By Kathy Corey
“About six years ago I was working in my garden, and I had a very bad back incident. I'd always had a bad back and experienced spasms, but this was something very different,” says Betty Schroeder of Baton Rouge, Louisiana. “I went to a chiropractor for several months, but when that didn't help, I went to a sports medicine doctor. I was diagnosed with osteoarthritis in my lower back. This came as a shock to me since I had no idea that I even had arthritis. I found that if I exercised, my back would not go out as much, but about 2 1/2 years ago, my back was so bad that I could not bend over to feed my two cats and my dog. I couldn't unload my dishwasher. I felt that I was on my way to becoming an invalid because of arthritis.
WHAT IS ARTHRITIS
Simply put, arthritis is the inflammation of a joint. A joint is the junction of two bones – the place where they meet. Our bodies have 143 different joints. Some joints, like those found in our skull and pelvis, have limited or no movement. But others, like those in our fingers, elbows, and knees, have a wide range of motion. Arthritis is most likely to occur in these highly mobile joints.
Joints hold our bones together and move in different ways. The ankle, for example is a gliding joint that contains two bones with flat surfaces that slide over each other. Hinge joints, like the ones in our knees and elbows, open and close like a door. Thumbs are an example of a saddle joint, where a bone with a convex (round) end fits into another bone with a concave (like a spoon) end. Saddle joints move up, down and side-to-side, but they do not rotate. Finally, we have ball-and-socket joints in our hips and shoulders, which go up, down, side-to-side, and they rotate.
Arthritis comes from the Greek word “arthron” meaning joint, and “itis” meaning inflammation. This inflammation causes pain and stiffness, which can make it difficult to perform even the simplest movements, such as buttoning a shirt or starting a car. Arthritis isn’t a single ailment, but encompasses over 100 different diseases including: osteoarthritis, rheumatoid arthritis, gout, ankylosing spondylitis, juvenile arthritis, lupus, scleroderma, and fibromyalgia. Altogether, these diseases affect one in five Americans or over 46 million people in the United States, according to the Centers for Disease Control and Prevention.
The most common type of arthritis is osteoarthritis, which accounts for more than 85 percent of arthritis cases, according to A. Lynn Millar, P.T. Ph.D., author of the American College of Sports Medicine’s Action Plan for Arthritis (Human Kinetics Publishers, 2003) and professor of physical therapy at Andrews University in Berrien Springs, Michigan. In this type of arthritis, the cartilage that cushions the ends of the bones deteriorates. When this happens, bone rubs against bone, causing pain every time you move that joint. Osteoarthritis is a degenerative joint disease that most often occurs in the hips, knees, back, and hands. Stiffness tends to get worse as the day goes on and can be aggravated by overuse or activity. It usually results from wear and tear, which can occur naturally as you grow older (osteoarthritis is rare in people under 40) since cartilage becomes more brittle and loses its ability to repair itself as you age. It can also be caused by repetitive activities, such as working on an assembly line, performing ballet, pitching baseballs, or even typing. Injuries, such as a torn cartilage, broken bones or joint surgery can also contribute to the onset of the disease.
Poor body alignment and excess body weight puts major stress on your joints, particularly in your hips and knees, causing cartilage to break down faster. In fact, every time you gain one pound, you add 3 pounds of pressure to your knees and 6 pounds of pressure to your hips, reports the Arthritis Foundation. “Damage to cartilage as a result of weight gain is fairly new research. Scientists are just now learning what cartilage is made up of and why it deteriorates,” says Veronica Braun, President of The Arthritis Foundation, San Diego chapter. And for every 10 pounds of extra body weight you carry, your risk of arthritis increases 1.4 times, according to Jason Theodosakis, M.D., author of The Arthritis Cure. Finally, osteoarthritis is hereditary, so if it runs in your family, you are more likely to develop it.
The second most common form of arthritis is rheumatoid arthritis. While osteoarthritis is often a natural result of getting older, rheumatoid arthritis is an “autoimmune disease,” which results when your body’s immune system attacks its own tissues. A normal, healthy immune system protects the body from disease. But in autoimmune disorders, like rheumatoid arthritis, a defect in the immune system or a virus can cause the system damage its own cells. . In rheumatoid arthritis, this causes the lining in the joints to become inflamed, which in turn breaks down the cartilage cushion, resulting in damage to the bones and surrounding tissues. Joints become painful, swollen, deformed and unstable.
