hello and welcome to this edition of joint action [Music] this podcast is dedicated to all those out there who have osteoarthritis on the show we unpack the truths and demystify the myths about the disease and its management if you have joint pain and want to know more about how to manage it from the world's best experts you've come to the right place without further ado it is time to welcome your host david hunter hello and welcome to this week's edition of the joint action podcast where we have the opportunity to talk about is osteoarthritis preventable
osteoarthritis is the most common joint condition affecting more than 500 million people worldwide there is currently no cure for osteoarthritis and current management strategies for osteoarthritis are largely focused on alleviating symptoms your experience of the disease these management strategies include core treatments such as patient education exercise and physical activity and weight loss or weight management where necessary given that there is no cure for osteoarthritis research into the field of osteoarthritis prevention has been emerging and although there is still work to be done in the field there has been new insights into modifiable risk factors such
as obesity and joint injury and on this week's episode of joint action we're joined by associate professor jackie whittaker to discuss osteoarthritis prevention risk factors and prevention strategies associate professor jackie whitaker who works in the department of physical therapy at the university of british columbia is also recognized as a clinical specialist in musculoskeletal physiotherapy by the canadian physiotherapy association she completed her physiotherapy degree at the university of alberta a phd in musculoskeletal rehabilitation at the university of southampton in the uk and a post-doctoral fellowship supported by an alberta innovates health solutions clinician fellowship in injury
prevention and epidemiology at the university of calgary jackie is currently an associate professor in the department of physical therapy and research director of the glenn sadler sports medicine clinic at the university of alberta hello jackie and welcome to the show nice to be here thank you so much for coming along it's a great privilege to have a chance to chat with you about such an important topic but before we get into the main content of today just wondering if you can share with the listeners a little bit more about your background and what a typical
day might look like yeah so i am a physiotherapist and i'm also associate professor of physical therapy at the university of british columbia so i graduated as a physiotherapist quite some time ago and i took a slightly unusual path to academia i practiced actually clinically for about 17 years before i went back and did a phd which i did in the uk and then went on and did a postdoc and then um started as an assistant professor and and then things have gone from there so um yeah i had quite a bit of a clinical
background i think before i i took that step and some might have said i should have took the step a little bit sooner but i often find that my clinical grounding helps a lot with my current job so as an associate professor i'm blessed to have a salary award so 80 of my time is spent with research and or supervising graduate students i do a little bit of teaching once a year and i've got some service commitments but what does a typical day involve oh you know a lot of meetings a lot of zoom meetings
whether that be with students or groups i'm working with patient partners you name it hopefully there's a little bit of time every day to to do some of the tasks that i said i would do in those meetings and then i try to always save a little bit of time every day to be able to either work on papers or research proposals or documents that i need to be writing and working on to move my research program forward superb yeah there's never enough time in the day but wonder if i could just probe one of
those topics that you brought up particularly that one around working 17 years as a clinician before getting into academia how do you think that that flavors what you do now how do you think it influences and makes what you do a little bit different you know i think a couple things i think i still and i say this often when i speak i have this constant battle between my clinical brain and my research brain because i think as you know clinicians we look at things certain ways and as researchers we have to kind of compartmentalize
and operationalize things to be able to carry out studies and and often those two brains don't work so well together but i would say probably two things number one i think i look at things a lot more pragmatic and so i'm always looking for unique study designs or ways that we can do things that reflect more what is going to happen in the real world and i think the piece with that is that i hold my clinician and patient partners really close at hand when i'm developing proposals and i'm conducting research and i don't think
of myself as just representing that clinician perspective anymore because i know that my perspective has been skewed by being a researcher so i make sure that i always surround myself with clinicians as well as patient partners so that i'm sure that what we're doing actually is relevant and makes sense in the real world so i often think about it you know a lot of my research is really where the rubber hits the road and really how do we take a lot of what we're learning theoretically but actually make it manifest and work in the real
