Arthritis and Exercise

by Katie Hopkins, DPT

It’s one of the most common causes of disability in the U.S., according to the CDC, and about 1 in every 5 adults is diagnosed with it. Two-thirds of those diagnosed with it are under the age of 65.

Would it surprise you to learn that I’m talking about arthritis?

It is a common misconception that arthritis is an ailment only for the elderly. In fact, arthritis can describe a variety of conditions, including rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and gout. Of these, the two most common types of arthritis diagnosed are osteoarthritis (OA) and rheumatoid arthritis (RA). While both have symptoms that include swelling around the joints, those with osteoarthritis tend to experience more joint pain, stiffness and achiness while rheumatoid arthritis sufferers experience more muscle stiffness, achiness, fatigue and weakness.

Due to weakness and fatigue, patients with RA often have difficulty lifting items over 5 lbs., climbing a flight of stairs or walking more than 1/4 of a mile. In fact, studies show that people with RA are anywhere from 33% to 55% weaker than healthy controls. An aggressive exercise regimen is often recommended to combat muscle atrophy and fatigue, as this keeps patients functioning at a higher level in their daily lives. Research shows that patients with RA benefit from both short-term and long-term aerobic capacity and dynamic strengthening programs to produce and maintain higher levels of function.

Conversely, patients with OA tend to suffer from more joint pain and stiffness affecting their range of motion and muscle function. Hips and knees are two joints commonly affected by OA, and OA in these joints tend to lead to the most functional limitations and greatest decrease in quality of life. Research studies indicate that resistance training - along with aerobic exercise - lead to the most changes in patients with OA in their knees. While there has not been as much research done specifically on hip OA, preliminary studies do show that therapeutic exercise programs are as effective for the hip as they are for the knee. Perhaps one of the most notable factors in osteoarthritis research is that long-term results tend to diminish when a prescribed exercise program is not updated or a patient does adhere to the same levels of exercise independently.

The research supports the effectiveness of an individualized physical therapy program in treating symptoms of arthritis. A physical therapist can help you to determine what specific exercises are best for you and your joints and how to manage your symptoms long term.

References:

Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive Resistance Training Improves Overall Physical Activity Levels in Patients with early Osteoarthritis of the Knee: A Randomized Controlled Trial. Phys Ther. 2010;90(3);356-366.

Fernandes L, Storheim K, Nordsletten L, Risberg MA. Development of a Therapeutic Exercise Program for Patients with Osteoarthritis of the Hip.  Phys Ther. 2010;90(4);592-601.

Iversen MD, Brandenstein, JS. Do Dynamic Strengthening and Aerobic Capacity Exercises Reduce Pain and Improve Functional Outcomes and Strength in People with Established Rheumatoid Arthritis. Phys Ther.  2012;92(10);1251-1257.

Lin CC, Taylor D, Bierma-Zeinstra S, Maher CG. Exercise for Osteoarthritis of the Knee. Phys Ther. 2010;90(6);839-842

The Harm of Overtraining in Adolescents

by Stephanie Korso, PT

This is part two in our two-part series on overtraining.

If you have been following our blog, then you are probably already familiar with overtraining and ways to prevent overtraining, especially with regard to endurance running and weightlifting. In case you are tuning in for the first time, however, here is a brief summary of what you need to know:

• When we train, we stress our system and then allow it to recover. This then allows our system to adapt so it can tolerate greater stress in the future. With any training program, there is a risk of overtraining.
• Overtraining involves a loss of balance between stress and recovery. Not only does this contribute to overuse injuries, pain syndromes, and decreased performance, but overtraining can also have negative physiological effects. It can contribute to altered hormone levels, systemic inflammation, immune system suppression, excessive fatigue, poor concentration, sleep disorders, and even depression.

While it is possible for anyone to be affected by overtraining, some people are at higher risk than others. Adolescents are at high risk for overtraining because there is pressure for early sport specialization and there are increased opportunities to play on multiple sports teams (school, park district, travel, etc.). Overtraining in adolescents is especially concerning because it can affect puberty, contribute to poor academic performance, and limit socialization. Furthermore, injuries sustained during adolescence, especially if not appropriately managed, can limit sport participation throughout high school, college, and even adult life.

The best treatment for overtraining is prevention. For adolescents, the following formula is recommended to avoid overtraining: hours trained per week < years old. That means, if Kevin is 12 years old, he should avoid playing more than 12 hours of baseball each week to help prevent overtraining and its potential negative consequences.

If overtraining syndrome is present in adolescents, relative rest for 6-12 weeks is recommended. Then, as young athletes begin returning to sport, they should gradually increase activity volume before increasing intensity. If signs of overtraining reappear, then activity levels should be again be modified to allow proper recovery. 

