Arthritis – It is defined as a degenerative, non – inflammatory joint disease characterized by destruction of articular cartilage and formation of new bone at the joint surfaces and margins. It can occur in all the joints due to ageing, it is more commonly seen in weight – bearing joints like knee, hip, ankle and spine. Finger joints are more frequently affected. Knee joint is more commonly affected.
- WHO IS PRONE TO ARTHRITIS
- WHAT ARE TYPICAL SYMPTOMS OF ARTHRITIS
- WHAT JOINTS ARE USUALLY AFFECTED
- WHAT CAUSES ARTHRITIS
- DRUG MANAGEMENT
- EXERCISE GUIDELINES FOR ARTHRITIS
- EXERCISES FOR KNEE ARTHRITIS
- EXERCISES FOR HIP ARTHRITIS
- EXERCISES FOR WRIST AND HAND ARTHRITIS
- EXERCISES FOR SPINE ARTHRITIS
- EXERCISES FOR LUMBAR ARTHRITIS
- ANKLE ARTHRITIS
WHO IS PRONE TO ARTHRITIS
- Middle aged patients
- Women have a greater tendency than men
- One in three people over 60 years are affected and more than three in four persons over the age of seventy show radiographic evidence.
- Very rarely it can be seen in younger people.
WHAT ARE TYPICAL SYMPTOMS OF ARTHRITIS
- Early morning stiffness
- Restricted joint movements
- Swelling of the joints
WHAT JOINTS ARE USUALLY AFFECTED
- Weight bearing joints like hip, knee, ankle
WHAT CAUSES ARTHRITIS
- Age more than 40 years
- Hereditary conditions
- Previous joint injuries
- Disease of the joints
- Poor posture
- occupational stress and strain
- a combination of above factors
- physical examination
- blood tests
- CT AND MRI
- COX – 2 inhibitors
Exercises are recommended in arthritis. It helps the individuals in the following ways.
- Maintain muscle strength and joint mobility.
- Improves functional capabilities
- Relieves pain and stiffness
- Prevent further joint deformities
- Improves overall functional capabilities
- Restores neuromuscular coordination
- Mobilize stiff and contracted joints
Before beginning any exercise program consult with a proper physiotherapist and design a plan. Start with a goal to improve flexibility. Later progress to strengthening exercises to improve the muscle endurance. After that progress to aerobic exercise.
EXERCISE GUIDELINES FOR ARTHRITIS
- Begin with frequent, low intensity sessions
- Reduce exercise durations and intensity during pains and inflammation.
- Do warm up and cool down phases
- Perform full range of motion in every joint so as to prevent stiffness in the joints
- Rest properly after exercise. Do not exert yourself
EXERCISES FOR KNEE ARTHRITIS
- SEATED HAMSTRINGS STRETCH
Sit down on a long secure chair. Slide out to the edge of the chair. Straight one leg out and gently reach out the same hand down to try and touch the toes. Hold for 30 seconds. Repeat with other side.
- STANDING QUADRICEPS STRETCH
Stand facing the wall. Bend one knee grabbing the ankle. Bring heel to buttocks. Maintain the body straight. Do not tilt the body. Hold for 30 seconds. Repeat on the other side.
- QUADRICEPS SETTING ( QUAD SETS )
Position can be lying or sitting in a chair with heel on the floor or long sitting with the knees extended. Try to push the knee back and tighten the thigh muscles and pull your knee cap up. Once this exercise is performed properly, try to reinforce the exercise with ankle moving towards the face simultaneously with the pressure movement. Hold for 10 seconds and repeat 10 times.
- SHORT ARC TERMINAL EXTENSION
Position can be lying or long sitting. Place a small towel or bolster under the knee to support the knee into a little bend position. Now extend the slightly bend knee against the resistance of the gravity. Hold for 10 seconds and repeat it 10 times. Increase the resistance of the exercise by adding the weight cuff on the leg.
- CHAIR SCOOTING
Position should be sitting, on a rolling stool or chair. Try to “walk” forward to use hamstrings ( muscle in back of thigh) or “walk” backward to use quadriceps ( muscle in front of thigh). Resistance can be increased by putting the obstacles in between or you can also roll the stool on the carpet.
- LEG EXTENSION
Sit up straight in a chair and maintain a good posture. Extend the leg straight contracting the quadriceps (muscles on front of the knee) and foot facing upwards towards the face. Hold for 10 seconds and repeat 10 times. Add the resistance to the exercise by adding the weight cuff on the lower leg.
- LEG CURL
Stand up straight or hold the wall for support. Try to bent the knee towards the hip. Hold for 10 seconds and repeat 10 times. Add the resistance to the exercise by adding the weight cuff on the lower leg.
