1. Osteoarthritis: An overview and introduction to pain management and activity Presented by: Melanie Fuller-Clinical Exercise Specialist Sherwood Park Primary Care Network

2. Objectives What is arthritis? What are the symptoms of arthritis?
Ways to decrease pain and manage symptoms
Things you can do at home to help with daily living tasks
Specific exercise guidelines and resources

3. Over 100 types.

4. Osteoarthritis: What Is It?
Also called "wear and tear" arthritis or degenerative joint disease, osteoarthritis (OA)
Progressive breakdown of the joints' natural shock absorbers. This can cause discomfort when you use the affected joints
Most people over 60 have some degree of OA, but it also affects people in their 20s and 30s
Researchers recognized OA in Egyptian mummies.

5. Osteoarthritis: Where Does It Hurt?
In most cases, osteoarthritis develops in the weight-bearing joints of the knees, hips, or spine. It's also common in the fingers, thumb, neck, and big toe.
Other joints are usually not affected, unless an injury is involved.

6. What does it look like?

7. Osteoarthritis: Symptoms
Pain
Tenderness
Stiffness
Loss of flexibility
Grating sensation
Bone spurs: hard lumps
Swelling
The symptoms of osteoarthritis tend to develop slowly. You may notice pain or soreness when you move certain joints or when you've been inactive for a prolonged period. The affected joints may also be stiff or creaky. Typically, osteoarthritis leads to morning stiffness that resolves in 30 minutes. When osteoarthritis affects the hands, some people develop bony enlargements in the fingers, which may or may not cause pain.

8. Osteoarthritis: What Causes It?
Every joint comes with a natural shock absorber in the form of cartilage.
This cushions the ends of the bones and reduces friction in healthy joints.
As we age, joints become stiffer and cartilage is more vulnerable to wear and tear.
Repetitive use of the joints over the years irritates the cartilage. If it deteriorates enough, bone rubs against bone, causing pain and reducing range of motion.

9. Risk Factors You Can't Control
Older Age
Gender
Female (2.6 times more likely to develop OA)
Bone deformity: bow legged
One of the major risk factors for osteoarthritis is something none of us can control – getting older. Gender also plays a role. Over age 50, more women than men develop osteoarthritis. In most cases, the condition results from normal wear and tear over the years. But some people have a genetic defect or joint abnormality that makes them more vulnerable.

10. Risk Factors You Can Control
Body Weight (11 lb weight loss results in 50% decrease chance of OA in the knee
Activities
Repetitive motions
Previous Injury from certain sports (ACL)
Research shows that “for each 1 pound increase in weight, the overall force across the knee increases 2 to 3 pounds. (Felson et al. 2000).
Maintaining a healthy body weight through a combination of a balanced diet and regular activity is a particularly important part of managing arthritis. Less weight means less pressure on the joints. A long-term study on the effects of weight loss on knee OA in overweight and obese patients suggests that losing a pound results in a four-pound reduction in knee-joint load for each step.20
In some cases, a healthy body weight can help prevent the onset of the disease, as obesity is a risk factor for osteoarthritis (OA).21 Those who are obese are 2.5 to 3 times more likely to develop knee OA and twice more likely to develop hip OA compared to those who are not.22
Because injured joints are more vulnerable to osteoarthritis, doing anything that damages the joints can raise your risk. This includes sports that have a high rate of injury and jobs that require repetitive motion, such as bending the knees to install flooring.
Obesity is another risk factor – it has been linked specifically to osteoarthritis of the knees and hips. This is the strongest modifiable risk factor.

11. Impact on Daily Life Everyone is different Mild pain v.s. severe pain
Osteoarthritis affects each person differently. Some people have few symptoms despite the deterioration of their joints. Others experience pain and stiffness that may interfere with daily activities. If bony knobs develop in the small joints of the fingers, tasks such as buttoning a shirt can become difficult. Osteoarthritis of the knees or hips can lead to a limp. And osteoarthritis of the spine can cause debilitating pain and/or numbness

12. Diagnosing Osteoarthritis
Describe symptoms
X-ray or other imaging
Blood tests (rheumatism)
To help your doctor make an accurate diagnosis, you'll need to describe your symptoms in detail, including the location and frequency of any pain. Your doctor will examine the affected joints and may order X-rays or other imaging studies to see how much damage there is, and to rule out other joint conditions. In many cases, blood tests are used to rule out other forms of arthritis