The Harm of Overtraining

by Meredith Franczyk, PT

This is part one of a two-part series on overtraining.

Chicago is in marathon and triathlon season, which often means there is an influx of patients who come in with injuries due to overtraining. As athletes try to increase their mileage and speed, they can fall prey to the common misconception that more exercise is always better. As a physical therapist, however, I frequently see injuries among athletes who try to increase their activity level more intensely than their bodies are ready.

While overuse tends to occur more frequently among endurance athletes, they can occur among weightlifters as well: trying to increase the amount of weight lifted too quickly can lead to injury just as much as trying to drastically reduce mile time can. Athletes do not always account for the need for proper diet and increased rest and hydration as activity increases, and a lack of any of these inhibits proper muscle repair, causing the athlete to be weaker and less efficient. In addition to muscle injury and stress fractures, overuse can cause increased fatigue, muscle atrophy, insomnia, irritability, digestive problems and increased cortisol levels - and, most importantly, can lead to athletes enjoying exercise less.

So, how does one prevent overuse while maintaining a consistent training schedule? The answer is cross training: a way to let the muscles you use during training rest while working on alternate muscle groups that are not being trained. Not only can cross training prevent overuse injuries, but it also improves athletic performance in general. The Mayo Clinic recommends low impact activities such as walking, biking, swimming and water jogging as a way to stay active while giving muscles a break. A sample training schedule for a runner might include 4 days of running with 2 days or strength training; for weightlifters, it could involve lifting 4 days a week but spending 2 days adding cardio or yoga.

Cross training, along with making sure one follows a training schedule in which speed and distance (or repetitions and weights) are increased gradually, helps to keep athletes safe and healthy. Having an athletic off-day can mean that your body needs a day off - being in tune with what your body is telling you will help prevent overuse injuries and make you a better athlete.

The Advantage of a Small Physical Therapy Practice

by Sally Fansler, PT

Imagine you're in pain and are looking for relief through physical therapy. You've heard the big names tossed around, but you're concerned: will they give you the attention you need to recover? Will they know who you are each time you walk in the door?

Small physical therapy clinics often have a distinct advantage over their corporate counterparts. While large entities can build brand recognition by consolidating service and decreasing cost, smaller practices aim to set themselves apart with attention to detail, ultimately allowing for more effective care for their patients. 

A smaller private practice boasts an intimate atmosphere that often feels more comfortable and less generic, allowing the patient and the therapist to focus on treatment and goals without unnecessary distractions. As a result, the therapist and the patient are able to form a solid connection that easily translates to enhanced delivery of care. Through one-on-one treatments with ample time, the physical therapist becomes firmly invested in the patient's treatment, tailoring it to his or her needs and adapting as progress is made. 

Without a complex administrative hierarchy, the staff at a small physical therapy clinic is also able to make every patient feel like a priority. The theme song from Cheers, “Where Everybody Know Your Name," comes to mind and is the perfect analogy for a small, comfortable spot for physical therapy treatment. 

With an unyielding commitment to care and a desirable atmosphere, the benefits are clear. A small practice with a warm environment excels in the areas that count.

Improving Posture

by Lauren Sweeney, Office Manager

As an office manager in a physical therapy office, I see people working on a variety of exercises to strengthen injured body parts. While the specific exercises they do vary, I often hear the therapists encouraging patients to be mindful of their posture. This may be surprising - "posture" seems a word more at home in a Victorian etiquette class or with a book balanced on one's head than in a therapeutic setting. However, holding our bodies in the optimal position for efficient and effective work is as much a part of our health as diet and exercise ought to be. In fact, posture is something I have to think about every day: when I type at my desk or answer the phone, it's tempting to sit on my feet or hold the phone between my ear and my shoulder. While those body positions may be comfortable in the short term, the asymmetry can lead to long-term pain and strain.

It's easy to go too far the other direction as well. As I feel myself start to slouch at my desk, I sometimes attempt too much correction to achieve proper posture, squeezing my shoulder blades together in an attempt to sit up straighter. Unfortunately, this exaggerated movement is also not a neutral spine position, and can be every bit as uncomfortable as slouching. To achieve a neutral spine - meaning that the three natural curves of the spine are present and in good alignment - try the following:

Definitely not a neutral spine

•   Open up your chest slightly and align your ears over your shoulders.

•   Sit smarter by keeping your back in contact with the back of your chair and your feet squarely on the ground. Try not to cross your legs.

•   If you work at a computer, position your screen to avoid straining forward and jutting your chin out. Be sure to seek proper corrective eyewear if needed.

•   When using a mobile phone, move your phone up instead of dropping your head to your phone to avoid "texting neck."

