Strategies to live better and preserve function with knee arthritis Thursday, 06 November :06

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1 WHILE it seems counterintuitive that exercise would be good for an already sore joint, Cleveland Clinic experts say that even with knee arthritis, you can (and should) stay active and, by doing so, you ll bolster your joint s mobility and strength and potentially ease your pain, says the September 2014 issue of the Cleveland Clinic Men s Health Advisor. It makes sense if exercise is probably the last thing you want to do if you have knee arthritis - your knees ache even as you totter across the room, so you can t imagine walking any significant distance or doing strengthening exercises, the health letter adds. However, a study published online June 12 in Arthritis Care and Research suggests that if you can walk about two to three miles a day despite knee arthritis, you ll reduce your chances of experiencing declines in day-to-day functioning. The study involved researchers who examined the walking habits of 1,788 obese individuals (average age 67) with or at high risk of osteoarthritis (OA): The participants wore activity monitors for seven consecutive days and, two years later, underwent objective and self-reported assessments of their functionality. The results showed that few of the participants who walked more than 3,000 steps a day developed functional limitations two years later, and that walking 6,000 steps a day appeared to be the threshold that separated individuals who developed functional limitations from those who 1 / 5

2 did not. The study authors noted that a goal of more than 6,000 steps a day is more attainable for individuals with knee OA compared to the 10,000 steps a day recommended for the general population. Rather than promoting potentially difficult-to-achieve walking activity goals that could further discourage individuals with knee OA, our study results suggest that lower targets may still provide therapeutic benefits, the researchers wrote. Katie Lawton, a Cleveland Clinic exercise physiologist and athletic trainer, says, A lot of times, there s a misunderstanding that if you have arthritis it is safer to remain inactive. But according to most research, implementing an exercise routine may produce an increase in function and a decrease in pain in most arthritis patients. According to Mark Kalinowski, a Cleveland Clinic physical therapist, walking takes the knee through its natural range of motion, and provides the knee cartilage with necessary stimulation. A knee has to move through a full range of motion...studies show that in people who are immobile, all that stress is put on one focal point, so it tends to break down the cartilage more than spreading it over a greater area - if you increase motion in the joint, that stress can be spread out over a greater area of the cartilage, he says. Kalinowski recommends starting out at about 3,000 steps a day and gradually increasing your step count by 10 to 15 percent every two to three days as your knee allows. If you re new to exercise, Lawton says to start slowly and use a pedometer to track your progress. As you become more at ease that your activity isn t going to hurt your knees, then increase the 2 / 5

3 time and intensity of your exercise or activity, she says. In addition to walking and other aerobic exercise, experts recommend doing strength-training exercises every other day, to strengthen the muscles supporting your knees. Also, you need to preserve your knee s mobility - so do flexibility and range-of-motion exercises for about 15 minutes daily. However, be aware that you may have to modify your exercise to accommodate the limitations posed by your knee arthritis - for instance, a popular exercise to boost leg and hip strength and flexibility is the squat, in which you bend your knees and lower your buttocks until they re even with your knees. But if you have knee arthritis, try a partial squat (with upper body support using your sink, a chair or table) in which you limit the depth of the bend. Furthermore, try pool exercises, such as water walking, to preserve joint flexibility and build muscle without taxing your knees - the buoyancy of the water eliminates stress from your knees, but it provides 12 times the resistance of air, giving your leg muscles a greater workout. Again, keep in mind there are some modifications arthritis patients need to consider, depending on the severity of the arthritis, according to Lawton. These simple exercises are suggested to help your knees: Sink squat - a) Hold the edge of a sink with your feet about 20 inches from the edge; b) Slowly bend your knees, keeping your heels on the ground, and lower your hips so that your upper legs form a 45-degree angle with the floor; c) Hold five seconds, and return to the standing position. Do two sets of repetitions, two to three times a week. 3 / 5

4 Hamstring stretch (with strap) - a) Lie flat on your back, and loop a strap (or a belt or towel) around your right foot so that you re holding both ends of the strap; b) Pull on the strap and use it to lift your right leg into the air, keeping your knee straight and your opposite leg flat on the floor, until you feel a stretch behind your thigh; and c) Hold for seconds. Do six repetitions with each leg daily. Step-ups - a) Step forward onto a bottom stair, leading with your arthritic leg; b) Step back down to the starting position. Do two sets of repetitions, two to three times a week. Consider using smaller steps (4 to 6 inches in height) at first, and then, graduating to higher steps. Or, use an adjustable stepper to gradually increase the height of your steps. These practical self-help tips are offered: Work with your physician and/or an exercise professional to tailor an exercise program best suited for your arthritic knees. Know your limits - Stop or alter your exercise if you feel knee pain. Choose a good pair of comfortable walking or running shoes that can minimize stress on your knees, hips and ankles. Use a pedometer, and keep a log of your daily walking. Document the following: 1) How long you walked; 2) How far you walked (step count); 3) The type of surface on which you walked; 4) Knee pain or swelling after you walked; and 5) Your need for ice/pain medication afterward. Symptoms are going to be the main indicator that tells you you re doing too much, Lawton says. 4 / 5

5 Even on days when you begin the day sore, just doing the same activity, but not as long or less intense, will also be beneficial because you still want to get your joints moving. Joints are made to move, Kalinowski adds. Stay active, but within reason. If you have arthritis, you can still do some modified exercises to maintain some health for your knee, he concludes. 5 / 5