WHAT CAUSES ARTHRITIS?

Arthritis is inflammation of a joint. Any word with “itis” at the end of it means “inflammation,” whether it’s tendonitis, bursitis, etc. But arthritis is joint specific, so it literally means “inflammation of a joint.”

There are two main types of arthritis: osteoarthritis and rheumatoid arthritis. 

Osteoarthritis is typically a wear & tear kind of arthritis from using the joint over the years, perhaps from having a sports injury when you were younger that damaged that joint a little bit, or carrying too much weight that puts too much stress on that joint. 

Rheumatoid arthritis is an autoimmune disease where the body is actually attacking itself and destroying the lining of those joints. So osteoarthritis can be very joint specific, so just the left knee or the hip, while rheumatoid artists is more systemic where you have multiple joints affected at the same time.

HOW CAN WE PREVENT ARTHRITIS?

As we get older, we have more and more use of our joints which causes this osteoarthritis. However, arthritis isn’t inevitable—many people get through their lives without having arthritis, or having a very minimal amount of discomfort from it. A lot of it has to do with lifestyle and how strong and flexible you keep yourself. Any issues with strength, flexibility or stability of a joint will increase the wear on that joint.

There are things that we can do as we get older that can lessen the chance of having to deal with the pain of arthritis. Keeping moving is a big part of it, but also keeping the body balanced and keeping all of your muscle groups strong and maintaining flexibility is key. Unfortunately, those things tend to go by the wayside as we age and get busy and as life gets in the way, but when you lose that strength and flexibility and that compounds itself over a number of years, that’s when you get wear down of those joints.

ARTHRITIS PAIN

The biggest problem with arthritis is the pain associated with it, which leads to a greater decrease in activity, and then a greater decrease in strength and flexibility…and it all compounds on itself like a vicious cycle.

You don’t have to go far to see this: look around any parking lot and just watch the people and you’ll notice the different gates and different levels of ability to walk, and you’ll be able to see that something is amiss. That’s because they’re in pain.

The pain is there because, in essence, you’ve lost your shock absorbers around the joint. You’ve lost some stability and flexibility so the joint can’t move properly. You have that wear down in the joint, then due to the lack of stability and flexibility it causes even more irritation. So in order to get relief you have to break that cycle through movement.

HOW AQUATIC THERAPY CAN HELP

Our goal with patients suffering from arthritis is to get them moving as pain-free as we can, and to address the concerns of increasing strength, flexibility, endurance, and ultimately quality of life. This can be accomplished very effectively with Aquatic Therapy.

Aquatic therapy is simply physical therapy that takes place in water. When we get you into the pool, the buoyancy of the water unweights that painful joint, whether it be the hip or knee. Plus the warmth of the water will loosen up the tissues around that joint. This usually results in some level of immediate pain relief. Then we target different muscle groups as far as strengthening based on what we see: uneven gate patterns, increasing your endurance, lack of strength—we touch on all of those things as we design your program. 

Say we have a patient with knee arthritis: We watch their gate pattern when they come in and address any issues with that. Then we strengthen all the muscles that will support that knee joint from the glutei to the hamstrings to the quadriceps, all the way down the leg. 

A lack of flexibility tends to be one of the biggest causes of a lot of that pain; the hamstrings and quads are tight just from the lack of mobility because it hurts to move. The imbalance between the two makes them fight each other all the time, and that is what is stressing that knee joint. So we stretch out the muscles in the front of the thigh, the back of the thigh, the lower leg. All that combined with strengthening and walking exercises really does make a big difference. 

WHAT SHOULD I EXPECT FROM AQUATIC THERAPY FOR ARTHRITIS PAIN?

Something that I ask patients on their first day of treatment is “what would you like to get back to doing that you haven’t been able to do?” That becomes a goal for us to focus on attaining. Many times patients will come back in and say “I never though I’d be able to garden again,” or “I can walk my dog around the block again,” so it’s great to see them doing those things that they love.

The first day they come in, we take measurements of what their range of motion is like, then periodically we’ll retake those measurements and see what kind fo progress we’re making and recheck their strength gains and see what kind of progress we’re making there—just to make sure we’re doing what we need to be doing to get them better. Every person is different as far as how long it will take based on the severity of the arthritis or their level of inactivity, but we typically see pretty steady progress. Usually within a couple weeks we see noticeable improvements. 

People go from limping in the door and thinking of joint replacement surgery in the near future to being relatively pain free and putting off joint replacement surgery for years.

IS JOINT REPLACEMENT SURGERY INEVITABLE?

Not necessarily. We’ve had a lot of people come in who have talked about knee or hip replacement with the surgeon and are expecting that in the future, but the respond so well to therapy that they are able to postpone it indefinitely. Even if they do need surgery, if they do the therapy beforehand their recovery usually goes much better because they’re addressing their strength and flexibility issues before, which set them up for success. 

If a patient has a knee replacement, for example, they usually come see us quickly. The surgical procedures have gotten much better over the years; the incisions are smaller and the invasiveness of the procedure isn’t what it used to be, so there’s not as much trauma to the surrounding tissues. So now people are up and moving the day of surgery or the the day after surgery—it’s pretty amazing. There’s typically a short stay in the hospital and a minimal amount of physical therapy there, and then once they get home and graduate to outpatient therapy, they come work with us very quickly. 

Therapy for a knee replacement usually starts with base exercises to get the muscles firing correctly, then aggressive range of motion work. You really want to get the knee moving as quickly as possible so it doesn’t start to freeze up on you. So that’s what we usually focus on initially, then we gradually increase the strengthening component and continue working on flexibility, and once the incisions are healed up the patient can get into the pool and do pool exercises as well. Recovery time is different from person to person, but we generally see at least 3-6 months of rehab time for a knee replacement from start to finish. 

PUTTING IT ALL TOGETHER

Arthritis is a fact of life for a large portion of our aging population, but it doesn’t have to lead to a sedentary lifestyle. In fact, the more you move, the better off you will be. Strength, flexibility, and mobility are the key components, so stay active. If arthritis pain is hindering you from doing the things you love, aquatic therapy may be able to help. The buoyancy of the water takes the stress off of your inflamed joints, and the warmth of the water will loosen up the tissues around the joints. These qualities of the water, combined with the expertise of a trained aquatic therapist, can help balance and strengthen your muscle groups to help you move more naturally and with less pain. 

If you would like to discuss how to relieve your arthritis pain, contact us to set up an appointment with one of our physical therapists—we look forward to helping you move better!

By Brian Sherlock, PTA, B.S., ATRI, ACE, AEA