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Treat Osteoarthritis with Exercise

Osteoarthritis means that you have pain in a joint and your doctor does not know the cause. Your blood tests for the known causes of joint pain are all normal, so you do not have an immune disease such as rheumatoid arthritis or gout. Your X-rays may show broken cartilage or narrowing of the joint, or they may be completely normal. Three recent studies show that:
• Inactivity worsens osteoarthritis (Arthritis Care & Research, March 2015;67(3):366–373),
• Osteoarthritis can be caused by being overweight (Osteoarthritis and Cartilage, January 2015;23(1):34–40), and
• Exercise is a primary treatment for osteoarthritis (American College of Rheumatology annual meeting, November 17, 2014).

Osteoarthritis is Very Common
Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant pain. Osteoarthritis usually starts around age 40 with gradually increasing pain in the knees, hips, hands or spine. Osteoarthritis more commonly affects the joints at the ends of the fingers and at the base of the thumb, while rheumatoid arthritis usually affects the middle joints of the fingers and the joints where the fingers attach to the hand. In osteoarthritis, joints on one side of the body often hurt more than the other side. In rheumatoid arthritis, the same joints usually are affected equally on both sides of the body. In both, the pain is usually worse in the morning when a person first gets and usually lessens as the person moves around. Treatments include exercise, pain medications, physical therapy, weight control, and eventually, for some, total joint replacement.

Not Exercising Increases Joint Damage from Osteoarthritis
Adults with osteoarthritis of the knee usually walk far more slowly than people without joint pain and spend more than 70 percent of their days sitting. People with knee osteoarthritis who spend a lot of time sitting develop more joint damage and far more disability, even if they exercise (Arthritis Care & Research, March 2015;67(3):366–373). The authors recommend that people with osteoarthritis, "need pre-planned activity to strengthen, tone, and become more flexible. That includes walking, yoga, parking your car farther away from the store, walking to the mailbox, going up and down stairs, doing laundry, etc."

Exercise Treats Osteoarthritis
One year of exercise therapy decreased pain and increased range-of-motion and function of the involved joints (Osteoarthritis and Cartilage 2013;21:525-34), and the improvements in joint function were even greater at two years (presented at the annual meeting of the American College of Rheumatology, November 17, 2014). For this study, the exercise therapy program included:
• muscle strengthening,
• range-of-motion drills,
• neuromuscular coordination exercises, and
• aerobic activities.

Osteoarthritis Risk Factors
Researchers reviewed 46 studies on risk factors for osteoarthritis of the knee and found that being overweight was associated with 28.8 percent of cases, and having a previous knee injury was associated with 5.1 percent of the cases. Vigorous exercise was not associated with knee osteoarthritis in middle-aged women (Osteoarthritis and Cartilage, January 2015;23(1):34–40).

Osteoarthritis can follow trauma such as a football injury or just falling. You are at increased risk for osteoarthritis if you have:
• joint cartilage fractures,
• trauma to your knee that tears ligaments or damages cartilage, or
• one leg longer than the other, which causes excess force on the shorter leg.

Recent data shows that long-term exercise or joint loading does not increase risk for osteoarthritis. Lifetime runners are at decreased risk for osteoarthritis. No good data show that people with regular joint loading, such as farmers or manual laborers, are at increased risk for osteoarthritis. However, if you have hip or knee pain, you are probably better off avoiding impact sports such as running or jumping. Instead, concentrate on sports with low impact such as pedaling a bicycle or swimming.

Joint Replacement
Try to delay replacing a knee or hip joint as long as possible. An artificial joint has no local immunity, so if you get an infection anywhere in your body, you are at increased risk for that infection ending up in the replaced joint. A general rule is to put off replacing a joint until it hurts so much that you cannot sleep at night.

An artificial joint is held in place by a spike that is driven into the middle of a long bone. This markedly weakens that bone. If you fall with a replaced joint, you are at high risk for cracking the bone around the spike of the joint replacement. The broken bone around the spike may never heal so that you lose the ability to exercise that joint forever. If you have a joint replacement, you should restrict running and jumping and exercises that put you at high risk for falling. Choose exercises that use smooth motions such as elliptical machines, cycling or swimming.

Checked 2/14/17

March 15th, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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