Tag Archives: OA

Posted on

Osteoarthritis vs. Rheumatoid Arthritis

What’s the Difference?

By Dr. Matthew Crooks

Arthritis is a condition involving tenderness and swelling in your joints, and it’s often coupled with inflammation as well. With over 100 different types of arthritis, the two most common forms are Osteoarthritis (OA) and Rheumatoid Arthritis (RA). Both of these involve inflammation in the joints; however, learn how these conditions differ.

Breaking Down the Differences

The main differentiator between Osteoarthritis and Rheumatoid Arthritis is that RA is an autoimmune disorder while OA is a degenerative disease. Another major difference between the two is that RA is a type of polyarticular arthritis meaning that it affects multiple joints as well as different sides of the body. Osteoarthritis affects only a few joints and just one side of the body.

Autoimmune

An autoimmune disease is one that causes your body to think there is an issue in a particular area. As a result, it attacks and damages healthy tissue. In the case of RA, it causes your body to attack the tissue surrounding the affected joints. Your immune system will produce antibodies that will attach themselves to the joints. Your body will then attack these joints which then cause inflammation, swelling, and pain in the area.

Degenerative

Being a degenerative disease, OA is one that affects you as you begin to age as well as prolonged wear and tear on your joints. Over time, the protective cartilage that pads and protects the ends of your bones begins to wear down. As this cartilage begins to wear down, the bones within the joint will start to rub together, resulting in pain and stiffness.

Osteoarthritis Symptoms:

Pain and stiffness within the joints are the most common symptoms of Osteoarthritis. These two symptoms typically appear in the morning or after a period of rest.

Some other symptoms that you will notice with OA: 

  • A limited range of motion or stiffness that tends to go away after activity.
  • Clicking or cracking sounds when bending a joint.
  • Mild swelling in the joint area.
  • Tenderness to touch.
  • Pain in the joint that gets worse with activity and at the end of the day.

The most common areas that are affected are hands, fingers, knees, hips, and spine. Over time these symptoms will increase and build up rather than show up suddenly and out of nowhere. However, if the stressors that are causing the wearing and breaking down of the joint cartilage are continued, you may notice a sudden increase in the symptoms.

Rheumatoid Arthritis Symptoms:

Like Osteoarthritis and other forms of arthritis, pain and stiffness will be associated with Rheumatoid Arthritis. Besides this, RA will bring with it: swelling; tenderness; and more than one joint that is affected or the same joint on either side of the body is affected. Fatigue and loss of appetite can also be symptoms of RA.

Other areas of the body can also be affected when dealing with RA besides your joints. The prolonged inflammation that comes with the disease can cause the following:

  • Dryness, pain, and redness in your eyes.
  • Dry mouth.
  • Gum irritation.
  • Small lumps under your skin called rheumatoid nodules.
  • Shortness of breath.
  • Anemia.

Osteoarthritis Prognosis

The prognosis for those with Osteoarthritis will vary from person to person and case to case. There are some cases where patients will not be adversely affected much at all by OA while others are severely affected. The fact that it’s a degenerative disease carries the assumption that the condition will continue to get worse over time.

While this is the case with some patients, other times the disease tends to stabilize at a certain point. While some patients will eventually need to undergo some sort of joint replacement surgery, it’s rare for the condition to progress enough for this to be the recommended course of action.

Osteoarthritis is not a condition that can be reversed. However, it is a condition that can be treated. When experiencing symptoms of OA, limiting the activity in those joints and the amount of stress you put on them will help. The most effective strategies you can take are to maintain a healthy weight and exercise regularly.

Rheumatoid Arthritis Prognosis

In the past, Rheumatoid Arthritis carried a more negative prognosis than it does today. Typically, patients can now live a productive and healthy life while continuing to go to work, school and partake in social and physical activities.

Like most conditions though, the prognosis will vary from case to case. In some patients, the symptoms will go through periods of dormancy while others will experience chronic symptoms. In some severe cases, life expectancy can decrease but this is not as common.

Common prognoses associated with RA include: persistent joint inflammation; a decline in mobility/range of motion in the affected area; and pain and stiffness that does not improve with treatment.

Like OA, it can affect other areas of the body as well, outside of the joints. Some patients will experience psoriasis; heart disease; eye inflammation; osteoporosis; anemia; respiratory complications; and depression. Patients with RA will need constant medical care and should be in contact with their primary care physician as well as a rheumatologist regularly.

Treatment

While both of these conditions are chronic and neither can be cured, both are treatable. Treatment can make living with the disease more comfortable (and in some cases, normal).

Reducing inflammation is an important part of treatment. A doctor may suggest anti-inflammatory drugs which will also alleviate the pain and stiffness in the joint. Other forms of treatment are physical therapy or injections depending on your specific area of pain.

Increasing the mobility and range of motion in the affected area will help slow down the progression of the disease. It’s important to be in contact with your doctor if you are experiencing any of these symptoms. There are always options to improve your quality of life.

For more information on RA and OA, please refer to Q and A: Exercises Beneficial to Managing Rheumatoid Arthritis and 4 Key Strategies for Preventing and Treating Osteoarthritis.

About Dr. Matthew Crooks

Dr. Matthew Crooks is a double board certified, fellowship trained interventional pain specialist. He has had the distinction of training with leading experts in pain medicine at two of the nation’s top hospitals, with extensive training in acute and chronic pain management, completing residency in Anesthesiology at Johns Hopkins Hospital. While at Johns Hopkins, he had the honor of being selected Chief Resident of the Department of Anesthesiology and Critical Care Medicine for the 2008-2009 year.

 

Posted on

4 Key Strategies for Preventing and Treating Osteoarthritis (OA)

Osteoarthritis (OA) is the most common form of arthritis that affects an estimated 12.1% of the U.S. population (nearly 21 million Americans age 25 and older).  OA is one of 171 different types of arthritis.  The chance of developing osteoarthritis increases with age.  Most people over age 60 experience OA to some degree.

