Arthritis and Physical Therapy
By Clint Choquette, Habits Physical Therapy, Nampa ID
When we think about arthritis, I think most of us think about our joints wearing out over time. And along with that line of thinking, there is a misconception that the more we use a certain body part the faster it will wear out and develop arthritis. I do think there is a mechanical stress component to it, and I think in general if we have a repetitive movement that we perform often and that area never gets appropriate rest to recover then over time you do run a risk of that joint wearing down. Thats where I think having a smart training program can allow appropriate stress to a certain body part but then allow it to recover and rest before we train it again. However, recently I think we are starting to uncover there is much more to it than just wear and tear. Recent research has shown there is a metabolic and inflammatory component to it as well. It seems the healthier we are overall, the less likely we are to develop severe arthritis. I say severe, because everyone will develop arthritis (it’s part of aging) it just seems to happen at different rates.
Speaking of everyone developing arthritis. A study looked at prevalence of facet arthritis (a joint in your spine) and found that 53% of 20-29 years olds, 82% of 30-39 years olds, 93% of 40-49, 97% of 50-59 year olds, and 100% of people over 60 had some form of facet joint arthritis. Those are kind of staggering statistics but I think we need to think of it a different way. Developing some arthritis is part of normal aging. The severity and the disability it causes are what should be more focused on. This is one reason I often do not recommend quick imaging of someone’s low back pain (unless there are red flags present that state imaging is necessary). Once someone with low back pain gets imaging (I can almost guarantee it will find something) getting past the impairments that it uncovered can be a difficult thing even though it may just be normal aging. The other thing with arthritis is there are lots of people walking around with moderate to severe arthritis in different areas and they don’t even know it. For some people arthritis can be painful and debilitating and others don’t seem to be as affected. I think there is a lot still to learn, but I think the main take-away from this paragraph should be, arthritis isn’t a guarantee that you will end up in pain and debilitated especially if it is low to moderate in severity. I do think if there is a correlation with pain in a joint and moderate to severe arthritis present, then that’s when interventions are necessary.
Back to the wear and tear part of arthritis. I often see people with OA who are afraid to exercise for fear that it will cause additional wear and tear. The truth is movement and exercise in the appropriate amount can be beneficial for slowing the progression of arthritis and help prevent stiffness and pain. One way I often speak with people about exercise and OA is to talk about runners and knee OA. One myth that it seems almost everyone has heard is running is bad for your knees. People almost always think, if you run, you will develop knee OA. The truth is there is evidence out there that recreational runners have lower incidence of knee OA than sedentary individuals. There is a small study that looked at runners’ knees before and after marathon training and found some improvement after training. Now with everything I think finding a balance is key. If you start running and build up too fast for what your body is adapted to handle or recover from, the opposite could be true. Go back to my first post about how injuries occur from March 5th to read more about that. I use running as an example because it is easy for people to understand and most people have heard the myth, but it applies to all forms of movement and exercise. Establishing a good program in the long run can be beneficial to help prevent or manage existing OA. Some repetitive movements in life are unavoidable, especially when it relates to your occupation. I do think most employers are trying to prevent repetitive use injuries by having people vary their tasks throughout the day, but that is not always the case. In some instances, if you have the ability to adapt your activities throughout the day, that can be beneficial to not overuse a certain area.
One thing I don’t want to make any false promises on regarding exercise, physical therapy, and arthritis are those with severe arthritis, high pain, and limited mobility. If your arthritis has progressed to the point that the bone structure has changed significantly and that has led to range of motion limitations physical therapy is often not successful in those cases. If your bone structure is what is preventing your knee from flexing farther no amount of stretching is going to change that and exercise may just be downright painful. Those are the cases where I think joint replacement ect.. are other options. I think for physical therapy, we are best suited in the low to moderate symptom and severity or before it develops, to help prevent it by establishing good health and exercise habits. Remember preventing and managing arthritis isn’t just about the movements we perform, but our overall health as well. Focus on your stress, nutrition, sleep and recovery also. If you are dealing with arthritis and want to know if physical therapy would be a good option for you, I would be happy to assess and give my best recommendations.
Contact:
Habits Physical Therapy
8 6th St N ste 102, Nampa, ID 83687
406-560-1048
habitspt@proton.me