Osteoarthritis:An overview and introduction to pain management and activity

Presented by: Melanie Fuller-Clinical Exercise Specialist Sherwood Park Primary Care Network

Objectives

• What is arthritis? • What are the symptoms of arthritis? • Ways to decrease pain and manage

symptoms • Things you can do at home to help with daily

living tasks • Specific exercise guidelines and resources

Osteoarthritis: What Is It?

• Also called "wear and tear" arthritis or degenerative joint disease, osteoarthritis (OA)

• Progressive breakdown of the joints' natural shock absorbers. This can cause discomfort when you use the affected joints

• Most people over 60 have some degree of OA, but it also affects people in their 20s and 30s

Osteoarthritis: Where Does It Hurt?

• In most cases, osteoarthritis develops in the weight-bearing joints of the knees, hips, or spine. It's also common in the fingers, thumb, neck, and big toe.

• Other joints are usually not affected, unless an injury is involved.

What does it look like?

Osteoarthritis: Symptoms

• Pain• Tenderness• Stiffness• Loss of flexibility• Grating sensation• Bone spurs: hard lumps• Swelling

Osteoarthritis: What Causes It?

•Every joint comes with a natural shock absorber in the form of cartilage. •This cushions the ends of the bones and reduces friction in healthy joints. •As we age, joints become stiffer and cartilage is more vulnerable to wear and tear. •Repetitive use of the joints over the years irritates the cartilage. If it deteriorates enough, bone rubs against bone, causing pain and reducing range of motion.

Risk Factors You Can't Control

• Older Age• Gender

– Female (2.6 times more likely to develop OA)

• Bone deformity: bow legged

Risk Factors You Can Control• Body Weight (11 lb weight

loss results in 50% decrease chance of OA in the knee

• Activities– Repetitive motions– Previous Injury from certain

sports (ACL)

Research shows that “for each 1 pound increase in weight, the overall force across the knee increases 2 to 3 pounds. (Felson et al. 2000).

Impact on Daily Life

• Everyone is different• Mild pain v.s. severe pain

Diagnosing Osteoarthritis

• Describe symptoms• X-ray or other imaging• Blood tests (rheumatism)

Long-Term Complications

• It can lead to deformities that take a toll on mobility.

• Severe loss of cartilage in the knee joints can cause the knees to curve out, creating a bow-legged appearance (shown on the left).

• Bony spurs along the spine (shown on the right) can irritate nerves, leading to pain, numbness, or tingling in some parts of the body.

What causes pain?

Arthritis pain can be caused by:

• inflammation, the process that causes heat and

• swelling in your joints• damage to the joints• muscle tension, from trying

to protect joints from• painful movements.

Medication for OA

• Consult your family physician or pharmacist

• Over the counter pain relievers

• Sprays, gels, creams• Prescription pills• Natural remedies: hot/cold

therapy, massage therapy.

• Pain Management is key!

Treatment: Exercise Therapy

• There is no treatment to stop the erosion of cartilage in the joints, but there are ways to improve joint function.

• Increase flexibility • Strengthen the muscles

around the affected joints• Hot or cold therapies to

relieve pain.

Supportive Devices

• Supportive devices, such as finger splints or knee braces, can reduce stress on the joints and ease pain.

• If walking is difficult, canes, crutches, or walkers may be helpful.

• People with osteoarthritis of the spine may benefit from switching to a firmer mattress and wearing a back brace or neck collar.

Osteoarthritis and Weight

• Losing weight is one of the most effective ways to relieve pain.

• Can reduce long term damage

Preventing Osteoarthritis

• The most important thing you can do is keep your weight in check. Extra weight puts stress on the joints and may even alter the normal joint structure.

• Preventing injuries is also important.

• Take precautions to avoid repetitive motion injuries on the job. If you play a sport, use proper equipment and observe safety guidelines.

WORK SMARTER….NOT HARDER

Osteoarthritis and Exercise

• Many patients do not exercise because of fear of pain.

• Exercise helps:– Strengthen muscles– Support joints– Increase joint lubrication– Improve flexibility

How do I Achieve theseHealth Benefits?

What do I need to know?

There are 3 major components to physical activity

Flexibility or Range of Motion Exercises

Muscle Strength and EnduranceOverload principle

Aerobic/Cardiovascular Fitness

Lets get moving!

Warm up to work out• Apply heat to the joints you'll be working before you exercise.

• Move your joints gently at first to warm up. You might begin with range-of-motion exercises for five to 10 minutes before you move on to strengthening or aerobic exercises.

• Exercise with slow and easy movements. If you start noticing pain, take a break. Sharp pain and pain that is stronger than your usual joint pain might indicate something is wrong. Slow down if you notice inflammation or redness in your joints.

• Ice your joints after exercising. This can reduce swelling and pain. Use a cold pack on your joints for 10 to 15 minutes.

Range of Motion or Flexibility

Stretching Continued

Seated Hip March

• This move can strengthen hips and thigh muscles to help with daily activities, such as walking or rising from a chair.

