July 3, 2007
By: Vert Mooney, MD
While it may seem paradoxical, for those with so much osteoarthritis pain that it hurts to move, exercise is actually beneficial and will help manage the pain.
Exercise helps manage osteoarthritis pain in a number of specific ways, including:
* Flexibility and stretching exercises can expand or preserve the range of motion and elasticity in affected joints and thus relieve the stiffness that leads to pain
* A consistent low impact aerobic exercise program can aid in controlling weight, which in turn lessens impact and stress on the joints
* Repeated motion of the joint is necessary to maintain normal joint health
* Aerobic exercise that increases heart rate produces endorphins, the bodyÌs natural pain relieving hormone, which in turn lessens the pain associated with osteoarthritis
* Maintaining normal muscle strength is necessary to control impact to the joints. Good muscle strength acts like shock absorbers around the joints. This is true for the spine as well as for other joints.
The cartilage damage in joints affected by osteoarthritis (also referred to as spinal arthritis or degenerative arthritis), and the attendant inflammation, can generate an extreme amount of pain, making everyday movement difficult. Understandably, the motivation and energy to exercise when suffering osteoarthritis pain can be elusive, and many osteoarthritis sufferers avoid any unnecessary movement that might jar joints.
Pain management to make exercise tolerable
For many, it is necessary to first address the pain undertaking exercise in order to make movement more tolerable. Gradual joint motion through increasing range at first in an unloaded manner will tend to reduce the pain of normal activity.
The variety of options available to control pain is extensive, including:
* Heat therapy prior to exercise to warm up stiff muscles and joints and make them more easy to stretch
* Ice therapy or cold packs after exercise to cool swollen joints
* Over-the-counter medications, such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen), to alleviate pain and reduce inflammation
* Prescription anti-inflammatories and pain medications, including corticosteroids, COX-2 inhibitors, to treat both acute and chronic pain
* Elastic supports, sometimes worn for several hours, are often effective.
Specific osteoarthritis exercise programs
Exercise need not result in heart-pounding, sweat-inducing fatigue to be beneficial. In fact, exercise does not, and in the case of osteoarthritis sufferers probably should not, include high impact activities such as running, or sports such as tennis, basketball or racquetball, which require a lot of stopping, changing directions and jumping Ò all of which can stress vulnerable joints and jar bones together.
Rather, an exercise program that balances a combination or exercises that increase flexibility, build strength and provide low impact aerobic conditioning will deliver substantial benefits. There are certain forms of exercise that are particularly easy on the joints:
* Water therapy. When doing exercises in a pool, the water provides enough resistance to help build strength but it also stabilizes the body in a way that open-air exercise cannot. The buoyancy of water supports the body, imposing little or no impact on joints and allowing for easier flexing and stretching. Rapid, repetitive movements in the water can increase heart rate to accomplish aerobic conditioning. Water walking, using resistance bands anchored around a stationary object like a pool ladder, or hand webs to create pull and resistance, can all add variety and work a number of muscle groups. Some pre-packaged programs call for 10 minutes of stretching and flexing, 20 minutes of aerobic work (water walking or running or swimming) and 10 minutes of resistance and strength exercises. That mix covers all three categories of exercise needed.
* Tai Chi. This Eastern exercise approach is especially beneficial for building strength and flexibility and balance, and provides moderate for aerobic benefits. For elderly individuals, Tai Chi is considered a relatively save form of exercise because the movements are slow and fluid. The Arthritis Foundation recommends tai chi as an activity for seniors because it provides balance of body and mind. It is sometimes called "moving meditation," because the focus is on breathing and creating inner stillness -- quieting the mind, relaxing the body. One small, randomized controlled study concluded that older women with osteoarthritis were able to safely perform 12 forms of Sun-style tai chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning1. Note that Tai chi can be combined with water therapy, called ai chi.
* Yoga. Another Eastern exercise approach, yoga is especially beneficial for building strength, balance and flexibility, all factors that help control osteoarthritis pain. For many, the meditative nature of yoga also provides mental benefits, such as peace of mind and a feeling of overall well-being, which are positive factors in pain control. Can help reduce the feelings of stress and anxiety that often go hand in hand with osteoarthritis pain and disability.
* Pilates. This is primarily a strengthening program that provides an overall workout that slightly elevates the heart rate and incorporates stretching the limbs and joints to increase flexibility. While this form of exercise is typically more demanding than many forms of Tai Chi and yoga, but in general pilates exercise is effective for building strength, especially the in the core body muscles, and is gentle on the joints.
* Exercise walking or using a treadmill, stationary biking, or using an elliptical trainer are all relatively low-impact forms of exercise that primarily provide cardiovascular benefits, meaning that they provide a good workout for the heart, lungs and burn calories. For those with osteoarthritis pain, these forms of exercise provide a good aerobic workout with relatively little stress on the joints. Stationary biking and the elliptical trainer cause less stress on the spine than walking or using a treadmill.
When developing an exercise program it is important not to ignore strengthening exercises. Strength is needed to counter balance the aerobic training. To improve muscle strength and control it there needs to be repeated muscle activity with greater resistance than normal daily activity (e.g. walking). To increase muscle strength in the torso, the core body muscles (ab and back) need to be specifically exercises, with particular attention paid to the extensor muscles.
Most doctors recommend 20 to 30 minutes a day of aerobic conditioning, combined with 10 minutes of stretching (before and after exercising). As a general rule, stretching is best done everyday, while strengthening exercises should be done every other day to allow muscles time to repair themselves between sessions.