- CALF RAISES
Stand with weight evenly distributed over both feet. Hold onto the back of the chair. Lift the unaffected foot off the floor so that all the weight is placed on the affected foot. Raise the heel of the affected foot as high as you can and hold for 10 seconds and lower it. Repeat 10 times.
- HEEL SLIDES
Lie down on a comfortable mat with leg stretch out in the front. Keeping the foot to the floor, slowly bend one knee until you feel it is being comfortably bent without any pain. Hold for 10 seconds and straighten the leg for 10 seconds. Repeat for 10 times.
- PARTIAL SQUATS
Stand with feet shoulder distance apart. Hold the chair for support. Squat down for just 30 degree until your kneecap covers the big toe. Start with hold for 5 seconds and repeat 5 times.
Later increase the holds for 10 seconds and 10 times.
EXERCISES FOR HIP ARTHRITIS
- SEATED HIP STRETCH
Sit down in a strong and comfortable chair. Cross the left leg over right. Gently lean forward into the stretch. Hold for 30 seconds. Repeat on the other side and for 10 times .
- LYING DOWN HIP STRETCH
Sit down on a comfortable mat and extend the right leg out. Cross the left leg over the right. Bring your left hand back, with the help of right hand push the left leg towards the shoulder, and rotate your body towards left shoulder. Hold for 30 seconds and repeat 10 times.
- Straight leg raise
Lie on the back. Bend the right leg. Tighten the muscle of the left leg and slightly lift the left leg off the floor. Hold the leg for 10 seconds. Lift the leg to approximately 30 cm off the floor.
- PRONE STRAIGHT LEG RAISE
Lie on the floor on the stomach with your leg straight. Rest your head on the arms. Tight your hip and back of the thigh muscles and raise the leg towards the ceiling as high as you can. Hold for 10 seconds and repeat 10 times. Lower the leg and rest for 2 seconds and repeat with other leg.
- SIDE STRAIGHT LEG RAISE
Lie on one side with the bottom leg little bend for support. Straighten your top leg and slowly raise to 45 degrees keeping knee straight but not locked or hyper extended. Hold for 10 seconds, slowly lower the leg, and hold for 2 seconds and repeat. Perform the exercise 10 times with both the legs.
- STRAIGHT LEG LOWERING
Maintain the position of the straight leg raising exercise. Now try to lower down the extremity gradually by holding at the different angles. Maintain the position for 5 seconds and repeat 10 times.
- STATIC HAMSTRINGS EXERCISE
Position should be lying on the back. Keep a towel roll or bolster under the heel or little above heel. Try to press the heel or above heel area downwards without bending the knee or lifting the pelvis. Hold for 10 seconds and repeat 10 times.
EXERCISES FOR WRIST AND HAND ARTHRITIS
- WRIST EXTENSORS STRETCH
Hold one hand at chest level with elbow bend. With other hand grasp the thumb side of the hand and bend your wrist downwards. To increase the stretch, bend the wrist towards the little finger. Repeat the exercise with straight-arm. Repeat with other hand. Hold for 30 seconds and repeat 10 times.
- WRIST FLEXORS STRETCH
Hold one hand at chest level with elbow little bend. Grasp the fingers of that hand with other hand. Pull the hand back gently. Repeat the exercise with hand straight. Hold for 30 seconds and repeat 10 times. Repeat with other hand.
- RESISTED EXERCISE
Resisted wrist extension – put your hand facing down on the table. Keep the other hand on top of it. Try to raise the lower hand against the resistance of the upper hand. Hold for 10 seconds. Repeat 10 times. Repeat with other hand.
Resisted wrist bending – everything is same . just keep palm facing up.
- FLEXIBILITY EXERCISE FOR FINGERS
THUMB TO FINGER TIP – Try to touch the tip of the thumb to each finger tip.
THUMB TO BASE OF FINGERS – Try to touch the tip of the thumb to base of the fingers.
Make circles with the thumb.
Keep the fingers straight on the knees. Try to expand all the fingers out and then back.
- STRENGHTNING EXERCISE OF FINGERS
Keep the handkerchief and put some weights on it. Place the hand on it and try to bend the fingers against the resistance. Similarly try to expand the fingers out and in against the resistance.
- STRENGTHEN FINGERS
Hand pointing in opposite direction and place the pads of each fingers of one hand against the pads of each finger of other hand, and then curl the fingers against the resistance provided by other hand.
EXERCISES FOR SPINE ARTHRITIS
- Neck movements – bend the neck downwards 5 times. Extend the neck 5 times. Bring your neck to sideways. First right then rest for 2 sec., then left side and then again neutral.
