5 Easy Exercises for Your Hip Replacement Recovery

Hip replacement surgery relieves pain for hundreds of thousands of people each year.  However, some are disappointed because of persistent weakness and trouble walking.  Early after surgery we hear “be patient” or just “take it easy”.  Or, “all you need to do is walk more”.  This approach to hip replacement recovery is just not good enough if you want your quality of life back.

By working closely with your physical therapist, you can do better.  An individually tailored exercise program will speed up your recovery.  Perform the exercises at home or in the clinic with your physical therapist.  Both methods are effective.  They key is that you are performing the right exercises based on your deficits and goals.

Exercise is Proven to Speed Up Your Hip Replacement Recovery

 A 2013 review of clinical studies proves that exercise leads to better outcomes after hip replacement.  Stationary cycling improves quality of life during the first 3 months after surgery and 2 years later.  Early strength training during the first 2 months after surgery results in the greatest functional improvements.  After 8 weeks, weight bearing exercises (examples included below) are best to improve your function.

A more recent review of the research suggests both at home or supervised exercise improves outcomes after surgery.  Patients who attended supervised physical therapy did slightly better.  However, both approaches improve strength, walking, and reduce pain after your surgery.

The decision to exercise at home or under the direction of your physical therapist is not universal. Both approaches work.  It is best to discuss this with your physical therapist, surgeon, and family.  Develop a plan that fits your needs and adjust as you go.

A Sample of Easy Exercises for Hip Replacement Recovery

Whether you exercise at home or with your physical therapist, they key is that you are performing the right exercises.  This is determined by your physical therapist after your initial evaluation.  Everyone who has a hip replacement doesn’t do the same exact exercises.

In general, start with low intensity exercises lying down.  After a week or 2 your pain and stiffness will improve.  Then you will transition to more challenging exercises.  This includes weight bearing exercises done in standing instead of lying down.

Below are 5 examples of some of the common exercises we prescribe.  They emphasize muscle activation and strengthening of your glutes and quads.  These exercises are safe to perform whether you had your surgery through the front (anterior approach) or back of your hip (posterior approach).  Perform them once per day.  We recommend you do 2 to 3 sets of 8 to 12 repetitions for each of them.

1. Prone Glute Squeeze

Isometrics are done by contracting the muscle without joint movement.  This makes the isometric glute squeeze an exercise you can do early and often.  Start with gentle contractions.  Increase the intensity as your pain decreases.  If you have trouble lying flat on your stomach put a pillow under your abdomen.

2. Bridge

The bridge strengthens your glutes and core.  It also helps restore hip extension mobility.  Be sure not to arch your back too much.  Concentrate on squeezing your buttocks.

3. Clam Shell

The clam shell strengthens your gluteus medius.  This muscle is important because it stabilizes your hip and pelvis when you walk.  Weakness will cause you to walk with a side to side lean.  If you are struggling with this exercise you can modify it.  Lie on your back, instead of your side, and place a band around your thighs.  Pull apart with both legs.  When you get stronger, go back to doing it on your side.

4. Sit to Stand

Start by doing this exercises with a few pillows stacked on a firm chair.  The higher you make the chair, the easier it will be at first.  As you get stronger, remove the pillows or find a slightly lower chair.  Don’t over do it at first.  You want to make sure the exercise is challenging but not painful.  Also be sure not to lean away from your involved side.  Your body is really good at compensating.

5. Single Leg Balance

Ok, this exercise is going to be tough for you.  Modifications will probably be needed at first.  Stand close to a chair or counter.  Use 1 hand to assist with your balance.  Over time, slowly decrease your dependence on the chair or counter.  The better you get at this exercise, the better your walking will become.

Start Early for Your Best Hip Replacement Recovery

Don’t delay getting started.  If you are stiff and sore, do the glute squeezes and modify the clam shell.  Work the other exercises in as you feel better.  Also, don’t underestimate the power of getting outside and doing a short purposeful walk every day.  Keep moving but don’t overdo it.

Delaying your rehabilitation will lead to poor habits.  Your body is great at figuring out how to compensate.  So if you develop a poor walking pattern it will be very difficult to correct this later on.  This is why working with your physical therapist early can save you time and aggravation down the road.  If you need help getting started call our office and schedule an initial evaluation with your physical therapist.

 

Reverse Shoulder Replacement and Early Rehabilitation

Reverse shoulder replacement is becoming an increasingly common surgery.  If you are plagued by painful shoulder arthritis along with rotator cuff disease this surgery is an option for you.  Also, some types of arm or shoulder fractures are best treated with a shoulder replacement.   After surgery, your outcome becomes largely dependent on your rehabilitation.  This article focuses on what is most important during the first month of your recovery.

Early Motion is Beneficial after Reverse Shoulder Replacement

There are two possible early complications following reverse shoulder replacement.  First, it is important to protect the shoulder from dislocating during the first month of your recovery.  Your shoulder is most at risk for dislocating when you attempt to reach behind your body.  You should avoid movements that involve reaching behind your back to dress or reaching into the backseat of your car.