world to help patients feel better and help clinicians do their job yeah and wonder wonderful insights and it's so important and i think being able to continue those interactions both with patients and with clinicians is so valuable as you move forward with the important work that you do now when you're not doing your day job what is it that you like to do i'm a big nature outdoors person i love just being outdoors whether that is you know i've got a cabin and whether that's splitting wood or raking or cleaning outside just being outside and
being in the dirt i love to hike i love to mountain bike i just like being outside and i love photography outside as well i'm a big fan of taking pictures of scenery so a lot of us just get outside whenever i can sounds wonderful it's probably pretty cool there at the moment so what sort of activity do you do in the winter all of the above yeah well you know being in bc being in vancouver the lower mainland it's not too bad we get a lot of rain we get a bit of snow but
it's not too bad you know a cross-country ski or snowshoe but we're pretty lucky i can run outdoors pretty much all year long and i can mountain bike although it gets a little slippery sometimes but yeah you know just get out there and i'm lucky here compared to living in other parts of canada where it's you know brutally cold in the winter it's not quite as restrictive here yeah that sounds fantastic now if you had to describe yourself in five words what would they be yeah so this is an interesting question so how i would
describe myself and how others might describe me may be very very different but um i would say that you know i'm kind of intense so i tend to you know be a very forward person and and sort of speak my mind or ask questions i tend to be also very focused and with that being said i i one of the words i think that i've used a lot to describe myself is i tend to be honest and i tend to maybe the honest isn't the word it's integrity that's something that's really really important to me
i also really enjoy having fun so i'll throw the word fun in there and it's kind of two words it's either mentor or mentorship i think that having mentors in my life is really important and also being a mentor for others is important so i'd throw that word mentor out there but meaning kind of both sides of things herb qualities and as little as i know about you you carry that out and with wonderful aplomb now let's get into the topic of the hand of the day and it's really about osteoarthritis prevention and it follows
a wonderful review that you co-authored with some colleagues called lifespan approach to osteoarthritis prevention that we'll include in the show notes for today's show so for those people that might like to dig into that a little bit further it's come out relatively recently but really about osteoarthritis prevention but before we really get into that main topic can you just tell us a little bit about the difference between illness and disease sure yeah and this is something that we it was interesting as we were writing this paper the four of us just kind of catching that
we were talking about different things but we couldn't quite put our hand on what the difference was and i think at some point we realized that actually sometimes we were talking about disease and sometimes we were talking about illness so disease is really i guess the underlying biology or pathophysiology of a health condition so it's the you know in osteoarthritis it's the changes that we see in the cartilage or the changes we see in the synovium or the the structural things i guess that we can measure and we can look at it's a blood test
maybe it's with imaging maybe it's with whatever type of a test so it's that underlying biology and physiology where illness is really a person's experience of that condition so yes i've got osteophytes but does that change how i experience my knee or my hip or i've got alterations in my synovium the disease but does that change in how i experience what my hip and my knee can do or how they feel so illness is really that experience and we often talk about it at a personal level but you could also think of it almost even
at a societal level so the experience of knee osteoarthritis might be the burden of total knee arthroplasty so it's really the manifestation of the biology and the pathophysiology and i think the reason it's important to understand that in the context of oa is that they're different things but they're related obviously but one doesn't always lead to the other and just because one's high doesn't mean the other is high there can be a lot of structural changes and not a lot of an impact on someone's experience of their knee or you can have someone who's really
being disabled by their knee but actually when you look at the joint and you look for the altered pathophysiology you're not really seeing a lot so they are very distinct things and as you say i think particularly critical when we're talking about osteoarthritis prevention and you know as we go through today hopefully will allude to whether we're preventing the disease as in the structural changes or whether we're preventing the illness as in the person's lived experience with the disease and what they actually present complaining of but before we get into that what do we mean
