Those plagued with the most common form of arthritis are told to take paracetamol to relieve their pain.
But a major study published yesterday found it does little to ease agony caused by osteoarthritis – as many sufferers can no doubt attest.
The research, published in The Lancet, warned no matter how high the dose, paracetamol is ineffective against this form of the condition.
Osteoarthritis affects up to 10 per cent of men and 18 per cent of women worldwide, according to the World Health Organisation.
Paracetamol has traditionally been the main treatment for the condition, because although stronger drugs are more effective, paracetamol has fewer side effects.
Research has found the powerful painkiller diclofenac was the most effective treatment, but it comes with severe effects if used over the long-term.
Paracetamol does little to ease agony caused by osteoarthritis, the most common form of the condition, a study revealed. But arthritis expert Professor Phillip Conaghan says exercise is the best cure for joint pain
Now, however, growing evidence suggests even paracetamol has side effects if taken in high doses over long periods.
The health watchdog, the National Institute for Health and Care Excellence (NICE), has warned that taken regularly at high doses, the painkiller may have long-term impacts including heart, kidney and intestinal problems.
Instead, it says exercise should be the principal treatment for osteoarthritis.
Professor Phillip Conaghan, chair of musculoskeletal medicine at the University of Leeds, explained this is because exercise is a natural painkiller.
He told MailOnline that joint pain occurs in people with osetoarthritis because the disease means there is damage in and around the joints that the body cannot fully repair.
The cartilage protecting the ends of bones becomes thin, and the synovial fluid, the liquid which acts as a buffer in between two bones, becomes inflamed.
Yet some of the pain is also caused by weak muscles.
‘The pain probably arises when muscles, which are attached to the bones by tendons, stick into the bones,’ he explained.
‘When we have weak leg muscles we take anywhere between 4 and 20 times the force through our joints, causing pain.
Strong muscle, on the other hand, ‘unloads joints’ he said.
This relieves stress and strain on them and keeps them mobile rather than stiff, easing pain.
Taken regularly at high doses, the painkiller may have long-term impacts including heart, kidney and intestinal problems, NICE has warned
He said: ‘I’m on a crusade to get people stronger, to beat arthritis and to allow them to live independently.
‘I’m faced with people who can’t undo jars, or get out of chairs unless they push down with their hands. Strengthening exercises would help them.’
And just two minutes of exercise a day is enough, according to one study published in the Scandinavian Journal of Work and Environmental Health.
Workers with frequent neck and shoulder pain who carried out resistance exercise with elastic tubing experienced relief similar to those who completed 12 minutes of daily exercise, it showed.
Professor Conaghan continued: ‘Arthritis causes varying degrees of pain, so the natural instinct is to stop moving.
‘But the best medicine is actually to exercise to strengthen the muscles, which help support the joints.
‘It may mean working through a bit of a pain barrier initially to reap the benefits and you must commit to exercising daily for the best effect.
He added: ‘You can begin walking, or walking in a pool to add extra resistance. Then build up to an exercise bike, for the lower limbs.
‘Do small amounts of exercise a day and build up to strength training.’
Here, experts suggest the best exercises to beat joint pain…
Strong muscles relieves pain in the joints as it ‘unloads them’, Professor Conaghan said. He added: ‘I’m on a crusade to get people stronger, to beat arthritis and to allow them to live independently’
KNEES: BALLET PLIES, PILLOW LIFTS AND HAMSTRING STRETCHES
For pain-free knee joints, it is essential to have strong leg muscles – including those of the buttocks, hamstrings (which run down the back of the thigh) and quadriceps, the group of muscles in the front of the thigh.
If you spend much of your day sitting, your buttock muscles can become weak, London-based physiotherapist Sammy Margo said.
‘Like the core muscles of the abdomen, these are critical in stabilising the legs,’ she added.
Strengthening the buttock muscles will help improve stability in the knee joints, decreasing pain.
She recommends performing a few ballet plies (like a gentle squat, with your legs wide apart and toes turned out) each day.
Stand with feet apart, toes turned out, and one hand resting on the back of a chair. Slowly bend your knees (keeping them pointing in line with your feet, heels on the floor, without leaning forwards or allowing your bottom to stick out).
Osteoarthritis affects up to 10 per cent of men and 18 per cent of women worldwide
Lower yourself just a little at first, then squeeze the buttocks and slowly return to the standing position. Repeat regularly, aiming to gradually deepen the bend over time. go walking or cycling
General exercise is also going to help. If the muscles around your knees become tired quickly, injury is more likely, so increase their endurance by building up periods of gentle walking or cycling until you can keep going for 20- 30 minutes at a time, two to three times per week.
