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 not only require muscle strength but also good standing balance. Balance problems are very common in people with arthritis.  Balance problems lead to an increased risk of falls and poor mobility. Therefore, standing balance exercises are an essential part of any exercise program to improve the lives of people with hip and knee arthritis.

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 falls risk in older fallers with knee arthritis.

Older adults performed the OEP 3 times per week in their own home.  After 6 months, those 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 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 a 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 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, injections, or surgery.  We want to help you take back control of your health and 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.

How to Manage Your Shoulder Arthritis with Exercise

Shoulder arthritis is present in approximately 15% of people over the age of 65.  It is more common in women.  As with other forms of arthritis, most often 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 perpetual cycle of pain culminating in a joint replacement surgery.  Many people we work with who have shoulder arthritis achieve excellent results by committing to the right exercise program.

Osteoarthritis

Non-Surgical Treatment of Shoulder Arthritis

Lifestyle changes, activity modification, and adoption of strategies to protect the shoulder joint are important parts of treatment.  Activities that involve weight bearing or impact on the joint should be minimized or avoided.  Examples include push-ups and heavy overhead work.  In cases of acute pain, medications or injections can be helpful.  However they should be used sparingly due to their long-term adverse effects on the joint and other body systems.

Exercise is beneficial because it improves health of the existing cartilage, decreases joint stiffness, improves muscle strength, decreases pain, and improves function.  Gentle passive exercises are performed first.  These are usually performed lying down with the assistance of a cane or wand.  Manual therapy techniques performed by a physical therapist can enhance the benefits of exercise.  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.  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 each day.

Wand-Assisted Shoulder External Rotation

Begin lying on your back with a small pillow or towel roll under the 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.  Your elbow of the involved arm should be maintained at a 90-degree angle throughout the exercise.  When a mild stretch is felt, 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 the hand of the involved arm resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly step backwards while keeping the hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions each day.  Avoid holding your breath, bouncing, or exercising through pain.

Wall Chest Stretch

This purpose of this exercise is to restore normal posture and position of your shoulder.  Most people with arthritis develop rounded shoulders and this further increases joint stress within the shoulder.  To begin, stand next to the corner of a wall or door jam.  Place the hand, forearm, and elbow on the wall.  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 the 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 and step back so there is tension on the band with the arms stretched in front of you.  Pull the 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.

Get Started

Exercise can not reverse or cure arthritis.  Nothing can, not even surgery.  But the pain and suffering from shoulder arthritis can be managed with the right exercise program.  Shoulder surgery can be extremely successful for some but 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 a physical therapist, give us a call.

Understanding Arthritis Pain and How You Can Best Manage It

Over 30 million people in the United States are affected by arthritis pain.  Osteoarthritis is the most common form of chronic painful joint disease.  The knee is the most frequently affected joint with up to 1 in 8 men and women over the age of 60 years having painful knee arthritis.  It is also common in the hips, spine, and hands.  Arthritis is a leading cause of impaired mobility and disability in older adults.

Osteoarthritis

Many people believe arthritis is a natural part of aging and little can be done for it.  This belief is false and unhelpful.  Understanding what arthritis is and why it can be painful will provide you with a sense of control.  The purpose of this article is to educate and inspire you to take action so you can manage your arthritis without medication, injections, or surgery.  We will start by explaining how the joints and nervous system change in people with arthritis.  Then we will briefly explain several methods of treatment that have been proven to work in people with arthritis.

Structural Changes In and Around Joints with Arthritis

In a typical joint, a layer of cartilage protects and cushions the ends of each bone.  The hallmark sign of arthritis is a loss of cartilage on the ends of each bone.  Cartilage has no nerve supply therefore it cannot be the direct source of pain.  In severe cases, the bone underneath the cartilage can trigger pain.  More often inflammation within the lining of the joints and ligaments trigger pain.