what is osteoarthritis prevention and what are the different aims as we as we approach this big type of objective well you know prevention is this interesting word and i think it means different things to different people so part of my training was in epidemiology so when i think of prevention i think of it from an epidemiological perspective and it's really all the things that we can do to reduce the burden of a health condition on individuals and society so that might mean anything from preventing risk factors or doing something to allow somebody who's been exposed
to a risk factor to either not progress to the condition or progress more slowly but it might also be improving the function and reducing the disability of people that have the condition so it's actually quite a large spectrum prevent risk factors or identify people early on that have been exposed to a risk factor in intervene so they don't progress or they progress slower or actually working with people with the condition and doing everything we can to reduce the burden of that condition on them and society by making them more functional and reducing their disability so
it's very broad yeah great explanation and if we were to look at how preventable osteoarthritis is and you know hypothetically if we if we were able to modify all of those modifiable risk factors that are potentially available what proportion of osteoarthritis is preventable there's probably an unfair question but i'll let you crack it well it's a tough question isn't it i mean i think in theory and i think that's what we got into in the in the paper is that in theory there's these modifiable risk factors we know we can modify them with a variety
of different things but have we ever been able to show that by modifying them we've changed the progression of oa disease or oa illness i think we've shown with some modifiable risk factors that we can improve the function of people that have a way so that kind of what i didn't use the word tertiary prevention but you know improving function in people that are living with the condition to make the burden of that condition on them less i think we can do that i think we have evidence of that but do we have evidence that
if we prevent risk factors well you could say if we prevent a knee injury we probably could prevent posttraumatic knee osteoarthritis so maybe we have that there but we really lack a lot of evidence around you know if we've got a modifiable risk factor and we address it can we change the course of the progression after that so it's difficult to say what proportion could we remove i just don't know and i think that's actually what we were really hoping when we wrote the paper was to just provoke a lot of our colleagues to understanding
that there's actually a lot of ways in theory we could go around trying to prevent or delay the progression from the exposure to a risk factor to developing the condition but we're going to have to be pretty ingenious in how we develop studies to do that to actually show that and you know we've had colleagues that have been ingenious and have done amazing jobs particularly in the obesity perspective but it's really hard work and that's because there's a there's a time lag between when somebody's exposed to a risk factor and when they develop the condition
yeah some older studies have spoken about this concept called a population attributable risk but essentially you know what is the risk attributable to certain risk factors and have spoken about you know varying proportions of osteoarthritis incidence development of disease and or illness being attributable to certain factors and specifically overweight or obesity and joint injury being the two most eminent ones and at least the percentages that i've heard banded around range substantially i mean you know for obesity between 20 and 50 and for joint injury between 10 and 20 what do you think of those numbers
and do you want to make any comment about them yeah so i mean i think obesity i think the numbers are 20 to 50 percent make sense and i my gut is it's probably a little bit closer to the 50 but i don't know that and if you ask me what evidence i was basing that on i'm not sure i could you know say exactly what i'm basing that on but i think there's more and more of an argument that obesity and that kind of inflammatory milo or the inflammatory piece that's associated with obesity has
a really important role to play in setting our joints up for health or not having being healthy joints i often think and again this is probably just my bias because a lot of my work is related to post traumatic osteoarthritis i often think that 10 to 20 percent is an undersell but i might be wrong and i guess the reason for that is that injury typically happens when we're younger you know if we talk about the knee most injuries kind of happen between the ages of 15 and 35 and a lot of what we've looked
at for post-traumatic osteoarthritis has really been focused on one or a couple types of knee injuries which are tears of the anterior cruciate ligament and or meniscal tears but we do have evidence to show that other knee injuries could also potentially contribute to post-traumatic osteoarthritis so i sort of feel like we don't have the full understanding of the burden of post-traumatic osteoarthritis but i do think we're in the target we know we're in the range i think we're probably in the range and i also think it's difficult for somebody who maybe develops osteoarthritis in their