Posture is not simply a description of one's physical state - it is also often a reflection of one's emotional and mental state. I feel more relaxed and confident when I'm maintaining strong posture: I'm able to breathe more easily and do my job more efficiently because my body is well supported. Conscious awareness of your own posture is the best way to start making a change in both how you look and feel. Good posture can instantly make you look an inch taller, more confident, younger, and slimmer. Why not give it a try?

Stretch the Truth: Resistance Bands vs. Free Weights

by Katie Hopkins, PT

Whether you’ve used them or not, resistance bands are a common sight in any fitness area: the array of rainbow-colored tubes is easy to spot. First appearing in a patent for “a gymnastic apparatus” by a Swiss inventor in the late 1800s, resistance bands were once primarily used for rehabilitation and fitness, gaining popularity among therapists during the 1960s. As the modern fitness revolution took hold, the bands became attractive to the general public for their effectiveness, variety, convenience, ease of storage, affordability, and travel capabilities.

There’s more to their popularity than just hype, too: studies have shown that resistance bands can increase muscle strength, muscle size and decrease body fat at a similar rate as weight training.  The muscle activity and muscle peak load are similar during training for resistance bands and free weights, and they both provide exercise with free range of motion, variable speed of movement and progressive resistance.

Where resistance bands differ is in their functionality. Bands do not rely on gravity to provide resistance and give a continuous tension throughout the range of motion.  The resistance of the band increases as the range of motion increases, allowing the muscle to work all the way through the range. Resistance bands also translate better into functional movement patterns for daily tasks and sports related training: exercises can be done in multiple directions and planes relating more to natural body movements, such as twisting one’s trunk, reaching, kicking a soccer ball or swinging a tennis racquet. Resistance bands can decrease the ability to “cheat” while performing an exercise, as momentum does not provide a big advantage.

Katie can be reached at katie@lakeshore-pt.com.

Pain Management: The PT Alternative to Opioid Use

by Stephanie Korso, PT

Pain can make us feel uncomfortable, frustrated, and just plain miserable. It can interfere with our ability to perform everyday activities, like getting dressed and doing household chores. It can stop us from going to work or even fun social events. Who wants to live like that?

With our busy lives and hectic schedules, we tend to look for the easiest and most convenient fix. Often times, prescription pain medications (opioids) seem like the answer. Opioids can be helpful for short periods of time, but our bodies naturally adapt to these drugs with prolonged exposure. To continue feeling the positive pain-relieving effects of these drugs, our bodies require higher doses, which can lead to dependence, abuse, and addiction. Unfortunately, there has been a recent rise in abuse of both prescription and illegal drugs, and prescription pain medications seem to be a gateway to illegal drug abuse.

That's why the White House has an initiative to combat prescription and illegal drug abuse, and the American Physical Therapy Association (APTA) has joined this initiative. Research shows that pain can be effectively managed by conservative, non-drug approaches such as physical therapy. Physical therapists are trained in hands-on therapy (manual therapy), exercises (to improve mobility and strength), and modalities (ice, heat, electrical stimulation and ultrasound), all of which can have pain-relieving effects. If pain is interfering with your everyday activities or ability to participate in fun summer events, you may benefit from physical therapy.

Stephanie can be reached at stephanie@lakeshore-pt.com.

TLC for the ACL

by Amy Goldstein, PT

No matter what sport you follow, there's a good chance you've heard of athletes suffering from an ACL tear. The anterior cruciate ligament (ACL) is a knee ligament that attaches the front top portion of the shin bone (tibia) to the back bottom portion of the thigh bone (femur). One of four ligaments in the knee, the ACL prevents the tibia from sliding forward and medially from the femur. ACL tears are one of the most common knee injuries, with over 100,000 occurring annually in the US.

While it may not be surprising that contact sports such as football and soccer are a common source of ACL injuries, it is possible to tear the ACL without any direct contact at all. Changing direction rapidly, stopping suddenly, landing from a jump incorrectly or landing with a hyperextended knee can also cause injury to the ACL. Females are 3.5 times more likely to tear their ACL than males, and ACL injuries are most prevalent among 15-19 year-olds.

So what can be done to prevent injury? Evidence has suggested that strengthening the muscles of the leg and core, as well as working on neuromuscular control and balance of the leg, can help prevent a tear of the ACL. Strengthening the hamstrings, gluteal muscles and external hip rotators can help to prevent the inward collapse that occurs during an ACL injury, while working on neuromuscular control and balance helps to improve the timing of the muscles in the leg. Athletes can also work on jumping mechanics to improve landing form and to prevent excess strain on the ACL. Typically, a strengthening program of 3 times a week for at least 6 weeks is required to notice a change.

Amy can be reached at amy@lakeshore-pt.com.