Arthritis is a commonly used term that can have multiple meanings depending on the person.  In general, arthritis means inflammation of the joints.  OA is commonly associated with wear and tear on the joint surfaces from injury or overuse.  It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body.  OA seems to have a genetic or heredity component.

OA is most commonly found in joints that were previously damaged through injury or wear and tear (particularly, the load bearing joints of the body which include the spine, hips, knees, ankles, and toes).  Finger joints are also commonly affected by OA.

Preventing an injury is always best in order to avoid OA.  Unfortunately, accidents occur.  The following actionable key strategies will help you to prevent and treat OA.

4 Key Strategies for Preventing and Treating Osteoarthritis (OA):

Range of Motion (ROM)

A mobile joint is a healthy joint.  A joint must go through its full ROM on a daily basis to remain healthy.  Most joints do not contain a direct blood supply delivering important nutrients.  Without full ROM, synovial fluid (a nutrient rich and internally lubricating fluid) cannot properly circulate and coat the joint surface.  Over time, this can lead to stiffness and dysfunction along with joint deterioration (such as arthritis).

Appropriate stretching and ROM can be used as a treatment and preventative measure.  Although there are many different stretching methods, not all of them are created equal and are not appropriate in every circumstance.  Research indicates that stretching improperly or at the wrong time can inhibit performance and can lead to worsening pain symptoms in the case of OA.

Five different methods of stretching or improving ROM include:

  • Static Stretching
  • Dynamic Stretching
  • Myofascial Release with Foam Rolling
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Neuromobilization or Neural Gliding

Please refer to 5 Ways to Improve Range-Of-Motion (ROM) for detailed descriptions for each method.

Stretching is critical to maintaining flexibility.  Flexibility is a critical component to healthy and optimally functioning body and joint surfaces.  While often being overlooked, flexibility and stretching are critical to optimizing health, preventing injury, and maximizing performance.

Stretching should never be done to the point of causing pain.  It is possible to cause injury by over aggressively stretching.  The best results are usually through consistency and a mild to moderate stretching sensation.  Yoga, Pilates, and Tai Chi can also be great forms of exercise to maintain ROM.

Strength

Appropriate strength is the key to insuring proper joint function and stability.  An appropriate strengthening program should be a staple to a healthy aging lifestyle and for osteoarthritis prevention and treatment.  Appropriate amounts of strength insure the body’s joints have appropriate stability for activities of daily living and any desired recreational activities without pain or further wear and tear.

If you have OA, seek a professional (such as a physical therapist) who is familiar with managing OA in order to establish an exercise program that includes strength training.

Excessive shearing forces, rotational forces, and exercises should be avoided.  Joints with severe involvement should be exercised with caution and an emphasis should be placed on ROM and stability versus actual loading of the joint.  All exercises should be performed in a slow and controlled environment within the available ROM.  Maintaining muscle mass through strength training is critical.  Strength training should be performed only one to two times per week to minimize any risk of over stressing the joint.

Healthy Diet

Osteoarthritis as well as many other forms of arthritis can have an inflammatory component.  Other types of arthritis, such as Rheumatoid Arthritis (RA), have an autoimmune component.  Appropriate nutritional management is critical for treatment as well as general prevention.  Consume foods that promote a low inflammatory diet.  This includes a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation.

Healthy Weight

OA is often associated with wear and tear of the joint surfaces (including overuse syndrome).  The most susceptible joints affected are load bearing joints such as the knee and spine.  Weight management is a critical component.

For example:  Every pound of excess weight exerts about 4 pounds of extra pressure on the knees.  A person who is 10 pounds overweight has 40 pounds of extra pressure on his/her knees.  If a person is 100 pounds overweight, that is the equivalent of 400 pounds of extra pressure on his/her knees.

It is important to manage your weight effectively.  Excessive body weight can cause additional wear and tear, particularly on the lower extremities joints, and can worsen any damage caused by OA.

While osteoarthritis (OA) is a common aliment for most of us as we age, it doesn’t have to be symptomatic.  The research on OA is very clear.  If you have OA, it doesn’t mean that you will have pain or develop any form of debility associated with OA.  In order to increase the likelihood that OA doesn’t affect your ability to age well, it’s best to stay as active as possible.  Implement these 4 key strategies in order to prevent and treat OA.

What are your experiences dealing with osteoarthritis?  What has worked or not worked for you?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post please e-mail contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

How to Maintain Healthy Joint Motion

Healthy aging could be defined as having the physical, mental, social, emotional, and spiritual capacity to live life on your terms. Maintaining adequate health is a combination of physical strength, cardiovascular endurance, joint motion, and balance in order to perform activities of daily living (ADLs).  This includes any or all desired tasks, such as picking up your grandchildren, to playing golf or running.

The ability to move a joint through its full range of motion (ROM) is critical in maintaining the ability to perform many important functional tasks. Imagine trying to lift a box overhead with a shoulder that only has half its motion.  That makes for a very difficult task.  There are many reasons for loss of joint motion:  muscle or tendon tears; generalized muscle weakness; paralysis; and severe arthritis.

Typically, osteoarthritis (OA) will occur in a joint that has previously been injured or one that doesn’t adequately move. Movement allows the proper nutrients to be circulated through the blood and synovial fluid that coats and lubricates the joint.  There are also genetic factors that may predispose a person to developing OA, which is one of 171 different types of arthritis.

How can you best maintain joint mobility throughout the aging process? What is the minimum effective dose to help insure joint mobility as you age well? The key to maintaining mobility is to take each joint of the body through its full range of motion (ROM) at least once per day.

