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1st Jul

2011

Manual Therapy and Exercise Therapy Specific to Osteoarthritis

Degenerative arthritis, or osteoarthritis, is a consequence of aging. Some people are affected more than others, due to e.g. genetic predisposition, past traumas, excessive or insufficient physical activity, being overweight, poor diet, smoking, metabolic disorders and other disease, etc. The condition entails a wearing away of the cartilage in our joints, most commonly in weightbearing joints such as hips, knees, neck, back, but also joints such as the thumb and fingers, big toe and ankle, shoulder and jaw.

Joint motions become painful, joints may swell from time to time, and over time movements become limited, and there may be visible thickening of the bones around the joint, and some deformity may develop.

Although we cannot stop the degenerative process of our joints as we age, we know that appropriate conservative treatment and modified exercise often results in reduced pain, improved mobility and increased tolerance to daily activities. Research furthermore tells us that long-term heavy or sustained joint compression, such as with high impact or heavy strengthening exercise, or work under heavy loads, may accelerate the arthritic process whereas regular moderate exercise does not.

With arthritis, the joint capsule around the joint may become tight and fibrotic, limiting mobility. Manually applied joint mobilization can help restore capsular extensibility, and specific forms of active and passive exercises can further help to restore mobility and lessen the joint pain. Consequently, manual therapy is often highly beneficial for people with osteoarthritis.

Cartilage in joints has very low metabolism, and therefore exercises require a large number of repetitions of low loading over a period of time, to have the desired effect of elevating cartilage metabolism and stimulating production, or regeneration, of cartilage cells. Cyclic off and on joint compression also stimulates production of ground substance including proteoglycans, which allows for osmotic transfer of synovial or joint fluid, with necessary nutrients, into the cartilage. Such a lubrication process also increases the joint’s tolerance to compression, whereas joint immobilization rapidly decreases it. Therefore, a sedentary person with arthritic joints tends to have reduced tolerance to activities.

The most effective exercises for osteoarthritis are performed multiple times a day, with many exercise repetitions, with anywhere from no resistance, to with light to moderate intensity, in order not to produce excessive joint compression, and there should be no increase in pain or swelling over the next 24 hours after exercise. For weightbearing joints, emphasis is placed on exercise without, or with partial weightbearing, with slow and gradual increase in weightbearing over time, as tolerated and depending on the extent of arthritis.

For the knee and hip, daily light to moderate cycling is an excellent way to provide beneficial joint lubrication and stimulation. Additional exercise is often recommended, to improve joint stability, allowing better distribution of forces through the joint during ambulation and movements. At times, braces, such as for the thumb, and shoe inserts, can provide additional joint protection during activities.

I want to wish you a great summer and continued good health.

Best wishes,

Gunnar

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