Arthritis and Movement: Your Weightlifting Prescription

ARTHRITIS AND MOVEMENT: YOUR WEIGHTLIFTING PRESCRIPTION

by Mike DeMille, DPT and Erin Murray

Arthritis can be a debilitating condition in which cartilage is degraded in joints–resulting in pain or discomfort, inflammation, and loss of function. Oftentimes, this pain and dysfunction can lead to total joint replacements if movement or comfort cannot be regained. For years, the medical field has been working on medications, approaches, surgeries, and therapeutic modalities to prevent progression of the condition and alleviate symptoms. Thankfully–as new research emerges–having a deeper understanding of potential underlying mechanisms can lead to more preventative and noninvasive approaches.

“Osteoarthritis can be viewed as the clinical and pathological outcome of a range of disorders that result in structural and functional failure of synovial joints with loss and erosion of articular cartilage, subchondral bone alteration, meniscal degeneration, a synovial inflammatory response, and bone and cartilage overgrowth (osteophytes)” -Nuki, 1999

Understanding this definition becomes important when we consider the impact of exercise on development of osteoarthritis (OA). In particular, the concept that perhaps osteophytes (typically the first feature identified on radiographs) are not necessarily a deleterious finding and may represent an effort on the part of the joint to promote stability (Hunter and Eckstein, 2009).

In fact, we can even see an increase in osteophyte production in the areas where there is less joint surface contact. Suggesting that extra bone forms in an effort to increase contact area and stability. Many of our clients at Pure Performance deal with symptoms in this arena, and like to learn more about preventative measures, post-operative modalities, and more self-efficacy and empowerment in managing their condition.

Arthritis Evaluation and Strategy

One of my initial phases of treatment is to identify how the patient’s body distributes force across their joints. During the evaluation, I look at range of motion at all joints, as well as movement strategies utilized during a wide array of activities–such as sitting, going up and down stairs, turning, pivoting, rotating, bending, and recreational activities like jogging.

“As little as 50 of genu varum (bow-legged) malalignment results in an estimated 70–90% increase in compressive loading of the medial knee compartment (Tetsworth & Paley, 1994). This dramatic increase in compressive load corresponds to a four-fold increase in the risk of worsening medial knee OA over 18 month (Sharma et al. 2001). Conversely, genu valgum (knock-kneed) malalignment markedly increases compressive load on the lateral compartment of the knee and elevates the risk of lateral OA progression five-fold” (Sharma et al. 2001).

When working with these patients, my long-term goal is to improve force distribution across all joints–especially those that are affected by arthritic symptoms. There is a wide array of strategies that can help achieve this, ranging from weight lifting to breathing therapies.

The key concept for understanding why breathing and weight lifting are such therapeutic modalities is pressure management. As an example, if I were to place a 50-pound kettlebell flat on the ground, the force would be distributed over the wide base of the kettlebell and there would be a certain amount of pressure going into the ground. Now, If I were to take that same kettlebell but balance it on a toothpick, I will have greatly the surface area of the force going into the ground, and therefore exponentially the amount of pressure. The moral of the story is that decreased surface area leads to increased pressure. Guess where we don’t want increased pressure? In your joints!

This same principle of pressure management in the kettlebell applies to our bodies. If the surface area is decreased in a joint, then there will be more pressure exerting force into one (smaller) area constantly. This can progress arthritic symptoms due to overloading cartilage in some areas and increasing catabolic activity of the regional cells.

One of the key ways to improve these systems is to ensure we are able to load joints evenly during all movements. I work with patients to improve their access to more planes of motion at each joint in order to optimize loading, recruitment, and strength across the tissues and joint capsules.

An example would be a split squat exercise. If a patient is doing a split squat, I look for a forward translating tibia, a knee that is stacked directly over the foot, and a femur that is not favoring the inside or outside angle of the ankle. This would indicate how someone walks up stairs, rises from a chair, squats to the ground, walks, hikes, runs…etc. If this position is compromised, it would make sense that the knee is aching, and the goal would be to optimize the management of pressure through that joint in that movement archetype.

The Most Effective Way to Alter Pressure is to Weight Lift

Not only does changing pressure improve surface contact relationships between articulating bones, but it also promotes the release of synovial fluid, which lubricates joints; and increases the synthesis of proteoglycans and collagen, both of which constitute articular cartilage. Additionally, the muscles and tendons surrounding a joint also will increase in strength, which helps antagonistic and agonistic muscle activity–and thus yet again increase mobility.