50s or their 60s to attribute it back to an injury that happened when they were younger and so i think it's a difficult thing to estimate so i always feel like we're maybe underplaying that but i will say that i'm probably a bit biased in that and it's just because in my mind you know that's a big focus of my life understandable completely understandable we've touched upon them but can you give us a little bit of a framework about what those risk factors for osteoarthritis are what are the different risk factors people talk about yeah
so you touched on it there's probably two that get a lot of press and have gotten a lot of press for a long time and and i suspect that it's because they are risk factors and i think you know we could talk about the types of studies that you need to be really confident that something's a risk factor but i think there's been enough studies done on a couple of them that we can feel very confident that they are risk factors and that is obesity or an increase in adipose tissue fat tissue as well as
traumatic joint injury both of those are associated with an increased risk of osteoarthritis but there are other things as well we know that muscle weakness i think there's more and more emerging evidence that weakness of certain muscles around the joint are risk factors for osteoarthritis and probably the best evidence we have here is related to the quadriceps muscle or the muscle in the front of our thigh and knee osteoarthritis but we also know that the shape of a joint influences how that joint deals with load and we know that there's certain conditions that we are
more prevalent when we're younger and our joints are growing that might lead to altered shape of the joint which might set us up for osteoarthritis down the road i'm talking mostly here about modifiable factors in theory we can modify muscle strength we can modify whether or not somebody has a joint injury in theory we can modify obesity we might be able to modify joint shape if we catch it young while the bones are still developing or as a surgeon may also may be able to have some impact on that and then the other thing that's
talked a lot about are sort of like high impact sports and high occupational loading and that's kind of a loaded conversation the last thing i want people to think is that it's bad for you to wait there or bad for you to do impact activities but as with any activity or any posture or any position the real value comes from a diversity of loading and a diversity of postures and a diversity of movements but it doesn't mean by any means that high impact things are bad but you can imagine if you were doing them all
the time and you hadn't really prepared the joint or the muscles around the joint to deal with those impacts that that could potentially be a problem and there's a little bit of evidence for that and then there's also non-modifiable factors which are things that we may not be able to change so we know for whatever reason that females have a higher risk of osteoarthritis now we don't know if that's due to their biology their sex or if that's related more to sociocultural aspects of their identity such as their gender most of it has looked at
the biology piece and in particular looked at the piece around perimenopause and menopause but i think that's something we're still trying to flush out we also know that the older you are the more likely you are to have osteoarthritis so age is a risk factor and there's evidence without a doubt that there are types of osteoarthritis that may have a genetic predisposition to them and i would actually argue there's some evidence to suggest that certain types of knee injuries there's potential that there's a genetic predisposition or at least a familial predisposition to those things yeah
so those are kind of the big ones that we talk about that's a wonderful overview of a very very complex area and why don't we spend a little bit of time digging into those two big risk factors that you've mentioned and starting with those people who are above a healthy weight there's a lot of evidence out there to suggest that that increases risk for osteoarthritis can you tell us a little bit about that yeah and and i will just promise this by saying i'm certainly not an expert on this but i think it comes down
to two things so number one there's a common belief in society and i sort of just touched on it that if you load your joints too much you're going to get degradation or breakdown of the joint and then you're going to have osteoarthritis so i think for a lot of time you know we see this association between obesity or weight and osteoarthritis and the belief was that that was due to just excessive loading of the joint and i think we have some evidence to support that but i think what we're learning more and more and
more is that obesity or fat tissue or adipose tissue in and of itself sort of changes the internal environment of our body and it makes it more inflammatory and it's actually those inflammatory processes that in a way really are degradate our cartilage they really sort of attack our cartilage and create an environment that's not healthy for our cartilage and that can lead to a breakdown so you know the current understanding is that there's a loading component but there's also more this sort of chemical environment that starts to happen within the joints in the body related
