The exercise program that will work best for you is one that fits your lifestyle and physical abilities. Doctors generally recommend a combination of stretching exercises, mild strengthening exercises (such as lifting weights), and low-impact aerobic exercises (such as swimming, walking, or bicycling).

It's important to talk to your doctor before you begin any regular exercise program. Your doctor can help you determine which exercises are best for you, how often you should exercise, how much exercise you should do, and how to time your medication (if you are taking medication for your arthritis) to make your exercise session more comfortable. Your doctor may recommend that you work with a physical therapist to design a program that is right for you.


Make exercise a part of your life If your exercise routine is comfortable and enjoyable for you, it will become a habit that will be easy to keep up. It doesn't have to be a formal exercise program. Just fitting more activity into your daily routine, such as taking the stairs instead of the elevator and walking or riding your bike instead of driving, can provide many benefits.

You will get the most out of your exercise program if you plan workouts for those times of the day when your pain is least severe and your joints most flexible. For many people, pain and stiffness are often worse in the morning than at other times. If this is the case for you, try exercising after you have taken a hot shower, which can help loosen your joints.

When you are exercising, doing housework or chores, or engaging in other activities, rest frequently, change positions regularly, and stretch your muscles between periods of exertion. Pacing your activities throughout the day can help you save energy and reduce stress on your joints. It is best to exercise several times throughout the day for shorter periods than to do it all in one long session. Begin and end each exercise session with a warm-up and cooldown by walking around slowly for 5 minutes before and after. Exercise at a rate at which you can speak comfortably.

Warning You have exercised too much if you have sharp pains or more pain than usual while you are exercising, or if you have pain 2 hours after you exercise. Stop exercising immediately and call your doctor if you have chest pain, severe dizziness, difficulty breathing, or an upset stomach.

Stretching exercises Stretching exercises, which are also called range-of-motion exercises, are good for helping to reduce stiffness in your joints and improve their flexibility. Stretching exercises include anything that requires regular movement of a joint to its fullest capacity. For example, holding your arms out to your sides and circling them in a windmill fashion stretches your shoulder joint. Some forms of water exercise use warm water to loosen joints and help them stretch. Doing stretching exercises for a few minutes every day can significantly improve the movement in your joints.


Strengthening exercises Strengthening exercises help maintain or build the muscles around your joints, which helps keep the joints stable. Stronger muscles also improve the joint's movement. Lifting light weights, such as 1- to 2-pound dumbbells, every other day is often enough to make a difference. (Muscles need a day off in between to rest and rebuild.) But before you begin any type of weight training, talk to your doctor. You will need to be carefully instructed in this type of exercise to avoid injury and further damage to your joints. Some forms of water exercise include strengthening exercises.


Fitness exercises Fitness exercises, also called aerobic exercises, increase your endurance, strengthen your heart and lungs, and give you energy. Try to exercise aerobically for at least 60 to 90 minutes each week. Brisk walking, swimming, and bicycling are good fitness exercises if you have arthritis because they allow for smooth rather than jerky movements. You should avoid high-impact exercises—such as jogging, tennis, or step aerobics—because they can put too much pressure on your joints and can worsen your symptoms.

Swimming is especially good if you have arthritis in your knees or hips because the water supports your weight, which reduces stress on those joints. Many communities offer supervised swimming or water exercise programs for people who have arthritis. Call your local parks and fitness centers to see if there are any such programs in your area.

Walking is also a good exercise for relieving the pain and stiffness of arthritis. And it's convenient; you can do it anywhere, at any time. Going for regular walks with a friend or family member is a good way to develop the habit of staying active.

Heat and Cold

The use of heat and cold are time-honored techniques for relieving the pain, stiffness, and occasional swelling that can result from osteoarthritis. Finding the most effective treatment for you may require a certain amount of trial and error. Some people get better results with heat; others prefer cold. Do not apply either heat or cold for longer than 20 minutes at a time. Your skin should be allowed to return to normal temperature between applications. And do not combine either heat or cold with rubbing or the use of creams. This combination can cause burns.

Heat Heat is usually used to relax muscles and sometimes to warm them up before exercising. You can heat up your sore joints with heating pads or hot packs or by sitting in a hot tub or heated pool. For many people who have arthritis, a hot shower in the morning is all they need to loosen their stiff joints.

Cold Applying cold to a sore joint reduces the pain by numbing the area. Use ice or reusable cold packs. Never apply ice directly to your skin because it can burn the skin; wrap ice and cold packs in a towel. Although applying cold can be helpful for short-term pain relief, you have to be careful because the lack of feeling may cause you to overuse the sore joint or muscle.

Medication

If weight loss and exercise are not effective in relieving your symptoms, your doctor may recommend medication. Arthritis medications generally are used to reduce pain and tenderness in the joints. No drugs are available that can actually stop the progression of the disease or cure it. Many medications that are used to relieve osteoarthritis pain are available over the counter (without a prescription). Some of the stronger arthritis drugs are available only with a doctor's prescription.