One of the first signs we see in someone demonstrating symptoms of OA is weakness of the quadriceps muscle. Weight lifting, in particular, can help ward off muscle weakness that contributes to the development of OA. The quadriceps muscle group is helpful for eccentric control of single-leg movement–such as walking down stairs. It acts like the break in a car on our body’s locomotion. When we’re breaking inefficiently, we’re failing to manage pressure optimally. Additionally, there are a number of benefits that occur only when the cartilage is loaded. The cells that are found embedded in articular cartilage, chondrocytes, are mechano-adaptive. Meaning, they specifically respond to mechanical loading only. The chondrocytes are going to alter their activity based on the amount of load that a joint is receiving. If there is not enough load, the chondrocytes will not engage in any anabolic activity. This will make cartilage overly thin, and there will be lower production of collagen and proteoglycans.

When joints are loaded appropriately–that is, interacting with gravity and resisting load properly–the chondrocytes will engage in anabolic (building-up) activity. In order to be the most prepared for the activities of daily life, as well as recreational hobbies, the best way to train your body, chondrocytes, and cartilage, would be to create an environment where they must be forced to adapt to the demands placed on them. This means that each person’s body is equipped with its own built-in defense system against some of the deleterious effects that osteoarthritis can produce.

Arthritic symptoms and diagnoses can seem overwhelming, and deter people from participating in their favorite activities–especially when those activities are weight-bearing. However, the latest research and therapies are demonstrating the resiliency of our joints, and that a total-systems-approach to inflammation and pressure management can vastly decrease symptoms. Not only can we actually embrace weight-lifting exercise (when we’re in the capable hands of a progressive physical therapist or strength coach), but we can also promote systemic wellness with our nutrition, sleep, breathing, and recovery strategies. We are always thrilled to see people who were once suffering from arthritic symptoms increase their movement options and ability to manage pressure, and thus report a major decrease in discomfort.

This compromised split squat demonstrates that inability to manage pressure as the body descends towards the ground.

This proper split squat demonstrates more optimized pressure management at the knee joint as the body descends towards the ground.

ARTHRITIS AND MOVEMENT: YOUR WEIGHTLIFTING PRESCRIPTION

by Mike DeMille, DPT and Erin Murray

Arthritis can be a debilitating condition in which cartilage is degraded in joints–resulting in pain or discomfort, inflammation, and loss of function. Oftentimes, this pain and dysfunction can lead to total joint replacements if movement or comfort cannot be regained. For years, the medical field has been working on medications, approaches, surgeries, and therapeutic modalities to prevent progression of the condition and alleviate symptoms. Thankfully–as new research emerges–having a deeper understanding of potential underlying mechanisms can lead to more preventative and noninvasive approaches.

“Osteoarthritis can be viewed as the clinical and pathological outcome of a range of disorders that result in structural and functional failure of synovial joints with loss and erosion of articular cartilage, subchondral bone alteration, meniscal degeneration, a synovial inflammatory response, and bone and cartilage overgrowth (osteophytes)” -Nuki, 1999

Understanding this definition becomes important when we consider the impact of exercise on development of osteoarthritis (OA). In particular, the concept that perhaps osteophytes (typically the first feature identified on radiographs) are not necessarily a deleterious finding and may represent an effort on the part of the joint to promote stability (Hunter and Eckstein, 2009).

In fact, we can even see an increase in osteophyte production in the areas where there is less joint surface contact. Suggesting that extra bone forms in an effort to increase contact area and stability. Many of our clients at Pure Performance deal with symptoms in this arena, and like to learn more about preventative measures, post-operative modalities, and more self-efficacy and empowerment in managing their condition.

Arthritis Evaluation and Strategy

One of my initial phases of treatment is to identify how the patient’s body distributes force across their joints. During the evaluation, I look at range of motion at all joints, as well as movement strategies utilized during a wide array of activities–such as sitting, going up and down stairs, turning, pivoting, rotating, bending, and recreational activities like jogging.

“As little as 50 of genu varum (bow-legged) malalignment results in an estimated 70–90% increase in compressive loading of the medial knee compartment (Tetsworth & Paley, 1994). This dramatic increase in compressive load corresponds to a four-fold increase in the risk of worsening medial knee OA over 18 month (Sharma et al. 2001). Conversely, genu valgum (knock-kneed) malalignment markedly increases compressive load on the lateral compartment of the knee and elevates the risk of lateral OA progression five-fold” (Sharma et al. 2001).