Rehabilitation

The second common complication is a stiff shoulder.  Not moving your arm at all will result in shoulder stiffness.  This leads to a poor long-term outcome.  A recent study from the University of California showed excellent results when patients began range of motion exercise 1 week after surgery.  Both early exercisers and those who delayed exercise 6 weeks achieved excellent outcomes with very low complication rates.  This study suggests both immediate and delayed rehabilitation are safe and effective.

Exercises after Reverse Shoulder Replacement

This article describes 5 exercises we prescribe early after shoulder replacement.  We emphasize overhead range of motion.  For the first 6 weeks we refrain from performing exercises that involve reaching behind your back.  Some pain is acceptable during exercise.  However, pain should be minimal and dissipate soon after completing your exercises.  Most surgeons advise using a sling for the first few weeks.  You want to slowly wean yourself from using the sling to minimize your change of developing stiffness.

Table Slides

 Stand holding a towel with your hand resting on a table top or counter.  Relax your shoulder and neck muscles.  Slowly lean forwards and slightly out to the side (a 45 degree angle) while sliding your hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Waiter’s Bow

Begin standing with your hands resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly step backwards while keeping your hands on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions.  Avoid holding your breath, bouncing, or exercising through pain.

Washcloth Press Up

Lie on your back with your knees bent.  Hold a small towel with your hands close together.  Your other arm assists lifting your involved arm straight up to the ceiling.  Straighten your elbow fully.  Then pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.   Progress this exercise by performing it in a slightly reclined position.

Self-Assisted Shoulder Flexion

Begin lying on your back with your hips and knees bent.  With your other hand grasp the wrist of your involved side.  Next, passively lift your involved arm overhead.  Maintain a straight elbow.  Pause and hold the position for 5 to 10 seconds.  As your pain decreases, progress the exercise by increasing the duration of the stretch up to 30 seconds.

Wand-Assisted Shoulder Flexion

Begin on your back holding a cane or wand in each hand.  Space your hands slightly wider than shoulder-width.  The cane or wand is grasped between your thumb and index finger with a thumb-up position.  The thumb-up position will maximize movement at your shoulder joint.  With both elbows straight, lift your arms overhead until a mild to moderate stretch is felt.  Hold this position for 5 to 10 seconds.  Then slowly lower back to the start position.  Perform 10 to 20 repetitions.

Final Thoughts on Rehabilitation after Reverse Shoulder Replacement

We have described 5 safe and effective exercises to begin soon after your reverse shoulder replacement surgery.  Start with the 2 or 3 exercises that are most comfortable for you.  Perform these exercises 2 to 3 times per day.  After a few weeks you want to be performing all 5 exercises several times per day.  After 6 to 8 weeks you will be ready to begin some gentle strengthening exercises.  Next week’s article will go into more detail about this phase of your rehabilitation.  Give us a call if you have questions or would like some help getting started.

Knee Replacement: Improve Your Balance and Walking

Knee replacement surgery is a proven way to decrease pain from knee arthritis.  This surgery also results in substantial improvements in your walking and overall mobility.  However, surgery alone cannot restore your muscle strength or balance.  For this reason many people who undergo knee replacement are plagued by poor balance and falls.  This article highlights several exercises you can perform to decrease your risk of falling after your knee replacement.

A 2019 review of more than 1 million patients undergoing knee replacement showed the following factors increase the risk of falling:

  1. Females
  2. Living alone
  3. Previous history of falls
  4. Previous history of joint replacement surgery
  5. Use of pain or psychiatric medications

Proven Exercises to Improve Your Balance after Knee Replacement

A 2018 review article in Sports Medicine looked at more than 700 people undergoing knee replacement surgery.  Greater improvements in walking and balance were observed following physical therapy programs placing a greater emphasis on balance training when compared to conventional methods of rehabilitation.  Balance training also improved function and knee range of motion to a greater extent than conventional methods of rehabilitation.

Balance training

Research from the University of Pittsburgh has identified specific exercises that improve your balance and walking after knee replacement surgery.  Five of these exercises are described in this article. They can be easily performed in your own home or under the guidance of your physical therapist. For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.  These exercises will only take you about 20 minutes to perform. For safety, perform each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Side Step Walking

Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.  Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.

Shuttle Walking

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.  Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.  Stand at the first cone and walk to the second cone.  Stop at the second cone and then walk backwards to the first cone.  Next, walk to the third cone.  Stop.  Walk backwards to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backwards to the first cone.  Complete this cycle 5 times.

Carioca Walking

Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Toe and Heel Walking

Stand on your tip toes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.   If this is not difficult for you, try walking backwards on your toes and backwards on your heels.

Tandem Walking

You may notice that your feet have become spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.  Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  It is okay to use one hand or finger on a counter for light support when first starting out.

