What Is This Pain?
Osteoarthritis (OA) isn't supposed to happen to people in their 30s. But don't tell that to D.J. Hopwood of Tempe, AZ. When she was 39, Hopwood was diagnosed with OA of the spine, knees, hands, and ankles. Now 46, she's had surgery on her back, an ankle, and a knee, and she expects to need surgery on her other knee. It's just a matter of time, she says. As an exercise physiologist who's been helping others with OA since 1983, Hopwood should have recognized the warning signs—in her case, stiffness and pain during and after exercise combined with a strong family history of arthritis. But like many competitive athletes, she pushed herself to the limit, running on worn-out knees and lifting weights with a spine that simply wasn't prepared to handle the amount of stress she placed on it.
And that may have worsened her condition, she concedes. "Had I paid attention to my body and known what was going on, I may have been able to avoid surgery by doing the proper types of exercise for someone with my condition," she says.
Now, as a volunteer and trainer for the Greater Southwest Chapter of the Atlanta-based Arthritis Foundation, Hopwood wants others to learn from her experience. Among her lessons is this nugget: Don't think that OA strikes only the 65-plus crowd. "I've seen an awful lot of people in their late 20s and early 30s with arthritis," says Hopwood, who estimates that 95 percent of her clients have some form of the disease. In fact, baby boomers are at prime risk: More than half of the estimated 21 million Americans affected are under 65.
But there's no need to panic. We'll tell you who to see and how to assess your risk—but it's important to take action now. Early and accurate diagnosis is critical to keep this disease from preventing you from doing what you love.
Am I Really At Risk?
Sorry to say, you may very well be. Of the more than 100 types of arthritis, the most common is OA, a joint disease that mostly affects cartilage, the slippery tissue that covers and protects the ends of your bones in the joint. When cartilage breaks down—as it does in people with OA—bone may rub on bone, causing pain, swelling, and restricted range of motion. According to John Klippel, MD, the Arthritis Foundation's medical director, no one knows exactly what makes cartilage deteriorate, though genetics, anatomical structural problems, and injury all may play a role.
OA typically affects people over 40. But it can happen sooner, as in D.J. Hopwood's case, especially if you've had a joint injury. Being overweight may lead to OA of the knees because of the increased stress on the joints. And family history may also play a role: Middle-aged and older women with a family history of OA have a particularly high risk of developing the disease. But while age is considered a risk factor, OA is not an inevitable part of aging. (Think you know your risk? Take this quiz to find out!) [pagebreak]
Why Do I Have To See a Doctor?
The first stages of OA may be silent; mild cartilage damage typically has no symptoms. OA is most likely to show up in hands and weight bearing joints, including the knees, hips, spine, lower back, neck, and end joints of the fingers. But it's only when there is significant cartilage loss that you'll begin to notice real pain and loss of joint function. So once you feel those first twinges, you need to see a doctor to prevent further damage. "Many people assume that arthritis pain is just part of getting old and that they're going to have to put up with it. That's simply not true," says Dr. Klippel. "They think that little can be done for their symptoms, so they question why they should even bother."
A doctor can offer diagnosis, pain-relieving medications, and, most important, invaluable information about keeping OA from getting worse. If you don't take care of your OA now, cautions Dr. Klippel, you risk disability later on and the possibility of joint replacement surgery. Need another reason? Not all joint pain is OA, and only a doctor can rule out other reasons for your pain. Visit our Pain Relief Center and study up before your appointment.
How is OA Diagnosed?
Your doctor (usually your family practitioner or internist) makes a diagnosis of OA based on a physical examination of the joints, questions about family history (did your parents or grandparents have it?), past joint injuries, and any symptoms you've experienced. If you're overweight or physically inactive, your doctor will also take that into account. Unfortunately, there currently aren't any tests to definitively diagnose OA. Your doctor may order a blood or urine test to rule out other forms of arthritis; he may also order an x-ray of the affected joint. (But x-rays tend to be more helpful in the later stages of OA, when there's loss of cartilage or changes in the bone.)
Can I Prevent OA?
Since there's no cure for OA, your best bet is to try to prevent it. You can lower your risk by staying physically active, maintaining a healthy weight, and preventing injuries to your joints. Give it a try with these 12 ways to break-proof your bones.
"We tend to think of heart health as the main reason to keep physically fit and keep our weight down. But we need to consider another good reason—preventing OA," says Dr. Klippel. Weight loss can also help if you already suffer from OA, and you don't have to shed a lot of pounds to make a difference. When you walk, your knees absorb a force equal to about three times your body weight with each step. So losing just 10 lb actually relieves each knee of about a 30-lb load with every stride you take.[pagebreak]
I have OA—What Next?
If you're in pain, your doctor will recommend over-the-counter (OTC) or prescription drugs. Along with weight loss (if necessary), he'll also prescribe aerobic activity and exercises to strengthen the muscles around your joints.
Exercise? Won't that hurt?
If you want to feel less pain, take fewer medications, improve your flexibility, get stronger, and avoid joint replacement surgery in the future, then you're going to have to get moving, says Justus J. Fiechtner, MD, MPH, head of rheumatology at Michigan State University in East Lansing. "Medications may take away the pain, but if you don't do some form of exercise, you're never going to increase your strength and, therefore, your function."