ShoulderPulleyExercise

A crucial component to joint health and mobility is to insure that the joint surfaces remain coated with the body’s natural lubricant known as synovial fluid. Synovial fluid is best circulated in joints through mobility.  To insure that the entire joint surface is coated, a full arc of motion needs to be performed.

By performing a full arc of motion for each joint, you also insure that the associated ligaments, tendons, and musculature can accommodate for this motion and won’t shorten over time due to lack of use. Moving each joint through a full ROM daily is the key to maintaining motion.  In order to insure optimized healthy aging, it’s best to move that joint frequently.

The latest research indicates that sitting for more than two hours at a time can significantly lessen your life span. The real headline should read, “Even if you are a regular exerciser, sitting for more than two hours a day will still lower your life span.”

Frequent movement throughout the entire day is critical for health.  This includes frequent mobility as it is important for joint health as well as critical for cardiovascular health. Ideally, you should choose movements and exercises that are functional and address multiple joints at the same time.

How to Maintain Healthy Joint Motion:

  • The Squat. The squat activates nearly all of the muscles in the lower leg. It also takes the hips and knees into end range flexion as well as the ankles into near end range dorsiflexion. The squat is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates muscles in the hips, the calves, the stabilizing muscles in the ankles, the quadriceps, and as well as the core (the abdominals and lumbar extensor muscles). These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. For more information on squatting, please refer to 7 Reasons Why the Squat is Fundamental to Life.
  • Tai Chi and Yoga. Tai Chi, yoga, and Qigong all implement slow simple movements into a full body exercise that can help you to maintain your mobility, balance, strength, and general health as you age.
  • Stretching and Self-Mobilization. There are generally 5 Ways to Improve Range of Motion when utilizing different stretching methods or self-mobilization. Using a foam roller is an excellent method to decrease pain and improve mobility throughout the hip and pelvis. For more information on how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Shoulder Pulley. A simple, yet popular, method to maintain shoulder motion is through a shoulder pulley. Shoulder pulleys are an excellent way to use active assistive motion to regain motion in the shoulder post injury or surgery. I also instruct many of my clients to utilize shoulder pulleys for pain management as well as a prevention strategy for arthritis and loss of shoulder motion and function.

Maintaining adequate joint mobility and range of motion is an important component in healthy aging and can be a critical strategy in order to avoid many orthopaedic or arthritic conditions. Be proactive now, so you can save yourself from experiencing pain and debility in the future. It’s never too early or too late to implement strategies to help you age well!

Which strategy do you use to maintain your joint range of motion and mobility? It could be as simple as using the foam roller or a shoulder pulley.  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide. Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

How to Properly Perform Pendulum Exercises

In this video, I demonstrate the proper technique for performing shoulder pendulum exercises. Shoulder pendulum exercises are frequently utilized early in the rehabilitation process to help maintain a basic amount of shoulder motion as well as to promote blood flow to aid in the healing process.  When performed correctly, these important exercises provide very little stress to the recovering structures.  Pendulum exercises help to maintain a baseline amount of motion which is critical in promoting blood flow for proper tissue healing, for pain management, and in order to avoid frozen shoulder syndrome (adhesive capsulitis).  Shoulder pendulum exercises are typically one of the first exercises allowed post-surgery or shoulder injury in conjunction with elbow, hand, and wrist exercises (depending on the injury).

In this video, I explain the basics of how to properly perform pendulum exercises. Although these exercises are basic, they are typically performed incorrectly by utilizing active motion instead of a passive motion.  Pendulum exercises are commonly utilized after rotator cuff repair, sub acromial decompression surgery, collarbone fracture and/or surgery, total shoulder replacement/total shoulder arthroplasty, and frozen shoulder (adhesive capsulitis).

Have you performed shoulder pendulum exercises before? If so, did you make these common mistakes?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

How to Use Shoulder Pulleys to Regain Shoulder Motion

In this video, I demonstrate how to utilize over-the-door shoulder pulleys.  Shoulder pulleys are an excellent way to use active assistive motion to regain motion in the shoulder post injury or surgery.  In this video, I explain the basics of how the shoulder pulley works.  They are frequently utilized early in the rehabilitation process to not only help regain motion, but to also promote blood flow which aids in the healing process.

Shoulder pulleys are commonly utilized after rotator cuff repair, sub acromial decompression surgery, collarbone fracture and/or surgery, total shoulder replacement/total shoulder arthroplasty, and frozen shoulder (adhesive capsulitis).  I also instruct many of my clients to utilize shoulder pulleys for pain management as well as a prevention strategy for arthritis and loss of shoulder motion and function.

Have you used shoulder pulleys before? If so, what was your favorite way to utilize them?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Q & A: Rehabilitation for a Total Knee Replacement

Q.  I’m going in for a total knee replacement. I wondered what type of advice you could give me so that I’m better prepared.  Thanks!  -Judy

A.  Great question, Judy! A total knee replacement is often referred to as a total knee arthroplasty (TKA).  It’s really more like a resurfacing of the knee joint.  TKA is most often used as a treatment for those suffering from moderate to severe osteoarthritis in the knee.  Other common causes for the procedure include Rheumatoid arthritis and injury.  Knee replacement is more common among women and the likelihood of replacement increases with age.

The following information on total knee arthroplasty (TKA) and rehabilitation is not meant to be all inclusive, but to serve as a starting point as to what you will likely experience during rehabilitation. Each person’s rehabilitation process is likely to vary depending on his/her particular needs.

Four basic steps are performed in a Total Knee Arthroplasty (TKA):

  1. Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  2. Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
  3. Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. This is not performed with every procedure unless necessary.
  4. Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Proper rehabilitation is a critical component to overall success with this procedure.  In most cases, a physical therapist and possibly an occupational therapist will be involved in the rehabilitation process.  I tend to classify the rehabilitation into the following four major stages.

