Osteoarthritis is the medical name for the changes which happen in a joint with age. In most people, this process plays out as a natural part of aging, and is really nothing to worry about (no more so than grey hair and wrinkles!). In some people, osteoarthritis can start to become painful, and it's a pretty common reason for seeing your GP or physiotherapist. While we can’t cure arthritis, there’s plenty we can do in terms of exercise and lifestyle to manage it well. Joint replacements are often discussed as a potential treatment, but it's not just as simple as swapping out a mechanical part. It involves a pretty substantial surgery, a years worth of rehab, and the new joint will need replacing again after roughly 15 years.
In the past, we’ve always thought of arthritis as being mainly a mechanical issue, wear and tear. This has always made exercise sound a bit counterintuitive, why would you exercise on a joint which is already worn out from too much use? More recent research has found out that rather than worrying about the wear, we should be thinking of osteoarthritis as being in the same camp as things like high blood pressure, type II diabetes and heart conditions. For this reason, regular general exercise, at least 30 minutes every day is essential.
On top of general exercise, we also know that specific strengthening of your thigh, buttock and trunk muscles can take some pressure off the sore joints, and make them last longer. These can range from simple squeezing exercises all the way to weighted squats. This is where it's worthwhile checking in with a physiotherapist, too much or too little strength work will be like taking medication at the wrong dose.
Lastly, your general health and wellbeing plays a huge role in the comfort and health of your joints. Your GP is your best port of call for general check ups and pain relief. Getting a nutritionist or dietician to take a fine tooth comb over your diet is also really helpful and worthwhile. Body weight and general inflammation play a huge role in making arthritis better or worse, and even small changes to your diet can make a huge difference.
We know that people who make a sustained effort with their general fitness, strength, general health and lifestyle can put off joint replacements for years, or even get rid of the need altogether!
The shoulder is a pretty remarkable piece of kit; it’s by far the most flexible joint in our body, capable of loading up in an almost infinite combination of movements. It’s also the fastest; a good thrower can make it turn at an acceleration of 6000-7000 degrees per second! All this performance doesn’t come without a few issues though, and shoulder injuries are some of the most common reasons people come to our clinic.
The most common pattern we see is called rotator cuff related pain, sometimes also called bursitis, impingement, subacromial syndrome or any combination of those. This is generally from a big spike in how much you’ve been using your shoulder. Think push up challenges during the COVID lockdowns, heavy loads of laundry, or doing lots of throwing after time off over winter. It’s a soft tissue injury, irritation or damage to the big 4 muscles which rotate your shoulder, and the network of other tissues around them.
Most of the time, this is pretty simple to manage. Early on, basic range of motion, grip strength and gentle loading exercises help to keep things steady. This is also where you might consider some pain relief, heat packs and making sure you’re getting plenty of good quality sleep and food.
*Example movement exercises courtesy of Physiotec - the program we use to provide patients with their individualised exercise programs.
If you find that after 5-7 days of this, the pain is sticking around and you’re still a bit weak or stiff, a good physiotherapist can point you in the right direction with more specific exercises targeted at your specific issues. If this sounds like you, you shouldn’t be worried at all. These injuries can be a bit stubborn and take a few months to settle completely, but it’s rare for them to stick around beyond that.
More serious shoulder injuries can be spotted by pain levels, strength levels and by big, fast, high impact stories. Normal rotator cuff pain will settle with rest, basic pain relief and heat. If you find that isn’t that case and your pain is throbbing when you’re at rest or trying to sleep, it’s a good idea to get checked out. If you get really weak after your injury, with or without pain, then that can also be a sign of some more substantial soft tissue damage. It’s actually not uncommon for more serious rotator cuff injuries to be pretty much pain free early on. If you can’t lift your shoulder above rib height in the first 48 hours, and you can’t support the weight of your own arm, that’s another reason to come in ASAP for some more tests.
Lastly, if you got injured by something big, heavy and/or fast, then there’s a higher chance of something serious happening. This is particularly true if you felt the joint “pop” in or out, or if you felt something move in the joint. You don’t necessarily need surgery if this is the case, but catching big injuries early on gives us a much better chance of getting you a good outcome.
The bottom line is to keep moving, do your basic rest and pain relief early on, and if there’s anything stubborn or suspicious from what I’ve mentioned above, then come in for a check up.