to obesity and so it's really about trying to minimize that or do anything that we can to reverse that and we do have some inkling i think in the evidence space that if we can do it and we can do it successfully we can change people's pain that have osteoarthritis i'm not sure we've got evidence to say we can reverse structural changes or the disease of osteoarthritis but we can certainly make people's experience of that condition different so we can change their experience or the illness of osteoarthritis for them but there's work to do yeah
great great explanation a lot of that evidence really relates to knee osteoarthritis but there are some evidence to suggest it increases risk for hip and also hand osteoarthritis and if you want to dig into that a little bit further there's an older episode that we did with steve messier who's sort of one of the gurus in that weight clinical trial space but i'm more interested in hearing from you particularly around that area of great interest to you specifically post-traumatic osteoarthritis what is it who does it affect i'll premise this by saying i'm mostly talking about
the knee here as well i think that probably a lot of the listeners know maybe they don't but you know 80 85 percent of what we know about osteoarthritis i might be exaggerating it's probably related to knee osteoarthritis and there is a real need to understand more about hip and hand osteoarthritis and actually by understanding more about hip and hand osteoarthritis i actually think we're starting to understand osteoarthritis better in all honesty so what is post-traumatic osteoarthritis well it is osteoarthritis that happens after there's been trauma to a joint an injury to a joint and
if we talk about knees as i alluded to earlier most people we hurt our knees when we're between the ages of 15 and 35 and quite commonly those injuries are related to a sport or recreational activity probably the next thing down on the list would be some sort of an occupational injury so they tend to happen to young active people and they can impact young active people's lives for the rest of their lives because they happen at a time that's very formidable for people when they're developing their activity patterns going forward in life and they
obviously have an impact on the health of the joint so the current belief is that there's some sort of trauma or mechanism that gets set off when there's trauma to the joint and that starts to lead to a degradation of the cartilage or or structures within the joint that then lead to the onset of osteoarthritis and i think probably the really interesting thing here that really delineates post-traumatic osteoarthritis from other forms of osteoarthritis is that it happens when people are young and we know that within sort of 10 to 15 years people can have a
diagnosis a clinical diagnosis of osteoarthritis so we're talking about people you know as early as 25 or 30 and we've certainly seen those people in our studies that really have full-blown osteoarthritis they are as cherished colleague of ours stefan lomander said they are young people with old knees and they live with these disease for the rest of their lives and it can have a significant impact on their future health through its ability to impact their activity levels and stay functional and that's probably why i get all excited and passionate about is that i think you've
got these young active people they are doing all the right things as far as leading a healthy lifestyle it goes they have this one incident happen and it sort of leads to this downward spiral in their health both mentally and physically that can take this them on a really negative journey but we also have young people that have this injury that actually end up doing really really really well and i think the really cool thing is trying to figure out you know who does well with it and who doesn't and what can we learn to
try to improve the journey of all those people great overview of janna wonderfully complicated area that you have fantastic expertise in but wanting to dig into a couple of points there particularly given that the young age group that disaffects are there particular sports or activities that people do that might affect them more than others and are these contact or non-contact types of injuries the types of knee injuries that have the greatest risk for osteoarthritis is the two that we know the most without a doubt well probably inter-articular fracture so if you fractured the joint surfaces
in your joint and that usually is traumatic and usually it's traumatic related to some sort of a you know motor vehicle collision or something where there's an external force but most of what we know is related to anterior cruciate ligament tears which is a ligament inside your knee that can tear and or at the same time damage to the meniscus or the kind of a little cartilage plate that sits inside the knee and these types of injuries tend to be sport and recreational related they tend to be non-contact and they tend to be related to
sports where there's a lot of pivoting or quick changes of direction so really common in what we in north america call soccer but you could call football if you were in europe or other parts of the world any of the kind of field code sports so australian rules football very very common basketball anything that's sort of court or field base where there's that quick turning it can happen in ice hockey it can happen in other you know more high-speed activities like downhill skiing etc but really really common in sort of those field and court code
