Osteoarthritis and Exercises

What is Osteoarthritis ?

• Osteoarthritis is a common cause of pain and disability in the aging population. Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease, 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.A variety of causes hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage.
• When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.
• Treatment generally involves a combination of exercise, lifestyle modification and analgesics. If pain becomes debilitating joint replacement surgery may be used to improve the quality of life. OA is the most common form of arthritis.

Patients with osteoarthritis often ask, how can exercise help me? Wont exercise make my arthritis knee pain worse?

Studies for instance, have shown that strengthening the quadriceps muscles can reduce arthritis knee pain and disability. One study shows that a relatively small increase in strength (20-25 percent) can lead to a 20-30 percent decrease in the chance of developing knee osteoarthritis.    

Diagnosis

Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis. The typical changes seen on X-ray include:

• joint space narrowing
• subchondral cyst formation
• subchondral sclerosis (increased bony formation around the joint)
• osteophytes
• Plain films may not correlate with the findings on physical examination or with the degree of pain

Usually other imaging techniques are not necessary to clinically diagnose osteoarthritis.

Osteoarthritis Treatment

Lifestyle modification (such as weight loss and exercise), physical therapy and analgesics are the mainstay of treatment. Acetaminophen / paracetamol is used first line and NSAIDS are only recommended as add on therapy if pain relief is not sufficient.

Goal of Osteoarthritis Exercises

Main aim of Osteoarthritis Exercises are to reduce pain, improve function, and prevent disability, all with the ultimate goal of improving quality of life. There are many ways that these goals can be achieved through exercise programs, as discussed below.

• Muscle Strengthening
• Improving Flexibility and Joint Motion
• Improve Aerobic Functioning
• Weight Loss

Osteoarthritis Exercises

There are mainly three kinds:

• Range-of-motion: To maintain normal joint movement and relieve stiffness. These make the joints flexible.
• Strengthening exercises: To increase the strength of muscles that support the joints affected by arthritis.
• Aerobic or endurance exercises: They improve cardiovascular fitness, control weight and improve overall body function.

Osteoarthritis Exercises Plan

• Discuss the osteoarthritis exercises plan with your health care provider.
• Start under supervision of a physical therapist or a qualified athletic trainer.
• Apply heat to sore joints before you begin exercising.
• Begin exercising with stretching, flexibility and range of motion exercises.
• start strengthening exercises slowly with small light weights or resistance band.
• Increase the difficulty of your exercise routine slowly.
• apply cold packs to sore joints and muscles after osteoarthritis exercises.
• ease off exercise programme and talk to your health care provider if your joints get painful, inflammed or red.

How Often Should You Exercise?

• Range-of-motion: Either daily or every alternate day.
• Strengthening exercises: Every alternate day.
• Endurance exercises: For 20 to 30 minutes three times a week.

Range-of-motion Osteoarthritis Exercises There are several types of knee therapy exercises to help increase the range of motion of the knee joint and begin to re-strengthen the muscles that support the knee. The facilitated heel slides range of motion exercises are the movements described here.In people with osteoarthritis, improving flexibility has an even greater benefit than simply providing a warm up before exercise. There are a few different types of stretching exercises; static, ballistic and something called proprioceptive neuromuscular facilitation (PNF).

Strengthening exercises Strengthening exercises can be classified into three categories: isometric, isokinetic, and isotonic exercises.

• Isometric exercises are those in which you are strengthening your muscles by contracting them and not moving them through their normal range which might be painful if you have arthritis. An example of this is simply contracting your leg muscles, without moving your joints. Isometric exercises are often the best type of exercise to begin with in a strengthening program, particularly in patients who can not tolerate repetitive joint motion. A problem with isometric exercises is that they tend to raise the blood pressure more than others.
• Isotonic exercises are those in which you contract your muscle throughout the full range of motion, again using constant weight or resistance, such as performing a biceps curl while holding a dumbbell.
• Lastly, isokinetic exercises involve constant speed of motion throughout the joint range during muscle contraction, while the amount of resistance may vary throughout the range. Isokinetic exercises are infrequently used, due to equipment requirements and uncertain correlation to functional activities.
• When beginning resistance training, it is good to start with just a single set of up to 15 repetitions, done 2 days a week. It should incorporate exercises that target major muscle groups such as quadriceps, hamstrings, and gluteal muscles. One possible goal is to complete 2 sets of 10 repetitions before resistance is increased.
• For people who have restrictions in their ability to execute full range of motion, it is better to use lighter and easier weights with additional repetitions. For patients in which putting the joint through repetitive range of motion aggravates their pain, it is best to start with isometric exercises.
• A word of caution in patients with a history of heart problems; isometric exercises may not be the best type of strengthening for you and, therefore, it is best to discuss this with your doctor before implementing such an osteoarthritis exercises plan.

Some examples of exercises specifically for the legs good for those with osteoarthritis of the knee and or hips.

• Quad sets: while in a seated position, with legs fully extended in front of you, make a muscle with your thighs trying to push the back of your knee down towards the floor. Hold for 10 seconds, relax and then repeat.
• Wall slide: place your back up against the wall with your hips and knees bent to a 90 degree angle as if you were sitting in a chair. Hold this position for 10 seconds, then come up and relax. Repeat.
• Isotonic Quad exercise: sitting in a chair with your feet planted flat on the floor, raise your right leg straight out in front of you. Relax and bring back to the floor. Repeat on the left. As you are able to you can add ankle weights to increase resistance.
• Isometric Hamstrings while lying on the floor place heels on surface such as a couch or an exercise ball. Press down using the backs of your thighs and hold contraction for 10 seconds. Relax and then repeat.
• Isotonic Hamstrings lying on your belly with a pillow under your abdomen to support your back, bend your knee and bring your foot back towards your buttock. Bring back down to the floor repeat on the other side.
• Isometric Glutes Lying down on a flat surface back flat on the floor, bend your knees so that your feet are flat on the floor. Raise your buttocks up off the ground contracting your butt muscles together. Hold for 10 seconds then relax.
• Calf muscles Strenthening Using a wall or chair for balance, go up on your toes using your calf muscles hold yourself. Contract for 10 seconds, relax and repeat.

Endurance and flexibility exercises: Aerobic exercise strives to improve cardiovascular function through activities that will increase your heart rate. Traditionally, this can be achieved via activities such as walking, jogging, biking, swimming and rowing, when these are done for an appropriate amount of time. With any aerobic activity, one must remember to consider proper breathing techniques, adequate hydration and nutrition, and prior cardiovascular status. Factors such as frequency of activity, duration of exercise, intensity can all be tailored to your personal needs and abilities. On the whole, it is recommended that for benefits of aerobic exercise to be achieved, that you should aim to have 30 minutes of moderate activity most days of the week. Within that 30 minute time interval, there should be a warm up, a workout and a cool down. In people who are sedentary, the first goal should be to minimize time spent sitting throughout the day. Exercise in water, like swimming or water aerobics, relieves weight on stiff or sore joints. The ability to move freely in water can also be a liberating experience, improving your psychological outlook. Walking or using a stationary bike or elliptical trainer helps promote weight loss. The less weight you carry, the less stress there is to your joints.

Osteoarthritis Exercises reduces joint pain and stiffness, and increases flexibility, muscle strength, and endurance. It also helps with weight reduction and enhances a sense of well-being.