When working with these patients, my long-term goal is to improve force distribution across all joints–especially those that are affected by arthritic symptoms. There is a wide array of strategies that can help achieve this, ranging from weight lifting to breathing therapies.

The key concept for understanding why breathing and weight lifting are such therapeutic modalities is pressure management. As an example, if I were to place a 50-pound kettlebell flat on the ground, the force would be distributed over the wide base of the kettlebell and there would be a certain amount of pressure going into the ground. Now, If I were to take that same kettlebell but balance it on a toothpick, I will have greatly the surface area of the force going into the ground, and therefore exponentially the amount of pressure. The moral of the story is that decreased surface area leads to increased pressure. Guess where we don’t want increased pressure? In your joints!

This same principle of pressure management in the kettlebell applies to our bodies. If the surface area is decreased in a joint, then there will be more pressure exerting force into one (smaller) area constantly. This can progress arthritic symptoms due to overloading cartilage in some areas and increasing catabolic activity of the regional cells.

One of the key ways to improve these systems is to ensure we are able to load joints evenly during all movements. I work with patients to improve their access to more planes of motion at each joint in order to optimize loading, recruitment, and strength across the tissues and joint capsules.

An example would be a split squat exercise. If a patient is doing a split squat, I look for a forward translating tibia, a knee that is stacked directly over the foot, and a femur that is not favoring the inside or outside angle of the ankle. This would indicate how someone walks up stairs, rises from a chair, squats to the ground, walks, hikes, runs…etc. If this position is compromised, it would make sense that the knee is aching, and the goal would be to optimize the management of pressure through that joint in that movement archetype.

The Most Effective Way to Alter Pressure is to Weight Lift

Not only does changing pressure improve surface contact relationships between articulating bones, but it also promotes the release of synovial fluid, which lubricates joints; and increases the synthesis of proteoglycans and collagen, both of which constitute articular cartilage. Additionally, the muscles and tendons surrounding a joint also will increase in strength, which helps antagonistic and agonistic muscle activity–and thus yet again increase mobility.

One of the first signs we see in someone demonstrating symptoms of OA is weakness of the quadriceps muscle. Weight lifting, in particular, can help ward off muscle weakness that contributes to the development of OA. The quadriceps muscle group is helpful for eccentric control of single-leg movement–such as walking down stairs. It acts like the break in a car on our body’s locomotion. When we’re breaking inefficiently, we’re failing to manage pressure optimally. Additionally, there are a number of benefits that occur only when the cartilage is loaded. The cells that are found embedded in articular cartilage, chondrocytes, are mechano-adaptive. Meaning, they specifically respond to mechanical loading only. The chondrocytes are going to alter their activity based on the amount of load that a joint is receiving. If there is not enough load, the chondrocytes will not engage in any anabolic activity. This will make cartilage overly thin, and there will be lower production of collagen and proteoglycans.

When joints are loaded appropriately–that is, interacting with gravity and resisting load properly–the chondrocytes will engage in anabolic (building-up) activity. In order to be the most prepared for the activities of daily life, as well as recreational hobbies, the best way to train your body, chondrocytes, and cartilage, would be to create an environment where they must be forced to adapt to the demands placed on them. This means that each person’s body is equipped with its own built-in defense system against some of the deleterious effects that osteoarthritis can produce.

Arthritic symptoms and diagnoses can seem overwhelming, and deter people from participating in their favorite activities–especially when those activities are weight-bearing. However, the latest research and therapies are demonstrating the resiliency of our joints, and that a total-systems-approach to inflammation and pressure management can vastly decrease symptoms. Not only can we actually embrace weight-lifting exercise (when we’re in the capable hands of a progressive physical therapist or strength coach), but we can also promote systemic wellness with our nutrition, sleep, breathing, and recovery strategies. We are always thrilled to see people who were once suffering from arthritic symptoms increase their movement options and ability to manage pressure, and thus report a major decrease in discomfort.

This compromised split squat demonstrates that inability to manage pressure as the body descends towards the ground.

This proper split squat demonstrates more optimized pressure management at the knee joint as the body descends towards the ground.

2019-03-31T15:15:22+00:00

About the Author:

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Erin is a graduate student working toward a Masters of Science in Nutrition and Health Promotion, as well as completing the Didactic Program in Dietetics to become a Registered Dietitian. She’s also a Precision Nutrition Certified Nutrition Coach and Certified Sports Nutritionist.