Osteoarthritis, also known as a wear-and-tear arthritis, occurs when the cartilage at the ends of your bones begins to break down over time. It is the most common version of arthritis, affecting nearly 27 million Americans age 25 and older according to the US National Institute of Health. We in the physical therapy community often work with people with osteoarthris, focusing heavily on improving mobility and strength and educating our patients on joint protection and body mechanics.  As a PT, it’s also important for me to educate patients on the importance of remaining active and some very recent research supports this concept.

A new study published this week in Arthritis Care & Research suggests that walking about an hour a day or a total of 6,000 steps can lessen the severity of knee osteoarthritis and help prevent disability.  The study tracked the number of steps taken over a week by adults who were at risk for knee arthritis or already had it. Two years later, the researchers assessed the 1,800 participants for any arthritis-related limitations and found that for every 1,000 steps taken, participants’ functional limitations were reduced by 16 to 18 percent.  The study’s authors also found 6,000 steps was the critical threshold that predicted who would go on to develop disabilities or not. According to the study’s author, Daniel White, a research assistant professor in the department of physical therapy and athletic training at Boston University, every step a person takes during the day counts towards that critical threshold; in other words, the steps did not have to all be taken at the same time. While the 6,000 steps per day is considerably less than what is recommended for good health, the study’s authors were looking for the fewest number of steps that would help arthritis patients remain mobile. 

It is extremely common to hear patients with arthritis complain that they can’t exercise because of their pain levels but it’s important to realize that the less a person moves, the weaker their muscles become, which can lead to potential instability in their joints. The good news is that the amount of activity needed to help keep disability at bay may be less than we previously thought and can be spread out throughout your day.  So if you’re dealing with knee arthritis, it may be time to lace up those walking shoes and monitor your steps with a pedometer or smart phone app.

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Joint Replacement 0014I think it is safe to say that many of us know of at least one or more people who have been affected by osteoarthritis resulting
 in joint replacement. Surgeons are able to replace many joints from the shoulder to the hip, knee, fingers and even joints within the toes. Technology has come a long way over the years and made joint replacements simpler and less invasive, resulting in shorter recovery period over all. However, during my short career as a clinician so far I have seen a common theme among many joint replacement patients: recovery is much harder and takes longer than anticipated.

I have heard on more than one occasion “I thought this would be a 6 week recovery,” or “I didn’t’ realize how painful this would be.”  I have even had one patient allude to the fact that their surgeon told them the recovery would be only a few weeks. The reality is that joint replacement, especially knee, hip and shoulder, are very involved surgeries and can take up to one year for full recovery.

Maybe you are reading this knowing that you are facing one of these joint replacements in the near future. My intent is not to give you doubt or make this a negative experience, but to help you enter this challenge with eyes wide open. Your surgeon may have a very good reputation and while they may perform the surgery perfectly, the body will always react to trauma the same… With swelling, inflammation and pain. But don’t worry! There are things that can be done to help! And physical therapy is an important part.

First, you will want to educate yourself before arriving for your surgery date. Often there are classes that are offered through your surgeon or the hospital that help to prepare you. I think it is important to do your own research as well. The internet is a great tool to use to understand the process of surgery itself. You may even want to find a video on Youtube (if you can stomach it) to watch whatever surgery you are about to go through. It will also be important to know what is expected of you in the 1-2 days following your procedure. For the lower extremity, many surgeons have requirements such as the ability to walk a certain distance or going up or down stairs before they will sign discharge documents.

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Recently, I was given the opportunity to speak to members of the Arthritis Foundation about managing their activities when dealing with osteo- or rheumatoid arthritis.  Many people either have osteoarthritis or rheumatoid arthritis or know someone who does.  However, not all people understand the fundamental differences between these two types of arthritis.  In osteoarthritis, the articular cartilage (the cartilage that lines the ends of your bones) starts to degenerate.  The joint space becomes narrowed and bone spurs can form at the edges of the joint.  Eventually, if enough degeneration occurs, there is injury to the bone lying underneath the cartilage and a person is told her joint is "bone on bone." In contrast, rheumatoid arthritis is an autoimmune disorder where the synovial tissue produces diseased and excessive synovial fluid.  Normally, a person's synovial fluid gives proper nutrition to your cartilage and lubricates your joints but rheumatoid arthritis interrupts this process. This results in swollen, red and painful joints that can lead to deformities in the involved joint(s) if untreated. Osteoarthritis is more common in the weight-bearing joints, like your knees, hips and spine where rheumatoid arthritis typically involves the hands, feet or neck (but is not exclusive to these).

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