- CHIN TUCK IN – you can do this in sitting or standing posture. One can also do the exercise in lying position. Try to bring the chin slight back and down so that the ears are in line with the shoulders and you feel the stretch at the back of the muscle. Keep your shoulders and upper back well supported in sitting position. While tucking, hold for 5 seconds. Repeat this 10 times. Breathing should be normal. Perform this exercise many times a day. It helps to strengthen the
muscles as well as keep the posture correct.
- Self-resistance exercises– place both hands on the forehead and press the forehead into the palms in a nodding fashion while not moving.
Side bending – press one hand against the side of the head and attempt to side bend, as if trying to bring the ear towards the shoulder but not moving.
Axial extension – press the back of the head, which are placed in the back, near the top of the back.
Rotation – press one hand against the region just superior and lateral to the eye and attempt to turn the head to look over the shoulder but not allowing motion.
- Self stretch
Sit on a firm, straight – back chair with the hands behind the back. Clasp the fingers together. Bring the elbows together. Then bring the elbows apart and stretch to the maximum. Hold for 10 seconds and repeat 10 times. This exercise can be performed in the offices. One can coordinate with the breathing pattern by inhaling as the elbows are out and exhaling as the elbows are together.
- WALL PUSH UPS – stand in front of a bare wall. Lift your arms up to shoulder level. In this position try to inhale to the maximum, and then while exhaling, pushes off the wall until your arms are in an outstretched position with elbows slightly bent. Hold for 10 seconds and repeat 10 times.
- To stretch neck muscles – sit upright in a chair and turn your head to the right, place the right hand on the top of the head. Slowly bend neck towards the right shoulder. Do not pull the head, simply allow the hand to support the head and neck in this position. With the left hand grasp the chair and slowly lean towards the right so that the stretch is felt. Hold for 10 seconds and repeat for 5 times.
EXERCISES FOR LUMBAR ARTHRITIS
- STANDING BACK BEND
Stand with feet hip distance apart. Place the palms of your hands on the low back with fingers pointing down. Take an inhale as you lift up focusing on drawing the belly in, keeping your core strong. Exhale and arch the body backwards until you feel comfortable. You can keep your neck in line with spine or drop it back. Hold for 10 seconds and repeat 10 times.
Lie on the stomach. Prop yourself up on the elbows, allowing the pelvis to sag. Breathe and hold for 5 seconds and then come back to starting position. Remember not to bend your neck backwards and always keep the hips grounded.
Lie on the stomach. Progress the above exercise. Prop yourself up on the hands, allowing the pelvis to sag down. Breathe and hold for 5 seconds and then come back to starting position. Remember not to bend your neck backwards and always keep the hips grounded.
- KNEE TO CHEST EXERCISE– lie straight on the back in a comfortable position on the yoga mat. Bring one knee towards the chest, clasp the hands around the thighs and pull it towards the chest. Hold for 10 seconds and then repeat with another leg.
Progress the exercise by bringing both the knees towards the chest elevating the sacrum off the mat.
- PELVIC BRIDGING– Lie on the flat surface like a yoga mat. Bend your feet flat on the floor with feet 6-8 inches apart. Palms should be flat on the floor. Relax your upper body and back while you draw in your abdominals and squeeze your pelvic floor muscles- thinking of stopping your urine. while exhaling press your hands into the floor and lift the pelvis up towards the ceiling. Hold for 10 seconds and then while inhaling slowly bring the pelvis down. Keep the abdominals tight. Repeat for 10 times.
- PELVIC ROLLING
Lie on your back. Keep your knee bend and together. Keep your upper body relaxed and chin gently tuck in. Roll your knees on one side followed by the pelvis keeping both shoulders on the floor and then back to neutral position. One should move until the comfortable position. hold for 10 seconds and repeat 10 times.
EXERCISES FOR ANKLE ARTHRITIS
1 . SELF STRETCH EXERCISE
Position is sitting. Grasp the hind foot and mid foot with the opposite hand and try to lift the foot into inversion that is inward movement.
Now, the position is long sitting. Wrap the towel around the foot and pull the towel inwards or outwards as well as upwards for the stretch.
2 . ANKLE TOE MOVEMENTS
Position is lying on the back. Knee straight. Try to move the ankle upward, downward, inward and outward. Repeat 10 times each.
- Place a ball or foam roller under the mid foot and try to push it down.
- Keep the cloth on the floor and keep some resistance on the cloth. Try to curl the fingers on the clothes.
These are some of the exercise for arthritis. It is advised to consult a physician as well as physiotherapist for severe pain and swelling in any joint. Do exercises daily twice a day. Every joint should be involved so that muscles remain flexible and strengthen. Try doing all these exercises slowly and gradually .
- Exercises for arthritis, JCCNV
- Therapeutic exercises, Carolyn kisner, 5th edition
- Essentials of orthopaedics and applied physiotherapy, jayant joshi
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