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Arthritis Pain Treatment: The Right Way To Exercise

By Kenneth Hudspeth, MD

May is Arthritis Awareness Month, and there’s no better time to get advice to combat symptoms of arthritis and work to live a pain-free, happy and healthy life. Many people who suffer from arthritis pain are timid about staying active because their symptoms tend to worsen under high impact activities. However, without physical activity, joints become less mobile and muscles shrink. Goals for arthritis treatment should be to strengthen the joint and increase the range of motion of the joint, which will then help lessen the pain. When exercising, it’s important to be mindful of your body and practice healthy training habits, including listening to your body’s aches and pains. The following answers to common questions will help.

How can I ease the arthritis pain before and after a workout?

We certainly want to minimize pain because it tends to shorten or prevent the arthritis sufferer from participating. The key ingredients would be: 1) Do thorough stretching prior to your workout. This will add to overall flexibility and serve as a warm up to muscles that have been at rest. 2) Choose exercises that are minimally traumatic to the joint surface; these include light aerobics—swimming, cycling, the elliptical—and workout with light weights. 3) Massage therapy is also an excellent way to stretch and stimulate musculature and relieve pain. The main thing to remember is that these joints are already somewhat damaged and will react very unfavorably to any new trauma.

Many trainers suggest low dose anti-inflammatories such as naproxen or ibuprofen prior to workout as an arthritis treatment. The vigorous activity helps to stimulate circulation to deliver the medication. This is always suggested with precautions because some people have contraindications to these substances. Subsequent to the workout patients may want to use a topical to relieve inflammation and pain. An excellent over the counter topical for arthritis pain is Castiva. It contains capsaicin, a topical pain reliever, in a castor oil base, which delivers the medication well to the site of pain. I've also found that Castiva is very effective as a topical in the pain associated with rheumatoid arthritis. Other topicals such as salicylate are effective for inflammation.

What are the best fitness programs for arthritic patients?

As suggested in the first question, the ideal is a vigorous workout without trauma. This is the so-called "low impact" type workout. This consists of active low impact weight bearing exercises and non-weight bearing exercises such as light aerobics, swimming, cycling and the elliptical. The main thing to remember is that if the exercise causes arthritis pain at the time of exercise or increased pain symptoms the next day, then adjustments should be made in the regimen to decrease trauma to the painful joint.

Unfortunately, the damage done to most joints is permanent. Some benefit has been seen with glucosamine/chondroitin products in about 50 percent of patients. The chronic nature of this condition is most frustrating and unfortunately most noticeable in people who have been the most physically active in their lifetime. Only about 20 percent of the population will escape these problems prior to the age of 70.

What daily preventive actions should be considered?

For those who are able to tolerate anti-inflammatories and whose drug regimen does not preclude them, they are very helpful in keeping patients more active. Most of the physical activities that alleviate on-going symptoms consist of maintaining muscle tone, flexibility and muscle strength. This necessitates daily activities of stretching, light low impact exercise, massage, moist heat and the topicals for relief.

In 35 years of treating patients I have found osteoarthritis to be very frustrating for the patient, the primary care physician and the rheumatologist. At this point we still do not have a "magic bullet" to prevent this disease. These folks have generally been very active, and in some cases very athletic during their lifetime. They are some of the most motivated patients I meet. I aggressively work with these patients to optimize their lifestyle.