Closing Thoughts on Improving Your Balance after Knee Replacement

The right rehabilitation is crucial to your outcome after knee replacement surgery.  Range of motion and strength require dedicated exercise to make improvements.  Balance training is often left out of physical therapy programs after knee replacement.  However, research shows high-intensity exercise combined with balance training is best.  The 5 exercises included in this article can get you started.  If you would like more help, give us a call.

Pool Exercise for Arthritis: Tips to Get You Started

Arthritis leads to more trouble walking and climbing stairs than any other muscle, joint, or bone problem.  Treatment cannot “cure” arthritis. However, many treatments can slow the progression, reduce pain, and improve your quality of life.  Exercise is one of the most researched and proven treatments for people suffering with arthritis pain.  But what type of exercise is best for you?  This article focuses on the benefits of aquatic, or pool, exercise.

Yes, exercise is medicine for people with arthritis.  Regular exercise increases your muscle strength, improves your balance, and makes you more mobile.  Increased muscle strength in people with arthritis is correlated with improved ability to walk and climb stairs.  Improved balance is correlated with reduced fall risk and greater confidence leaving your home.  All these benefits can occur by exercising in a pool.

But It Hurts to Exercise with Arthritis

Aquatic exercise may be the best option for some people with painful arthritis. It is best to seek out heated pools, typically 82 to 88 degrees.  Warm water reduces your joint pain and stiffness while exercising.  It also leads to greater muscle relaxation.  Aquatic exercise may therefore be more beneficial as an initial form of exercise for people with painful arthritis.

Arthritis exercise

Exercising in water is a gentle way to exercise your painful joints and muscles. The buoyancy of the water supports and lessens stress on your joints.  This encourages freer movement.  Water also acts as resistance to help build muscle strength.  So exercising in warm water reduces your pain, allows easier movement, and builds your muscle strength.  And don’t forget, exercising in water with friends can be very enjoyable.

Aquatic Exercise: A Proven Treatment for Arthritis

A review of 13 clinical trials including more than 1,000 people with hip and knee arthritis showed significant benefits to exercising in water.  Aquatic exercise was proven to reduce pain, and improve both disability and quality of life in people with arthritis.  However, there is one caveat to these findings.  Improvements are greatest in the short term or for about 12 weeks.  After the initial benefits have occurred with aquatic exercise, it is recommended that you also start to incorporate land exercises.

Walking in Water vs. Land

Walking in water burns more calories than walking on land.   This leads to greater weight loss compared to walking on land.  This is because the resistance of the water requires extra effort to move your body.

Compared to the walking on land, joint forces are reduced by 36–55% when exercising in water.  In fact, some forces during weight bearing exercises are reduced by more than your body weight when performed in water.  This creates an ideal environment to improve your strength, endurance, and walking ability without loading your painful joints.

Guidelines for Starting Aquatic Exercise

You will feel really good moving in the warm water.  However, it’s possible to over-exercise, become fatigued and aggravate your joint pain.  You may not realize this until you get out of the water.  Therefore, it is best for you to start slow.  The Arthritis Foundation has put out guidelines for exercising in water.  Follow these and you will minimize the risk of any painful flare ups.

  1. Start slowly and don’t overdo it.
  2. Submerge your body part being exercised.
  3. Move your body part slowly and gently.
  4. Begin and end with some really easy exercises.
  5. Move through your complete range of motion, but do not force movement. Stop if you experience any sudden or increased pain.
  6. Do about 8 repetitions of each exercise as tolerated. You can do 2 to 3 sets of each exercise.
  7. Pain that lasts for more than 2 to 3 hours after exercise may indicate overuse. Cut back next time.
  8. Exercising in excessively warm water (more than 98 degrees) can lead to weakness and exhaustion.
  9. If you have severe joint damage or a recent joint replacement you should check with their doctor before starting.

Pool exercise

Here are a few more important considerations:

  1. Water shoes will help you with traction on the pool floor.
  2. Water level can be waist or chest high.
  3. Use a Styrofoam noodle or floatation device to keep you afloat in deeper water.
  4. Slower movements in the water provide less resistance than faster movements.
  5. You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
  6. You will not notice that you sweat with pool exercises, but it is still very important to drink plenty of water.

Want More Help Getting Started

If you are ready to get started, try some or all of these 10 exercises in the pool.  Also, the Arthritis Foundation sponsors pool exercise classes.  These are great for people looking for some help at first.  Or, you may be looking for a more individualized program.  Your physical therapist will perform an examination to help you identify your weak points.  Then, you and your physical therapist can design the best pool exercises specific to your needs.  Give us a call if you would like help getting started.

Arthritis: Aerobic Exercise to the Rescue

Arthritis pain leads to reduced mobility and poor physical fitness in older adults.  Pain from arthritis starts a viscous cycle.  This includes reduced physical activity, depression, more pain, and ultimately worsening health and quality of life.  Does this sound painfully familiar?

