Blaine Hawkes, DPT
How to Counter-attack the Downward Spiral of Arthritis and why you Should Start Now
Osteoarthritis. One of the common joys of getting older. Osteoarthritis (OA) is breakdown of the cartilage that covers the ends of our bones. It provides cushioning and a nice slippery surface for our joints to move back and forth. OA should not be confused with rheumatoid arthritis (RA), an autoimmune disease that attacks the joints. RA is less common than OA and is treated and managed very differently. RA deserves its own article and will be a future topic of discussion.
Many people refer to OA as normal “wear and tear” on the joints that occurs with aging. While it is more common as we get older, it is not necessarily normal. Some people get into their golden years free of osteoarthritis. OA can occur in any joint in the body. It often happens in the knees, hips, low back, shoulders, neck, and knuckles in the hands. OA makes the joint feel stiff, and often results in decreased flexibility and strength in the joint and surrounding musculature.
OA can make it difficult and painful to do things like walk up stairs, climb onto the floor, lift things up, etc. It often makes people feel depressed when they stop doing their normal activities or stop participating in the things they love doing.
OA can be a downward spiral if it isn’t dealt with appropriately. The spiral goes something like this: 1. The joint pain sets in 2. The person stops using the joint because it hurts 3. The muscles around the joint become weak and stiff from inactivity 4. The weakness and inactivity makes the OA pain worse. And the cycle repeats itself in a downward spiral, potentially to the point where the joint becomes completely dysfunctional.
So now some good news: there are several interventions that can treat and manage OA pains. OA pain is even reversible to a certain extent! While there is a genetic component to OA, there are several things you can do to keep from going down the spiral.
As you can see in the spiral, muscle weakness and stiffness make the arthritis worse. Joints like to be moved, stretched, and exerted, it’s what they were designed for. While it may feel counterintuitive, the cartilage needs to be stressed some to stay strong and avoid further degredation. The solution is quite simple really; keep the muscles around the joint strong and flexible… but how is that possible when it hurts to exercise?
The trick is to identify exercises that appropriately strain/stretch the muscles without exacerbating the joint pain too much. These exercises may need to start very gently in a non-weight bearing form, or in the pool, or on a piece of gym equipment that is appropriate for the joint you’re focusing on. If you’re struggling to identify exercises you can do, you should probably speak with a physical therapist. Orthopedic physical therapists know every muscle in the body, and are experts in joint mechanics and body movement. They also work in gyms that are full of different exercise options. An orthopedic therapist should be able to give you several stretches and exercises that aren’t too painful, and as the joint gradually becomes stronger and more limber you can advance the exercises and progress to functional movement training.
You’ve probably heard the quote that goes something like “If exercise could be put in a pill form it would be the most effective and prescribed drug on the planet.” This is probably true in terms of diabetes, obesity, heart disease, and is probably also true in terms of OA. Just like a drug needs to be administered with an appropriate dose and frequency, so does exercise. There are several different types of exercise that have different benefits, and just like you can take too much or too little of a drug, you can make the same mistake with exercise. A big reason why physical therapists exist is so they can guide you to the appropriate type, dose, and frequency of the proper exercise in managing arthritis pains and other ailments. Many, many joint and orthopedic pains are caused because someone either took too little, too much, or the wrong kind of the “exercise drug.” Exercise is a drug that takes time to build a tolerance to higher doses, and taking too much too soon can create a discouraging situation for people dealing with OA.
Physical therapists have other resources at alleviating joint pain. A good manual therapist can provide joint mobilizations, which are stretches on the joint in very specific directions and with appropriate amounts of force. Joint mobilizations stretch the joint in ways that it cannot be stretched through normal self-stretching. They generally feel quite good during the procedure, and are a time-tested way to restore joint range of motion and alleviate arthritis pains.
Here at Recover Physical Therapy we have also brought in some very exciting innovations to the Magic Valley that provide great ways at exercising without exacerbating joint pain: The Neubie electrical stimulation device is a new form of electrical stimulation that uses a pulsed DC current. Unlike traditional e-stim devices that use an AC current (which your nervous system doesn’t recognize), the Neubie can provide a very thorough workout to the muscles we choose to focus on while adding no strain on the joint. Patients can go through gentle non-weight bearing exercises while the current provides a challenging workout to the muscles, and no joint pain. This allows us to advance to more functional movements once the muscles have gained strength and are better stabilizing the joint.
We are also excited to bring the first Alter-G treadmill to town, a NASA engineered treadmill capable of offloading up to 80% of your body weight. It is an extremely effective tool for patients with arthritis in the knees, hips, and ankles. Patients who normally suffer with walking or running can do so in this machine while it supports a portion of their body weight. As they start to regain strength we can gradually taper down the support until the patient is 100% supporting their own body weight as they walk or jog.
For patients with lower-body OA, it's important to stress the importance of maintaining a healthy body weight and healthy nutrition. Diets high in refined simple sugars contribute to increased joint pain and obesity. Being overweight has a strong correlation with OA pains. Medical studies researching knee OA have found that losing just 10 lbs can have a dramatic effect on knee OA. The mechanics of your knee are such that for every pound you weigh, about 7 lbs of force go through your knee joint while walking, and much higher with running or athletic activity. It’s important to form a relationship with the proper coach in a quest to achieve a healthy body weight and composition. In our holistic approach at Recover Physical Therapy we team with Nutritional Therapy Practitioners that can guide you through the process and also guide you to foods that will minimize inflammation in your body. This is an affordable and effective long-term solution to a healthy body weight and good arthritis management.
Counter-attacking the downward spiral of OA is always easier the sooner you start. Keeping your joints strong and flexible is not an easy, quick fix. It requires a commitment, sometimes some lifestyle changes. Don’t fall into the trap of seeking out the quick fix; the pills and the joint injections may offer some temporary relief, but they don’t fix a root cause in the OA downward spiral (weakness and stiffness), and in long-term research studies they are consistently inferior to physical therapy in regards to pain, function, and quality of life.
If your OA is so far down the spiral that you need joint replacement surgery, do yourself a favor and pursue a course of physical therapy beforehand (prehab). Some prehab patients find sufficient relief that they choose to cancel or postpone their joint replacement surgery. If the joint is so far gone that it needs replaced, the strength and flexibility gains you achieve in prehab will carry on to after the surgery, and make your post-surgical rehab so much better.
There are several medications, devices, and procedures marketing for your attention and promising to eliminate joint pain. While some of these products have their time and place, I would recommend you be wary of the quick fixes that promise results without any effort. Like everything else in life, dealing with a big challenge like OA is going to require some effort, commitment, and time to get sustainable results. It may require some coaching and expert oversight. If you are struggling with where to begin or how to manage arthritis pains, there are so many resources and helpful suggestions to help you get started. Don’t be afraid to call in and ask for some help!