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Old 08-15-2007, 08:54 AM   #1
Iaian Park
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Osteoarthritis

I have a couple of clients with Osteoarthritis of the knee. I have consulted several Physio's and Doctors and have gotten almost different answers from all of them. They have been, no squats or deep knee bends (lol), to do seated knee extensions, lying leg raises.

Is there anyone here that has prescribed a program successfully to work with this pathology?

I realise that each client is going to be different and work within their pain tolerances but am looking for something that will help them maintain functionality.

Thanks.
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Old 08-15-2007, 12:35 PM   #2
Bryan Veis
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Iaian,

I've had OA (hip, not knee) for over 20 years. This is a use-it-or-lose-it condition. Your clients have to make a choice -- they can work to whatever level they can tolerate to maintain strength and range of motion, or they can do nothing and lose both. In my experience, the more you move, the less it hurts. Exercise and movement won't make the OA worse; that's a condition that operates on its own schedule. Exercise actually makes it feel better in my case.

If things are so bad that they can't use their knees at all, though, then they ought to be looking into joint replacement surgery rather than exercise or therapy, but that's something to discuss with their rheumatologist and orthopedic surgeon.
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Old 08-16-2007, 07:03 PM   #3
Elliot Royce
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I have a slightly different perspective. Certainly I agree that exercise should continue to be a focus. OA is not only tough physically but also mentally and exercise creates endorphins and a positive mood.

Having said that, avoid exercises that will continue to wear away the cartilage. There is often a fine line between tolerable pain and incredible agony depending on how much cartilage you have.

A good guide is to avoid anything which leaves a lasting pain or creates a sudden pain. There will be aches when you exercise which you have to get used to but you should avoid things that create pain for hours or days afterwards.

I had severe OA on both hips and have artificial ones now, but spent 4 years learning to live with the pain. I was still playing hockey up to the weekend before I got operated on. No need to give up exercise, just minimize the pain.
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Old 08-17-2007, 03:39 AM   #4
Aileen Reid
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There are really differing views on this. I have always been of the belief that let pain be your guide. Now, I can do leg extensions no worries but my physio says absolutely NOT!!!!!! Even if they don't hurt. This baffles me.

Being of advancing years myself :-), I try and take my glucosamine, fish oil and flaxseed oil regularly.

The other major danger I find is changing your routine. More often than not it brings me grief - for the most unexpected of reasons. See my post on knee pain! It seems to me, looking back, the onset of all that saga was a few free lessons with a PT. I said - give me stuff I don't normally do, anything to help my running. I did lots of one legged squats (both stepping up onto and also down off a step) and one legged leg presses, static lunges and very narrow stance leg presses. My reward was the slow onset of what I now have and can't get rid of!

I think my mantra is never give up!
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Old 08-17-2007, 09:23 AM   #5
Ken Mindoro
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The best way patients with osteoarthritis can save their knees is to use them. I personally don't see any problems with prescribing squats for patients with knee osteoarthritis if they can be done with proper form. When I encourage my patients to exercise, I suggest that they choose activities/movements that minimize further wear on their joints. (i.e. exercises that keep muscles strong and maintain flexibility, exercises that allow them to take short breaks)

As always, exercise intensity is scaled to the patient's ability. A combination of exercises that use a good ROM, encourage body awareness, build strength around the joint and improve metcon would be ideal. Just be sure to ramp things up slowly, stay within their tolerance and allow ample time for recovery. A warm pad on before exercise can help improve ROM. Icing the knees after exercise can also help. As always, make sure they get clearance from their doctor first.

Disclaimer: This advice is freely given is probably worth what you are paying for it. It is not meant to be a replacement for talking with your own personal physician.
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Old 08-20-2007, 05:38 AM   #6
Iaian Park
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Re: Osteoarthritis

Thanks for the feed back everyone. Kinda of what I thought. My clients are learning to manage the pain and we are taking each workout 1 at a time.
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Old 08-27-2007, 10:35 PM   #7
Chris Wong
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Re: Osteoarthritis

Hey Iaian, what's up man? Hello from downunder! Total fluke i happened to come onto your post, but from the sounds of it i think your on the right track as well as most of the others who posted.

OA is a degenerative condition, so it's more a matter of trying to prolong a person's functional status and managing their symptoms. Use pain as a guide; modify the activity or the range of motion within the activity too keep it within a pain-free range or tolerable range. Strengthen and increase endurance in the musculature to take off the load from the bony structures. Good luck and keep me informed! Still waiting for that update from ya!

CW
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Old 08-27-2007, 10:50 PM   #8
Ken Froese
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Re: Osteoarthritis

Pick up Wear and tear by Dr Bob Arnot, its all about learning how to live with osteoarthritis. Another book I picked up, but have not read yet is 3 minuttes to a pain free life.
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