People with chronic conditions, such as arthritis, should perform regular aerobic exercise.  We do not recommend excessive rest and relaxation.  Regular exercise leads to improved functional abilities that are important to perform your daily activities like shopping and taking care of your home.

To maintain aerobic fitness and weight control, the American College of Sports Medicine recommends you perform aerobic exercise 3 to 5 days a week for 20 to 60 minutes each day.  The type of aerobic exercise you perform is completely up to you.  Also, it is important that you select the method that resonates most with you so you can stick to it.

Aerobic Exercise for Arthritis: A Proven Treatment

 

A large group of medical providers and researchers from around the world have developed aerobic exercise guidelines for people with knee arthritis.  Their recommendations include performing aerobic exercise along with strengthening exercise to achieve the greatest benefits.   Individualized programs or exercising in a group are both effective.

Types of Aerobic Exercise for People with Arthritis

Walking, cycling, and even running are popular forms of exercise for people with arthritis.  You can perform these forms of exercise indoors or outdoors. According to the latest research, great results are achieved with walking programs performed at least 3 days per week.  Many other people get great results from group aerobic exercise classes.  For example, zumba and step aerobics are excellent options.

Hip and knee arthritis

Individualized or Group Aerobic Exercise 

Physical therapists prescribe strengthening, stretching, balance and aerobic exercise for people with knee and hip arthritis.  If you are looking for an individually tailored program, reach out to your physical therapist.

Group classes provide social support that can help you stick to it for the long-run.  Group aerobic classes are available at many local health and fitness facilities.  We recommend Tilton Fitness, Elite Fitness, Pyour Core, Black Sheep, and others.

The Biggest Myth about Arthritis and Exercise

Have you ever been told exercise is harmful?   We sometimes hear, “exercise will only make my arthritis worse.”  Many well-educated medical professionals even make these erroneous claims.  Yes, the wrong type or amount of exercise may exacerbate your pain.  When in doubt, get some help when starting out.  In fact, well-prescribed individualized exercise will help your arthritis pain and make you a happier healthier person.

2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with pain from hip and knee arthritis.  These were strength training, stretching, aerobics, and mind-body exercise like yoga or tai chi.  Yoga, tai chi, and aerobic exercise are proven forms of exercise for reducing your pain.  In fact, 8 weeks of regular aerobic exercise is proven to reduce your pain from hip and knee arthritis by 50%.  This is pretty powerful.

Accept the fact that all pain is not harmful.  Some pain is expected when starting out.  However, do your best to keep it to a minimum.  Pain is your brain’s way of telling you about a potential threat.  Humans are naturally wired to be on the look out for threats to survival. However, you can decrease this perceived threat, and your pain, by truly believing that exercise is in your best interest for survival.  And this is a fact.  If you are unsure, learn more about how pain works here.

Tips to Start your Exercise Program Today

Exercise

If aerobic exercise is new to you, start small.  For example, begin with 5 minute walks 3 days per week.  Then set a goal to increase the frequency of your walks up to 5 days per week.  Also, track your steps or keep a log.  Enlist family members or friends to join you and hold each other accountable.

If you need more help, sign up for a class or see your physical therapist.  Don’t wait if you are having trouble on your own. Waiting for circumstances around you to change is going to change your life for the better. Mark Twain said, “the secret to getting ahead is getting started.”

Arthritis: Treat Your Pain with Yoga and Tai Chi

Your arthritis pain can be treated with exercise.  Many forms of exercise have proven effectiveness for arthritis.  These include aerobic exercise, strength training, stretching, and balance training.  It is important for you to choose the type of exercise that resonates most with you. Then stick with it.  Mind-body exercise is another effective type of treatment for people with arthritis.  This article discusses how your mind-body connection influences your pain.  We offer suggestions so you can manage your arthritis for optimal physical and psychological health.

Mindfulness involves focusing your awareness on the present moment.  It acknowledges and non-judgmentally accepts your feelings, thoughts, and bodily sensations. Mediation is an effective practice to promote this state. Mindfulness is associated with better pain coping skills, greater physical activity and greater weight loss from exercise.  Importantly, difficulties coping with pain are a big barrier to adhering to an exercise program.   If you struggle coping with your pain, mind-body exercise, such as Yoga and Tai Chi, are excellent options for you.

Yoga for Knee Arthritis

People with knee arthritis who demonstrate higher mindfulness scores achieve greater benefits from exercise.  The most important component of mindfulness seems to be the ability to engage fully in activities in the present moment.  Yoga is a form of mind-body exercise that incorporates the acting-with-awareness facet of mindfulness.  Yoga combines mental focus with breathing techniques, stretching, and strengthening exercises.  It provides relaxation benefits and reduces your stress.  It is also a proven way to decrease your pain.

A 2016 study out of the University of Minnesota compared the effects of yoga to an aerobic and strengthening program in 84 people with knee arthritis.  After 8 weeks, both groups showed large improvements in pain, strength, anxiety, and fear of falling.  However, the people who performed yoga did slightly better in most areas.  The findings of this study support the Arthritis Foundation’s recommendation for yoga as part of a regular arthritis treatment program.