It's important to remember that all drugs used to treat osteoarthritis, whether they are over the counter or prescribed by a doctor, can cause side effects in other parts of the body. For this reason, if you are taking a medication for your arthritis, tell your doctor immediately if you feel anything unusual at all. Keep in mind that you may not have any problems until after you have been taking the medication regularly for a long time.

Topical pain relievers Topical (which means "applied to the skin") medications are creams, rubs, or sprays that you apply on your skin over a sore muscle or joint to temporarily relieve pain. Most of these medications are available over the counter. Topical medications work in different ways, depending on the ingredients. Some contain combinations of salicylates (the pain-relieving substances in aspirin), skin irritants (which cause feelings of cold, warmth, or itching to take your attention away from the pain), or capsaicin (a substance that blocks pain messages to the brain). For some people, topical medications may be all they need to control their pain.

Capsaicin is the substance in chili peppers that makes them hot. Over-the-counter creams that contain capsaicin reduce the sensation of pain by blocking the ability of the nerve endings around the joint to send pain messages to the brain.

To be effective, creams containing capsaicin must be applied three to four times every day; the pain will return if you stop using the cream. It can take about 2 to 4 weeks for the medication to work. Creams containing capsaicin are usually used with other treatments, such as weight control, exercise, and other medications.

Capsaicin appears to have no serious side effects. However, some people feel stinging and burning on their skin when they first start using capsaicin-containing creams. This usually occurs when the treated area of the skin is exposed to perspiration or hot water. For this reason, you should not apply the cream immediately before you exercise or shower. The burning and stinging usually stop after the medication has been used for several days.

Here are some general guidelines to follow when using topical pain relievers for arthritis:

• Read and carefully follow the directions on the package.
  
  
• Wash your hands after each application or wear gloves when you apply the pain relievers; these medications can sting.
  
  
• Do not use a heating pad or bandage with a topical pain reliever because you can burn your skin.
  
  
• Keep the medication away from your eyes, the inside of your mouth or nose, cuts, or irritated skin.
  
  
• If you are allergic to aspirin or taking an anticlotting medication (anticoagulant), talk to your doctor before you use any rubs, creams, or sprays that contain salicylates (the pain-relieving substances in aspirin).
  
  
• Keep all topical medicines out of the reach of children.
  
  
• If the treated skin becomes irritated or red, or painful for more than 10 days after you begin treatment (30 days for medications containing capsaicin), stop using the medication and call your doctor.

Analgesics Doctors often first recommend an analgesic (pain reliever) called acetaminophen for people who have osteoarthritis. Acetaminophen is the active ingredient in many over-the-counter pain relievers. Acetaminophen does not cause stomach irritation like some other pain relievers, such as aspirin. For this reason, doctors usually prescribe it for older people and for those who have had ulcers (open sores in the stomach lining) or bleeding problems.

Acetaminophen is more effective when it is used regularly than when it is used only occasionally. The drug does not reduce inflammation (redness, warmth, and swelling), but inflammation is not as much of a problem in osteoarthritis as it is in some other types of arthritis, such as rheumatoid arthritis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs are often used for relieving the pain of osteoarthritis. The most frequently used NSAIDs are aspirin, ibuprofen, and naproxen. Like acetaminophen, these drugs relieve pain in the affected joints. They may reduce inflammation as well, which is why they are called anti-inflammatory medications. Many NSAIDs are available over the counter, but stronger ones require a prescription from a doctor.

Ibuprofen and naproxen Ibuprofen and naproxen are the two over-the-counter NSAIDs that doctors recommend most often for relieving pain caused by osteoarthritis. These drugs may be more effective than aspirin in reducing symptoms and improving movement in the joints, and they usually cause less stomach irritation than aspirin.

Like aspirin, ibuprofen and naproxen can cause stomach irritation when they are used for several months or longer. This stomach irritation can eventually lead to ulcers (open sores in the lining of the stomach), which can sometimes be life-threatening. For this reason, if you are taking ibuprofen or naproxen, you should tell your doctor right away about any signs of stomach irritation (such as heartburn) or bleeding inside your stomach (such as dark stools). Your doctor is likely to recommend a lower dose of the medication or prescribe the analgesic acetaminophen, which does not cause stomach irritation.


Aspirin Aspirin, which is an NSAID, is often recommended for relieving the pain of arthritis. It can be a very effective pain reliever for many people with osteoarthritis. However, in some people, long-term use of aspirin can cause ulcers. If aspirin irritates your stomach (which you may feel as heartburn or similar symptoms of stomach upset), your doctor may recommend trying the enteric-coated aspirin tablets, which do not release their contents until they reach the intestines. If you still have stomach irritation with the enteric-coated aspirin, your doctor may recommend acetaminophen, or an NSAID that is not as irritating as aspirin.

Corticosteroids Corticosteroids are man-made substances that are related to cortisone, a naturally occurring hormone that your body makes. Corticosteroids are used to reduce pain and inflammation (redness, warmth, and swelling). In some cases, a doctor will give these drugs by injection directly into the affected joint. Although the shot cannot stop the progression of osteoarthritis, it may help relieve the symptoms for many months.