Stage I Rehabilitation

This is the initial post-surgical recovery stage in the hospital with physical therapy (typically the same day).  The goal is for you (the patient) to be upright and walking with an assistive device, such as a walker, in order to initiate very basic motion in the knee.

Although same day procedures can be performed, you will typically spend two to three days in the hospital following this procedure.  With the new surgical techniques utilized, most patients will not have any weight bearing or other mobility precautions.

There are risks of complications with any medical procedure.  The biggest risk initially is falling either from the newly operated knee giving way or complications from medication (which can cause dizziness, lightheadedness or other symptoms).  Other possible unlikely complications include: loosening of the prosthetic within the bone; blood clots; and infection.

Prior to leaving the hospital, pain management is a priority.  In addition, you need to be able to walk at least to a bathroom (typically with some assistance to maintain safety).

Four typical options for discharge:

  1. Discharge home and continue rehabilitation with in-home care.
  2. Discharge home and initiate physical therapy in an outpatient clinic.
  3. Discharge to a skilled nursing facility. This is typically reserved for those who are expected to need an extended recovery.
  4. Discharge to a sub-acute rehabilitation facility. This is typically reserved for those who may need additional medical care, but who can tolerate a more intensive rehabilitation program.

Regardless of the discharge location, the initial treatment is very similar.  Focus on pain management.  Improve your ability to ambulate.  Initiate RICE (Rest, Ice, Compression, and Elevation).  Start with basic range of motion (ROM) exercises (as described in Stage II).  Also, please refer to Total Knee Replacement Rehabilitation Exercises for many of the most common exercises you may perform depending on your individual need.

Medication Management

A major component of the rehabilitation will be to insure proper pain management.  This is typically through pain medication (both narcotic based and/or acetaminophen).  It is important to maintain proper pain management because it allows you to perform necessary activities of daily living (ADLs) as you progress through your rehabilitation.  Additional medication management may be necessary if you’re taking blood thinning medications in order to decrease the risk of blood clots.

RICE 

  • Rest. Your body has just undergone a major surgery. It will require more rest initially to properly heal and recover. Although exercise and movement will be critical to your recovery, additional rest will be needed. Limit walking on any hard surfaces, such as the flooring in grocery stores, for at least the first three to four weeks in order to minimize pain and swelling.
  • Ice. Apply ice to the painful areas especially in and around the knee. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel style Cold Pack. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing. Often, your physician will prescribe a machine known as an IceMan (or something comparable) to help with cryotherapy to reduce pain and inflammation.
  • Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You may utilize a common ACE wrap or your physician may recommend wearing TED hose which helps with swelling and decreases the risk of blood clots.
  • Elevation. When resting, keep the leg as straight as possible and elevated above the level of your heart to help reduce swelling (edema). Try not to prop anything under the knee because it would cause flexion (bending). You want the knee to move straight into full extension.

Stage II Rehabilitation

Stage II typically starts on about day three to five.  It can last up to six to eight weeks depending on your recovery.  Continue to progress with pain management, edema management, gait/ambulation training, RICE, and range of motion as initiated in Stage I.

Movement 

Regaining range of motion (ROM) is one of the primary goals with TKA rehabilitation.  Knee extension (straightening) and knee flexion (bending) must be regained as quickly as possible.  There is a limited window of time that ROM must be restored.  Aim for full recovery of ROM within the first six to eight weeks (if not sooner).

SeatedKneeExtensionStretch

Regaining both full knee extension and flexion are critical to long term success.  Once you regain full ROM, you must maintain it throughout the process.  Movement helps tissues receive the needed nutrients and can help with pain management.  Movement, including frequent toe tapping and ankle motion along with knee ROM, can also help to reduce swelling and prevents blood clots.

If the patient doesn’t regain adequate motion through the rehabilitation process, I find that knee pain usually remains a long term issue along with poor mobility.  The goal for TKA ROM is usually 0-120 degrees of motion.  (Zero meaning that the knee is perfectly straight.  The 120 degrees is how far backward you can bend the knee.)  For a point of reference, touching your heel to your buttock is usually about 150 degrees of motion.  Your knee will not have the same available ROM as a healthy knee joint, but it will be functional for most tasks.

Restoring full ROM can be accomplished in many ways.  The gentlest way is to perform heel slides by lying on your back and sliding your heel toward your buttock (as demonstrated in Total Knee Replacement Rehabilitation Exercises).  A stationary bicycle is also very helpful.  These exercises should be performed within a mild to moderate amount of pain and discomfort.  Although ROM exercises can be a little painful, they don’t damage the new joint and ultimately, the ROM will help to decrease pain.

Ambulation

In most cases, your initial ambulation will require an assistive device such as a front wheeled walker (FWW), crutches or a cane for safety and pain relief. Initially, the knee motion will be limited. Pain and swelling will affect the strength of the leg. This means that the leg could have a tendency to give way or be unsteady. This should improve quickly over the first several days, but I always recommend an assistive device initially.

Son with Elderly Father

Walking with an assistive device also gives you the opportunity to walk with a normal gait pattern which will help improve your knee’s range of motion and aid in your recovery. Your physical therapist will work with you to help restore as normal and safe a gait pattern as possible. It is common to feel or even hear clicking during ambulation and movement due to the plastic and metal components. This is normal (particularly, early in your rehabilitation when the knee is swollen and ROM remains restricted).

Strengthening

Increasing your leg strength is an important part of your recovery, but it will not necessarily be an initial focus of your recovery. The primary goals for rehabilitation initially involve proper ambulation, reducing the swelling, pain relief, and range of motion for your knee.   Adequate strength throughout the lower extremity is important. The primary focus will be on quadriceps strengthening and hip abduction (gluteus medius) strengthening. These two muscle groups tend to be the most important in regaining full functional mobility after TKA.