Starting Your Yoga Program

When first starting out, it is best to get some help from an instructor.  You can try taking a class once per week for a few months.  Practice at home another 2 or 3 days per week.  Then you can either continue fully on your own at home or stick with regular group classes.  Some people prefer the expert instruction and social aspect of exercising in a group.  Other people do better at home.  It’s up to you.

It’s important to select yoga poses that challenge you but are not outside of your capabilities.  Some pain is acceptable.  Remember to focus your thoughts and feelings on the present moment, not the possibility of pain.  Concentrate on each breath and your sensitivity to pain will decrease.  The following yoga poses are a great starting point for anyone with knee arthritis and new to yoga.  If needed, use a chair close by for balance.  Start with holding each pose for 5 seconds which is about 1 slow deep breath.  As you become stronger, increase how long you hold each pose (3 breaths or more).

Tai Chi for Knee Arthritis

Tai Chi is a traditional Chinese mind–body practice that combines meditation with slow, gentle, graceful movements.  It also incorporates deep breathing and relaxation similar to yoga.  Tai Chi offers physical and psychological benefits.  It results in improved quality of life for many people with arthritis. It is also less physically demanding than other forms of exercise and this makes it a very popular option.

A 2016 study in the Annals of Internal Medicine compared the benefits to Tai Chi to physical therapy treatment for people with knee arthritis.  After 12 weeks, both groups showed similarly large improvements in pain, function, walking ability, depression scores, and overall well-being.  This study suggests Tai Chi is an effective treatment option for people with arthritis.  In particular, Tai Chi is a viable option for people seeking a group exercise experience.  Those looking for more individualized exercise instruction would be better off working with a physical therapist to start.

Getting Started with Tai Chi

Similar to starting off with yoga, it is a good idea to seek out a qualified Tai Chi instructor. Stafford Township holds group sessions at the Bay Avenue community center.  Once you learn the basics you can develop a routine for home or continue with the group.  Also, physical therapists often incorporate components of Tai Chi into balance training for their patients.

Tai Chi involves moving from one pose flowing into the next.  The body remains in constant motion.  It’s low-impact, so it puts minimal stress on your muscles and joints.  This makes it safe and appealing for most people with arthritis. Tai Chi is also appealing because no special equipment is needed.   There are different styles of Tai Chi.  The video that follows shows a few basic Tai Chi poses to get you started.  Dr. Paul Lam is a physician and world-renowned expert in Tai Chi.  His programs are designed specifically for people with Arthritis.

Mind-Body Exercise for Arthritis: Take the Next Step

Arthritis pain can impact your physical and psychological well-being.  You may start to avoid long walks, limit your social outings, and become depressed over your pain. You can change this. Mind-body exercises can help you. Take a local group class to get started (Yoga or Tai Chi).  If you don’t feel like you can do it alone, call your physical therapist. The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health.

The Best Balance Exercises for Hip and Knee Arthritis

Are you having trouble walking, climbing stairs, or standing up from a chair.  Is your knee or hip pain interfering with these activities?  Are you losing muscle strength because of painful arthritis?  Most daily activities require both strength and good standing balance. Balance problems are extremely common in people with arthritis. Balance problems lead to poor mobility and falls. If you are dealing with hip and knee arthritis, standing balance exercises are an essential part of any exercise program to improve your quality of life.

A Proven Approach: The Otago Balance Exercise Program

The Otago Exercise Program (OEP) is a proven falls prevention program for older adults.  The OEP is especially beneficial for adults 75 years and older.  A 2018 clinical trial looked at the OEP to improve balance, fear of falling, and fall risk in older fallers with knee arthritis.

Older adults performed the OEP 3 times per week in their own home.  After 6 months, people who were consistent with performing their exercises showed significant improvements in balance and reduced their fear of falling.  This study provides a framework to build your own home balance exercise program.

The Basics of Balance Exercise

Physical therapy for balance

Balance exercises can be easily performed in your own home or under the guidance of your physical therapist. For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.

These exercises will only take you about 20 minutes to perform.  This investment in time and energy is well worth the reward.  For safety, start by performing each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Toe and Heel Walking

Stand on your tip toes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.  If this is not difficult for you, try walking backwards on your toes and backwards on your heels.  

Tandem Walking

You may notice that your feet have become spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.

Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  It is okay to use one hand or finger on a counter for light support when first starting out.

Sidestepping

Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.  Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.

Carioca

Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Shuttle Walk

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.

Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.  Stand at the first cone and walk to the second cone.  Stop at the second cone and then walk backwards to the first cone.  Next, walk to the third cone.  Stop.  Walk backwards to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backwards to the first cone.  Complete this cycle 5 times.

