Leigh Schafer, 51, is a computer programmer by day, but the rest of the time, she's a triathlete in training. She recently completed her first half Ironman, a killer combo of swimming, running, and biking. She keeps up a workout routine that takes 10 hours or more per week. And she does it all on two barking knees: Six years ago, she was diagnosed with moderate osteoarthritis (OA).
"I listen to my body, eat more anti-inflammatory foods, use ice to reduce swelling, and get joint-fluid injections every 6 months. And on bad days, I take a little arthritis-strength acetaminophen," she says. But she won't skip the workouts she loves. "The more I do, the less pain I have. I figure my knees are going to hurt no matter what," says Schafer, who lives near Washington, DC. "I might as well have fun in the meantime."
She's right. Even though wear and tear can contribute to OA, experts now agree that exercise is one of the best ways to address—and ease—your symptoms.
Like the fan belt in a car, many people's joints can take only so many years and miles before they start to deteriorate, and overuse and injury speed that breakdown. Once you pass age 40 or so, cartilage—the juicy, rubbery tissue that cushions and protects one bone from another—starts to disintegrate. And for reasons that are still unclear, many of those joints can go on to develop full-fledged OA, an inflammatory process that results in more loss of cartilage and damage to bones, causing stiffness, pain, and reduced function. The most commonly affected joints are in your knees, hips, hands, neck, and lower back.
"While wear is definitely a factor, it's not the whole story," says Patience White, MD, vice president of public health at the Arthritis Foundation. "We still don't fully understand what makes some people more vulnerable." The latest thinking is that inflammation plays an important role in the development of OA. Inflammation is the body's normally time-limited response to injury or infection, rushing white blood cells and protective chemicals where they're needed to help us heal. But in some diseases, such as arthritis, inflammation may work overtime and cause joint damage.
However, we do know what some of the risk factors are, and one of the biggies is weight: Since the start of the obesity epidemic, the average age of OA diagnosis has plunged to 56—that's 13 years earlier than in the 1990s, says research from Brigham and Women's Hospital in Boston. Overweight women have four times as great a risk of developing OA in their knees as women at healthy weights. Every extra pound exerts roughly 4 pounds of additional pressure on each knee. But heavier women are also more likely to get OA in their hands, hinting at systemic causes. (Obesity has been linked to inflammation.) And there are risk factors you can't control: Genes play a part too. So does gender—women account for more than half of America's 27 million OA patients.
But while researchers are still exploring the multiple causes of OA, they, like Schafer, are sure of the smartest solution: exercise. Done right, it's both the best treatment for OA and the best way to prevent it.
Illustrations by Wendy Beth Jackelow
WHY MOTION WORKS
Wait a minute, you may be saying. If wear and tear contributes so much to OA, won't exercise make it worse? The answer is an emphatic no. Extensive research—including a recent Norwegian study of 30,000 people—has shown that physical exercise does not increase the odds of developing OA, even for heavy people who work out. In fact, exercise is the very best medicine you can give your tender joints. It builds muscle, stabilizes joints and gives them flexibility, and keeps weight down, which provides major benefits. In fact, if you don't have OA now, losing just 11 pounds will decrease your risk of knee OA by more than 50%.
"But movement does much more," says Magdalena Cadet, MD, a rheumatologist for the New York Presbyterian Healthcare System. "It promotes healthy hormonal balances that may ease symptoms. And it can enhance brain chemicals that boost your mood and may help fight the depression that can trouble people with OA."
If you've just been diagnosed with OA—or if your joints have been aching for years—a stepped-up fitness commitment can seem like a lot to ask. "It's easy to give in to that stiffness and move less because of OA, but we now know that only makes it worse," says A. Lynn Millar, PhD, a physical therapy professor at Winston-Salem State University and the author of Action Plan for Arthritis. "It becomes a vicious cycle. But even in the most severe cases, it's never too late to start exercising. Just be smart about it." Check out the Best And Worst Exercises For Knee Pain to find the right exercises for you.
Is It Really Osteoarthritis?
OA may be common, but it's not the only cause of joint pain and stiffness by a long shot, so you need to get an official diagnosis to ensure that you're properly treated.
"If joint pain lasts more than a few weeks, if it starts to limit daily function, or if you hear bone grating on bone, see a doctor and ask about OA," says Magdalena Cadet, MD, a rheumatologist for the New York Presbyterian Healthcare System. But keep in mind that other possible causes include one of the more than 100 other varieties of arthritis (among them: rheumatoid arthritis, Lyme disease, gout, and fibromyalgia), muscle strain, or tendinitis, says Jonathan Chang, MD, a spokesperson for the American College of Sports Medicine.
When you go to your doc with symptoms, she may suggest an x-ray or MRI to diagnose your problem, but she may also investigate other factors. "Sometimes changes to the bone and cartilage won't show up right away in images," Dr. Chang says, "so we also pay attention to how well the joint is actually working and how healthy the soft tissues—tendons, ligaments—around it are." Your doctor may also ask about your family history, so she can consider all those factors in reaching her final diagnosis—and her treatment recommendations for you.
PAIN IS TALKING TO YOU
Pain is a message from your body, but it's up to you to decode it properly—with the help of your doctor. Don't start a new exercise program until you've discussed safety parameters and pain-management options.
