Exercise For Osteoarthritis

Osteoarthritis (OA) is among the leading causes of global disability, with the hip and knee contributing most to the burden. Most people with OA are of working age, with more than half being less than 65 years of age. Maybe most importantly, OA has been found to be a significant barrier to physical activity. Not only will this affect how the person functions because of the OA pain, the inactivity also has been shown to be a causal factor for most chronic diseases, including type 2 diabetes, cardiovascular disease, some types of cancer, and dementia. ​[..]

Osteoarthritis (OA) is among the leading causes of global disability, with the hip and knee contributing most to the burden. Most people with OA are of working age, with more than half being less than 65 years of age. Maybe most importantly, OA has been found to be a significant barrier to physical activity. Not only will this affect how the person functions because of the OA pain, the inactivity also has been shown to be a causal factor for most chronic diseases, including type 2 diabetes, cardiovascular disease, some types of cancer, and dementia. Therefore, properly managing OA of the knee and hip is not only important for management of symptoms, but also in the prevention and management of chronic conditions leading to increased risk of death.

Common thoughts are that knee or hip OA is best managed with medication,  injections, or surgeries (knee arthroscopy or total joint replacements). I have discussed knee arthroscopy for an arthritic joint in detail elsewhere but to summarize, it is not beneficial.  Taking medication is not a good long term solution as many medicine have negative side effects when taken for extended periods. Having a total joint replacement is a drastic step, particularly in a younger patient population and the research shows that even after a replacement, most people’s activity level does not change much.

So what is the alternative? Substantial evidence supports the effects of exercise therapy in the treatment of at least 36 chronic conditions, including hip and knee OA. In fact, there are over 50 randomized-controlled trials (RCT)  in knee OA and 10 RCTs in hip OA that support the use of land based exercise therapy in reducing symptoms and impairments. However, many people with OA have stopped exercising or trying to be active secondary to the pain. This is where an informed physical therapist can help immensely in designing a program tailored to your specific symptoms and needs.

Recently, an article published in the Journal of Orthopedic and Sports Physical Therapy journal discussed several exercise recommendations for hip and knee OA based published research. Here are the recommendations for you or someone you know who may be limited by knee or hip OA pain and are not satisfied with taking pills, having injections, or having surgery.

1. Exercise and physical activity should be tailored to your needs and preferences. This should not be a one-size-fits-all process. There is evidence to support the idea that some people respond to different types of exercise and your therapist should work with you to determine what works best for you.
2. Consider water exercises if it is too painful to exercise on land.
3. Supervised exercise therapy over a 6 week period is often helpful to get started.
4. Some people may need up to 12 weeks. It will take time for the body to adapt and improve strength, range of motion, and function-especially if activity and pain have been limiting for a long time.
5. Even after completing the initial exercise therapy, “booster sessions” have been shown to be beneficial. These are periodic “check ups” with your therapist to answer questions, progress your exercises so that you are getting the most out of your program.
6. Home exercises should be performed. Your sessions with the therapist will be supplemented with specific activities to work on at home of at your gym.
7. Make sure your therapist helps you understand what you are doing and why as well as how to manage any flare ups. Sometimes, things may not feel real good so you need to know how much pain is ok to have during your activities and how to adjust as needed.

The symptoms and limitations in activity level caused by knee or hip OA can be improved with specific exercises and education. Research has shown that when properly done, this can be just as effective as medication, injections, or surgery in the long-term. In addition, the increase in physical activity will help you avoid more serious health conditions.

​The key is that the program needs to be specific to you, you will have to be patient, and you have to understand and learn about your condition. If you, or someone you know need help, please feel free to let me know if you have questions or need some assistance.

Thanks for reading,

Bob

Author Bob
​Posted onJune 13, 2018