Corticosteroids are strong drugs that can cause serious side effects, such as damage to bones and cartilage (the cushioning tissue inside joints). For this reason, these shots are given no more than a few times a year.

Surgery

Surgery is usually done only in severe, disabling cases of arthritis for which other treatments have failed. In fact, most people who have osteoarthritis will never need to have surgery. If your doctor recommends surgery, it's a good idea to get an evaluation from another doctor to be sure the surgery is absolutely necessary.

When surgery is necessary, it is performed by an orthopedic surgeon (a doctor who specializes in surgery on bones and joints). Surgery may be done to prevent the joint from becoming deformed, to correct a deformity, to remove bonelike material from around the joint to allow for greater movement, or to replace a damaged joint with an artificial one.

Replacing a joint There are now artificial devices to replace almost any joint in the body. Joint replacement surgery is most frequently done to repair hips and knees, but is also done to repair ankles, finger joints, wrists, and toes. A successful joint replacement relieves pain and restores most of the joint's movement.

For a joint replacement, the surgeon first removes all the damaged bone from the joint. Artificial replacement parts are then cemented to the healthy bone that remains. For younger people who are more active, doctors sometimes use newer artificial joints that do not require cement to stay in place. Instead, the artificial joint is designed with spaces into which the person's own bone can grow; this holds the artificial joint in place more naturally. By avoiding the use of cement, which can weaken over time, these artificial joints usually last longer than those that are held in place with cement.

Recovery from joint replacement surgery depends on several factors, including your general health and your level of activity before the surgery. For this reason, it is not a good idea to put off the surgery for long. The more active you are before your surgery, the faster your recovery is likely to be. Hip replacement and knee replacement surgery require more time for recovery than replacement of smaller joints, such as those in the fingers, wrists, toes, or ankles.

If you have hip or knee replacement surgery, you will probably spend no more than 7 days in the hospital. You will be encouraged to start walking with the help of a walker or cane while you are still in the hospital. It's important to begin moving as soon as possible after surgery to get your blood flowing. This helps prevent blood clots from forming in your legs, which can occur from lack of activity. Your doctor may also prescribe medication to prevent your blood from clotting.

Although complications from joint replacement are rare, the new joint can become infected or slip out of place after surgery. For this reason, your doctor will ask you to come in regularly for checkups after your surgery so that he or she can monitor your healing and recovery.

Joint replacement surgery is serious and will cause a short period of disability during your recovery. Complete recovery can take from about 3 to 6 months. Most people who have a hip or knee replaced will need physical therapy to help them regain their mobility. A physical therapist will recommend special exercises to help you build up the muscles around your new artificial joint. Your physical therapy will start in the hospital shortly after surgery and you will continue it on your own at home.

Here are some things you can do to make your recovery easier:

• Arrange to have help at home. Ask family members and friends for assistance.
  
  
• Make sure that getting around your home is safe. This may require moving furniture or installing ramps and grab bars inside the house. It should be easy for you to get in and out of bed, prepare food, and use the bathroom.
  
  
• Make arrangements before your surgery to live on one floor of your house when you return home; climbing stairs is not possible right after surgery.

Immobilizing a joint A surgical procedure called arthrodesis is sometimes used to correct severe joint problems caused by osteoarthritis. In this procedure, the surgeon makes the affected joint permanently immobile by inserting a metal or plastic screw or using a special type of plaster to hold the joint in place. Arthrodesis is performed only when the pain from osteoarthritis is so severe that immobilizing the joint is an improvement. This procedure is usually performed on smaller joints, such as those in the toes or fingers.

Removing bone Osteotomy (which means "cutting of a bone") is a surgical procedure that is not frequently performed. It is used mostly for younger people who have osteoarthritis, usually in a hip or knee. The procedure is most often done to repair a joint that arthritis has damaged unevenly. This uneven damage can put more stress on the cartilage (the cushioning tissue inside the joint) and cause further damage.

For an osteotomy, the surgeon removes a small piece of bone near the affected joint. This realigns the bone and improves the contact between the remaining, healthy areas of cartilage in the joint. This procedure may be a good solution for younger people with arthritis because it can delay joint replacement surgery for years.

"Scoping" a joint Arthroscopy is a procedure that is being used increasingly to diagnose and sometimes repair joints. The procedure is performed most often on knees and shoulders. For arthroscopy, the doctor uses a long viewing tube called an arthroscope that he or she inserts through a small incision in the skin over the affected joint. The arthroscope, which has a light and a tiny video camera at its tip, can be inserted directly into the fluid-filled space in the joint.

Through the arthroscope, the doctor can look for any tissue damage and make necessary repairs. He or she may use the tube to remove damaged areas of cartilage or cartilage particles that may be causing irritation. This may provide temporary relief of symptoms, especially if the osteoarthritis is caused by an injury, such as a torn piece of cartilage. However, this repair may not stop the progression of the arthritis. Arthroscopy is performed on an outpatient basis—it does not require an overnight stay in the hospital.


Osteoarthritis Case Study | Osteoarthritis Index