Stage III Rehabilitation

Similar to Stage II, rehabilitation in Stage III continues to focus on range of motion (ROM).  At this point, you would typically ride a stationary bike regularly while working to maintain full ROM (0-120 degrees).  Movement helps tissues receive the needed nutrients and can help with pain management.  Movement also reduces swelling and prevents blood clots.  This stage is typically eight to twelve weeks after the operation.

The Stage III exercise program (as demonstrated in Total Knee Replacement Rehabilitation Exercises) is designed to improve strength of the entire lower extremity while still focusing on quadriceps and gluteus medius (hip abduction) strength.  Balance and gait drills are typically introduced.  The goal is to ambulate without any noticeable abnormalities from the TKA and to reduce the risk of falls (particularly if you’re no longer using an assistive device).

During Stage III rehabilitation, I would generally expect that you have proper pain management without the use of narcotic medications.  Mobility for basic daily tasks is usually quite good and the intensity of the rehabilitation has increased.  In this stage, you’re working hard on self-rehabilitation and may be continuing formal rehabilitation in an outpatient physical therapy clinic.

Stage IV Rehabilitation

Stage IV usually occurs four to nine months after the operation.  Exercises should be designed to help maximize your mobility and desired mobility outcome/goal.  Increased exercise intensity and more dynamic balance training are introduced.  A return to full functional mobility is the desired outcome.  In this stage, a majority of the exercises are performed independently.  You may intermittently consult with a physical therapist to progress in rehabilitation to insure that you’re meeting your goals.

Each person’s rehabilitation process is likely to vary depending on his/her particular needs. Always be open and honest with the medical professionals who are assisting you. If you feel as though something is not quite right, don’t hesitate in discussing the issue.

During your recovery, don’t forget the basics! Proper hydration and consuming nutrient dense food is critical to providing your body with the necessary building blocks to optimize your recovery. Proper hydration is critical in reducing your risk of blood clots.  It also helps the body to deliver much needed hydration and nutrients to your healing tissues.

Physical therapy will be an important component to your recovery and rehabilitation.  If you don’t already have a physical therapist that you are comfortable working with, The American Physical Therapy Association offers a wonderful resource to help find one in your area.  Depending on how you progress during your rehabilitation, you will likely work with multiple physical therapists while at the acute care or rehabilitation hospital, during in-home care, and/or at an outpatient clinic.

Thank you, Judy, for your question.  Good luck with your procedure!  I hope your rehabilitation for your knee goes smoothly and that you recover quickly!

Have you undergone a total knee arthroplasty (TKA)?  What was your experience like?  Please share your best tips for recovery.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Posted on

Why Walking is Critical for Your Health

Walking is a wonderful method of exercise.  Out of all the possible movements humans can perform for mobility, we are best at walking! Since most of us started at a very early age, we are familiar with walking.  It has different purposes and offers many benefits.  We walk to get somewhere, to have fun, to relax, and to exercise.  Compared to other activities, walking is easy on your body and can fit into your busy schedule.  Walking daily can reduce stress, improve circulation and hormone regulation as well as benefit your overall well-being. It just makes you feel good!

As we consider what it means to age successfully, we must look at our ability to live safely, independently, and comfortably regardless of age.  In order to age successfully, we must be intentional about the process.  A walking routine can help you to manage each of these critical components to successful aging including: physical health, mental health, emotional health, community, and finances (particularly if leading a healthy lifestyle helps you to avoid the ever growing costs of health care).

Almost anyone can walk, even those who may have a temporary or permanent medical condition which doesn’t allow for other forms of exercise. Walking can still be appropriate for those with the following conditions:

  • Certain Forms of Arthritis – There are 171 different kinds of arthritis. Although causes and presentations vary, the most common form is osteoarthritis (OA). Regular exercise and a range of motion (ROM) program is a critical component to proper management of arthritis. For more information specifically on Rheumatoid Arthritis, please refer to Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis.
  • Joint Replacement – As America’s population continues to age, total joint replacement has become an increasingly more popular method to treat pain and arthritis in joints.
  • Morbid Obesity – Morbid obesity is defined as a Body Mass Index (BMI) greater than 40 or having more than 100 lbs. of body weight.
  • Recent Medical Procedures or Injury – Often after a medical procedure, physicians will advise not to run or participate in overly strenuous exercise during recovery. Walking is nearly always indicated as part of a recovery process (particularly after spinal surgery). Many lower leg surgeries may indicate a reduced or non weight bearing time period when walking isn’t recommended. Always refer to your physician and physical therapist regarding when to avoid activity. Once you have sufficiently healed, you can taper back into your prior level of activity and walking program. Your physician or physical therapist can offer advice on how to safely resume your activities.
  • Chronic Injury or Illness – Past injuries or illness can cause permanent injury and debility. Sometimes it may cause someone to have to permanently alter his/her ability to participate in more high impact activities. Other forms of chronic disease, such as fibromyalgia, may make intense exercise unreasonable. In almost all of these cases, a walking program may be indicated.
  • Severe Osteoporosis – Osteoporosis is the weakening of the bones. Besides dietary modification, the best course of treatment is weight bearing activities such as weight training and walking.

Recreation

Walking is a wonderful form of exercise.  Regardless of your age and fitness level, I believe walking should be part of a healthy lifestyle.  Many of the benefits of walking overlap.  Improving your circulation and hormone function will have a positive effect on other areas of your health.

What are the benefits of walking?

