Agony In the Bones
Arthritis is crippling more people, but there are nine key ways to beat the pain
3. STRENGTH AND BALANCE
One of the more dramatic recent discoveries about OA is that it can be driven by "malalignment" of the bones, says rheumatologist David Felson of Boston University. In the legs, this shows up as being either knock-kneed or bowlegged. "If you are malaligned you get worse; if you are neutral you don't," Felson says. If the upper and lower legs are bent out at the knee, for instance, the inner side of the joint will be closer together. That makes cartilage damage more likely, and erosion of cartilage brings the bones even closer, producing a vicious cycle of more erosion.
The way out of this trap is to balance the joint, usually by strengthening the muscles and tendons that support it. A brace can also hold the joint in a neutral position. Because of this, doctors are recognizing that managing arthritis often can be done by physical therapy rather than drugs. "It's not the caboose; it's the engine. Too often we tend to pick up the newest prescription with the hopes that will be it," says Kenneth Brandt, a rheumatologist at the Indiana University School of Medicine. The first goal is stretching to improve the range of motion, says Brenda Greene, a physical therapist at Emory University. Then comes strengthening the surrounding muscles, and then a plan for aerobic exercise to increase overall fitness and control weight. "I'm bicycling, I'm swimming, I'm on the elliptical trainer--if you'd told me I'd be doing all that two months ago, I'd have said you were crazy," says Shlomo Twersky, 63, who had both knees replaced earlier this year.
Physical therapists or orthopedists may also recommend other simple changes. "I tell most of [my patients with arthritis] to move into sneakers," says Altman.
4. EXERCISE
Outside the physical therapist's office, you can't use arthritis as an excuse for staying on the sofa. Exercise, in fact, should be part of your routine. Strength and flexibility exercises help keep your joints supported and allow you to reach the full range of motion, and aerobic exercise helps keep off the weight that can exacerbate arthritis. Even weight loss of 7 or 8 pounds helps cut the strain.
The much-maligned sport of running can help. If you're used to your daily runner's high, there is no reason to stop solely out of fear that in 10 years or so you will wear out your knees. There's no link between running and developing arthritis, says Cedric Bryant, chief exercise physiologist with the American Council on Exercise. The only connection is to sudden trauma, which occurs in contact sports and other activities. Torn cartilage or ligaments make it more likely that you'll get arthritis further down the road.
If you begin developing arthritis, it's probably time to switch to something less pounding. "Your knee is like a tire--there's only so much life to the tread," says Jason Snibbe, an orthopedic surgeon at the Beverly Hills Orthopedic Group. Bryant suggests looking for low-impact alternatives, like an elliptical trainer or activities in the water, like swimming or pool running. Cycling is also great, especially on a recumbent bike, which strains the knees less. Studies have shown that to lose weight, you need 60 to 90 minutes of aerobic activity six days a week, but even walking 30 minutes a day is a good start. In addition to cardiovascular exercise, weights help build up the muscles, and activities like yoga and tai chi are great for improving flexibility, he says.
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