Some studies show that aerobic exercise such as walking can reduce inflammation in some joints. For his patients with OA, Dr. Fiechtner writes an exercise prescription that includes stretching, aerobic exercises, and strengthening exercises. (Check out our fitness expert Chris Freytag's list of joint-friendly exercises!)
How can stretching help?
When a joint hurts, you don't feel like moving it. But when you don't move it, the joint gets increasingly stiff, making any form of exercise seem unbearable. That's where gentle stretches can help: They improve your flexibility and increase your range of motion so you can perform a variety of tasks that many people take for granted but that those with OA may find difficult, such as reaching overhead for something off the top shelf, or turning your neck in the car to see what's behind you.
Begin your stretches in the morning, preferably when you're warm, says Dr. Fiechtner. A warm bath or shower is a good place to start: Begin with the neck and jaw, and work your way toward the feet, systematically stretching each muscle group as you go. Move slowly, and hold each position comfortably for 10 to 20 seconds. This should take less than 5 minutes. Yoga provides a good opportunity to stretch and improve your flexibility. It's also an excellent form of relaxation, says Dr. Fiechtner. Most Westerners practice the form called hatha yoga, a system of gentle stretches and balancing exercises. Make sure your instructor understands your special needs, and talk with your doctor before starting any exercise program.[pagebreak]
Why do I have to build muscle? It's my joints that hurt!
When you have OA, you don't exercise to get in shape—you have to get in shape to exercise, says William J. Arnold, MD, rheumatologist and director of the Complementary Medicine Program at the Illinois Bone and Joint Institute in Des Plaines. "Before a person with OA of the knee or hip can comfortably do some forms of aerobic exercise, they have to get their muscles strong and build up the range of motion in their joints," says Dr. Arnold, who is also the medical editor of The Arthritis Foundation's Guide to Alternative Therapies. Strengthening the muscles around an arthritic joint supports the joint and lessens pain. For example, strengthening the quadriceps muscles, a group of muscles that covers the front of each thigh, helps stabilize and control the knee joint.
With help from your doctor or physical therapist, you can choose from an array of strengthening options, including elastic bands, resistive water exercises, exercise machines, and free weights. Do your strengthening program two or three times a week, 15 to 20 minutes per session. Anti-inflammatory medications taken several hours before exercising will help ease any stiffness you may be feeling, says Dr. Fiechtner. Start strengthening exercises slowly with light weights. You want to feel muscle fatigue but not pain, says Vanessa Dal Pra Wochner, PT, CSCS (certified strength and conditioning specialist), a physical therapist for AthletiCo Sports Medicine and Physical Therapy Center in Chicago.
Muscle fatigue goes away after you've finished the exercise. Pain, on the other hand, may persist long after you're done. Exercise should never be painful. To break up the monotony of a traditional strengthening regimen, consider signing up for a tai chi class at your local YMCA or fitness center. This gentle martial art consists of a series of controlled movements that strengthen muscles while improving balance. Movements are slow and fluid; your joints are held softly, never rigidly. Like yoga, tai chi helps you relax.
What kinds of aerobic exercises are best?
Choose an exercise that you enjoy and that doesn't hurt. When you have arthritis, there's no gain in pain. Aquatic exercises such as swimming or walking are excellent choices because they allow you to burn calories and tone up without placing weight on sore joints, says Dr. Arnold. The Arthritis Foundation offers an aquatics program designed for people with arthritis and related conditions. Classes are held two or three times a week at indoor pools. For information on programs near you, contact your local Arthritis Foundation office, call the national organization at (800) 283-7800, or visit the Arthritis Foundation.
Another good exercise choice for those with arthritis: a stationary bike, which also goes easy on the joints. If you like to walk, make sure you're wearing walking or running shoes with good heel and arch support. If your knees are unstable, you should probably stick to a smooth outdoor surface or treadmill instead of a bumpy or stone-covered sidewalk. If you're new to aerobic exercise, start with only a few minutes a day, gradually increasing to 20 to 30 minutes a day. For greater convenience, break it up into 5-minute intervals throughout the day, suggests Dr. Fiechtner. If you anticipate some stiffness or arthritis pain, take an OTC pain reliever 15 to 30 minutes before starting.
Take a Lesson from Broadway Joe's Knees
Quarterbacks take a beating on the field, and Joe Namath was certainly no exception. Today, the former New York Jets star suffers from osteoarthritis (OA) of the knees, spine, and thumb as a result of years of twisting, turning, stopping, and starting on the football fields he called home for most of his young life."Football is a great sport, but the body wasn't designed for it," says Namath, 69, who retired in 1977. He had both knees replaced in 1992, making it easier to lift his two young daughters without fear of falling down. The surgery also took away the pain, which was "always there, always in the back of my mind," he says. Today, Namath lifts weights and works out on an elliptical exercise machine, a combination stairclimber and cross-country skiing device that goes easy on his knees and spine. Arthritis will get worse if you don't take care of your body, he warns. "I know that it's hard to change habits. For people who may not have worried about diet or exercise for most of their life, it's hard for them to get into it now. But it's not impossible. You have to make it a priority." Injury to a joint may be an even more common cause of OA than previously believed, according to Allan C. Gelber, MD, assistant professor of medicine at Johns Hopkins University in Baltimore. In a recent study that followed more than 1,000 medical school graduates for 36 years, Dr. Gelber and his colleagues found that teens and young adults who injured their knees had a three times greater risk of knee OA by age 65. Injuring a joint as an adult also substantially increased the risk of OA.
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