  • Lowers the risk of heart disease, stroke, and diabetes.
  • Lowers your risk of cancer, including breast cancer.
  • Improves circulation and blood flow to the entire body.
  • Releases stress reducing hormones.
  • Releases hormones that can control blood sugar levels for up to 24 hours. This helps to reduce your risk of diabetes while keeping your energy levels stable throughout the day.
  • Keeps your mind sharp and reduces your risk of Alzheimer’s disease and dementia.
  • Boosts your immune system.
  • Improves sleep quality.
  • Reduces pain levels.
  • Helps to manage arthritis symptoms. Please refer to Exercise is an Effective Treatment for Knee Arthritis Pain.
  • Helps to maintain your eyesight and avoid cataracts through improved circulation.
  • Reduces the risks of periodontal disease.
  • Burns calories.
  • Helps to prevent constipation.
  • Walking in a fasted state can help your body to learn how to utilize fat more efficiently as an energy source.
  • We are naturally good at walking. Do it daily!
  • It is a weight bearing activity that can be beneficial in reducing osteoporosis.
  • Keeps the spine healthy. The walking motion is vital to nutrient exchange in the spinal discs.

Typical guidelines suggest walking for 30 minutes per day, five or more times per week.  The recommended 30 minutes per day doesn’t need to be performed all at once.  I highly encourage you to walk more than 30 minutes–just in shorter sessions throughout the day.  When formulating a walking plan, look for ways to add a short distance here and there.

As part of a regular exercise plan, walking in the morning can be an excellent method to help energize your day by starting out on the right path mentally and emotionally.  If performed prior to breakfast, walking also has the additional benefit of helping to regulate your appetite.  When performing low intensity exercise in a fasted state, your fat burning capability increases while your hormone levels stabilize.  Walking after dinner has a similar effect on hormone levels (particularly with stabilizing insulin levels).

If you want to increase the amount of calories burned during a walk, you may need to make a few changes to your morning or evening stroll.  Don’t walk at your preferred speed.  The trick is to make your body inefficient by walking slower, faster, uphill, downhill, or at varying speeds.  Perform a high intensity workout by walking uphill briskly or using the Fartlek method.

Nordic walking, which utilizes walking poles that can help to stabilize you if your balance is poor, is also very popular. The use of walking poles can reduce stress from your back and lower extremity joints, increase your body strength, and burn more calories than traditional walking!

The most important component of a walking program is actually doing it!  If you are unable to ambulate safely or need an assistive device to ambulate safely, walk with a friend or group.  You may consider walking in safe location, such as a shopping center or mall, to avoid environmental hazards.  With a little thought and preparation, walking can be possible for nearly everyone.  If you are experiencing issues with balance, safety or other orthopaedic concerns, please consult a physical therapist.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Choose walking as an intentional exercise and add it to your daily activities as part of a healthy lifestyle.  You will feel better and likely live longer when you incorporate this critical component to aging gracefully and successfully.

Which benefits have you experienced from your walking program? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Why You Should Practice Tai Chi

When was the last time you saw an American elder person perform a full squat or be able to move up and down from the ground?  Now ask that same question about an elder person in China or India.  The answer is much different.  We notice some interesting differences in how people age when we study other cultures around the world.  Many societies have fewer infirmed and immobile elders than does America.  Elders in many of the Mid East and Eastern cultures tend to function at a much higher level.  Lifetime participation in activities, such as Tai Chi and yoga, is one reason for this difference in healthy aging.

Fitness group doing tai chi in park on a sunny day

Aging healthfully and successfully involves integrating the body, mind, and spirit.  Few activities and exercises simultaneously address all three aspects of a person’s life.  Tai Chi and yoga are two forms of exercise that have an effect on all three aspects.

Tai Chi, also known as Tai Chi Chuan (TCC), is a soft form of martial arts that originated in China hundreds of years ago. Its basic movements allow for full body strengthening and balance. A focus on relaxed breathing and mental attention helps to achieve balance between body, mind, and spirit. It doesn’t require special equipment–only a small space indoor or preferably outdoor to perform. Research on Tai Chi supports many wonderful medical benefits. The major outcome of regular practice is reduced frailty.

12 Reasons Why You Should Practice Tai Chi:

  1. Increase your lower extremity and core strength.
  2. Improve your lower body and upper body arm control.
  3. Improve your balance and postural stability.
  4. Improve your flexibility.
  5. Reduce your body fat.
  6. Reduce your number of falls.
  7. Utilize your practice as part of a cardiovascular rehabilitation program for prevention and/or post surgically.
  8. To produce higher peak oxygen uptake during exercise and reduce your blood pressure.
  9. Safe and beneficial exercise if you have diseases such as rheumatoid arthritis (RA), osteoarthritis (OA), and multiple sclerosis (MS).
  10. Benefits your immune system and aids in hormone regulation.
  11. Improves your bone mineral density. Regular Tai Chi exercise can help to treat osteoporosis and osteopenia (the loss of bone density and associated with fractures of bones in the elderly).
  12. Improves your mood and reduces stress, tension, depression, anger, fatigue, confusion, and anxiety.

No wonder why Chinese doctors utilize Tai Chi to treat hypertension, stress, depression, mental strain, chronic indigestion, insomnia, and arthritis!

Tai Chi offers a wonderful method to maintain your mobility and health as you age.  With people living longer, the focus should be on health span versus life span.  Older adults participating in Tai Chi exercise report a sense of improved well-being, increased alertness, relaxation, an improved mental outlook, and greater confidence.

I strongly recommend finding a local Tai Chi class to participate in with a group. Active engagement in your community is a critical part of successful aging as well maintaining meaningful relationships with others.  If you are unable to locate a group or Tai Chi instructor, then utilize the free resources available on YouTube.  Daily Tai Chi, a free instructional video, will teach you how to perform the basic Tai Chi movements.  Tai Chi for Beginners discusses the origins of Tai Chi and offers a sample lesson.

