Wednesday, April 16, 2008


I had a friend ask me about the best ways to help her stiff and painful hips. The hips often bear the brunt of daily activities such as walking and running. It is important as you get older, particularly if you have arthritis, to get involved in three major types of exercises including stretching, strengthening, and non-impact aerobic forms of exercise.

Avoiding physical activity because of pain or discomfort also can lead to significant muscle loss and excessive weight gain. Exercise, as part of a comprehensive treatment plan, can improve joint mobility, muscle strength, overall physical conditioning and help to maintain a healthy weight.

A tailored program that includes a balance of three types of exercises - range-of-motion, strengthening and endurance exercises - can relieve the stiffness, soreness and protect joints from further damage. You can also increase muscle flexibility and strength, maintain joint movement, maintain weight to reduce pressure on the joints and help keep bone and cartilage tissue strong and healthy.

Range-of-Motion Exercises

Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving joint mobility and flexibility. In this group of exercises, affected joints are conditioned by gently straightening and bending the joints in a controlled manner as far as they comfortably will go. During the course of a range-of-motion exercise program, the joints are stretched progressively farther (maintaining comfort levels) until normal or near-normal range is achieved and maintained.

In addition to preserving joint function, range-of-motion exercises are an important form of warm-up and stretching, and should be done prior to performing strengthening or endurance exercises or engaging in any other physical activity. A physician or physical therapist can provide you with instructions on how to perform range-of-motion exercises for the fingers, shoulders and back, chin and neck, hips, knees and ankles.

Three excellent ROM of exercises are:

1. Internal Rotation - lie on your back bring your knee to your chest, clasp your hands on the front of your shin and internally rotate the hip while keeping the pelvis as flat as possible.

2. Thread-the-Needle - lie on your back, bend the knee on the good side and place the foot down flat. Take your affected leg, bend the knee and cross your "bad" leg on top of the "good" thigh. Reach down with the arm on the "bad" side through the hole created by the crossed leg on top of the thigh. Reach down with the hand on the good side and clasp both your hands together behind the good thigh. Pull up slowly and gently to stretch the bad hip.

3. Knees to Chest - lying on your back, bend both knees together, and bring them toward your chest. Then slowly move them in an ever-widening circle, keeping your lower spine on the floor. After you do 5 to 10 circles, switch direction. Then slowly come back to your original position.

Strengthening Exercises

Strong muscles help keep weak joints stable and more comfortable and protected against further damage. A program of strength-conditioning exercises that target specific muscle groups can be beneficial as part of your program. There are several types of strengthening exercise that, when performed properly, can maintain or increase supportive muscle tissue without aggravating affected joints.

Isometric exercises are designed to strengthen targeted muscle groups without bending painful joints. Isometrics involve no joint movement, but rather strengthen muscle groups by using an alternating series of isolated muscle flexes and periods of relaxation.

Isotonic Exercises are similar to range-of-motion exercises because they involve joint mobility. However, this group of exercises is more intensive, achieving strength development through increased repetitions or speed of repetitions, or by introducing light-weight resistance with small dumbbells or stretch bands.

Hydrotherapy or aquatherapy (water therapy), is a program of exercises performed in a large pool. Aquatherapy may be easier on painful joints because the water takes some of the weight off of the affected areas while providing resistance training.

A physical therapist or fitness instructor (preferably one with experience working with arthritis patients) can provide you with instruction on how to correctly and effectively perform isometric and isotonic exercises.

Endurance Exercise

The foundation of endurance training is aerobic exercise, which includes any activity that uses large muscle groups, can be maintained continuously for a long period of time and is rhythmic in nature. Aerobic activity conditions the heart, lungs and cardiovascular system to:

When paired with a healthy diet, aerobic activity also is fundamental for weight control (which reduces excess pressure on affected joints) and improving overall general health.

You should perform about 15 minutes of aerobic activity at least three times a week at first, then gradually build up to 30 minutes daily. The activity also should include at least 5 to 10 minutes of warm up plus 5 to 10 minutes of cool down. While peak benefits are achieved when an aerobic activity is performed continuously for at least 30 minutes, aerobic exercise can be spread out in smaller segments of time throughout the day to suit your comfort level, without overexerting yourself.

Aerobic exercise should be performed at a comfortable, steady pace that allows you to talk normally and easily during the activity. Ask your therapist what intensity of exercise is appropriate for your fitness level.

Examples of aerobic activities include walking, swimming, low-impact aerobic dance, skiing and biking, and may even include such daily activities as mowing the lawn, raking leaves or playing golf. Walking is one of the easiest aerobic exercise programs to begin because it requires no special skills or equipment other than a good pair of supportive walking shoes, and it's less stressful on joints than running or jogging.

Biking also may be more beneficial to people with arthritis than other aerobic activities because it places less stress on knee, foot and ankle joints.

New Exercise Program

Regardless of your condition, discuss exercise options with a physician before beginning any new exercise program. Also, begin new exercise programs under the supervision of a physical or occupational therapist, preferably one with experience working with arthritis patients.

People with arthritis who are beginning a new exercise program should spend some time conditioning using a program that consists only of range-of-motion and strengthening exercises, depending on their physical and athletic condition. Endurance exercises should be added gradually, and only after you feel comfortable with your current fitness level.

As with any change in lifestyle, your body will have to take time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, changes in your sleep patterns or different energy levels. These changes are to be expected with increased activity levels. However, improper exercise levels or programs may be harmful.

Consult your physician or therapist and adjust your program.

Good Luck
Funk Roberts
Don't Rush the Beat

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