Exercise Tip  
  Ocotober 2009
Osteoarthritis- Excerpts from Center of Science in the Public Interest  

Aching Joints/Arthritis Pain
From Center of Science in the Public Interest- Nutrition Action Healthletter, Oct 2009

“Our waistlines are expanding and we’re getting older, and those two factors are leading to a huge osteoarthritis epidemic here, “says rheumatologist David Hunter, an associate professor of medicine at Tufts University School of Medicine, and chief of research at New England Baptist Hospital in Boston.

“We’re seeing people who used to get osteoarthritis at 60-70 years old who are now getting it at age 40 and 50, “adds Stephen Messier, director of the J.B.Snow Biomechanics Lab at Wake Forest.  “If the obesity crisis continues, we’re gong to see young adults develop the disease prematurely.”

Osteoarthritis occurs when the cartilage that cushions joints breaks down. Without that protection, bone rubs against bone, which causes pain and stiffness.  If happens most frequently in the knees, but can also affect the hips, fingers, neck and toes.  “It used to be characterized as a ‘wear & tear’ disease but we know that for the weight-bearing joints like the knees and hips, it’s tear, not wear.” says rheumatologist James Fried, from Stanford.  “In our Runners Study, we tracked 450 people who have run 2000-5000 miles a year on pavement for 30-40 years.  And they do not have any greater risk of developing arthritis than non-runners.

WHO’S AT RISK?
1. Weight- “Being overweight of obese is far and away the biggest risk factor for developing osteoarthritis” says Hunter, “If people could control their body weight adequately, we could reduce the prevalence of osteoarthritis by 40 or 50%.”  “The increased stress on the knee from additional weight causes the cartilage to have to withstand forces that is wasn’t meant to withstand,” says Messier. And the increased inflammation that accompanies being overweight degrades cartilage.

2. Injury- That’s the “tear” in wear and tear.  “it probably accounts for 20-30% of cases, :says Hunter.  And you don’t have to be an athlete to suffer an injury.  “younger people- older weekend athletes – who tear a cruciate ligament or a meniscus in their knee skiing or playing basketball are very likely to develop osteoarthritis as a consequence, even if the injury is surgically repaired.”

3. Genetics, occupation, and alignment-  It tends to run in families and in people with occupations that stress the knees.  “if you are bow-legged or knock-kneed, you are more likely to get osteoarthritis, and if you combine this kind of misalignment with being overweight or obese, you increase your risk”.  says Messier.

4. Being female- Women are at greater risk.  “The strength and stability of the ligaments and muscles around the knee are not as solid and stable in women.” says Hunter.  Hormone fluxuations affect this too. 

IF YOU HAVE OSTEOARTHRITIS
1. Lose weight if you are overweight- its incredibly important.  “Even a 5% decrease in weight will improve your walking, reduce your pain, and raise your quality of life, “says Messier.  

2. Increase physical activity.  “30-40 years ago, rheumatologist would tell patients to just take it easy, sit down, don’t do anything.  Sitting down and doing nothing is no longer an option.  The more you walk, the better you walk.  Walking won’t hurt your arthritis.  It may not take away all the pain and you might actually feel more pain for the first few days.  But if you stick with it, you’ll experience less stiffness and discomfort. “, says Messier.  “Exercise is a matter of life or death for cartilage cells.  Cartilage is a tissue with living cells but no blood supply, so it has a problem of getting oxygen into its cells and waste products out. “says Fries.  The solution: MOVE the joint.  “Cartilage is mildly squish able, when the joint moves and the cartilage gets squished, it squirts out waste products.  When the pressure comes off, it takes in oxygen.  Without exercise, the cells die.” Exercise also affects synovial fluid that lubricates joints.  “When you’re moving around, the synovial fluid gets thinner and becomes more of a hydraulic shock absorber, but when you’re not active, it gets thick and viscous and doesn’t protect your joints as well.” Says messier

3. Strengthen muscles- “if you increase the strength of the muscles around the joints, you can decrease the pain in those joints, the knees in particular.  Start with the quadriceps, the muscles in the front of the thighs that support the knees.    When you’re sitting in your chair watching TV, take your right leg, slowing lift it out straight in front of you at a 90-degree angle to your body.  Then slowly raise your leg up a little higher for a few seconds.  You’ll feel that burn in the quads.  Return your leg to the straight-out-in-front-of-you position.  Do 10 of those per leg every day for the first week.  The next week do 10 with each leg in the morning and 10 at night.  The next week do 10 with each leg three times a day.”  Says another rheumatologist Emily Farrar from Medical University in SC.

4. Lower the load- “Running, basketball or tennis is likely to exacerbate symptoms and accelerate the progression of osteoarthritis.  In contrast, exercise like cycling, swimming and using a rowing or elliptical machine strengthen muscles- including the heart with little or no stress on the joints.   Wear shoes that provide good support, use orthotic inserts to make sure the feet are positioned correctly, or use a knee brace.” says Hunter.

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