‘If pain makes running difficult, switch to uphill walking on a treadmill instead,’ recommends Sammy Margo.
‘You’ll get a similar cardiovascular benefit without the painful loading on your knees that flat or downhill might cause.’
Then, it is also important to improve the quadricep muscles, according to Jim Johnson, a physiotherapist at Emory University Hospital in Atlanta, Georgia, and author of Treat Your Own Knees.
To do this, lie flat on your back on the floor or on a bed (or recline on your elbows if easier), with one leg extended and the other bent at the knee, foot flat on the bed or floor.
Fold a pillow in half and place it under the knee of the extended leg.
Press down on the pillow with your leg as hard as you comfortably can, then hold for three to five seconds.
The quadriceps above the kneecap should tighten up. Mr Johnson recommends repeating this up to 30 times with the painful knee, then switch legs. Do it three times a week.
And increasing the knee’s flexibility can also help.
A healthy knee should be flexible enough to straighten fully and bend back to an angle of at least 135 degrees, Mr Johnson said.
To help improve flexibility, stretch your hamstring (which runs along the back of your thigh) by sitting on the floor with one leg outstretched – or you can do this sitting on a bed with one leg outstretched on the bed and the other leg dangling over the side.
Lean forwards towards your outstretched foot until you feel a gentle stretch in the back of your thigh, holding for 30 seconds if you can.
Repeat on the other leg. Aim to reach your body closer to your foot as you become more flexible. Do this once a day for five days a week, working up to 30 seconds if you can’t do this to begin with.
For pain-free knee joints, it is essential to have strong leg muscles – including those of the buttocks, hamstrings (which run down the back of the thigh) and quadriceps, the group of muscles in the front of the thigh. Pictured is an X-ray of an arthritis sufferer’s knees
BACK: PELVIC TILTING AND BRIDGING
‘To strengthen, mobilise and stabilise the back, you have good scaffolding to support it,’ Ms Margo continued.
She suggests tilting the pelvis and raising the buttocks to create a bridge – doing sets of these movements each day to build up strength.
She said: ‘Lie on your back with your knees slightly bent, taking the slack off your lower back.
‘If you can’t like on the floor, lie on the bed. Throughout the exercises try and try to pull the stomach muscles in.
‘Raise the pelvis upwards, engaging the abdominal muscles. Hold the position there for 5 seconds and then relax. Do this 10 times.
‘Next, push the stomach muscles down, squeeze the buttocks up and raise them off the floor so the body is in a bridge.’
This is a great exercise for stabilising the back – reducing pain, she said.
Carrying out daily ballet plies – a move like a gentle squat, with the legs wide apart and toes turned out – can ease knee pain, according to London-based physiotherapist Sammy Margo
HIP PAIN: CLENCH AND LIFT
To train the hip muscles, swing the leg back and hold it in the air – a movement which also improves balance, Ms Margo said.
‘Stand with your hand on a chair and move one leg backwards, keeping your knee straight, while clenching your buttock.
‘Hold this for five seconds without leaning forward. Do this movement 10 times and repeat on the other leg.’
FOOT: TISSUE PICK UP
And an all-round good exercise for preventing foot pain is the ’tissue pick up’, Ms Margo continued.
There are many causes of pain, and so this movement will strengthen a range of muscles.
She said: ‘Sit down with a tissue on the floor and try to pick up a tissue by scrunching the foot.
In order ease pain in the hand, carry out simple exercises such as making fists and ‘OK signs’
‘This should be repeated 10 times, increasing the repetitions when the exercise becomes too easy.’
Another exercise that can help strengthen muscles in the foot is the wall push, according to charity Arthritis Research UK.
Facing a wall, put both hands flat against it at shoulder height, and put one foot in front of the other.
The front food should be approximately 30cm (12 inches) from the wall.
With the front knee bent, and the back knee straight, bend the front knee towards the weall until the calf in the back leg feels tight.
Repeat this movement 10 times for stronger feet.
HAND: MAKING FISTS AND ‘OK’ SIGNS
Simple hand exercises – making a fist or making the international sign for ‘OK’ can help sufferers, the Mayo Clinic advises.
Begin by resting the forearm, wrist and hand on a tabletop or another flat surface.
Hold the hands and fingers straight and close together, as if for a handshake. Then, close the fingers into a gentle fist, wrapping the thumb around the outside of the fingers.
Do this slowly and smoothly, without squeezing the fist, and then release the hand back into the starting position.
Then, carry out the same movement, except instead of making a fist, curve the fingers into a C shape, as if your hand is wrapped around a can or bottle.
Repeat both moves multiple times on each hand.