JACK'S STORY - ANY PARTS FAMILIAR?
Jack was down in the dumps. A star football player in his youth, 64-year old Jack still enjoys being physical, doing yardwork, playing golf with his pals, and working out at the gym. But pain and stiffness in his knees have worsened, sending him to an orthopedic doctor who prescribed synvisc injections to treat his osteoarthritic knee pain. “Don’t get me wrong,” he says. “These injections really help. The problem is they only work for so long. Eventually my knee gets stiff again and the pain comes roaring back. The doc says it’s only a matter of time until both knees need replacements.”
When Jack asked if I could help him, I noticed he had a subtle but noticeable stiffness in his trunk and leg when walking. He also had to use his hands to push himself up from sitting. As we talked more, he confessed, “To be honest, I’m frustrated that I need to use a golf cart. I miss the walking. And lately I’ve cut back on my gym workouts because my knees really hurt afterwards. I hate that I’m slowing down.”
Overcome the Limits of Knee Arthritis, One Step at a Time
Gain Important Leg Strength – Part 1 by Sharon Duffey, PT, FCP
A PRACTICAL WAY TO OVERCOME ARTHRITIS
While intermittent knee discomfort is more common with age, you might be surprised to know that arthritic joint changes can begin as early as age 30. Wear and tear of the cartilage along with changes to the bone are more common today. Some of us experience our first symptoms in our 40’s. It is not a disease of older people any longer, being overweight and less active are major contributors.
What you might not realize is, as you become less active, your muscles weaken. Strong muscles protect our knee joints from the impact of our body weight. Not having stronger muscles accelerates joint wear, tear, and deterioration known as osteoarthritis. Knee replacement surgeries are increasing at alarming rates. At a nationwide study presented at the 2014 American Academy of Orthopaedic Surgeons (AAOS) meeting, there was a 188% - increase in knee replacements for 45 to 64 year-olds.
There is good news!
You can reduce stiffness and pain. You can reverse joint wear and tear and slow down or eliminate future joint surgeries. The 7 December 2020 issue of Cleveland Clinic’s Health Essentials newsletter reports, “Losing as little as 10 pounds can decrease the progression of your knee osteoarthritis by 50 percent.” It’s tough to lose those pounds though, if discomfort limits you. So follow Jack and the steps he took to improve his arthritis symptoms so you can become more active too!
CHECK YOUR LEG STRENGTH – here’s how
A more important factor is muscle weakness. Strong muscles protect your knee joints from the impact of your body weight. I explained to Jack how even intermittent discomfort causes those muscles to not work as well. Our bodies compensate for the pain, becoming a little less agile. We don’t move as well. I stressed the principle of strengthening his muscles without further straining to his knee joints. To Jack, this was a new way of thinking. He had always believed he needed to push his body – the “No pain, no gain” philosophy.
Jack was anxious to get started.
We began by getting a baseline on Jack’s leg strength. I had him perform a timed Sit-to-Stand Functional Test. His score would help him see how he compares to others in his age bracket. Then, after doing high-value exercises in two to three weeks, we would repeat the test to measure how much his leg strength had changed.
Test your muscle strength to see how you compare?
All you need is a timer or a friend to help count.
Sit-to-Stand Functional Test
Sit toward the edge of a chair where the seat is about 17 inches from the floor.
Cross your arms over your chest.
Start the timer:
Stand up and sit back down, as quickly as you can. Try to do it without using your hands.
Repeat so you stand a total of five times.
Studies show the average score for someone 60-69 years of age is 11 seconds. If you have to use your hands or it takes longer than 15 seconds or if you feel any knee strain, you are at greater risk of falling. Also, leg weakness can accelerate osteoarthritis – eventually it may cause symptoms.
Jack found it difficult to do this without using his hands. He also noticed a little knee strain. To train and strengthen his muscles so he can stand from a sitting position without using his hands, we focused on a high-value exercise that can be done at home while watching TV or talking on the phone.
TRAIN YOUR WEAKER LEG MUSCLES TO WORK BETTER
Leg Strength Exercise
Sit upright in a chair with a pillow support behind you.
The seat of the chair should be at a height so your hips are level with or higher than knee level. [Important]
Spread your feet apart so your feet are directly aligned below your knees.
If your feet point straight ahead or are turned in, turn them out slightly.
SLOWLY tense stomach and buttock muscles to 50% effort.
Keep these muscles tense while you gradually push your right foot into the floor, slowly building tension in your thigh muscles.
Once you are at 60-75% muscle effort, hold for 10 seconds.
Do the same sequence on the left leg, pushing the left foot into the floor, slowly building tension and hold 10 seconds
ALTERNATE, R/L - for a total of 3-5 repetitions to each leg.
Do this exercise four to five times a day for 1 to 2 weeks.
Exercise TIPS:
If you have one leg stronger than the other, “feel” the muscles on the stronger leg working. Use that focus when you practice on the weaker leg. To retrain the weaker muscles to work better, it starts in the brain. Eventually, you need to feel the weaker muscles working equally hard.
Make sure when you push through the foot, it remains flat and you feel the pressure through the heel.
If you feel any knee strain, make a small change in your foot‘s position. With prior sciatica or knee problems, make sure your foot is positioned directly below your knee. Also, go slower and start with 40 – 50% muscle effort for a few days and do fewer reps for a couple of days. Then see if you can build up the muscle tension to 75%, without knee or back strain.
DO’S AND DON’TS AT THE GYM
We also reviewed Jack’s gym workout to ensure he wasn’t doing anything to aggravate his joints and exacerbate his pain. Here are the instructions I asked him to keep in mind at the gym:
When using an exercise bike, adjust the seat so when each pedal is at its lowest position, there is only a 20-degree bend in the knee. This will minimize the compressive forces that can aggravate arthritic knees.
When doing standing exercises with weights, do not “lock“ your knees. Locking the knee is stressful to the joint and does not allow normal joint movement when standing and shifting your body weight.
I suggested Jack temporarily discontinue using the treadmill until he becomes less stiff when walking. Currently when he walks, he has a slight forward lean and over-strides, putting excessive stress on his weight-bearing joints. Those steps would come later.
MAKING THIS EXERCISE A HABIT
Since we spend a lot of time sitting, the “doing“ part is easy. If your check-up revealed leg weakness, this simple exercise will begin to teach those muscles to work better. Try not to make excuses! Make a plan. Put a reminder on a post-it, where you sit when you watch TV so you do it during a commercial. To get the leg strength you need it’s important you do a little, but often, throughout the day. Also, hold the muscle tension a full 10 seconds.
You’ll never know if this helps if you don’t JUST DO IT.
Share your decision to take action steps with someone. Studies show soliciting a supportive friend to hold you accountable for completing your action steps through weekly progress reports is by far the most effective way to achieve your goals.
NEXT STEPS...
This was the first important step for Jack to start overcoming the physical limits from his osteoarthritis. Jack had more to do. He progressed with another at-home workout exercise that would result in a much better score on the Sit-to-Stand Test. Read, Overcome knee arthritis: Leg strength – Part 2.
Sharon Duffey PT, FCP, is a Physical Improvement & Pain Relief Expert, founder of SmartBody. [www.smartbody50.com]
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