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Physiotherapy Society (EPS)

Osteoarthritis Exercises

What is osteoarthritis ?
• Osteoarthritis is a common cause of pain and disability in the aging population. Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone.
• Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage.
• When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.
• Treatment generally involves a combination of exercise, lifestyle modification and analgesics. If pain becomes debilitating joint replacement surgery may be used to improve the quality of life. OA is the most common form of arthritis.

Studies for instance, have shown that strengthening the quadriceps muscles can reduce arthritis knee pain and disability. One study shows that a relatively small increase in strength (20-25 percent) can lead to a 20-30 percent decrease in the chance of developing knee osteoarthritis.

Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis. The typical changes seen on X-ray include:
• joint space narrowing
• subchondral cyst formation
• subchondral sclerosis (increased bony formation around the joint)
• osteophytes
• Plain films may not correlate with the findings on physical examination or with the degree of pain Usually other imaging techniques are not necessary to clinically diagnose osteoarthritis.

Osteoarthritis Treatment
Lifestyle modification (such as weight loss and exercise), physical therapy and analgesics are the mainstay of treatment. Acetaminophen / paracetamol is used first line and NSAIDS are only recommended as add on therapy if pain relief is not sufficient.

Goal of Osteoarthritis Exercises
Main aim of Osteoarthritis Exercises are to reduce pain, improve function, and prevent disability, all with the ultimate goal of improving quality of life. There are many ways that these goals can be achieved through exercise programs, as discussed below.
• Muscle Strengthening
• Improving Flexibility and Joint Motion
• Improve Aerobic Functioning
• Weight Loss

Osteoarthritis Exercises
There are mainly three kinds:
• Range-of-motion: To maintain normal joint movement and relieve stiffness. These make the joints flexible.
• Strengthening exercises: To increase the strength of muscles that support the joints affected by arthritis.
• Aerobic or endurance exercises: They improve cardiovascular fitness, control weight and improve overall body function.

Osteoarthritis Exercises Plan
• Discuss the osteoarthritis exercises plan with your health care provider.
• Start under supervision of a physical therapist or a qualified athletic trainer.
• Apply heat to sore joints before you begin exercising.
• Begin exercising with stretching, flexibility and range of motion exercises.
• start strengthening exercises slowly with small light weights or resistance band.
• Increase the difficulty of your exercise routine slowly.
• apply cold packs to sore joints and muscles after osteoarthritis exercises.
• ease off exercise programme and talk to your health care provider if your joints get painful, inflammed or red.

How Often Should You Exercise?
• Range-of-motion: Either daily or every alternate day.
• Strengthening exercises: Every alternate day.
• Endurance exercises: For 20 to 30 minutes three times a week.

Some examples of exercises specifically for the legs good for those with osteoarthritis of the knee and or hips.
• Quad sets: while in a seated position, with legs fully extended in front of you, make a muscle with your thighs trying to push the back of your knee down towards the floor. Hold for 10 seconds, relax and then repeat.
• Wall slide: place your back up against the wall with your hips and knees bent to a 90 degree angle as if you were sitting in a chair. Hold this position for 10 seconds, then come up and relax. Repeat.
• Isotonic Quad exercise: sitting in a chair with your feet planted flat on the floor, raise your right leg straight out in front of you. Relax and bring back to the floor. Repeat on the left. As you are able to you can add ankle weights to increase resistance.
• Isometric Hamstrings while lying on the floor place heels on surface such as a couch or an exercise ball. Press down using the backs of your thighs and hold contraction for 10 seconds. Relax and then repeat.
• Isotonic Hamstrings lying on your belly with a pillow under your abdomen to support your back, bend your knee and bring your foot back towards your buttock. Bring back down to the floor repeat on the other side.
• Isometric Glutes Lying down on a flat surface back flat on the floor, bend your knees so that your feet are flat on the floor. Raise your buttocks up off the ground contracting your butt muscles together. Hold for 10 seconds then relax.
• Calf muscles Strenthening Using a wall or chair for balance, go up on your toes using your calf muscles hold yourself. Contract for 10 seconds, relax and repeat.

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