type sports urban i think that's a wonderful segue into the fact can we prevent these from happening absolutely i think we can say fairly confidently we've got high level evidence that we can prevent sport-related knee injuries from happening can we prevent all i'm not saying we've shown that but we can certainly reduce the incidence of these things by 20 30 40 percent some might even estimate a little bit higher and we can do that through injury prevention programs which are just really souped up warm-up programs so warm-up where we're not just you know running around
and doing a few stretches but we're actually starting to increase the circulation of the blood to the muscles what we're practicing in slow motion and building up speed some of the movements that we're going to be doing while we're participating in the sport being very mindful about how we're doing those movements addressing any weakness in the muscles that might exist that we're going to be using and actually some of the injury prevention programs the other thing they do is they really talk about collegial play so you know when is it kind of not a late
check maybe you shouldn't be doing a late check and that puts your knee at risk and your opponent's knee at risk and so talking a little bit about fair play and best practice for sport as well so we definitely have evidence and most of it is in soccer but we're seeing it now adapted to rugby and other sports as well that these injury prevention programs are effective at reducing injury and when it comes to my world of post traumatic knee osteoarthritis that's the panacea because if i can prevent the injury then i prevent the whole
thing from happening and i think that's a really really important point and i guess before we get there we've done one podcast with tim hewett where we spoke a little bit about joint injury prevention he mentioned some of those programs but are there any injury prevention programs specifically that you'd like to highlight or recommend yeah and i mean i may get some of the names wrong and that's why i'm always skeptical to do it so probably the first one that was done was done by fifa and it used to be called the fifa 11 plus
and now it's just called the 11 plus and then the 11 plus has been adapted for a variety of different sports i also know there's an app that's called get started and it provides a bunch of different options around injury prevention for different sports there's a program called happy in denmark that's looking at doing this with more school and child age children we've also been involved with some research in calgary here where they've got an injury prevention program they've embedded in schools in physical education classes i also know the osteoarthritis action alliance has one and
i think it's called stay in the game or keep in the game and i apologize for getting that wrong but there's various organizations that have developed them and when you look at them they have a lot of similar components i think the main thing i would also mention is these injury prevention programs aren't just for elite athletes or high level athletes these are really programs that should be done from grassroots level we know that if we get kids started with them and coaches started with them early in their careers and their trajectory they're much more
likely to see the benefit and carry on with them throughout their entire sporting career yeah and i think that if we just want to elaborate on that a little bit further because i think one of the important points that you made there is that these should be happening particularly at the grassroots level my sense of it is that it's probably not happening to the extent that we would like what benefits would sports participants and teams gain from participation in these and how readily disseminable are these resources that you're talking about yeah so i'll start at
the end they're incredibly disseminable so there you just if you google 11 plus you're going to find the whole thing and all the videos on how to do it on the web no problem no cost nothing it's simple and easy and that will be the same for probably a lot of the other resources that i've mentioned they're very accessible they don't cost it's just finding ways to implement them or integrate them into your warm up and some of the challenges that coaches face there is just their own confidence in delivering them and sometimes you know
i don't know about you but i've coached my son in soccer it's that we don't have the field until it's actually practice time so warm-up doesn't really happen because we literally got a half an hour in the field and we've got to get out there or an hour on the field and we've got to get out there so some of it is about developing a plan for how it's going to be implemented remind me what was the first question the first question is what are the benefits of doing these training programs so this is interesting
and a lot of people have looked into this so you know it's really easy to say okay the benefit is you're not going to injure your knee and as a coach at a certain level that might be hugely beneficial to me because it means that i'm going to have more players available on my bench i'm more likely to win i'm more likely to achieve that championship so i'm going to be doing my job better but we also know that these programs improve performance they improve the satisfaction of the athletes and the coaches so there's a
