Knee and osteoarthritis and exercise
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Recent studies have shown that people with OA of the knee can tolerate weight-bearing exercise such as walking. In fact, studies show great benefits in exercise for people with OA.
A randomized control trial of 439 community-dwelling adults with knee OA compared groups that had 18 months of aerobic walking with programs of resistance exercise and of health education, for their effects on self-reported disability, physical performance, aerobic capacity, strength, radiographic signs and pain, with a control group. Both exercise groups improved in physical performance, knee flexion strength, and decreased pain compared to the education group. An analysis of outcomes by percentage of sessions performed showed significant improvements in disability, pain and walk scores associated with increasing compliance.
A systematic review of randomized clinical trials examined the effectiveness of exercise therapy in patients with OA of the hip or knee. Trials were selected if treatment had been randomly allocated and if pain, self-reported disability, observed disability, or patient's global assessment of effect had been used as outcome measures. The review showed evidence of beneficial effects of exercise therapy in patients with OA of the hip or knee.
A sample from a rheumatology out-patient department had 111 participants with knee OA. Quadriceps sensorimotor function and disability in 60 patients was compared before and after an exercise regime with a control group (n=37) who did not exercise. The results substantiate the association between quadriceps sensorimotor dysfunction and disability, emphasizing the importance of quadriceps exercise in the management of knee OA.
Exercise may be the most effective treatment for OA available. It is important to understand the different types of exercise.
Different kinds of exercise--aerobic, strengthening, flexibility, and specific joint exercises--can improve health in different ways.
Aerobic exercise. Raising the heart rate strengthens the heart and lungs. It increases energy and imporoves endurance. It helps break the cycle of pain, stiffness, and inactivity that can lead to disability.
Depending on the joints involved, swimming, walking, and cycling (perhaps on a stationary exercise bicycle) are often the best exercises for people with osteoarthritis. The goal: 30 minutes a day or more. But...
Start slowly. If a person is out of shape, walk (or swim or cycle) for no more than 5 minutes at a time. (Even 2 minutes is fine.) Do this several times a day.
Build up gradually. Increase the length ofthe sessions by 10% each week.
The idea is to get the heart pumping harder than usual... to break a sweat.
Maintain a healthy body weight. Carrying extra body weight can make the joints wear out faster. Even losing a few pounds leads to much less pressure on arthritic joints. Exercise plus healthy eating, is the best strategy for successful, permanent weight loss.
Strength and flexibility training. Lifting light weights builds muscle throughout the body. Stretching keeps a person limber.
Joint exercises. A workout for osteoarthritic joints can reduce pain and stiffness, improve motion of the joint, and prevent further damage.
Precautions. Common sense safety precautions will help you succeed:
•Warm up (with walking or other light aerobics) before a stretching and strengthening workout.
•Applying ice to your knee or other arthritic joint for 15 to 20 minutes after a workout will reduce soreness and help prevent swelling.
•Some muscle aches or minor, tolerable, joint discomfort after exercise is normal. But if the joints are much more painful that night or the next few days, cut back on the workouts for a brief time
Do not do these exercises unless you check with your physical therapist or doctor first
Strengthening exercises build the muscles that support and protect the knee.
To strengthen the quadriceps muscles at the front of the thigh, lie on your back on a firm, flat surface. Keep one leg straight and the other bent. Working the straight leg, tighten the muscles at the front of the thigh, and slowly lift the leg 6 to 8 inches Hold 5 to 7 seconds. Repeat 12 times, then work the other leg. When this is comfortable, add a 2-pound ankle weight. Work up to three sets of 12 repetitions.
To strengthen the hamstring muscles at the back of the thigh, lie on your stomach. Lift one leg slowly 2 to 4 inches. Hold 5 to 7 seconds. Build up to three sets of 12 repetitions with each leg.
To build calf strength, stand leaning lightly against a countertop, then slowly rise on your toes. Build to two sets of 12 repetitions.
Flexibility exercises fight stiffness and muscle tightness.
To stretch the hamstrings, sit on the floor with one leg forward and the other bent so the foot rests inside the knee. Lean toward your toes, until you feel stretch but not pain behind your knee. Relax and breathe easily as you hold for 15 to 20 seconds. Do not bounce. Repeat 5 to 7 times on each side.
To stretch the quadriceps muscles, hold onto a countertop for support, then raise your foot to the rear, bending at the knee. With your hand, gently pull your foot toward your buttocks until you feel a gentle stretch in the front of your upper leg. Repeat 5 to 7 times.
Knee range-of-motion exercises improve or maintain knee motion and reduce knee stiffness.
Lie on your back and bring your knee toward your chest. Grasp your shin and gently bring your heel toward your buttocks as far as the knee allows. Hold 5 to 7 seconds. Repeat the exercise five times.
Carefully sit up and straighten the leg as much as possible (resting the heel on a phone book as shown can help). Gently press on the knee, trying to fully straighten the leg. Hold 5 to 7 seconds.
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