Osteoarthritis is the most common form of arthritis affecting millions of people worldwide. Currently, it is the most common condition treated in the Physiotherapy department. Serendib Today, spoke to Chartered Physiotherapist and Bobath specialist, Dr. Gopi Kitnasamy on Osteoarthritis, its symptoms and treatments.
Chartered Physiotherapist, Dr. Gopi Kitnasamy says that Osteoarthritis occurs when the protective cartilage on the ends of the bones wears down over time. “Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine. In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In Osteoarthritis, the cartilage breaks down, causing pain, swelling and problems moving the joint,” he said.
According to Dr. Kitnasamy, Osteoarthritis symptoms can usually be effectively managed, although the underlying process cannot be reversed. “Staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function. Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include joint pain, joint tenderness, stiffness, loss of flexibility, grating sensation and bone spurs,” he says.
He further explained that the risk of osteoarthritis increases with age. “Women are more likely to develop osteoarthritis, though it isn’t clear why. Obesity is too a factor of Osteoarthritis as carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh the greater your risk. Increased weight puts added stress on weight-bearing joints, such as your hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints. Joint injuries too can cause osteoarthritis. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis. Even injuries that occurred many years ago and seemingly healed can increase your risk of osteoarthritis. Genetics, bone deformities and certain occupation that place repetitive stress on a particular joint too contribute to osteoarthritis,” he added.
Dr. Kitnasamy further said that exercise is an integral part of any arthritis treatment program, as it helps to strengthen and stabilize the joints, preventing further damage. “For patients suffering from osteoarthritis, the pain brought on by regular exercise can feel unbearable. Water Exercise is an excellent option for patients with osteoarthritis of the knees, hip osteoarthritis, and spinal osteoarthritis due to the decreased pressure placed on the joints,” he added.
He explained that water provides an ideal environment for patients to exercise because the buoyant force of water counteracts the downward pull of gravity, thus reducing the weight placed on the joints. Studies have shown that up to 50% of body weight is supported in waist-deep water, while 90% of weight is supported in neck-deep water. Patients suffering from osteoarthritis are often unable to perform traditional land-based exercises due to increased pain created by the impact. In a supportive medium such as water, patients can perform similar strengthening or endurance exercises with the benefit of gentle resistance, and also a reduction in pain.
“Water exercise is especially helpful in cases where a land-based exercise program is not possible due to the intensity of pain, decreased bone density, disability or other factors. Water exercise is particularly good for people with conditions such as Osteoarthritis, advanced osteoporosis (with susceptibility to and/or pain from fracture), muscle strain or tears and physical disabilities and neurological disorders,” Dr. Kitnasamy explained.
“In addition to those conditions, water exercise is frequently recommended as one form of exercise therapy to treat those with diabetes as well as individuals with high blood pressure. Both conditions can improve and become more manageable with water exercise. The physical properties of water make it a highly desirable medium in which to exercise to treat arthritis, back pain and other musculoskeletal injuries,” he further added.
Dr. Kitnasamy said that water walking is becoming popular. “Water walking is considered easy on the joints, according to the Arthritis Foundation. You can walk in the shallow end of the pool or walk in the deep end with a flotation belt. You can walk backwards and sideways, as well as frontwards in the pool, to tone different muscles. Sitting along the pool edge and doing kicks or squats also enhance your water workout,” he said.
“Overweight and Obese adults may have functional limitations that result in difficulty performing traditional weight-bearing exercises and activities. Water exercise is a commonly recommended alternative due to the potential therapeutic qualities of water. Weight loss involves burning more calories than a person ingests. Understanding this one basic fact takes the magic and intimidation factor out of the weight-loss equation. Water exercise allows people to work out longer at lower intensities, thereby burning more calories than shorter duration and is a high-intensity exercise,” he further explained.
Some of the most important properties of water that make exercise easier are:
- Buoyancy: water counteracts gravity and helps to support the weight of the patient in a controlled fashion as the patient is immersed. This can aid the development of improved balance and strength. The buoyancy of water also permits a greater range of positions due to the virtual elimination of gravitational forces, particularly for exercises that require lifting the legs, the heaviest limb of the body for most people.
- Viscosity: water provides resistance by means of gentle friction, allowing strengthening and conditioning of an injury while reducing the risk of further injury due to loss of balance.
- Hydrostatic pressure: there are powerful effects produced by hydrostatic pressure that improve heart and lung function, making aquatic exercise a very useful way to maintain and strengthen heart and lung function. This pressure effect also aids in improving muscle blood flow. Water provides 12 times the resistance of air, which means walking in water requires more effort and ultimately burns more calories than walking on land. And still it’s a great workout, as you walk, you’re really strengthening and building muscle.
Types of Water Exercises
Exercises often resemble those performed in traditional land-based exercise programs. They look similar to stretching or resistance exercises conducted on land, with the exception that they use the gentle resistance of water rather than gravity to exercise muscles or joints. A few of the more popular exercises are:
- Stretching, including stretching the hamstrings and lower back by slowly raising knees to chest, or stretching the upper back and neck by standing away from the side of the pool and leaning forward with arms outstretched to grasp the pool edge
- Strengthening, including using foam barbells to complete bicep curls or lateral side raises that work against water resistance
- Water aerobics, including water walking or slow jogging in a shallow pool which loosens the lower back and hips
- Ai Chi, a hybrid form of Tai Chi developed specifically for water exercise that develops strength, balance, and joint flexibility through slow gentle movements while focusing upon relaxation and controlled breathing.