Get Started with Improving Your Balance

Arthritis pain causes you to change your daily activities and lifestyle.  You may start to avoid long walks, avoid stairs, or limit your social outings because of pain. The more you change or reduce your activities, the weaker your muscles become and the more your balance is affected.  You can change this.  Home strengthening exercises and balance exercises is the safest and most effective way to overcome limitations from arthritis.

If you don’t feel like you can do it alone, call your physical therapist.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, shots, or surgery.  We want to help you take back control of your quality of life.

 

6 Strength Training Exercises for Hip and Knee Arthritis

If you are one of millions of Americans bothered by hip or knee arthritis, this post is for you.  And if you would prefer not to rush into popping pills, having injections, or pursuing surgery, this post is really for you.  The following paragraphs are for people who want to take back control of their health and quality of life.  You may be thinking, “But there is no cure for arthritis.”  We disagree.  The Cambridge dictionary defines a cure as something that makes someone who is sick healthy again.  A cure refers to making you, a whole person, healthy again not correcting or reversing some change in your joint.  With this definition in mind, there is no better cure for your hip and knee arthritis than exercise.

There are many different types of exercise which have been proven to be helpful for arthritis.  Aerobic exercise, stretching, yoga, tai chi, aquatics, and balance training are all proven forms of exercise.  This post goes into detail about one of the most effective forms of exercise for people with hip and knee arthritis: strength training.

You may be thinking, “But my knee [or hip] hurts too much to exercise.”  Or someone may have even told you,” Exercise will make your arthritis worse.”  These claims are flat out wrong!  If you accept them as true, you are playing the victim.  Victims wait around for their lives to change.  Successful people create the changes they want in their life.  If you don’t to be a prisoner to your arthritis pain, now is the time do get moving with an exercise program.

A Proven Approach: Strength Training for Arthritis

When we look at the entire body of research done on arthritis it is clear that strength training is beneficial.  A 2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with hip and knee arthritis.  These were aerobics, mind-body exercise (yoga or tai chi), strength training, and stretching.  A regular strength training routine was proven to be beneficial for decreasing pain, improving function, and restoring quality of life.

In 2016, a panel of medical experts across the world reviewed the best evidence looking at exercise for people with hip arthritis. Compared to all other forms of exercise, these experts found strength training to be the best for decreasing pain, improving function, and regaining mobility.  Recommendations include performing one to three 45-minute sessions each week.  You can use exercise equipment at a local gym or fitness center.  For most people, it is more practical to start strength training at home without all the fancy equipment.  The 6 home exercises that follow focus on strengthening your core, hips, and thigh muscles.  They are a great starting point for you.

Band Knee Extension

The quadriceps muscle or “quads” on the front of your upper thigh is crucial for walking, climbing stairs, and standing up from a chair.  The quads of people with hip and knee arthritis are weaker and smaller than people without arthritis.  Weakness places additional stress through your arthritic joints.  Stronger quads reduce joint stress and decrease your pain.  Band knee extension is a great exercise to start working your quads.

Loop a resistance band around your lower leg.  Attach the other end to the leg of a chair or your bed.  Sit up nice and tall with good posture.  Extend your leg straight to activate your quads.  Do this quickly.  Once you have your knee fully extended pause 2 to 3 seconds.  Then slowly lower your leg over a 5 second period.  To review, raise the leg fast, hold 2 to 3 seconds, and then lower it back really slow.  This will give you the best results.  Perform 10 to 15 repetitions for 2 to 3 sets.

Band Knee Flexion

The hamstrings in the back of your thigh are also critical for balance and walking.  Stand to perform this exercise.  Loop a resistance band around your lower leg.  Attach the other end to the leg of a chair or your bed.  Keep a nice tall posture.  Bend your leg behind you but keep your knee directly under your hip.  All movement occurs at your knee.  No movement occurs at your hip.  Bend the leg fast, hold 2 to 3 seconds at the top, and then lower it back really slow.  Perform 10 to 15 repetitions for 2 to 3 sets.

Partial Wall Squats

Many people cringe at the word “squat”.  In fact, you may have even had another healthcare professional tell you to never squat.  Unfortunately, it is impossible to go through life without squatting.  Every time you sit down or get into your car you are squatting.   You might as well get better at it and learn to do it in a way that minimizes stress to your joints.

Stand with your back against a wall.  Place your feet 12 to 18 inches out from the wall.  With your arms crossed over your chest, slowly squat to a depth you are comfortable with.  Start small and as you get strong you will be able to go a little deeper.  Be sure your knees stay in line with your hips and ankles.  Don’t allow your knees to cave in.  Hold the down position for 2 to 3 seconds, and then push up fast back to a standing position.  Perform 8 to 12 repetitions for 2 to 3 sets.

Bridge

Your glutes are the key muscles that extend your hips to stand up or climb a flight of stairs. The bridge is a great glute exercise to start with.  Begin by lying on your back with the hips bent and your feet lined up with your shoulders.  Perform the bridge by lifting both your hips from the floor.  A common mistake is to excessively arch your low back.  Hold the bridge position for 2 to 3 seconds then return to the starting position slowly over 5 seconds. Perform the lift fast but lower your body back down in a slow and controlled manner.  Perform 10 to 15 repetitions for 2 to 3 sets.

