Options Advice Knowledge (OAK)

OAK helps you understand osteoarthritis and the treatment options available. We provide up-to-date information based on current evidence and explain which approaches are known to be safe and effective.

The session also provides the opportunity to share experiences with others living with knee pain and learn about services available locally.

Everyone experiences osteoarthritis differently. Your symptoms, lifestyle, priorities and goals are unique, which means there is no single best treatment for everyone.

OAK supports you to make informed decisions about your care. Research shows that people who are involved in decisions about their treatment are more likely to engage with it and achieve positive outcomes.

Osteoarthritis is a condition that affects the whole joint, including cartilage, bone, ligaments, muscles and other surrounding tissues.

We now understand that osteoarthritis develops when the body's normal joint repair processes become less balanced. Over time, this can lead to changes within the joint and the surrounding tissues which contribute to symptoms such as pain and stiffness.

Research has also shown that pain does not always match what is seen on an x-ray or scan. Some people with significant joint changes experience very little pain, while others with fewer visible changes may have more symptoms.

Because of this, terms such as 'bone on bone' and 'wear and tear' can be unhelpful and do not fully explain an individual's experience.

In many cases, osteoarthritis can be diagnosed without an x-ray.

A diagnosis may be made in people aged 45 years or older who have:

• activity-related joint pain
• no morning stiffness, or stiffness lasting less than 30 minutes

X-rays are not usually needed to diagnose osteoarthritis because the changes seen on an x-ray do not usually match a person's symptoms. They may be requested if another condition needs to be ruled out or if surgery is being considered.

Maintaining a healthy weight can help reduce symptoms of osteoarthritis and support overall health.

Carrying extra weight can affect osteoarthritis symptoms in several ways. Excess body fat produces chemicals that may influence inflammation and the body's natural joint repair processes. Carrying extra weight can also make it more difficult to stay active, which may affect strength, fitness and joint function.

Losing weight can help reduce pain and improve function. Research shows that even a modest weight loss of around 5% of total body weight can make a meaningful difference to symptoms.

Get support in Cornwall

Healthy Cornwall offers support with:

• weight management
• physical activity programmes
• healthy eating advice
• general wellbeing support

Exercise is one of the most effective ways to manage osteoarthritis and support overall health and wellbeing.

Exercise can help:

• reduce pain
• improve strength and mobility
• increase fitness and balance
• improve sleep and mood
• build confidence and independence
• improve cardiovascular health

The most important thing is finding an activity you enjoy. People are more likely to continue exercising when they choose activities that fit their interests and lifestyle.

National guidance recommends aiming for at least 150 minutes of moderate-intensity physical activity each week, alongside activities that strengthen muscles.

If this feels overwhelming, start small and gradually build up over time. Even short periods of activity can be beneficial.

It is normal for symptoms to increase slightly when starting a new exercise programme. This does not usually mean that you are causing harm to your knee.

Support with exercise

There are local services that can support you to become more active. These can be accessed following OAK or through your GP.

Healthwise is a lifestyle programme delivered in partnership with Cornwall Council that helps people improve joint health, become more active and manage their weight.

The programme is available at Better Leisure Centres across Cornwall. Community-run leisure centres may also offer exercise classes and activities that may suit your needs.

Osteoarthritis exercise classes

The MSK Physiotherapy Service offers a 6-week class for people with hip and knee osteoarthritis.

The programme includes:

• 30 to 40 minutes of supervised exercise led by physiotherapists
• exercises that can be adapted to your individual needs
• 20 minutes of education and self-management advice

Information about joining the programme can be provided during your OAK session.

Medication may help to reduce pain and support you to stay active. Simple pain relief, such as paracetamol, topical anti-inflammatory gels or anti-inflammatory medicines, may be helpful for some people. However, medication is only one part of managing osteoarthritis and is most effective when combined with approaches such as exercise, weight management and self-management strategies.

Speak to a pharmacist or other healthcare professional about which medications are suitable for you, particularly if you have other health conditions or take regular medication.

A range of treatments and self-management strategies can help people with osteoarthritis. While exercise, physical activity and weight management remain the most effective approaches, some people may also benefit from additional support such as braces, walking aids, footwear advice or specialist interventions.

The best management plan is the one that fits your symptoms, lifestyle and personal goals.

Braces

Some people find knee braces or supports helpful, particularly during activities that aggravate their symptoms. Braces may improve confidence, provide additional support and help reduce discomfort during movement.

Not everyone benefits from a brace, and research suggests they are unlikely to provide significant long-term improvements in symptoms. If used, they should complement exercise rather than replace it.

Walking aids

Walking aids, such as a stick or walking pole, can help reduce pressure on the knee and improve confidence when walking. They may be particularly useful during flare-ups or when walking longer distances.

Using a walking aid is not a sign that your condition is worsening. For some people, it can be a useful way of staying active and independent while managing symptoms.

Footwear

Comfortable, supportive footwear can help improve comfort when walking and exercising. Shoes that fit well, provide cushioning and support the foot are often the most suitable option.

There is no single type of shoe that is best for everyone. Choosing footwear that feels comfortable and allows you to remain active is usually the most important factor.

Most people with knee osteoarthritis can successfully manage their symptoms through education, exercise, physical activity, weight management and other self-management strategies. Many people successfully manage their symptoms without surgery, even when x-rays show advanced osteoarthritis changes.

Surgery may be an option if your symptoms remain severe despite trying recommended non-surgical treatments. This is particularly true if knee pain is having a significant impact on your daily activities, work, sleep or ability to do the things that are important to you.

Before knee replacement surgery is considered, it is usually expected that x-rays show more advanced osteoarthritis changes. The decision to proceed with surgery is not based on x-rays alone. Your symptoms, how much your knee affects your quality of life, your general health and your personal goals are all important considerations.

Many people have osteoarthritis changes visible on x-rays but do not need surgery. Others may experience significant symptoms without advanced x-ray changes. For this reason, both your symptoms and imaging findings are considered when discussing surgery.

If you are considering surgery, OAK can help you understand the potential benefits, risks and alternatives so that you can make an informed decision about whether surgery is right for you.

Knee replacement surgery can be very effective for the right person. Like all operations it carries risks and requires commitment to rehabilitation afterwards. Before surgery, patients are encouraged to optimise their health by remaining active, strengthening their muscles, managing their weight where appropriate and addressing other health conditions.

After surgery, recovery involves regular exercise, increasing activity levels gradually and working towards personal goals. Most people notice significant improvements within the first few months, although recovery can continue for up to a year after surgery.

See here for more information on the benefits, risks and alternatives to surgery.

Understanding osteoarthritis and treatment options

• Arthritis Action: Understanding osteoarthritis.
• NHS England: Making a decision about knee osteoarthritis.

Healthy eating

• NHS Eatwell Guide.