Staying active as we age and dealing with arthritis
It is estimated 23% of adults In the usA (over 54 million people) have arthritis, equivalent to 1 in 4 adults.
As we age, general wear and tear takes a toll on our bodies. This, for some, leads to arthritis setting into one or multiple joints. In the US, for example, it is estimated 23% of adults (over 54 million people) have arthritis, equivalent to 1 in 4 adults, which ultimately can have a negative effect on our activity levels. The reduction in activity levels will then affect long-term health.
Common symptoms include pain, swelling and stiffness through the joint, which is due to changes in the synovial fluid and damage to the cartilage protecting the ends of the bones. While there are over 100 different forms of arthritis, osteoarthritis and rheumatoid arthritis are the most common, with the knee one of the most common joints affected.
What is Osteoarthritis?
This article focuses primarily on the knee and osteoarthritis specifically. Osteoarthritis is the most common arthritis which is classified as a degenerative disease causing wear and tear around the joint. Within osteoarthritis, there are different stages or grades, ranging from 0-4, which essentially refers to pain and restricted joint movement. Stage 0 would be considered a healthy knee and stage 4 with significant pain and severely restricted movement.
While there is no cure for arthritis, there are many different treatment options, starting with physical therapy, weight loss, anti-inflammatory drugs before progressing into various steroids and viscosupplements injections and surgery. A medical doctor is the best person to provide advice when it comes to the more complex treatments like injections and surgeries, but I believe incorporating an exercise regime to promote healthy weight loss, address movement patterns and biotensegrity will make a significant impact. These elements will all help provide pain relief and make a positive impact on your long-term physical and mental health.
In previous blog posts, I have talked about the importance of increasing daily activity levels and the missing link. The rest of this article is focused on specific exercises to address basic movement patterns, muscle imbalances and biotensegrity that will not only help alleviate the soreness and stiffness of the knee but address imbalances throughout the body. This will result in increased energy, strength, overcome potential long term health issues and the ability to keep up with your kids or grandkids.
The key to helping alleviate the soreness through the knee joint is to strengthen specific muscle groups, specifically the posterior chain, where we want to be using the big powerful muscles such as the glutes and hamstrings to initiate movement and generate power rather than purely relying on the quadriceps. A physical therapy program focusing on strengthening the muscles directly above the knee may not fully address the issue and may result in adding more pain and stress through the joint.
Specific exercises that focuses on isolating these muscles and/or all working together include:
Glute bridges (variations include single or double leg, adding various bands or external load with barbells and dumbbells)
Monster walks (using various bands and in multiple directions)
Side-Lying clams (progressing from bodyweight to using bands)
Hamstring isometrics and eccentrics
Hamstring curls (machine, band or stability ball based)
Deadlift variations
Squat variations
The balance between and progression from isolated exercise to compound movements will vary depending on the individual but the overall goal should be helping to alleviate some of the soreness and the musculature system to be working together rather than individual components.
The grade or level of the osteoarthritis, training history, specific movement patterns and imbalances will dictate where to start, but the overall focus should start with building the work capacity of the posterior chain before progressing into pure strength per se.
Weight loss, as mentioned, can make a significant impact on reducing pain through the joint due to reducing the stress and load placed on the knee. I believe Kevin Fontaine, PhD, assistant professor of rheumatology at Johns Hopkins University suggested being 10lbs overweight increases the force on your knees by 30 to 40lbs with every step. This is a significant amount and explains why people who suffer from osteoarthritis and are overweight struggle so much and why inactivity is becoming a real issue at the moment.
To address weight loss the best way to approach this is to be in a calorie deficit, meaning consuming less energy than what the body needs resulting in the body using current fat stores as energy. This doesn’t mean dropping down to one meal a day or going on some crazy diet, the goal should be to build sustainable habits, routines and a nutrition plan that works for the individual. This should include increasing daily activity levels in a way that is possible for the individual (could be something like cycling or if possible a weights based training program) while aiming to be in a calories deficit of 300-500 calories per day (result in a weight loss of 1-2lb per week).
Overall, the first steps to address osteoarthritis should be focused on the combination of a carefully planned training program and weight loss before assessing whether more invasive methods are required. This will ultimately have a positive impact on your daily activity levels and significantly improve your long term health.