Clam Shell

Your abductor muscles on the outside of your hip are important for stability when you walk, run, or climb stairs.  When these muscles are not working properly, you will walk with a side to side lean or lurch.   This will increase joint stress and increase your risk for falls.

Lie on your side with your hips and knees slightly bent.  Keep your feet together.  Pace a resistance band around your thighs just above your knees. Start the exercise by rotating the top hip to bring the knees apart. Hold this position for 2 to 3 seconds and then return to the starting position slowly over 5 seconds. Be sure to remain completely on your side with one hip stacked on top of the other.  Allowing the pelvis to roll back during the movement is the most common mistake with this exercise. Perform 10 to 15 repetitions for 2 to 3 sets.

Hip Abduction

Lie on your side with the bottom hip and knee bent.  Keep your top knee straight.  Your top hip is maintained in neutral or slight hip extension with the toes pointed forward.  Point your toes forward to orient your hip properly. Initiate the movement by lifting your top leg about 30 degrees.  Hold this position for a count of 2 to 3 seconds and then slowly lower the leg to the start position over 5 seconds.  Perform 10 to 15 repetitions for 2 to 3 sets.  For those who struggle with this exercise, try doing it standing instead of lying down.

This exercise activates the gluteus medius to a greater level than the clam shell.  However, it is also more challenging to perform correctly.  Similar to the clamshell, it is important to remain completely on your side with one hip stacked on top of the other.  Allowing the pelvis to roll back during the movement is the most common mistake.   Also, as your muscle tires, your leg will drift forward into hip flexion.  It is important to maintain your leg lined up or slightly behind your upper body.

Hip and Knee Arthritis: Get Started with Strength Training

The hardest part to any exercise program is getting started.  Commit to performing these exercises a few times each week.  You will see small changes after a few weeks.  Expect to see the best results after consistently exercising for 6 to 12 weeks.  If you don’t feel like you can do it alone, give your physical therapist a call.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health and quality of life.

 

 

 

 

4 Stretches for Arthritis of the Hip and Knee

Arthritis, according to the World Health Organization, is the single most common cause of disability in adults 60 years and older.  Osteoarthritis is a long-term chronic disease characterized by the deterioration of cartilage lining your joints.  This results in your bones rubbing together creating stiffness, pain, and impaired movement.  Osteoarthritis most commonly affects your knees, spine, and hip joints.  This article is for people suffering with hip or knee arthritis.

While arthritis is related to ageing, it is also associated with a variety of modifiable and non-modifiable risk factors.  Modifiable risk factors you can control include your body weight, exercise, nutrition, bone density, and trauma.  Exercise is one of the primary treatments for arthritis.  However, the most beneficial type and amount of exercise is up for some debate.  This article discusses the benefits of flexibility exercises and stretching for arthritis.  We have also included several helpful stretches for you to start with today.

Stretching is a Proven Treatment for Arthritis of the Hips and Knees

When we look at the entire body of research done on arthritis it is clear that exercise is beneficial.  The type of exercise you choose to perform matters less than how consistent you are.  A 2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with hip and knee arthritis.  These were aerobics, mind-body exercise (yoga or tai chi), strength training, and stretching.  A regular stretching routine was proven to be beneficial for decreasing pain and improving function and quality of life.

Again, the key is to be consistent.  Random or infrequent stretching will offer you little benefit.  The 4 stretches shown in this article are easy to perform in your own home.  They require little, if any, equipment.  Prolonged gentle stretching is better than an aggressive approach. Hold each stretch for 30 seconds and perform 2 to 3 repetitions.  And do them daily!

Chair Hamstring Stretch

Sit towards the edge of a chair.  Extend one of your legs in front of you.  Reach straight ahead with both hands.  Be sure to keep your chest up and back straight.  You should feel a gentle stretch in the back of your thigh or behind your knee.  Don’t bounce or hold your breath.  Maintain each stretch for 30 seconds.  Perform 2 to 3 stretches on both sides each day.

Standing Quadriceps Stretch

Stand with a chair placed behind you.  Rest one foot up on the chair so your knee is bent.  Your knee is aligned directly below your hip. Stand tall. Be sure to keep your chest up and back straight.  You should feel a gentle stretch in the front of your thigh above your knee.  Hold each stretch for 30 seconds.  Perform 2 to 3 stretches on both sides each day.

Kneeling Hip Flexor Stretch

Place a pillow or airex pad under one of your knees.  Your other foot is positioned in front of your body.  Tuck your hips and engage your abdominal muscles.  Stay tall.  Gently lunge forward.  Be sure to keep your chest up and back straight.  You should feel a gentle stretch in the front of your thigh or hip.  Hold each stretch for 30 seconds.  Perform 2 to 3 stretches each day.