Over 2 million people in the United States suffer from rheumatoid arthritis, according to the Arthritis Foundation, and 70 percent of sufferers are women. Rheumatoid arthritis most commonly affects small joints, such as those in the wrists, fingers, ankles, and toes; but can also affect the shoulders, elbows, hips, knees and neck. Rheumatoid arthritis usually causes pain or stiffness that lasts 30 minutes or longer, generally in the morning or after long rest or inactivity. It is bilateral which means it often occurs in the same joints on both sides of the body.
Another common form of arthritis is gout, which results when sharp crystals of uric acid build up in the joints. Gout usually affects smaller joints, especially the big toe. Men are most often affected, particularly between the ages of 40 and 50. Gout tends to run in families and can be aggravated by diet, especially from alcohol and foods high in purines, such as organ meats and some seafood.
HELP IS AVAILABLE
Fortunately, relief is available. While there is no cure for arthritis, many people are able to manage their pain and live full lives. Some therapies and techniques recommended by the Arthritis Foundation:
A wide variety of pain-relieving medicines can help, ranging from simple, over-the-counter aspirin and ibuprofen to stronger prescription medicines.
Research has shown that exercise is an essential tool in managing arthritis pain It reduces joint pain and stiffness, builds strong muscle around the joints, and increases flexibility and endurance. “People who have taken on an exercise program, particularly a low impact program, have seen a great improvement in both managing pain and increased flexibility,” says Veronica Braun, President of The Arthritis Foundation, San Diego chapter.
Heat and cold
A nice warm bath or heating pads and lamps can help you feel better by relaxing tense muscles and improving blood circulation. Cold packs can numb pain and bring down acute inflammation and swelling.
Learning to bend, lift, sit and stand in ways that minimize stress on your joints can reduce pain, as can avoiding activities that stress your joints.
Massage and other alternative therapies
Gentle massage (by yourself or someone else) can bring warmth and relaxation to painful joints. Acupuncture, TENS (transcutaneous electrical nerve stimulation) and ultrasound therapy have also been found to bring relief to some people.
In some cases surgery to repair or even replaced damaged joints can help.
Of all the therapies for arthritis, experts agree that regular exercise is one of the most important. Exercise lubricates the joints, builds cartilage, strengthens muscles and bones, and improves your overall health and fitness.
“Along with proper breathing and core work, supported movement can help lubricate joint surfaces, provide nutrition to the cartilage and flush inflammation from the joints,” says Melanie Byford-Young, co-owner of Pacific Northwest Pilates and a former physical therapist. “Pilates also provides joint protection by helping to develop the local stabilizer muscles that create precise motions, thus protecting the joint surfaces, along with the global muscles that are responsible for shock absorption, force distribution and joint motion.”
Betty’s story continues, “I began to look around at different gyms to see what was available. Then due to an unrelated incident I was sent to the Baton Rouge Physical Therapy Center for a rotator cuff injury. In 8 or 10 weeks, my shoulder was healed and it was then that I saw an ad about Baton Rouge Physical Therapy Pilates taught through Balanced Body of Baton Rouge. After four weeks of Pilates exercises, I did not know that I had a bad back anymore. The light went on in my head. Pilates totally manages my arthritis, and I'm on my way to becoming a normal person.”
Pilates is particularly good for arthritis because it can be tailored to meet individual needs. For example, isometric exercises, where you contract a muscle without moving your joints (such as pressing your palms together or arm presses against the wall), can be helpful when a joint is inflamed. Isotonic exercises (where muscles and joints both move, such as coordination and stomach massage on the reformer) are recommended because it moves your body through its full range of motion and builds strength.
Closed chain exercises, where your hand or your foot stays in contact with a stable surface or piece of equipment are recommended for arthritis sufferers, since they put less stress on joints and work several muscle groups at the same time, according to A. Lynn Millar in Action Plan for Arthritis (Human Kinetics Publishers, 2003). Good closed-chain Pilates exercises include leg and foot work on the reformer and Washer Woman/Hamstring 1 on the Wunda Chair.
In an open chain exercise, such as Double Leg Stretch or the Saw, your arm or leg is not attached to anything so you can move it freely in any direction. While open chain exercises are good for targeting a single set of muscles, they put more stress on joints and should be performed with reduced resistance around an arthritic joint and with limited repetitions.