America is heading into a generational change as the baby boomers move into their elder years.  For a more thorough discussion on successful aging, please refer to How to Age Successfully.  For an excellent read on America’s aging population and how it will re-shape our expectations, check out Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

Do you participate in Tai Chi?  What benefits have you experienced?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Q & A: How to Self-Treat a Baker’s Cyst

Q.  My knee started hurting about two weeks ago. I have noticed swelling in the back of my knee.  It’s painful when I bend or straighten the knee.  I looked up the symptoms on WebMD.  I think I might have a Baker’s cyst, but I’m not sure what to do now.  Your insight would be appreciated, thanks!  –Patti

A.  Great question, Patti! The symptoms you are describing sound like they may be caused by a Baker’s cyst.  Another common diagnosis with similar symptoms would be a meniscus injury.  I recommend that you read my previous post on meniscus pain, Q & A: 7 Tips to Get Rid of Knee Pain.  Much of the advice will carry over to either condition.

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled sack that forms in the back of the knee.  Synovial fluid from inside of the knee pushes out into a fluid-filled sack in the back of the knee.  Sizes of the cysts can wildly vary as do the symptoms.  The cyst can typically best be seen when a person is standing.  It may or may not be tender to the touch.  In fact, you may or may not have any symptoms at all.

BakersCyst_Arrows

Baker’s cyst symptoms include:

  • Stiffness or tightness in the back of the knee, thigh, or upper calf.
  • Swelling noted behind the knee. If the cyst ruptures, then the swelling may be also be in the lower leg and calf area.
  • Pain is most typically described behind the knee, particularly with full flexion (bending) or extension (straightening). A person may also experience pain in the upper calf or back of the thigh.
  • Another common complaint is pain when sitting due to the chair touching or rubbing the area behind the knee (known as the popliteal space).

It is not always entirely known why a Baker’s cyst will develop.  In my clinical experience, I have seen them form for the following reasons:

  • Rheumatoid arthritis (RA)
  • Osteoarthritis (OA)
  • Recent knee injury or post knee surgery
  • Poor lower leg biomechanics, which can lead to other forms of knee pain in addition to a Baker’s cyst.

Baker’s cysts should be diagnosed by a medical doctor.  Medical treatment of the cysts usually involves a course of anti-inflammatory medication (orally), a cortisone injection, aspiration of the fluid by utilizing a needle, and/or surgical removal.  The good news is that often a Baker’s cyst will typically resolve on its own if you just give it time.  Rest and treat any symptoms you may be experiencing.

Physical therapy may also be indicated, particularly if the cyst formed due to osteoarthritis pain, recent knee injury/trauma/surgery, or due to poor lower extremity biomechanics.  In most cases, I have witnessed Baker’s cysts successfully and conservatively treated by both a physical therapist and a medical physician who are working together to address the issue.

The rehabilitation for a Baker’s cyst is very similar process to treating meniscus pain.  The following 10 tips will help you to rehabilitate your knee.  You should experience improvement of your symptoms within in a few of weeks or less when initiating this program.  Depending on the severity, it could take longer for a full recovery.  If your pain continues or worsens, then additional assessment and follow up is likely needed.

10 Tips on How to Self-Treat a Baker’s Cyst:

1.  Rest. Initially, take extra time to rest the painful area. The pain and swelling has likely worsened due to a change in activity level.  If the pain is more severe, you may choose to use a cane or a crutch initially to take weight off of the knee.

2.  Ice. Apply ice to the knee and behind the knee in particular. The rule of thumb is to ice no more than 20 minutes per hour.  Do not place the ice directly against the skin especially if you are using a gel pack style Cold Pack.  Individuals with poor circulation or impaired sensation should take particular care when icing.  A bag of frozen peas can be ideal in this situation.

3.  Compression. Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response.  Limit it as much as possible.  You could utilize a common ACE bandage wrap or you could purchase a pair of mild over-the-counter compression socks.  If you utilize a compression sock, it will need to be at least thigh high like these Jobst Relief Therapeutic Thigh High Stockings.  Do not use a knee high version–you may make the swelling and pain worse.  Do not apply any compression too tightly as it could cause numbness or tingling in the leg, foot, or toes.

4.  Taping Techniques. Kinesiological style taping has been proven to be effective in reducing inflammation. Due to the location of the swelling, you will need help from someone trained in the specific style of kinesiological taping.  Many physical therapists (PTs), athletic trainers (ATCs), or chiropractors have training in these techniques.  Learn How to apply Kinesiology Tape for a swollen (edema) Knee Joint by watching this YouTube video that demonstrates the proper technique.  (However, the taping would be on the back side of the knee, not on the front as shown.)  I have had luck using the KT TAPE, RockTape Kinesiology Tape, and Mummy Tape brands.  The technique is fairly basic, so your spouse or a friend may be able to apply it for you.

5.  If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise.  This would also be true for a lunge position or step up.  Modify any exercise as you need to, and don’t compromise technique to complete an exercise.  Poor technique will only increase your risk of injury elsewhere or make the knee more painful and irritated.

6.  Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients.  Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

7.  Improve your Range of Motion (ROM). The goal of the rehabilitation program is to regain full pain free ROM. This can be accomplished many ways.  Perform heel slides by lying on your back and sliding your heel toward your buttocks.  Riding the stationary bicycle can be helpful, too.  Remember, the major goal is to regain full pain free ROM.  If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms.  To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. Do not use the foam roller directly behind the knee.

8.  Work on strengthening. The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening. These areas are commonly weak which can lead to poor knee biomechanics and cause pain and instability.  Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM).  Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing.  The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Baker’s Cyst Rehabilitation Exercises.  This exercise guide is designed to address the muscles that I find to be the weakest in most individuals.  The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening.  Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs).  Wall squats holding for time also works well.  A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts.  If further instruction is needed, search YouTube to watch the proper technique for a specific exercise.  If full ROM is causing an increase in your pain, then you need to stay within your pain free limit as you work on the ROM separately from weight training.

