My VA doctor prescribed Gabapentin, although he wants me to take too much of it in my opinion.
Degenerative Joint Disease and Studies
Beginning in the mid-1990's, a body of study findings indicated that exercise is one of the best things a person can do to relieve the functional limitations and pain related to hip and knee arthritis. Doctor Marian Minor, Chair of the Department of Physical Therapy at the University of Missouri School of Health Professionals and expert on arthritis stated, "People's pain levels go down, and they also report functional improvements in activities like climbing stairs, getting in and out of chairs, and walking speed."
A certain amount of caution is certainly warranted. For people with forms of arthritis such as DJD, it is important to avoid injuries. What this means is no strenuous activities or contact sports with an increased potential for impact on their affected joints. Yet biking, walking, or low-impact aerobics have been studied extensively and present great results for people with arthritis. For me, a walk along the path next to a local lake with my two little dogs is sufficient exercise.
In people with knee arthritis, pain is likely to appear first during weight-bearing activities involving bending of their knee such as climbing stairs; I whole-heartedly agree. I am very seriously considering putting in, 'easy-riser,' stairs in my home because of this. A large observational analysis of people with confirmed radiographic knee arthritis, or people considered at increased risk for the condition, found that of five activities that might result in mechanical loading on the knee joint - using stairs was most likely to be the primary cause of pain. Doctor Elizabeth Hensor of the Leeds Institute on Rheumatic and Musculoskeletal Medicine at the University of Leeds in England agrees.
The findings support the monitoring of people for development of pain during activities to identify those with the first stages of degenerative joint disease (DJD) who might benefit from early intervention. The analysis included 4,674 people from the Osteoarthritis Initiative (OAI) and 3,284 people deemed to be at increased risk of developing OA. The mean age of those affected was 61.3 years of age and 58% of those in the study were female.
Participants in the study completed the, 'Western Ontario McMaster Universities Osteoarthritis Index,' or, 'WOMAC,' at baseline and annually for up to 72 months. The WOMAC comprises sub-scales that measure pain, function and stiffness. Questions in the pain sub-scale relate to pain during five different activities:
- Using stairs
- Sitting or lying down
- Lying in bed at night
Each question had five possible responses - none, mild, moderate, severe and extreme, which were scored on a scale of 0 to 4. Researchers identified people in the incidence cohort who scored zero on the WOMAC at baseline and went on to score zero at a later time. The researchers selected the first knee score of less than zero and then calculated the proportions of people affirming each item at the point of the first scoring of less than zero. They restricted the analysis to people who had affirmed only one item and assessed whether the five questions were equally likely to be affirmed first.
The WOMAC has five response categories, although there are four associated thresholds which are points of transition on the scale expressing the trait value captured by an item. The authors stated, "We sought to identify the item that contained the threshold with the lowest logit score of all, representing the point of transition from a total pain score of 0 to a score of > 0, i.e. the onset of knee pain."
Chart showing pain levels related to activities in persons with DJD
There were 550 people in the incidence cohort with a complete set of WOMAC observations who scored zero at baseline and went on to score less than zero. At the point of scoring less than zero, the proportions of people affirming questions one through five were:
- In bed 19%
- Walking 40%
- Standing 27%
- Using stairs 81%
- Sitting or lying down 21%
To further capture which WOMAC activity became painful first as the pain score increased from zero, researchers used a, 'Rasch probability model.' The analysis provided a means of formally assessing which question, and therefore activity, is associated with the transition point between the absence and presence of pain. Analysis of a subset of 491 people showed a good fit with the Rasch model. The mean of the threshold locations for the question, 'pain on going up or down stairs,' was notably lower compared with walking, standing, in bed, lying or sitting down.
The results, according to the authors of the study, indicated that using stairs tended to be affirmed prior to the other activities measured. The authors noted that using stairs and walking are both weight-bearing activities involving knee bending while other activities do not. The authors of the study stated, "Pain experienced while lying or sitting or while in bed, is perhaps less likely to have a mechanical origin. It is tempting to speculate as to whether pain during these activities might be the result of underling structural damage within the bone itself."
The authors also concluded that prospective trials will help to determine whether people who develop DJD can be identified sooner if pain during weight-bearing activities involving bending of the knee are used during screening, maybe facilitating effective intervention to prevent additional progression. A limitation of the study was the use of the WOMAC itself, which captured self-reported pain during activities rather than obtaining symptom measures related to performance-based testing. The authors said, "Subjective interpretation of the questions could lead to variable results; however, pain will always be subjective irrespective of the nature of the associated activity." While another possible limitation was including people in the progression cohort in the Rasch analysis, the stairs item was consistently the first item to be affirmed irrespective of whether or not people had radiographic degenerative joint disease or a diagnosis of osteoarthritis.
- OA is derived from the Greek word part osteo-, meaning "of the bone", combined with arthritis: arthr-, meaning "joint", and -itis, the meaning of which has come to be associated with inflammation.
- Evidence for OA found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury.
- Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of osteoarthritis.
- Arthritis comprises more than 100 different rheumatic diseases and conditions including osteoarthritis, rheumatoid arthritis, lupus, and gout.
- Common arthritis symptoms include pain, aching, stiffness, and swelling in or around the joints.
- Some forms of arthritis, such as rheumatoid arthritis and lupus, can affect multiple organs and cause widespread symptoms.
- If disability is significant and more conservative management is ineffective, joint arthroplasty surgery or resurfacing may be recommended.
- Globally approximately 250 million people have osteoarthritis of the knee (3.6% of the population).
- Currently, there are about 50 million people diagnosed with arthritis in the United States. Arthritis is the nation's most common cause of disability, limiting the activities of 21 million Americans and causing 1 of 3 working-age adults (aged 18-65 years) to report work limitations.
- In the United States, there were approximately 964,000 hospitalizations for osteoarthritis in 2011, a rate of 31 stays per 10,000 population.
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