Through a balance of strengthening and stretching exercises, Pilates can help reduce muscle stiffness and improve joint mobility, flexibility and strength. “We have several clients with osteoarthritis and rheumatoid arthritis ranging in age from 30 to 84 years old,” says Jude Chatelain, program director of Balanced Body of Louisiana, Pilates Plus. “The great thing is they all successfully and painlessly get an hour of Pilates in 2, 3 or 4 times per week. What attracts these clients to pilates initially is the flexibility benefit that a pilates program helps provide. With the assistance of springs and/or straps, almost all of our arthritis sufferers can move their joints in safe and controlled angles that would otherwise create much pain or discomfort for them. By working in a pain-free range of motion, our goal is to strengthen the muscles around the problem joint areas. This in turn provides support when these joints are called upon to perform a task.”
Chatelaine says that clients continue with their Pilates program not only because of the improved flexibility they achieve, but also because they become aware of how much better their joints feel thanks to Pilates. They have much more endurance to get through the day, their overall stress is decreased and their sleep quality is enhanced.
“I think Pilates is a perfect fit in the care plan for an individual dealing with arthritis for a variety of reasons,” says Dane Burke, a licensed physical therapist, director of Clinics and co-founder of Northstar Pilates Solutions in Buffalo, New York. “The first and foremost is that Pilates involves structured, purposeful movement. I have heard the saying that, with respect to joints, ‘motion is lotion.’ This refers to the stimulation of joint surfaces which results in the production of synovial fluid, or the ‘motor oil’ of the joints. Pilates provides individuals with the opportunity to experience this movement while giving attention to detail and joint positioning. This increased awareness of joint alignment within movement promotes joint health while minimizing the destructive forces that weight bearing can subject joints to.”
The efficient, aligned movements of Pilates helps protect joints by strengthening the surrounding tissues and improving flexibility and proper biomechanics. This results in less pressure on joints; less pressure means less wear-and-tear; and less wear-and-tear means less pain.
Pilates has tremendous benefits to offer arthritis sufferers, according to Todd Ball, P.T., director of Polestar Physical Therapy Centers in Cherry Creek, Colorado. “I have had very positive results working with the arthritic patient,” says Todd. First, Pilates teaches important breathing principles, which makes for more efficient movement patterns. The fact that Pilates exercises are performed with attention to whole body alignment allows for more efficient movement patterns with less compressive forces on your joints than other exercises. Keeping your head and shoulders in a neutral position significantly increases full mobility in your shoulders and decreases injuries at the shoulder and neck, as well as other healthy joints. And once you progress to the level where you’re able to apply Pilates principles during more dynamic activities, your movements are naturally more efficient, confident and safer.
“There are occasions when many of our arthritic clients come in complaining of stiff joints by saying ‘maybe I shouldn’t be here today I am really stiff and sore’,” notes Jude Chatelain. “But after a session they are usually saying, ‘Wow, I sure am glad I came in today. I feel so much better!’”
“Pilates keeps me strong, and I am healthy because of it,” says Betty Schroeder. “I'm a very active person. I kayak, camp, hike and garden. I know my arthritis is still there, but it does not affect me and my lifestyle anymore. I've almost forgotten I have a bad back. Pilates exercise is awesome for me. I am a very loyal client. I go two times every week, and it has made a huge difference in my life. Before Pilates, I thought I would become incapacitated, but it has turned my life around.”
PILATES FOR ARTHRITIS
For a safe and effective Pilates workout, keep in mind the following guidelines from A. Lynn Millar, P.T., Ph.D., author of the American College of Sports Medicine’s Action Plan for Arthritis (Human Kinetics Publishers, 2003).
Start with a warm-up; end with a cool down.
Begin with exercises that work the major muscle groups (trunk, chest, abdomen, back, shoulders, hips, legs and arms).
Perform all exercises in a controlled manner with proper technique.
Don’t hold your breath!
Exercise both sides of a joint to keep muscles balanced.
Use full range of motion for each joint when possible.
Ease up or stop if pain increases or a new pain appears.
FOR PILATES PROFESSIONALS
What To Ask Your Clients with Arthritis
Have you consulted your physician and do you have his/her consent to start a new exercise program?
Are there any movements or positions you need to avoid, or any other restrictions due to your arthritis or other health issues that I should know about?
What general precautions do we need to take during your Pilates sessions?
What medications are you currently taking?