Sit up straight in chair. Slightly kick back your left foot but keep toes on the floor. Lift your right foot off the floor, keeping knee bent. Hold right leg in the air five seconds. Slowly lower your foot to the ground. Repeat 10 times. Rest and do another 10, then switch legs. Too hard? Use your hands to help raise your leg.

• Is the straight leg raise too tough? Do quad sets instead. With these you don't raise your leg. Simply tighten the thigh muscles, also called the quadriceps, of one leg at a time.

Start by lying on the floor. Keep both legs on ground, relaxed. Flex and hold left leg tense for five seconds, as seen in right-hand photo. Relax. Do two sets of 10. Then, switch to other leg.

Quad Set

Hamstring Stretch

• Lie down. Loop a bed sheet around your right foot. Use sheet to help pull and stretch leg up. Hold for 20 seconds. Repeat twice, then switch legs.

Straight Leg Raise

• To try this leg strengthening move, lie on the floor. Prop your back up on your elbows. Bend your left knee, keeping foot on floor. Keep the right leg straight, toes pointed up. Tighten thigh muscles of your right leg. Slowly and smoothly use your thigh muscles -- not your back -- to raise your leg.

Pause, as seen above, for five seconds. With thigh still tight, slowly lower leg to ground. Relax. Repeat 10 times. Rest. Do another 10; then switch legs.

Pillow Squeeze

• This move helps strengthen the inside of your legs to help support your knee. Lie on your back, both knees bent. Place a pillow between knees.

Squeeze knees together, squishing pillow between them. Hold for five seconds. Relax. Repeat 10 times. Rest, then do another set of 10.

Too hard? You can also do this exercise while seated. See photo to right.

Heel Raise

Hold back of chair for support. Stand straight and tall. Lift heels off ground and rise up on toes of both feet. Hold for five seconds. Slowly lower both heels to ground. Repeat 10 times. Rest. Do another 10.

Too hard? Do the same exercise, only sitting in a chair.

Side Leg Raise

Hold back of chair for balance. Place your weight on left leg. Lift right leg out to the side. Keep right leg straight and outer leg muscles tensed. Don't slouch. Lower right leg and relax. Repeat 10 times. Rest. Do another 10, then repeat with left leg.

Too hard? Increase leg height over time. After a few workouts, you'll be able to raise your leg higher.

One Leg Balance

Your goal is to do this hands-free. Steady yourself on a chair, if needed. First, shift your body weight to one leg but do not lock your knee straight. Slowly raise the other foot off the ground, balancing on your standing leg. Hold for 20 seconds. Lower raised foot to the ground. Do twice, then switch legs. This move helps when getting out of cars or bending.

Too easy? Balance for a longer time. Or try with your eyes closed.

Walking

With stiff or sore knees, walking may not seem like a great idea. But it's one of the best exercises for knee arthritis. It can reduce joint pain, strengthen leg muscles, and improve flexibility -- and it's good for your heart. The best part -- no gym membership needed.

Good form is key: Look forward, walk tall. Keep arms and legs moving, relaxed. Always ask your doctor before starting exercise when you have osteoarthritis.

Low-Impact Activities

Being active may also help you lose weight, which takes pressure off joints. Other exercises that are easy on the knees: biking, swimming, and water aerobics. Water exercise takes weight off painful joints. Many community and hospital wellness centers, YMCAs, and pools offer classes for people with arthritis.

Don't give up favorite activities, like golf. Talk to a professional about modifying painful moves.

How Much Exercise?

Start with a little. If you can do it without pain, do more next time. Aim for 30 minutes a day.

Over time you'll build your leg muscles to support your knee and increase flexibility.

Some muscle soreness is normal, but hurting or swollen joints need rest. Take a break and ask your doctor or health professional for advice.

How to Get Started?

•Assess your baseline•Work towards small achievable goals

Thank-you

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Additional Sources American Geriatrics Society Panel on Exercise and Osteoarthritis. Exercise prescription for older adults with osteoarthritis pain: Consensus practice recommendations. Journal of the American Geriatrics Society. 2001;49:808-823.Brandt KD, et al. Osteoarthritis, 2nd ed. New York, NY: Oxford University Press, 2003.Ezzo J, et al. Acupuncture for osteoarthritis of the knee: A systematic review. Arthritis and Rheumatism. 2001;44(4):819-825.Felson DT, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women: The Framingham Study. Annals of Internal Medicine. 1992;116(7):535-539.Garfinkel MS, et al. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. Journal of Rheumatology. 1994;21(12):2341-2343.Hinman RS, et al. Efficacy of knee tape in the management of osteoarthritis in the knee: Blinded randomised control trial. British Medical Journal. 2003;327(7407):135.Hortobagyi T, et al. Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis and Rheumatism. 2004;51(4):562-569.Johnston LB, et al. Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2004;34(8):440-448.Kuettner KE, et al. American Academy of Orthopedic Surgeons Osteoarthritic Disorders. Rosemont, IL: American Academy of Orthopedic Surgeons, 1995.18