Osteaoarthritis and Muscle Function

Osteoarthritis and Muscle Function

By Brian O’Neil PT, OCS, CSCS

Osteoarthritis (OA) is the most common form of arthritis, affecting some 27 million people in the US alone. Fifty percent of people over the age of 65 will have some evidence of OA in at least 1 joint on X-Ray. Risk factors for OA include age, being overweight, previous injury to a joint, genetics, and muscle weakness. Early signs of arthritis include pain, swelling, and reduced joint motion. One of the most common signs of osteoarthritis is stiffness in the morning or after a period of inactivity, which in the early stages usually resolves after a 10-15 minute warm-up period.

Many studies have focused on the relationship between muscle weakness and osteoarthritis. Significant weakness in both knee and hip muscles has been found in patients with knee arthritis. For years it had been unclear whether the weakness was a cause or a result of the arthritis; however more recent evidence indicates that muscle weakness in many cases precedes the onset of OA at a specific joint. It has also been well documented that swelling in a joint will inhibit, or shut down the muscles around the joint. This is a normal protective reflex in which the body is attempting to protect an injured joint. However, this prevents the muscle from being fully activated during voluntary contraction, and will lead to muscle atrophy, loss of strength, and difficulty with functional activities. Researchers have also recently found that strength deficits are not strictly isolated to the leg with the arthritis. The opposite limb will also exhibit muscle weakness, even when no OA yet exists in that limb.

Exercise, including targeted resistance training, global strengthening, and aerobic conditioning, has been shown to reduce pain and improve function in people with both knee and hip OA. Specific exercise can be used to reduce muscle inhibition. Exercise programs must include the entire lower extremity, and should also include strengthening activities for the uninvolved limb to promote function and prevent or delay onset of OA. Exercise programs must be considered long-term management of symptoms, with consistency the largest predictor of a positive long-term outcome. With recent evidence suggesting that muscle weakness precedes the onset of OA, exercise must be considered an important factor not only in the treatment of OA, but also in prevention.

Brian O’Neil is a physical therapist with Magill and Gardner Physical Therapy. He can be reached at MGPT@Comcast.net.

Falls and How To Prevent Them

By Brian O'Neil PT, OCS, CSCS

One out of three adults age 65 and older will fall each year.  Falls are the leading cause of injury death in the US, with 20,000 deaths among older adults each year.  Fifty percent of those hospitilized due to a fall-related injury are discharged to long term nursing care and will never return to independent living.  Direct medical costs from falls amount to almost 30 billion per year.  There are several risk factors that will increase an older adult's chance of suffering a fall.  They include gait and balance problems, poor vision, muscle weakness, chronic health problems, diabetes and/or peripheral neuropathy, taking 4 or more medications, and environmental factors such as poor lighting and lack of hand rails and grab bars.  Although advanced age is a risk factor, falls are not a normal part of aging and should not be tread as such.

Fall prevention must begin in the home.  Grab bars should be installed in the shower and beside the toilet.  All stairs should have hand rails on both sides, and any scatter rugs should be securely taped down or removed.  Re-arrange closets and kitchen so that the things used most often are between waist and shoulder height.  Review medications with your physician to see if dosages can be reduced, and see your optometrist yearly to have your vision checked.  Increase your vitamin D intake to help improve muscle strength.  You may also consider beginning a community-based exercise program, such as Tai Chi or the Otago Exercise Program.  Both programs have been thoroughly researched and proven to reduce falls from 35-60%.

Tai Chi is an ancient Chinese martial art that has been adapted over the past century into a popular exercise form.  It involves gentle motion exercises that improve body awareness, balance, and strength.  It is offered by many communities, including here in Scituate, as a proven, effective fall prevention strategy for seniors.  It has many other health benefits as well, including stress relief, cardiovascular health, and joint health.

The Otago Exercise Program is another evidenced-based exercise program designed to improve strength and balance.  Initially instructed by a physical therapist, it can be performed at home at a person's own convenience.  This program involves low-impact, standing weight training and balance exercises, and is supplemented by a walking program. 

If you have fallen in the past or feel like you may be at risk, please visit your doctor or physical therapist in order to be properly assessed and referred to an appropriate fall prevention program.

Brian O'Neil is a physical therapist with Magill and Gardner Physical Therapy in Scituate, Massachusetts.  He can be reached at mgpt@comcast.net.

 

Posture and Aging

        

My patients often ask me what they can do to improve their posture.  As a physical therapist, posture, or the correction of adverse postural adaptations, is one of the things I most frequently work on with people.   Posture is not only the basis for movement but also contributes to our overall health and well-being.  Good posture is essential for proper movement of the extremities, balance, gait, breathing, and emotional health. Poor posture can not only lead to problems with the musculoskeletal system but with cardiopulmonary and peripheral nervous systems as well. Research has shown that individuals with poor posture have higher incidences of depression, lower subjective life-satisfaction scores, and higher rates of chronic pain. Postural adaptations are a normal part of aging, but are effected by a confluence of physiological and environmental influences.  The more we can change or limit these influences, the more control we will have over our own posture and thus our overall health.

As we age, many things contribute to postural adaptations. Degeneration of the spine begins gradually in the third decade of life.  The intervertebral discs, the cushioning structures between each vertebrae, begin to lose some of their water content and also begin to lose height.  The individual bones, called vertebrae, begin to lose minerals which results in less dense, brittle bones. The breakdown of the vertebrae can cause excessive kyphosis, or forward lean of the mid and upper back. Osteoporosis can make this worse. And because this is the foundation for the head and neck, this will cause the head to pitch forward. If this becomes severe it can compromise lung capacity and can contribute to breathing problems and higher risk of pneumonia. It will also limit normal mobility at the shoulders and can lead to bursitis, tendinitis, and arthritis of the shoulders.

Other postural adaptations can be seen in the lower extremities. Decreased sensation and balance will result in a wider base of support and toeing out at the feet. This can lead to inhibition and atrophy of some of the larger core and buttock muscles, further contributing to functional weakness. Shuffling gait, decreased step length, and fear of falling can contribute to a higher risk of falls. Age-related collapsing of the arches of the feet can result in slightly flexed knees and hips, further contributing to a hunched over silhouette. 

Many of the unfavorable postural adaptions described above can be slowed or prevented. Regular stretching of the chest and back muscles can prevent excessive kyphosis. Regular balance exercises can help with fear of falling and gait disorders. Strengthening exercises for the arms, legs, and back muscles will contribute to more upright posture, and regular cardiovascular exercise will contribute to emotional health and help to keep all of your joints healthy. I would encourage anyone serious about addressing their posture to consult their physician or visit a physical therapist to learn how they can begin to make these changes.

Brian O’Neil is a physical therapist with Magill and Gardner Physical Therapy in Scituate, Massachusetts.