Absolutely, there’s a reason that they are such a staple in so many different fitness environments. One big reason why massage, manipulation and other types of manual therapy get criticised is that you don’t want to build too much of a dependence on other people to manage your aches and niggles, so foam rollers allow you to take some of that power into your own hands.
Massage in some form or another has been used in sport and exercise at least as far back as the Roman gladiators, and for good reason. Self massage with foam rollers can be used to improve recovery times after workouts, to lengthen restricted muscles and even to copy the “cracking” or “pops” that you get to free up a stiff spine. Similar to other types of exercise kit, if you’re not already comfortable with foam rollers, make sure that you check in with a physiotherapist or good personal trainer to show you a few techniques before you bring them into your weekly routine.
It was once said by the US Chief Medical Officer that if exercise was a pill it would be a billion dollar industry. This is not an understatement, physical activity really is the equivalent of a wonder drug, and without the negative side effects of many of its pharmaceutical counterparts. Exercise has been demonstrated to have positive impacts on multiple body systems including the cardiovascular, gastrointestinal, musculoskeletal and neurological system.
Cardiovascular - Regular physical activity increases the efficiency of the specialised heart muscle allowing it to pump oxygenated blood to all your body tissues easier. Regular physical activity also leads to increased lung capacity, increased number of functioning alveoli in which gas exchange occurs and improved strength of respiratory muscle including the diaphragm and intercostal muscles. All this allows for improved function of the cardiorespiratory system and increased cardiovascular fitness.
Musculoskeletal - Regular physical activity can have positive impacts on various soft tissues including bone, muscle, ligament and tendon. Increased mechanical stress on soft tissue causes cells within these tissues to increase production of collagen leading to increased tensile strength of these tissues. This process is known as mechanotherapy and can be used to explain why tissues increase strength in response to mechanical load and why exercise prescription is such a key part of a rehabilitation program with a physiotherapist. Likewise gradual increase in mechanical loading can increase bone density so long as sufficient opportunity is allowed for rest and bone cell production in between loading cycles. In relation to muscle regular exercise provides a training stimulus which leads to an increase in the ability of the nervous system to recruit more muscle cells to provide a contraction, leading to increased strength. An increase in muscle size (hypertrophy) is due to increase in muscle cell size following repeated bouts of exercise, followed by sufficient rest.
Neurological - Physical activity has been associated with reduced risk of alzheimer's, dementia and improved cognitive function, likely due to improved vascular supply to brain tissue. Regular physical activity is also associated with improved mental health and reduced rates of anxiety and depression. Exercise leads to the release of various endorphins and neurotransmitter chemicals responsible for improving mood and reducing pain. In addition to the likely hormonal and chemical contribution to improved mental health with exercise, it can also improve self-efficacy and provides opportunity for social interaction with others, a factor which is important in managing mental health. Exercise also has been demonstrated to regulate appetite and sleep pattern.
Given the range of body systems on which exercise helps the human body it is not surprising that it has been shown to help in the management of various medical conditions such as obesity, Type II diabetes, stroke, cardiovascular disease, anxiety and depression in addition to a variety of musculoskeletal conditions such as arthritis, spinal pain and tendon issues to name a few.
Recommendations for exercise:
The World Health Organisation (WHO) are the global experts in managing the health of humanity. Given that lack of physical activity and preventable health conditions is seen as a crisis by the WHO, it's not surprising that in 2020 they reviewed their guidelines for physical activity. For adults aged 18-64, at least 150–300 minutes of moderate-intensity aerobic physical activity are recommended weekly or 75–150 minutes of vigorous-intensity aerobic physical activity. In addition to this, adults should also do muscle-strengthening activities that involve all major muscle groups on 2 or more days a week.
Research shows that it takes on average 66 days to create a new habit forming behaviour, although this number varies widely between individuals (see here). Furthermore, in terms of fitness, after 2-4 weeks people start noticing changes in their strength and fitness when exercising. However, changes in body composition and muscle size more often take 12 weeks on average.
So, if you stick past the first month then your strength and fitness should improve, stick past the 2nd month and the exercise should become a habit. Once things are a habit they become a lot easier to maintain as part of managing our long-term health.
Type of exercise:
There are no suggestions for specific types of exercise. The key is finding something you enjoy and can stick to to make it a habit and part of your life in order to prolong and manage your health throughout your life. Get creative, do what you love! If you don't know where to start or are nervous, get myself or any of the physiotherapists or personal trainers at Auckland physiotherapy to help you. We also offer pilates classes which keep you healthy and moving and are fun at the same time. Win, win!