Is exercise your best non-invasive option to manage osteoarthritis?
What is Osteoarthritis?
Osteoarthritis (OA) is a common condition affecting millions of people worldwide that can cause joint pain and stiffness. It occurs when the protective cartilage that cushions the ends of your bones wears down over time, which is often referred to as “age-related changes”.
These changes can be very mild with very little or no discomfort. Unfortunately for others, it can cause severe pain and symptoms such as swelling and tenderness of the joint. OA can affect different joints in the body such as the hands, shoulders and knees.
What is the treatment for osteoarthritis?
There is no cure for OA, but there are various things you can do to relieve symptoms and slow its progress.
These include:
- Lifestyle changes include a healthy diet, exercise and weight management
- Medication: to relieve your pain. It’s best to discuss this with your GP
- Other pain relieving modalities: such as ice, heat, massage
- Surgery: as a last resort when your symptoms are affecting your quality of life
Why should I exercise with osteoarthritis?
While you may worry that exercising with OA could worsen your symptoms, research shows that exercise is the most effective, non-drug treatment for reducing pain and improving function in people with osteoarthritis.
Exercise can provide multiple benefits:
- Healthier cartilage: Exercise helps get blood and nutrients into the joints, helping them to feel better and keeping the remaining cartilage and bone healthier for longer
- Reduce stiffness: When you are moving, you are lubricating the joints which will help prevent the affected area from becoming increasingly stiff and losing more range of movement
- Reduce pain: Movement alone can ease your joint pain
- Reducing weight: Maintaining a healthy weight will decrease the pressure on joints, the less pressure on joints the healthier they will be
- Strengthens muscles: a regular and programmed weightlifting session strengthens the muscles around the joints so they are supported and protected better
- Improve bone health: Exercise, especially weight-bearing and resistance exercises, can slow the loss of bone density that naturally happens with age
- Improves overall health: The pain and stiffness from OA can keep you from being active, which not only aggravates your osteoarthritis but is also bad for your general health and a sedentary lifestyle can lead to other long-term health conditions
What is the best type of exercise for osteoarthritis?
There are no single best exercises when it comes to most conditions, and this is true with OA. Trying to find an activity that you enjoy and will perform regularly is very important as you want this to be something that you will continue long term.
Different activities will work you in different ways but can be equally helpful in managing your pain.
Strength training, pilates and aquatic exercises all work against some kind resistance to challenge your muscles but the style of exercise is very different. Consider strength training as body weight movements working towards using weights for resistance. Whereas, a low-impact pilates session incorporates strengthening and flexibility with particular focus on core muscles through slow and controlled actions. Aquatic exercises are performed while standing in water, the water’s buoyancy helps relieve the pressure on your joints while providing resistance for your muscles to get stronger. Aerobic exercise such as swimming, cycling or walking can reduce fatigue and will keep the joints moving.
What exercises should you avoid?
Everyone is different and there is no one exercise that we recommend everyone avoids. It will depend on your severity of OA, your pain levels, previous exercise ability and goals.
Some people with OA are advised to avoid impact exercises such as running however it may be perfectly suitable for others to continue running. There is no evidence that running increases your chances of getting OA or of its severity. Therefore, finding the types of exercises that best suits you is key.
Still not sure how to start exercising?
If you are still not sure what exercises are right for you or want any specific advice on your problem why not book a physiotherapy appointment with one of our specialised physiotherapists. They will be able to assess your joints, discuss your lifestyle and give you a structured exercise program specific to your needs and goals.
If you would like to discuss this further or book an appointment please do not hesitate to contact us on 01223 914140 or e-mail us at enquiries@vineryroadstudios.co.uk
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Strength Training with Blood Flow Restriction (BFR)
It might sound counterintuitive to restrict the blood supply in and out of your muscles when you exercise, but it’s an extremely effective way to alter the training effect and build strength and muscle size.
As the name suggests blood flow restriction (occlusion or Kaatsu) training involves wrapping a specially designed tourniquet cuff at the top of the arms or legs when training to safely restrict some of the blood flow in and out of your limbs. This alters the chemical balance in your muscles while you workout and triggers an increase in muscle size and strength.
As a Physiotherapist who specialises in post-operative orthopaedic rehab, I find BFR to be an invaluable tool in rehabilitation because gentler (lower intensity) exercises can be made to feel like heavier, more challenging exercises. Essentially, my patients can achieve the benefits of a more intense strength training session while still protecting the structures which are healing.
How does Blood Flow Restriction Training work?
Changing the blood blow in and out of muscles during a workout forces your muscles to work a bit harder and as a result they produce more lactate. This is a type of energy or fuel produced by your muscles when you exercise but there isn’t quite enough oxygen to meet the demand.
Increases lactate production creates a more demanding environment in your cells (metabolic stress) and stimulates a number of amazing changes which results in the changes you see in muscle size (hypertrophy) and strength including:
- Release of growth hormone
- Activation of more muscle fibres
- Growth of new blood vessels
- Adaptations in your cells (the mitochondria), so they produce energy more efficiently
- Widening of blood vessels (vasodilation) after exercising to improve recovery
Is blood flow restriction training safe?
BFR training is safe when it’s performed correctly and you follow the recommended guidelines. There are some conditions that mean blood flow restriction training would not be recommended, so I always recommend discussing this approach with a medical professional beforehand. They should screen to check if it’s an appropriate training technique for you and teach you how to do it safely.
Benefits of using BFR
To build muscle you normally have to lift about 70-80% of your maximum ability (1RM) but with a BFR workout, you only need to use 20-30% of your max to get the same results. So it really benefits people who are recovering from surgery (particularly in ACL rehab) or who might struggle to lift heavier weights due to injury or joint limitations. I also use it with patients who need a ‘joint friendly ‘approach to training like those with hypermobility or osteoarthritis.
So it’s perfect for rehabilitation. It’s also really time efficient since BFR training really maximises the activity in your muscles, so you get a more intense workout in a shorter amount of time. This makes it ideal for those with busy schedules or anyone looking for a more efficient way to train.
BFR mainly has an effect on the muscles of the limbs that the bands are placed on, but you will also get the benefits from the strength training in your torso as well as you lift.
Ready to get started with BFR training?
First of all you need to ask your physiotherapist or health care provider to complete a health screening questionnaire.
Once they are satisfied that it’s a safe training technique for you, the next step is choosing the right equipment. In my practice I use BFR bands which auto-calibrate so I know exactly how much pressure is being applied and can adjust them quickly and easily to the correct fit. Once applied BRF cuffs should be tight but not painful and you should be able to move in them easily. Your Physio should be able to teach you the correct placement.
When using BRF cuffs, you should train with lower weights than usual (20-30% of your max ability), complete high numbers of repetitions with a short break between sets. Start with simple compound exercises like squats, deadlifts, shoulder press or bench press. Make sure to remove the bands between sets and stop immediately if you experience any pain, dizziness or numbness.
Starting slowly and building things up carefully will give you safe, effective results … and don’t hesitate to get in touch if you have any questions or would like to learn how to do this with me!
Blog post written by Mateo Castaño Giraldo. A Chartered Physiotherapist specialising in post-operative rehab and Sports Injury Care. As an ex-pro footballer, Mateo enjoys helping his patients get back to their sports – particularly team running sports – safely and quickly.
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