Initially, you will likely need to taper down your activities.  The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehabilitation and recovery phase.  You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity.  You will need to modify some of the activities performed in your structured class to avoid further pain.

9.  Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine.  Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing ROM.

10.  Add a joint supplement. If you are experiencing osteoarthritis pain, you may want to consider adding a glucosamine and chondroitin supplement. CapraFlex is my preferred supplement for knee related injuries.  I have recommended this supplement for years as my clients have had successful outcomes with use.  It has also assisted me in recovery from my many injuries.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently to help heal from an injury.  I recommend that you try it for 30 days to see if it improves your knee pain, but do not use it in combination with other traditional anti-inflammatory medications.  If you are under the care of your physician, please inform him/her that you are taking this medication.  (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

In most cases, you should expect a complete resolution of your symptoms upon completion of the rehabilitation process. To prevent the condition from re-occurring, address any ROM or mobility restrictions as well as any weak areas that are causing altered lower leg biomechanics.

If your symptoms and pain continues or worsens after two to three weeks of rehabilitation, please seek additional assistance from your physician or a qualified physical therapist.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it would be a good idea to seek your physician’s opinion as well).

Thank you, Patti, for your question.  I hope these 10 tips will help you to rehabilitate your knee and recover quickly!

Which treatments for knee pain are the most effective for you?  Please share any recommendations that you may have by leaving your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Posted on

Why You Should Walk, Not Run

Although controversial and disappointing for some, running isn’t appropriate for everyone.  As a physical therapist and runner, I understand why some people cannot and should not take up running as a form of exercise.  Not all bodies are built to run. An existing injury may make it unsafe to run on a regular basis. If you can’t run, don’t worry about it! Many other forms of exercise without repeated impact can help us to keep fit. Walking is a wonderful method of exercise.  Out of all the possible movements we can perform, we’re best at walking!  Walking daily can reduce stress, improve circulation and hormone regulation as well as benefit your overall well-being.

Recreation

There are many wonderful methods to stay fit and improve your cardiovascular system, but running may not be the best choice for you if you have any of the following conditions:

  • Certain Forms of Arthritis – There are 171 different kinds of arthritis. Although causes and presentations vary, the most common form is osteoarthritis (OA). You can still run if you have OA, but you may choose not to if you are symptomatic (experiencing pain). Running would be ill-advised for those with other types of arthritis such as gout or rheumatoid arthritis (RA). The risk of joint injury during repetitive impact based activity (like running) is too high. For more information specifically on RA, please refer to Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis.
  • Joint Replacement – As America’s population continues to age, total joint replacement has become an increasingly more popular method to treat pain and arthritis in joints. The procedures continue to improve and evolve. Although you may be capable of running after a total joint replacement, I don’t recommend it. Running on a total joint replacement, particularly in the knee or ankle, increases the likelihood that the replacement will wear out and/or fail prematurely. If you have had a total joint replacement, I recommend a less impactful method of cardiovascular exercise.
  • Morbid Obesity – Running can be an excellent form of exercise and a wonderful method to help one reach his/her desired weight. However, running may not be the safest choice initially if you are morbidly obese. Morbid obesity is defined as a Body Mass Index (BMI) greater than 40 or having more than 100 lbs. of body weight. Running with excessive body weight increases your risk of injury and permanent damage to joints throughout the body. Initially, pursue non-impact activities. As your weight decreases, you may choose to participate in a running program.
  • Recent Medical Procedures or Injury – The inability to run can be temporary. Often after a medical procedure, physicians will advise not to run or participate in overly strenuous exercise during recovery. The list of possible conditions is long, so refer to your physician and physical therapist regarding when to avoid activity. Once you have sufficiently healed, you can taper back into your prior level of activity or even progress into a new activity. Your physician or physical therapist can offer advice on how to safely resume your activities.
  • Severe Osteoporosis – Osteoporosis is the weakening of the bones. Running is not contraindicated for all forms of osteoporosis, but it is for severe cases. In mild cases, the repeated impact during running can be beneficial to bone formation if the mileage or time spent on your legs isn’t excessive. In severe cases, running increases your risk of fractures. Initially, the best course of treatment, besides dietary modification, would be weight bearing activities such as weight training and walking.

The key is to rule out possible issues which may make running unsafe.  Being well informed initially allows you to tailor an exercise program which can be safe and effective in maximizing your particular goals and needs. For a more thorough discussion on the safety of running, please refer to Is Running Safe? In most cases, running is safe with proper training and a strong focus on technique.

What are the benefits of walking?

  • Improves circulation and blood flow to the entire body.
  • Releases stress reducing hormones.
  • Releases hormones that can control blood sugar levels for up to 24 hours.
  • Burns calories.
  • Helps to prevent constipation.
  • Walking in a fasted state can help your body to learn how to utilize fat more efficiently as an energy source.
  • We are naturally good at walking. Do it daily!
  • It is a weight bearing activity that can be beneficial in reducing osteoporosis.
  • Keeps the spine healthy. The walking motion is vital to nutrient exchange in the spinal discs.

Choose walking as an intentional exercise, and add it to your daily activities as part of a healthy lifestyle.  To increase the amount of calories burned during a walk, you may need to make a few changes to your morning or evening stroll.  Don’t walk at your preferred speed.  The trick is to make your body inefficient by walking slower, faster, uphill, downhill, or at varying speeds.  Perform a high intensity workout by walking uphill briskly or using the Fartlek method.

Nordic walking, which utilizes walking poles that can help to stabilize you if your balance is poor, is also very popular. The use of walking poles can reduce stress from your back and lower extremity joints, increase your body strength, and burn more calories than traditional walking!

Do you prefer to walk or run? What might be holding you back from participating in an exercise program? I encourage you to get started now by walking. You may be surprised how quickly you see results! Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!