lot of benefits beyond just preventing the injuries themselves and there's lots of really great work that's been done in a variety of sports to show that so it isn't purely about just preventing injury it's actually about improving performance and having a more cohesive group if you're talking about a team sport and you know obviously associated with that there's an economic piece too if you have less injuries then there's a benefit to you know the jurisdiction that's paying for the health care for the people that are having those injuries so we've seen economic benefits as well
so superb description and again an area where but the public health perspective it would be great if we did a hell of a lot more to prevent this from occurring because the long-term consequences of injuring young people subsequent again the rates differ but let's say 70 of people who injure their joints may develop osteoarthritis within the next 10-15 years it's catastrophic for a lot of these people who otherwise then can't continue to participate so that obviously has a huge impact are there any other things that you want to mention about prevention or injury prevention as
a whole before we move on to the next segment yeah i mean i guess the main thing and i'm sure we'll probably touch on it as we go is really the foundation for prevention and again i'm using that term very loosely from preventing a risk factor to doing something after say an injury to improving the function of people that have the disease or the illness is exercise and physical activity and healthy lifestyle and that fits very well with the obesity piece as well there's really and don't get me wrong hopefully one day we will have
a medication we'll have a pill we'll we will have something that can influence how the joint deals with trauma and how it recovers from trauma but we don't have that right now and so it's not rocket science it really comes down to people being active staying active and leading a healthy lifestyle and although that seems a little bit boring it really is the key but the biggest thing i think for us as researchers and clinicians is figuring out how to help people live that approach when they're struggling and whenever they try to do those things
they just find that they keep struggling i think a lot of what we were trying to throw out with this paper when we wrote it is there's so much we still need to know that we need all the smart people around the world that are experts in each one of these areas to grab onto something and start working on it so we can move the field forward really important message and again something that hopefully more people will get engaged in and contribute meaningfully to that as well now jackie the next portion of the show is
really meant to be a little bit of fun but in an effort to try to get to know you a little bit better this rapid fire round where i'll just throw something at you and hopefully you'll respond rapidly back but favorite book there's probably a few and you know a lot of the books that i read are related to my work so i tried not to pick one of those there's a book by a lady by the name of pema children that's called when things fall apart and i find uh it's a very interesting book
and i have definitely dabbled in a lot of buddhist philosophy in my life and it touches on that and i've found that a lot of the messages in there have been very helpful for me wonderful favorite movie i'm a big forrest gump fan i love that movie right dog or a cat person definitely dog i've always had dogs and then i inherited a cat loved the cat but i i would say dog person favorite quote the best way out is through and that's by robert frost but then i'm also a big star wars fan and
so there's one by yoda that is do or do not there is no try big star wars fan yeah big star wars fan superb what's your favorite food oh i'm gonna go with thai food there yeah lovely do you have a bad habit do i have a bad habit i definitely have a bad habit i talk fast and i like to say that's because i get excited about things and i think associated with that as i sometimes interrupt people because i just want to you know engage the conversation and keep it going more and i've
gotten a little bit better over the years but if you get me really excited about something i tend to talk loud and i tend to to kind of jump in a little bit too much but unless you acknowledge it where would you like to go on holiday this is a tough one because i'm i'm really privileged to have been able to travel a lot in the past although it's been pretty sparse in the last couple years but one place i've always wanted to go ever since i was a small child and i've not gone are
the himalayas and i think for me that that would be something i would very much like to do lovely part of the world what superpower would you have i don't know if organization is a superpower but i'm a fairly organized person and kind of a little bit over the top about that so if that's the superpower maybe yeah and i think kind of go the other way maybe this thing goes i'm really good at solving problems or puzzles and so i think it's kind of that organization puzzling piece if i had a superpower you could
meet anyone better alive who would it be i'm probably going to say the dalai lama i would love to have a conversation with him and just understand you know his positive take on a lot of things and and the way that he puts things in perspective at least my perception of how he puts things into perspective and deals with tough things yeah a really impressive individual what would you do if money were not an issue well a couple of things so i mean number one i would travel but in all honesty i'd probably buy a
