Ask the Expert: Is Stair Climbing Beneficial or Detrimental to Osteoarthritis?
Q: I have been diagnosed with degenerative joint disease. I understand this is the same as osteoarthritis. It is primarily in my hips and knees. I am considering going into an upper flat. Is stair climbing beneficial or detrimental to the OA?
A: Osteoarthritis is a synonym for degenerative joint disease. People in their 50s and '60s will frequently develop bony nodules over the small joints of the fingers (Heberden’s and Bouchard’s nodes) which are usually painless, though unsightly. These nodules are frequent markers of osteoarthritis, promising the possibility of joint involvement in other parts of the body. Although nobody knows what constitutes genetic risk factors for the development of osteoarthritis, a large number of people who have undergone trauma to the large weight-bearing joints (football injuries, falls, motor vehicle accidents, surgery) will lose cartilage over time. Cartilage serves as a protective tissue between adjacent long bones, and when lost through operations or injury, cannot readily be replaced. The consequence for patients who develop pain, stiffness and decreased range of motion in the involved joints is osteoarthritis, a distinctive rheumatologic diagnosis, typically lacking in inflammation (warmth, redness and swelling).
Hip and knee involvement are common in patients with osteoarthritis, particularly in their 4th to 5th decades. Patients frequently complain of pain while walking, climbing and descending stairs, and will avoid any activity which makes stiffness and discomfort worse. Rheumatologists frequently advocate quadriceps strengthening for patients with knee osteoarthritis, arguing that muscle building will decrease stresses across the involved joint. Weight reduction is a vital part of therapy for patients with established osteoarthritis, and many patients feel that medications (including nonsteroidals, glucosamine and dietary supplements) provide benefit.
With these caveats in mind, let us return to your specific question regarding stair climbing. Most physicians would recommend exercising on flat surfaces, including bicycle riding and water aerobics. Stair climbing is of cardiovascular benefit, but may be difficult for someone with established osteoarthritis who has weak quadriceps and hamstrings. For this reason, it might be beneficial to build strength first with resistance exercises, reserving stair climbing for a later date. Of interest, patients who undergo joint replacement (specifically hip and knee replacement surgery) are frequently delighted with their ability to climb stairs, walk for protracted intervals and enjoy aerobic activity without pain. Remember that pain relief is the number one indication for joint replacement surgery, particularly in those cannot tolerate nonsteroidals or opiate analgesic medications.
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Jonathan D. Krant, M.D., directs the teaching service in Rheumatology at Berkshire Medical Center in Pittsfield, Massachussetts. A busy clinician, he oversees the care of 6,000 patients and runs the clinical investigation unit at Berkshire Rheumatology Associates, where he is employed as a staff rheumatologist. He wrote about osteoarthritis for HealthCentral.