13. Long-Term Complications
It can lead to deformities that take a toll on mobility.
Severe loss of cartilage in the knee joints can cause the knees to curve out, creating a bow-legged appearance (shown on the left).
Bony spurs along the spine (shown on the right) can irritate nerves, leading to pain, numbness, or tingling in some parts of the body.
Bone spurs are often associated with osteoarthritis. As osteoarthritis breaks down the cartilage in joints, your body attempts to repair the loss creating new build up of bone along the edges of your existing bones. This generally occurs in response to pressure, rubbing, or stress that continues over a long period of time.
Bone spurs (osteophytes) also occur due to other diseases and conditions such as:
Plantar fasciitis: A bone spur, sometimes called a heel spur, can form where the connective tissue (fascia) connects to your heel bone (calcaneus). The spur results from chronic irritation or inflammation of the connective tissue, but it doesn't cause the pain associated with plantar fasciitis.
Spondylosis: In this condition, osteoarthritis and bone spurs cause degeneration of the bones in your neck (cervical spondylosis) or your lower back (lumbar spondylosis).
Diffuse idiopathic skeletal hyperostosis (DISH): This condition causes bony growths to form on the ligaments of your spine.
Spinal stenosis: Bone spurs can contribute to a narrowing of the bones that make up your spine (spinal stenosis), putting pressure on your spinal cord.
Bone spurs can also be a part of the aging process, many older individuals without any diseases may still have bone spurs without being aware as the body creates bone spurs to add to the stability of aging joints. Often you don't even realize you have bone spurs until an X-ray for another condition reveals the growths

14. What causes pain? • inflammation, the process that causes heat and
Arthritis pain can be caused by:
• inflammation, the process that causes heat and
swelling in your joints
damage to the joints
muscle tension, from trying to protect joints from
painful movements.

15. Medication for OA Consult your family physician or pharmacist
Over the counter pain relievers
Sprays, gels, creams
Prescription pills
Natural remedies: hot/cold therapy, massage therapy.
Pain Management is key!
When osteoarthritis flares up, many patients find relief with over-the-counter pain and anti-inflammatory medication, such as aspirin, ibuprofen, or acetaminophen. Pain-relieving creams or sprays can also help when applied directly to the sore area. If pain persists despite the use of pills or creams, your doctor may suggest an injection of steroids or directly into the joint.

16. Treatment: Exercise Therapy
There is no treatment to stop the erosion of cartilage in the joints, but there are ways to improve joint function.
Increase flexibility
Strengthen the muscles around the affected joints
Hot or cold therapies to relieve pain.

17. Supportive Devices
Supportive devices, such as finger splints or knee braces, can reduce stress on the joints and ease pain.
If walking is difficult, canes, crutches, or walkers may be helpful.
People with osteoarthritis of the spine may benefit from switching to a firmer mattress and wearing a back brace or neck collar.
Use supportive device on the opposite side of the pain!
Review technique.

19. Osteoarthritis and Weight
Losing weight is one of the most effective ways to relieve pain.
Can reduce long term damage
If you're overweight, one of the most effective ways to relieve pain in the knee or hip joints is to shed a few pounds. Even modest weight loss has been shown to reduce symptoms of osteoarthritis by easing the strain on weight-bearing joints. Losing weight not only cuts down on pain, but may also reduce long-term joint damage.

20. Preventing Osteoarthritis
The most important thing you can do is keep your weight in check. Extra weight puts stress on the joints and may even alter the normal joint structure.
Preventing injuries is also important.
Take precautions to avoid repetitive motion injuries on the job. If you play a sport, use proper equipment and observe safety guidelines.
WORK SMARTER….NOT HARDER

21. Osteoarthritis and Exercise
Many patients do not exercise because of fear of pain.
Exercise helps:
Strengthen muscles
Support joints
Increase joint lubrication
Improve flexibility
People with osteoarthritis may avoid exercise out of concern that it will cause pain. But low-impact activities such as swimming, walking, or bicycling can improve mobility and increase strength.
Training with light weights can help by strengthening the muscles that surround your joints. For example, strengthening the quadriceps can reduce pain in the knees. Ask your doctor or physical therapist which exercises are best for you.
Stretching is one of three important types of exercises for knee OA. Range of motion or stretching exercises keep you limber. Strengthening exercises build muscle strength to stabilize weak joints. Aerobic exercises, like walking, help lung and heart fitness

