Osteoarthritis Considerations & Exercises

Practical Considerations

Osteoarthritis (OA) of the knee, or degenerative joint disease, is an arthritic condition in which the protective covering (articular cartilage) which lines the bones on the tibia, femur and/or patella has begun to erode and become soft and frayed. As the cartilage deteriorates, the bones begin to rub together causing pain, swelling and a decreased ability to tolerate various activities.

In treatment of this condition, we have found a few things in particular to be very helpful in reducing the symptoms associated with this problem.

Activity modification:

First and foremost, modification of those activities that increase symptoms is essential. Finding the level of activity that your knee can tolerate with given activities will help in making the time spent performing them more comfortable. For instance, if you find that 1-2 days of doubles tennis a week is tolerable and does not significantly increase pain and swelling, then that is your guideline. If, however, your knee really bothers you every time you try to play singles or more than a couple of days a week, then it is time to listen to your body.

Shoe wear:

The use of shock absorbing insoles and/or cushioned shoes is also very helpful in reducing the pounding onto the joint throughout the daytime. Modification of shoe choice to accommodate insoles and preferably wearing a running-type shoe that has a significant amount of cushion can reduce the ground reaction force onto the joint by up to 20%. The less often you stress the joint repetitively, the less overall damage in the long run.

Unloading wedges:

If the standing posture of your knees is either bowlegged (varus) or knock-knee (valgus), then this also increases the stress onto the joint. We have found the use of unloading wedges in your shoes is also helpful in taking that load off the involved side of the joint and distributing it more evenly onto the knee. This aids not only in pain relief, but also decreased wear onto the joint.

Unloading knee braces:

Custom-made or off-the-shelf knee braces are another way that equipment may be utilized to reduce the forces onto the joint. Again, if you have more arthritic changes on one side of the joint . If your physician feels that you are a candidate for an unloading brace, then one can be fit to your leg and used for activities that typically produce pain or symptoms. Some wear their brace just for activity, while others wear their brace more often throughout the daytime.

Glucosamine and chondroitin sulfate:

Glucosamine sulfate and chondroitin sulfate are substances synthesized by the body and are naturally present in cartilage. It is believed that it somehow stimulates cartilage cells to produce certain compounds that are the building blocks of articular cartilage. We have found that 1500 mg of glucosamine and 1200 mg of chondroitin daily to be the most effective dosage. This can be obtained at most health food stores.

Body weight:

Maintaining a healthful weight helps to reduce the extra stress onto the joint. This is accomplished by regular exercise, good dietary intake, and maintaining a healthful lifestyle.

Pain management:

Pain management techniques such as moist heat packs, warm baths and hot tubs help to relax sore muscles and relieve the tightness and soreness. It is also good to use as a warm-up prior to a good stretching and strengthening program. The use of cold packs for 15 minutes is very effective when the knee feels acutely irritated or inflamed. The use of over-the-counter drugs such as acetaminophen (Tylenol) which is a non-aspirin pain reliever can also prove beneficial. Always consult your physician before taking any anti-inflammatory medication regularly.

Exercise:

Exercise is a critical component in the treatment of osteoarthritis because it helps strengthen the muscles that surround the joint and helps aid in shock absorption. Other benefits of exercise include improved stability throughout the day, increase in joint flexibility which lessens pain, and helping to keep the remaining cartilage healthy by supplying it with the oxygen and nutrients that the joint needs. Stationary bike with light to no resistance beginning slowly is one form of exercise that is non-pounding. Pool exercises such as leg lifts, smooth gentle kicking strokes with a kickboard focusing on the hip, and deep water running with the use of a flotation belt are also very effective in increasing strength without increasing symptoms.

Knee Osteoarthritis - Home Exercise Program

• Always try and precede exercises with some form of warm-up (i.e. pool exercises, stationary cycling).
• Extension stretching: Sitting on the front edge of a chair with your leg out straight, your heel resting on the floor and your opposite leg bent with foot flat. Place both hands on your thigh and push the leg down into extension. Hold 15 seconds and repeat 5 times.
• Quad sets: Leg straight out in front of you (either on ground or seated on the edge of a chair), tighten thigh muscle focusing on inner thigh just above kneecap and hold for 5 sec. Repeat 10 times / 3-5 times a day.
• Clam exercise: Theraband wrapped around both knees, lying on your side with both knees bent, lift top knee away from bottom knee, making sure not to have top hip rotate back. 2 sets of 15 reps.
• Leg raises: Start with sets of 10 repetitions and work up to 2 sets of 25 reps.
  • Lying back on elbows with one knee bent and the opposite leg out straight in front. Tighten thigh muscle of the lower leg and actively lift leg in front to the level of the opposite knee and then lower.
  • Lying on one side with bottom leg bent and the top leg out straight. Tighten thigh muscle of the top leg and lift to the side making sure to keep foot level to the ground.
  • Lying on stomach, tighten thigh muscle and lift leg behind you a few inches off the floor and lower making sure to keep hips on floor.
  • Lying on one side with top leg bent and foot on the floor in front of the bottom leg. Tighten thigh and lift leg towards the inside keeping foot level with ground.
• Seated marching: Sitting up straight on the corner of a bed with hands on hips, lift one knee and lower, then alternate. Make sure not to rock side-to-side and progress to standing or seated on a physioball. 2 sets of 20-30 reps.
• Bridging: Lying on back on floor with both knees bent, feet shoulder distance apart and theraband wrapped around both legs just above your knees. Press feet into floor and lift hips up so your body is straight from knees to shoulders. Tighten gluteal muscles and maintain knee position against the band. 2 sets of 15-20 reps.
• Calf raises: Go up and down on your toes 25 reps.