the washington post
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thursday, november
14
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MD
physically active. In that case,
Allentown, Pa., orthopedist Laura
Dunne frequently advises her os-
teoarthritis patients to begin with
aquatic exercise. “When you get
in water, you take gravity and
pounding out of the equation,”
she says. “At the same time, water
walking or water jogging
strengthens many of the same
muscles that are used on land.”
Dunne also likes stationary bikes,
noting that it’s important to ad-
just the seat height so the knee
doesn’t flex too much while ped-
aling.
There is a lot of research to
support the ability of moderate
exercise to safely combat arthri-
tis, including:
A year ago, the British Jour-
nal of Sports Medicine published
a review of randomized, con-
trolled trials. It found no evi-
dence that exercise harms the
“articular cartilage in partici-
pants at increased risk of, or with,
knee” osteoarthritis.
A 2015 Cochrane Review re-
ported less pain, better physical
functioning and a higher quality
of life among osteoarthritis sub-
jects who exercised vs. those who
didn’t.
And a recently published sys-
tematic review and meta-analysis
concludes that yoga may reduce
knee pain and stiffness while
enhancing physical functioning.
Be cautious, however, because
some yoga postures put too much
pressure on one foot and leg or
bend the knee too far. Don’t do
anything that hurts. The Arthritis
Foundation (www.arthritis.org)
offers a variety of exercise videos
on its website.
For those new to exercise, the
Arthritis Foundation suggests do-
ing a mild warmup to get past the
discomfort and finding an exer-
cise or walking partner to im-
prove your likelihood of getting
out there.
“Getting started is tough for
people with arthritis, no doubt
about it,” O’Koon says. “But once
you become consistent, exercise
is self-reinforcing, because it gets
easier, you lose weight, you gain
strength, you experience less
pain, and you feel better emotion-
ally.”
For decades-long vigorous ath-
letes experiencing arthritis pain,
experts suggest switching rou-
tines over stopping completely —
bicycling instead of running, for
example. They also advise going
BY AMBY BURFOOT
Some days, it seems regular
exercise has become a panacea —
good for the heart, good for blood
pressure, good for glucose levels,
good to limit sad days and depres-
sion. But what about people tor-
mented with the pain and stiff-
ness of osteoarthritis, particular-
ly in the knees and hips? What are
they supposed to do?
There was an era when ethical
medical practice demanded a no-
movement solution for people in
pain. Not anymore. Today, the
more than 50 million adult Amer-
icans with arthritis are advised to
seek the same 150 minutes a week
of moderate exercise as everyone
else.
Arthritis is actually a blanket
term for more than 100 related
conditions that frequently attack
the knees, hips, feet, spine and
hands. Osteoarthritis, the most
common form, is a wear-and-tear
condition that results from aging,
being overweight, injuries and
genetic factors. When a joint’s
articular cartilage — the tissue
that covers the ends of bones —
wears down, bones start rubbing
against bones. This often causes
pain, swelling and stiffness.
If arthritis pain is caused by
bone rubbing against bone, why
move? “A joint like the knee joint
doesn’t have a blood supply, so it
needs movement to swish around
the fluids that deliver nutrients to
the cartilage and other tissues,”
says Marcy O’Koon, senior con-
sumer health director at the Ar-
thritis Foundation and editor of
Arthritis Today magazine.
“Exercise should be part of
treatment for most arthritis, be-
cause inactivity increases joint
damage,” writes sports medicine
doctor Gabe Mirkin in his
DrMirkin.com newsletter. Mirkin
has been studying the relation-
ship between exercise and arthri-
tis for a half-century. Once an
avid runner, he switched to bicy-
cling years ago, and at 84, he rides
a tandem bike with his wife in
addition to doing solo rides. He
advises: “Choose a non-impact
sport like walking, cycling, swim-
ming or cross-country skiing, or
use exercise machines that sup-
port your feet, so they don’t
pound the ground.”
Moderate walking is usually
the go-to exercise for those with
osteoarthritis. Walking is simple,
inexpensive, low-force-produc-
ing, and requires no special
equipment or facilities. It’s also
effective; it builds cardiovascular
fitness and strength, reduces
pain, and improves mood.
But even walking proves too
difficult for some arthritis suffer-
ers, especially those who are over-
weight and/or have not been
shorter distances, less frequently
and with less intensely. Don’t
choose all or nothing; opt for
moderation.
Whether you’re a recent or a
lifelong athlete, there will be
pain. While NSAIDs — over-the-
counter, inflammation-reducing
painkillers such as aspirin, ibu-
profen and naproxen sodium —
can help, they do have occasional-
ly dangerous side effects and
should not be used for more than
10 days without consulting with a
doctor.
Walking poles, knee braces and
cushioned footwear can also take
some stress off the knees. A study
published in 2009 concluded that
walking poles reduce knee forces
by 27 percent. Exercising both the
arms and legs at the same time
also increases calorie burn, an-
other bonus.
Braces are helpful early in a
workout, says Casey Kerrigan, a
Harvard-trained rehabilitation
therapist, because they increase
your knee “proprioception,” or
awareness. This helps you listen
to your body and make appropri-
ate decisions. Kerrigan adds that
you don’t want to wear braces all
the time, or you will limit muscle
growth that can assist knee sta-
bility.
Kerrigan hit the global health
headlines in 1998 when the Lan-
cet published her study showing
that high-heeled women’s shoes
dramatically increase forces
across the knee joint. Eleven
years later, she left a tenured
position at the University of Vir-
ginia to begin manufacturing
Oesh shoes for women in Charlot-
tesville. (Women receive about 60
percent of knee replacements.)
Kerrigan has watched closely
as Nike and other major compa-
nies developed new shoes with
revolutionary thick, cushioned
midsoles. “These might be a good
option for those with knee pain;
the flatter the heel, the better,”
she says. “In all my years of
laboratory research, we found
that shoes with a flat, springy sole
are best at minimizing joint im-
pacts.”
No matter what products you
use or how careful you are, how-
ever, occasional setbacks remain
likely. “Don’t push through pain,”
O’Koon says. “But don’t stop, ei-
ther.”
[email protected]
Amby Burfoot is a freelance writer,
editor and a member of the Running
Hall of Fame. His most recent book is
“Run Forever: Your Complete Guide
to Healthy Lifetime Running.”
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Dealing with arthritis pain? Keep moving, or it might get worse.
KOTRYNA ZUKAUSKAITE FOR THE WASHINGTON POSTHome