An Osteoarthritis Treatment Plan
You are the most important partner in the treatment plan for your arthritis. The plan will have two complementary goals: improving your physical function and managing your pain. The former involves a balance between mobility and rest.
While being fit and flexible will reduce your pain, many individuals with osteoarthritis also need medications to help them feel well enough to remain active. If all goes well, however, you may find yourself in a positive cycle, in which medication helps you exercise and exercise helps you lose weight, so that you have less joint damage, less pain and consequently, less need for medications to relieve your pain.
Being overweight puts extra stress on the joints; therefore, losing as many extra pounds as you can is extremely important. In one study, researchers randomly assigned 21 individuals who were obese and had been diagnosed with knee osteoarthritis to either an exercise program or a combination of exercise and diet. After six months, people in the exercise group lost an average of four pounds while individuals in the exercise and diet group lost an average of 19 pounds. By the end of the study, both groups had a significant reduction in knee pain, but improvements were greater in those who had lost more weight.
The Arthritis, Diet and Activity Promotion Trial (ADAPT), which focused on overweight osteoarthritis patients over age 60, also found that modest weight loss plus moderate exercise provided the greatest improvement in knee pain and mobility. Moreover, in a Johns Hopkins study of older overweight or obese adults with osteoarthritis, a 15-pound weight loss improved the patient’s symptoms better than common pain relievers did. More good news about weight loss: other research shows that people who have osteoarthritis in one knee can reduce the likelihood that it will develop in the other knee if they lose weight.
If you are overweight and haven’t been successful in your weight loss efforts, ask your doctor to refer you to a dietitian for help in improving your eating habits. For information on weight management medications and weight loss surgery.
How much should you lose? Experts typically recommend that people who are overweight (BMI greater than 25) start with a goal of losing 5 percent of their body weight.
When you are experiencing significant joint pain, resting your joints is important. But when your pain improves, exercise is equally essential to maintain joint motion, muscle strength and fitness.
Appropriate exercise will not “wear out” your damaged joints. In fact, research shows that exercise is one of the best treatments for osteoarthritis. Regular exercise also improves mood, increases flexibility and promotes heart health. It can, in addition, improve balance, which is often impaired in people with knee osteoarthritis. Without exercise, you will lose muscle strength and your osteoarthritis may progress faster. Ideally, you should do some type of exercise daily. Studies show that people who exercise daily achieve the greatest improvement in pain and function, compared with those who exercise less often.
But how do you know which exercises are right for you? That’s where a physical therapist comes in. With your doctor’s approval, a physical therapist can develop an exercise program for you, based on your age, physical condition and the severity of your symptoms. At first, you may have to visit the therapist’s office to learn the exercises. But once you know how to do them correctly, you can continue the exercises at home or at a fitness center, with only periodic visits to the physical therapist to monitor your progress. Improvement takes time, and patience is crucial to your success.
For a typical exercise program, the physical therapist is likely to recommend three types of exercises—range of motion, muscle strengthening and aerobic—and a schedule for doing them.
Range-of-motion exercises. These exercises involve gently moving a joint as far as possible in every direction without causing pain. The purpose of range-of-motion exercises is to maintain flexibility, reduce pain and stiffness and improve joint function. Stretching exercises are also recommended as a warm-up before a workout.
Many people benefit from yoga or tai chi (a Chinese exercise that involves gentle stretching movements), finding that their joints retain a normal range of motion and are less stiff. An added benefit of yoga is that it also includes a deep-breathing component that can help your mind and body relax. Your local “Y” or community center may offer tai chi or yoga classes.
• Muscle-strengthening exercises. These exercises increase structural support for the joints, lessening the load placed on them. For example, lifting light hand weights is a good way to strengthen arm muscles. Another muscle-strengthening exercise is to lie on your back, raise one leg, hold it up for several seconds, and then lower it slowly, feeling the pull in the thigh muscles that help to support your knee. Repeat the exercise with your other leg.
In one recent study, an eight-week muscle-strengthening program improved muscle tone and decreased pain significantly in people with osteoarthritis of the knee.
• Isometric exercise—pushing or pulling against a fixed object— also is helpful for individuals with osteoarthritis. Isometric exercises can strengthen your muscles without damaging your joints because the joints remain immobile during the exercise. Muscle-strengthening and range-of-motion exercises are also good for hand arthritis.
• Aerobic exercises. This form of sustained exercise increases the need for oxygen, improving overall body fitness. Keep in mind, however, that high-impact aerobic activities such as jogging are risky for people with osteoarthritis because they may accelerate the breakdown of cartilage in weight-bearing joints. Low- or no-impact aerobic activities, such as swimming, walking and bicycling, however, are excellent ways to improve your fitness. Swimming is a particularly good choice because it puts little stress on your joints, increases joint flexibility, strengthens muscles and boosts self-confidence while providing a good aerobic workout. Other aquatic exercises, though not necessarily aerobic, are also beneficial.
Treatment of arthritis requires both rest and exercise. The trick is getting the right balance between the two.
When it comes to your joints, resting involves more than simply avoiding an activity that causes pain. Some people find that relaxation techniques, stress reduction and biofeedback improve their resting time. Another important aspect of rest is the use of assistive devices designed to reduce strain on your joints. Some examples of assistive devices include canes, crutches, walkers, shoe inserts or special shoes to improve walking, and splints, braces, taping or slings to support affected joints. Other devices that help make daily activities easier to perform are also available.
Although many of these items are obtainable without a prescription, consulting a physical or occupational therapist may keep you from selecting the wrong item or using it improperly and thus aggravating your arthritis.
Heat and ice
Using heat and cold to reduce pain can help you exercise in comfort. Heat can be applied to an affected joint before exercise to aid stretching and reduce minor aches. Cold packs are often used following exercise to reduce swelling and help relieve pain.
Heat relaxes the muscles around stiff joints, which often reduces osteoarthritis pain. You can apply heat in several ways: hot baths and showers or hot towels provide moist heat; for dry heat try heating pads and mitts, heat lamps (diathermy), and microwavable collars and pads that maintain heat for hours. Some people with osteoarthritis dip their hands and feet into warm paraffin wax, which forms a temporary coating of heat. Whichever heat treatment you choose, don’t apply it for more than 15 minutes at a time and be sure to follow all safety directions so you don’t burn your skin.
You may find that you prefer cold for osteoarthritis pain relief. Some people get the best results by alternating between cold and heat. For cold applications, you can use a wet towel soaked in ice water, a plastic bag full of ice cubes, or even a bag of frozen vegetables, which will mold around a joint. Many drugstores sell special fluid-filled pouches that can be frozen or heated for use on painful joints.
Whatever method you use, don’t apply cold for longer than 20 minutes at a time. Also be sure to put a dry towel or cloth on your skin first to prevent frostbite from direct contact with the cold source. If you have poor circulation, check with your doctor before using any cold treatment.
Learn all you can about your condition. Some chapters of the Arthritis Foundation offer a six-week self-management program that teaches people how to reduce and manage their joint pain. Studies show that after completing the program, participants typically report less pain, are more physically active, have an improved quality of life and enjoy significant reductions in health-care expenses. Contact your local Arthritis Foundation chapter for information about courses in your area. You can go to www.arthritis.org to find your local office.