big farm and basically adopt all the orphan dogs and cats out there and uh hire a bunch of people to help look after them i've got a pretty soft spot in my heart for creatures and i hate to see them suffer so that would probably be something i'd be pretty excited about doing i hope you get a chance to do it as well now given uh i haven't managed time particularly well today i'm going to wrap up with a couple of final questions but why do you do what you do what motivates you you know
it's interesting it kind of goes back to something i said at the start i think that when i started working as a physiotherapist clinically i really enjoyed what i did and i think i got to the point where i believed that i needed to do research to help more people and that by just seeing one person at a time it wasn't enough and that the research would allow me to help more people and i think what i've realized as i've done research is that actually the way that we change things is one person at a
time so it it's kind of come full circle but i think it points to the fact that i really do what i do because i want people to be able to live their full potential and it really frustrates me to meet somebody 10 or 20 years after a significant event in their life and they're still living the negative consequences of that event and would really like for them to have had better care or better advice or just more direction at the point when they had that incident happen so they didn't end up where they are
now yeah no it's a wonderful insight particularly given the complexity and damage that occurs in the context of injury and the long lasting consequences that ultimately could have been prevented in the first place but is is there one piece of advice knowledge of wisdom that you'd like to give for people out there who have osteoarthritis in closing yeah you know i think a lot of people who have osteoarthritis or maybe they've had a knee injury and they know that hey you know what my knee health isn't going to be what it was before that knee
injury there's two things number one they believe they shouldn't load their joint they shouldn't do impact activities they shouldn't weight bear and i would just say that is just such a false belief your cartilage needs to be loaded that's how it stays healthy and i would also say that you don't want to wait until you're in so much pain and disability to seek help to me the red flag of when you need to seek help is when you can't be physically active anymore so if you've got pain or lack of confidence or there's something going
on with your knee or your hip that's stopping you from being who you want to be physically and actively that's when you want to go and seek some help whether it be a family physician or a physiotherapist or an athletic therapist or somebody that that you trust that will send you in the right direction because there's no reason that you can't be physically active and have osteoarthritis it just might you might need the help of somebody else to figure out how to make that happen but just because you're experiencing pain with something doesn't mean you
cannot be physically active and it's really just figuring out with the help of others how to get over that hump wonderful message and said so persuasively and i hope many people follow through with that jackie it's been a wonderful privilege and chance to chat about such an important issue and i hope many people take away the important messages you've given them perfect well thank you for the opportunity it was awesome i'm hoping you found the content of today's show helpful and insightful and that you've learned as much from jackie as i did from that wonderful
conversation we just had the important messages i guess i'd like for you to take away from this is that at present we can do a lot to prevent osteoarthritis there's a lot of modifiable risk factors singularly there's a big focus on people who are above a healthy weight and people who are at risk of joint injury in preventing both of those but from a public health perspective at present there's very little done to prevent either of those risk factors which we know account for the most people who are developing osteoarthritis so there's a lot that
you can do as an individual if those risk factors pertain to you but there's also a lot that we can do societally to prevent those who might be at risk of subsequent development of osteoarthritis later in their life for those that are injuring their joints that can happen as a young adult and so it's incredibly important that we don't put those people at risk for subsequent development of osteoarthritis such an important area that's critically relevant both to you as individuals with osteoarthritis but also to the society as a whole as we try to implement public
health strategies to reduce the impact and burden of this omnipresent disease called osteoarthritis thank you so much for your attention your continued support of the podcast i look forward to speaking to you again very soon but in the interim please do take care thanks for listening to joint action with david hunter if you like our show and want to know more visit www.jointaction.info if you have any questions you can email us at hello at jointaction.info and follow us on twitter at joint action org this podcast was hosted by david hunter edited by vicky dwong music
produced by jordan hunter the information posted on this podcast is not intended to diagnose treat cure or prevent disease anyone seeking medical advice should consult a health professional [Music]