22. How do I Achieve these Health Benefits? What do I need to know?
There are 3 major components to physical activity
Flexibility or Range of Motion Exercises
Muscle Strength and Endurance
Overload principle
Aerobic/Cardiovascular Fitness
Range-of-motion exercises These types of exercises relieve stiffness and increase your ability to move your joints through their full range of motion. Range-of-motion exercises involve moving your joints through their normal range of movement, such as raising your arms over your head or rolling your shoulders forward and backward. These exercises can be done daily or at least every other day.
Strengthening exercises These exercises help you build strong muscles that help support and protect your joints. Weight training is an example of a strengthening exercise that can help you maintain your current muscle strength or increase it. Do your strengthening exercises every other day — but take an extra day off if your joints are painful or if you notice any swelling.
Aerobic exercise Aerobic or endurance exercises help with your overall fitness. They can improve your cardiovascular health, help you control your weight and give you more stamina. That way you'll have more energy to get through your day. Examples of aerobic exercises that are easier on your joints include walking, riding a bike and swimming. Try to work your way up to 20 to 30 minutes of aerobic exercise three times a week. You can split up that time into 10-minute blocks if that's easier on your joints.
Other activities Any movement, no matter how small, can help. If a particular workout or activity appeals to you, don't hesitate to ask your doctor whether it's right for you. Your doctor might give you the OK to try gentle forms of yoga and tai chi. Be sure to tell your instructor about your condition and avoid positions or movements that can cause pain.

23. Lets get moving!

24. REST:
Recommended for short periods during acute bouts of pain hours only, but then active and passive ROM should resume.

25. Warm up to work out
Apply heat to the joints you'll be working before you exercise.
Move your joints gently at first to warm up. You might begin with range-of-motion exercises for five to 10 minutes before you move on to strengthening or aerobic exercises.
Exercise with slow and easy movements. If you start noticing pain, take a break. Sharp pain and pain that is stronger than your usual joint pain might indicate something is wrong. Slow down if you notice inflammation or redness in your joints.
Ice your joints after exercising. This can reduce swelling and pain. Use a cold pack on your joints for 10 to 15 minutes.
Heat can relax your joints and muscles and relieve any pain you have before you begin. Heat treatments — warm towels, hot packs or a shower — should be warm, not painfully hot, and should be applied for about 20 minutes.

26. Range of Motion or Flexibility

27. Stretching Continued

28. Seated Hip March
This move can strengthen hips and thigh muscles to help with daily activities, such as walking or rising from a chair. Sit up straight in chair. Slightly kick back your left foot but keep toes on the floor. Lift your right foot off the floor, keeping knee bent. Hold right leg in the air five seconds. Slowly lower your foot to the ground. Repeat 10 times. Rest and do another 10, then switch legs. Too hard? Use your hands to help raise your leg.

29. Is the straight leg raise too tough. Do quad sets instead
Is the straight leg raise too tough? Do quad sets instead. With these you don't raise your leg. Simply tighten the thigh muscles, also called the quadriceps, of one leg at a time. Start by lying on the floor. Keep both legs on ground, relaxed. Flex and hold left leg tense for five seconds, as seen in right-hand photo. Relax. Do two sets of 10. Then, switch to other leg.
Quad Set

30. Hamstring Stretch
Lie down. Loop a bed sheet around your right foot. Use sheet to help pull and stretch leg up. Hold for 20 seconds. Repeat twice, then switch legs.

31. Straight Leg Raise
To try this leg strengthening move, lie on the floor. Prop your back up on your elbows. Bend your left knee, keeping foot on floor. Keep the right leg straight, toes pointed up. Tighten thigh muscles of your right leg. Slowly and smoothly use your thigh muscles -- not your back -- to raise your leg. Pause, as seen above, for five seconds. With thigh still tight, slowly lower leg to ground. Relax. Repeat 10 times. Rest. Do another 10; then switch legs.

32. Pillow Squeeze
This move helps strengthen the inside of your legs to help support your knee. Lie on your back, both knees bent. Place a pillow between knees. Squeeze knees together, squishing pillow between them. Hold for five seconds. Relax. Repeat 10 times. Rest, then do another set of 10. Too hard? You can also do this exercise while seated. See photo to right.

33. Heel Raise
Hold back of chair for support. Stand straight and tall. Lift heels off ground and rise up on toes of both feet. Hold for five seconds. Slowly lower both heels to ground. Repeat 10 times. Rest. Do another 10. Too hard? Do the same exercise, only sitting in a chair.