Over time, the inflamed joint lining and ligaments thicken and create stiffness of the joint.  This results in a cycle of pain and stiffness which begins to limit one’s use of the affected joint.  Reduced activity leads to weakness of the surrounding muscles.  Muscle weakness then contributes to increased stress through the arthritic joint.  The vicious cycle of inflammation, stiffness, pain, and weakness leads to more pain and a sense of hopelessness.

Changes within the Nervous System from Arthritis

Pain is a protective mechanism inherent in all of us.  It helps us escape danger.  However; pain is complex and sometimes can be overly protective when no danger is present.  The type, duration, and intensity of pain rarely can be explained by an x-ray or MRI.  This is because pain results from the interaction of many different factors.  These factors include changes in and around the joint.  However other social, cultural and psychological factors, including underlying anxiety and depression, are always interacting to produce pain. The term “neuromatrix” has been coined by world-renowned pain expert, Dr. Ronald Melzack.  This concept explains the complex interplay between the factors which lead to pain.

As a result of an injury or inflammation within a joint, nerve endings within the joint become stimulated.  Once stimulated, signals are transmitted up the spinal cord to your brain.  Your brain then processes these signals along with your past and present experiences, thoughts, beliefs, cultural factors, and social or work environment.  After considering all these influences, the brain determines whether or not you are in danger and if so, how much danger.  If the brain perceives a serious threat, it sends signals back down to your arthritic joint.  These signals result in an unpleasant experience of pain.  If no threat is determined, your brain produces no signals to create pain.  Read on and we will discuss how you can reduce any perceived threat.

How to Manage Pain from Arthritis

Understanding why arthritis causes pain allows us to identify treatments that can help.  During acute and painful times, treatments focus on reducing inflammation and stiffness.  Then gradually exercises to improve strength and mobility are added.  Finally, a holistic approach including the body and mind is needed to achieve long-lasting improvements in pain from arthritis.

Passive Treatments to Reduce Pain and Stiffness

Passive treatments provided by a healthcare professional or applied to the painful area can be helpful.  Many people experience temporary pain relief with moist heat treatments, massage, and topical creams.  Physicians utilize medications and injections to decrease inflammation and joint stiffness.  Physical therapists perform joint mobilization techniques and prescribe gentle range of motion exercises to achieve the same goals.  All of these treatments can be very beneficial in the short term but by themselves will not result in any long-lasting changes.

How to Exercise In Spite of Pain to Decrease Pain

The longer you experience pain, the more sensitive you become to experiencing more and more pain.  Contrary to popular belief, people with chronic pain from arthritis have low pain thresholds.  They actually begin to experience pain when little threat or danger is present.  This is because the body’s nervous system has been put on “high alert” to protect itself.  In this case, the body’s protective mechanisms are failing and becoming detrimental to its own health.  This is not a permanent state.  With practice, patience, and some help the body and mind can be re-trained to desensitize itself.

Active Adults Exercising

You must accept the fact that all pain is not a sign of damage or danger.  In order to overcome pain, some pain must be experienced when exercising.  The body and mind will never become less sensitive if all your actions are based on avoiding pain.  Instead, focus on the activity you would like to do like walking or gardening.  Perform the activity in small doses at first.  Walk for a few minutes each day for the first week.  Don’t overdo it.  Then add a minute or 2 next week.  Be patient.  Gradually, your nervous system will become less sensitive to the activity, your muscles with become stronger and your pain will begin to decrease.

Take Action and Get Some Help

There is no cure for arthritis.  However, pain and suffering can be managed if you choose to change your beliefs and actions.  Overcoming arthritis pain is not an easy endeavor.  Many are unwilling to commit and jump from one treatment to the next seeking the quick fix.  Joint replacements can work wonders for some.  However, they are not without serious risk and the outcomes are not always as promised.  If you are looking for a different, more holistic approach, your physical therapist can help.  Begin with the strategies discussed in this article. And if you need more help and are interested in teaming up with a physical therapist, give us a call.