Standing Calf Stretch

Stand with one foot back.  Your heel remains in contact with the floor as you lean towards the wall or a counter.  Your knee remains straight to stretch the larger gastrocnemius muscle.  Slightly bend the knee to stretch your deeper soleus muscle.  It is important to stretch both muscles.  Hold each stretch for 30 seconds and perform 2 to 3 repetitions on each side. 

Arthritis: Start Stretching Today

You can take control of your hip and knee arthritis. You don’t have to suffer.  These 4 stretches for arthritis you can easily perform in your home.  They are ideal for decreasing your pain and improving your mobility.  Most people can perform these stretches without considerable pain or difficulty.  The hip flexor stretch may require some modifications if you experience difficulty kneeling.  If you need some help give us a call.  We are here for you.  Many people do better when they perform their home stretches supplemented with manual therapy performed by your physical therapist.

5 Easy Exercises for Shoulder Arthritis

Shoulder arthritis occurs in approximately 15% of people over the age of 65.  It is more common in women.  As with other forms of arthritis, it begins with a slow progressive loss of cartilage within the joint.  This leads to changes of the bone and joint lining.  Joint inflammation, stiffness, muscle weakness, pain, and deformities within the joint are common.  Despite popular belief, arthritis is not always a downward cycle of pain culminating in a joint replacement surgery.  Many people we work with achieve excellent results by doing the right exercises for shoulder arthritis.

Osteoarthritis

Non-Surgical Treatment of Shoulder Arthritis

Lifestyle changes, activity modification, and strategies to protect your shoulder joint are important parts of treatment.  Weight bearing activities through the shoulder should be minimized or avoided.  Examples include push-ups and heavy overhead work. In cases of acute pain, medications or injections are helpful.  However, they should be used sparingly due to their long-term adverse effects.

Exercise is beneficial because it improves health of the existing cartilage, decreases joint stiffness, improves muscle strength, decreases pain, and improves function.  To start, gentle passive exercises are done.  These are best done lying down with the assistance of a cane or wand.  Manual therapy techniques performed by a physical therapist enhances the benefits of exercise for shoulder arthritis.

As pain and range of motion improve, stretching exercises are progressed and strengthening exercises are added.  The following 5 videos show examples of exercises we have used with excellent results for many people with shoulder arthritis.

Wand-Assisted Shoulder Flexion

Begin on your back holding a cane or wand in each hand.  Space your hands slightly wider than shoulder-width.  Hold the cane or wand between your thumb and index finger with a thumb-up position.  The thumb-up position will maximize movement at your shoulder joint.  With both elbows straight, lift your arms overhead until a mild to moderate stretch is felt.  Hold this position for 5 to 10 seconds.  Then slowly lower back to the start position.  Perform 10 to 20 repetitions each day.

Wand-Assisted Shoulder External Rotation

Begin lying on your back with a small pillow or towel roll under your upper arm.  Hold a cane, golf club, or similar object in both hands.  Use the non-involved arm to passively rotate your involved arm out to the side.  Maintain your elbow at a 90-degree angle throughout the exercise.  Pause and hold the position for 5 to 10 seconds.  Perform 10 to 20 repetitions each day.  Avoid exercising through pain.

Waiter’s Bow

Begin standing with your hand resting on a table top or counter.  Relax your shoulder and neck muscles.  Slowly step backwards while keeping your hand on the table or counter.  Pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions each day.  Don’t hold your breath, bounce, or exercise through pain.

Wall Chest Stretch

This purpose of this stretch is to restore normal posture and position of your shoulder.  Most people with arthritis develop rounded shoulders.  This increases joint stress within the shoulder.  To begin, stand next to the corner of a wall or door jam.  Place your hand, forearm, and elbow on the wall.  Next, take a small step forward and slightly turn your body away from the wall.  You should feel a mild to moderate stretch in the front of your shoulder or chest. Hold the stretch for 15 to 30 seconds and perform 3 to 5 repetitions daily.  If you experience pain, slightly lower your arm or decrease the intensity of the stretch.

2-Arm Band Row

The row is a great exercise to begin strengthening the muscles around the shoulder.  This exercise emphasizes the muscles that hold the shoulder blades back.  To perform this exercise, anchor a resistance band to a piece of furniture or door knob.  Grasp the ends of the band in each hand.  Next, step back so there is tension on the band.  Pull your hands and elbows back.  The most important part of the movement involves squeezing or pinching the shoulder blades together.  Perform 10 to 20 repetitions for multiple sets 3 times per week.

How to Get Started with Exercises for Shoulder Arthritis

Exercise can’t reverse or cure arthritis.  Nothing can, not even surgery.  But your pain and suffering from shoulder arthritis can be managed with the right exercise program.  Although shoulder surgery can be extremely successful, it is not an option for everyone.  If you are looking for a different approach, your physical therapist can help you.  Begin with the strategies discussed in this article.  And if you need more help and are interested in teaming up with one of our doctors of physical therapy, give us a call.