34. Side Leg Raise
Hold back of chair for balance. Place your weight on left leg. Lift right leg out to the side. Keep right leg straight and outer leg muscles tensed. Don't slouch. Lower right leg and relax. Repeat 10 times. Rest. Do another 10, then repeat with left leg. Too hard? Increase leg height over time. After a few workouts, you'll be able to raise your leg higher.

35. One Leg Balance
Your goal is to do this hands-free. Steady yourself on a chair, if needed. First, shift your body weight to one leg but do not lock your knee straight. Slowly raise the other foot off the ground, balancing on your standing leg. Hold for 20 seconds. Lower raised foot to the ground. Do twice, then switch legs. This move helps when getting out of cars or bending. Too easy? Balance for a longer time. Or try with your eyes closed.

36. Walking
With stiff or sore knees, walking may not seem like a great idea. But it's one of the best exercises for knee arthritis. It can reduce joint pain, strengthen leg muscles, and improve flexibility -- and it's good for your heart. The best part -- no gym membership needed. Good form is key: Look forward, walk tall. Keep arms and legs moving, relaxed. Always ask your doctor before starting exercise when you have osteoarthritis.
Use walking poles
Canes
Crutches
Walker
Whatever allows you to do more

37. Low-Impact Activities
Being active may also help you lose weight, which takes pressure off joints. Other exercises that are easy on the knees: biking, swimming, and water aerobics. Water exercise takes weight off painful joints. Many community and hospital wellness centers, YMCAs, and pools offer classes for people with arthritis. Don't give up favorite activities, like golf. Talk to a professional about modifying painful moves.

38. How Much Exercise?
Start with a little. If you can do it without pain, do more next time. Aim for 30 minutes a day. Over time you'll build your leg muscles to support your knee and increase flexibility. Some muscle soreness is normal, but hurting or swollen joints need rest. Take a break and ask your doctor or health professional for advice.

39. How to Get Started?
Assess your baseline
Work towards small achievable goals

40. Thank-you

41. References
BuckwalterJA. Sports, joint injury and posttraumatic osteoarthritis. Journal of Orthopedic & Sports Physical Therapy. 2003;33(10):
Coggon D, et al. Knee osteoarthritis and obesity. International Journal of Obesity. 2001;25:
FelsonDT (conference chair), et al. Osteoarthritis: New insights. Part 1: The disease and its risk factors. Annals of Internal Medicine. 2000;133(8):
HaqI, et al. Osteoarthritis. Postgraduate Medicine Journal. 2003;79(933):
KusterMS. Exercise recommendations after total joint replacement. Sports Medicine. 2002;32(7):
Messier SP, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The Arthritis, Diet, and Activity Promotion Trial. Arthritis and Rheumatism. 2004;50(5):
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Health. National Institutes of Health. (2002). Handout on Health: Arthritis. Publication number
VadV, et al. Exercise recommendations in athletes with early osteoarthritis of the knee. Sports Medicine.2002;32(11)
VenesD, et al. Taber’s CyclopedicMedical Dictionary. Philadelphia, PA: F.A. Davis Company, 2001.
Walker JM, et al. Physical Rehabilitation in Arthritis, 2nd ed. St. Louis, MO: Saunders, 2004. 17

42. Additional Sources
American Geriatrics Society Panel on Exercise and Osteoarthritis. Exercise prescription for older adults with osteoarthritis pain: Consensus practice recommendations. Journal of the American Geriatrics Society. 2001;49:
Brandt KD, et al. Osteoarthritis, 2nd ed. New York, NY: Oxford University Press, 2003.
Ezzo J, et al. Acupuncture for osteoarthritis of the knee: A systematic review. Arthritis and Rheumatism. 2001;44(4):
Felson DT, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women: The Framingham Study. Annals of Internal Medicine. 1992;116(7):
Garfinkel MS, et al. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. Journal of Rheumatology. 1994;21(12):
Hinman RS, et al. Efficacy of knee tape in the management of osteoarthritis in the knee: Blinded randomised control trial. British Medical Journal. 2003;327(7407):135.
Hortobagyi T, et al. Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis and Rheumatism. 2004;51(4):
Johnston LB, et al. Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2004;34(8):
Kuettner KE, et al. American Academy of Orthopedic Surgeons Osteoarthritic Disorders. Rosemont, IL: American Academy of Orthopedic Surgeons, 1995. 18