Osteoarthritis is a chronic and progressive disease characterized by loss of the cartilage that covers and protects the ends of the bones where they meet at a joint. The result is pain and stiffness in the joint and often pain in the muscles and ligaments that surround it.
Osteoarthritis is the leading cause of disability in the United States, affecting more than 22 million adults. It most often affects the hips, knees, spine, and hands.
Because most people diagnosed with osteoarthritis are older — about half of those over 65 have it to some degree — it's long been considered a normal part of aging that reflects a lifetime of wear and tear on cartilage. But experts now know that many factors besides age are involved. Osteoarthritis risk can be inherited. An injury or disease may also kick off the deterioration.
Excess weight is also strongly linked to osteoarthritis, because it places added stress on the knees, hips, and spine.
Proper treatment includes exercise
There's no cure for osteoarthritis, but there is a lot you can do to slow its progression, reduce pain, and maintain or improve function. Losing weight can be particularly helpful if you're overweight or obese. You can often relieve pain with over-the-counter analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and aspirin. But if there's one prescription an individual with osteoarthritis should take every day, it's exercise. Regular exercise strengthens muscles and improves flexibility and balance. It not only helps ease pain and stiffness but also improves overall health.
Lack of exercise may contribute directly to osteoarthritis, especially by causing the atrophy of supportive and shock-absorbing muscles, such as those surrounding the knee.
The basic components of the exercise prescription are activities that improve flexibility, muscle strength, and endurance. Exercise should be individually tailored, to prevent injury and aggravation of the osteoarthritis or other medical conditions. That usually means starting with an evaluation by a health professional experienced in the management of osteoarthritis.
Flexibility (range-of-motion) exercises
The first step is flexibility exercise to improve joint mobility, reduce stiffness, and help prevent tightening of the tissues around the joint.
Flexibility exercises gently stretch and lengthen the muscles and move the joints through a range of motion that's comfortable — you should not feel pain — but produces a sensation of resistance. You should perform these exercises when you are feeling the least pain and stiffness. If you take a pain reliever, do your stretching when the drug is having its strongest effect. Hold each for 20-30 seconds.
Inner leg stretch.
Sit with your knees bent and the soles of your feet together. Holding the shins or ankles with your hands, slowly bend your upper body forward and gently press your knees down with your elbows.
Hip and lower back stretch.
Lie flat on your back with legs extended. Keep your neck on the floor but look down toward your chest. Bend both knees and clasp them with your hands, pulling your knees toward your shoulders as far as they will comfortably go. Breathe in deeply and exhale, bringing the knees closer as you breathe out.
Double hip rotation.
Lie on your back with your knees bent and feet flat on the floor. Keeping your shoulders on the floor, gently lower your knees to one side and turn your head to the opposite side. Bring your knees back to the center and repeat on the other side.
Strength (resistance) training
By strengthening muscles, you protect and support affected joints and improve overall function.
Strength training involves contracting the muscles against resistance. The resistance can be from your own body or from hand or ankle weights or resistance bands. Your clinician will recommend specific exercises based on the condition of your joints and your level of pain. You should not do strength training more than two days per week.
Rest a chair against a wall. Sit at the front of the chair, knees bent, feet flat on the floor. Lean back in a half-reclining position with your arms crossed and your hands on your shoulders. Keeping your head, neck, and back straight, bring your upper body forward, and then stand up slowly. Sit back down slowly and return to your original position. Repeat four to six times; build up gradually to eight to 12 repetitions.
Holding onto the back of a chair for balance, bend your trunk forward and slowly raise your right leg straight behind you. Lift it as high as you can without bending your knee or pitching forward. Pause. Slowly lower the leg, returning to the starting position. Do four to six repetitions. Repeat with the left leg.
Lie on your back with your knees bent and your feet flat on the floor. Place your palms flat on the floor next to your hips. Keep your back straight as you lift your buttocks as high as you can off the mat, using your hands for balance only. Lower your buttocks not quite to the floor, then lift again. Repeat four to six times.
Endurance (or aerobic) exercise
Low-impact aerobic exercise improves cardiovascular and overall function, contributes to your sense of well-being, helps control weight, and builds muscles while protecting joints. Good choices include bicycling, walking, swimming, rowing, and the use of an elliptical trainer. Avoid activities that put too much strain on the joints, such as running and sports that involve jumping, quick turns, or sudden stops — tennis and basketball, for example. Try to work your way up to 30 minutes of low-impact aerobic exercise at least four times a week.
October 2007 update