One of your first steps should be to precisely assess your pain so that you can record your progress. Each morning when you first wake up, give any joint aches a number from 1 to 10: 1 means you feel like trying a few cartwheels; 10 is "haul me out back and shoot me now, please." Then do simple range-of-motion and flexibility exercises for the body part that hurts (your doctor can advise you on moves) and give your pain a score again 1 hour later.
Track your pain during and after exercise too. The cardinal rule of exercise—don't do anything that hurts—can be pretty confusing when everything seems to hurt. Instead, focus on workouts that don't intensify pain. "Some pain during exercise is to be expected with arthritis," says Jonathan Chang, MD, clinical associate professor of orthopedics at the University of Southern California and a spokesperson for the American College of Sports Medicine. "But it shouldn't increase during or after workouts."
Once you understand its pattern, work with your doctor to develop ways to manage your pain, which may include medication. OTCs like acetaminophen or ibuprofen can help but come with risks, such as gastrointestinal bleeding, so be sure your doc knows how often you take them. For more severe pain, she may prescribe a stronger painkiller, like Celebrex. Antidepressants can also significantly reduce pain (probably by increasing the action of neurotransmitters in your brain that affect pain perception) and are used either alone or in combination with conventional painkillers.
Other options that can keep you comfortably active include the kind of joint-fluid injections Schafer gets, which juice up knee joints with hyaluronic acid and produce results that often last for 6 months to a year, as well as aids like braces and insoles. Some doctors may recommend physical therapy, very focused exercises designed to get you moving more effectively. And integrative remedies include acupuncture and massage, which decrease pain and inflammation and improve mobility. The takeaway: You and your doc have an arsenal of ways to control OA pain and keep you active.
Learn more about determining what your aches mean with What Is This Pain?
NOW TRY THIS
As you develop and update your exercise routine, create a program that includes at least several sessions per week of:
CARDIO Experiment with anything that appeals to you, from salsa to Zumba, hula-hooping to hiking. "If it doesn't cause additional pain or swelling during or after the exercise, then it's probably OK," says Jerry Cochran, MD, an orthopedist and ACSM spokesperson. "But if they do hurt, your joints are telling you that you're doing something you shouldn't." That doesn't mean you should give up and retire to a recliner; it means you should try something else.
If you've been sedentary recently, walking is a great place to start. "Begin with short distances, even a few blocks," Dr. Cochran suggests. "Walk the same route every day for 2 weeks, and if there is no difference in the pain or swelling, increase the distance by 10% each week." Once you've reached 2 miles, you can experiment with jogging for short intervals and see how it feels. If walking does increase your pain, try something more joint-friendly, such as swimming or walking in a pool.
If, however, you're an ardent runner, you can say, "Full speed ahead!" There is solid research that your exercise of choice benefits knees. Just make sure to discuss your plans with your doctor, who may prescribe standing x-rays, as well as different shoes or inserts to help you keep your stride strong. "Every patient is different," Dr. Chang says, "but there are all kinds of things we can do to keep people moving in the ways they want to."
And don't be afraid to pick up the pace. "Research on rheumatoid arthritis [RA] has shown that moderate to intense exercise is quite beneficial, and we believe that is true for OA as well," Dr. Millar says.
STRENGTH TRAINING Building up your muscles, especially around the knees, shoulders, and core, prevents injuries, including strain on tendons and ligaments, which worsen OA pain. Strength training using resistance bands is especially effective. Body weight exercises, like push-ups and modified squats (keep your body weight behind your knees), are good options.
SMART STRETCHING Every joint has its limitations, says Dr. Chang. But a regular stretching routine strengthens tendons and ligaments, maintains and improves range of motion, and plays a big role in staving off injuries. Experiment with stretches you already know, backing off if any increase your pain.
Evidence is also mounting that suggests guided classes can be a huge help. Just two weekly tai chi classes were shown to improve range of motion and reduce pain in a study funded by the National Center for Complementary and Alternative Medicine. Yoga helps, too, especially poses that tone the quadriceps so they can relieve pressure on your knees. Try a yoga class or DVD in the evening: Nighttime yoga helps women with OA sleep more soundly, battling pain-related insomnia. (Watch Prevention's fitness expert Chris Freytag demonstrate 3 knee-saving exercises.)
WHAT ABOUT SURGERY?
Finally, while many people can stay active and reduce symptoms simply by maintaining a healthy weight, exercising regularly, and working with their doctors for occasional pain-relief strategies, not everyone experiences that success. In some cases, joint-replacement surgery may be the best solution. The good news is that, thanks to improved materials and surgical techniques, joint replacement isn't the end of the road—it can help you stay more active than ever.
Take Michele Melkerson-Granryd, 52, of Austin, TX. She started feeling tightness and pain in her hips about 7 years ago. "I've been a fitness instructor my whole life, but gradually it got to the point where I couldn't even sit cross-legged," she says. "I went first to my chiropractor. He took x-rays and told me I had the hips of an 80-year-old woman. I cried when I saw the images! The head of my left thighbone was actually mangled."
Her doctor prescribed physical therapy, which she pursued religiously for a full year, but the pain steadily increased. On a visit to Chicago with her parents, she says, "my mom insisted we take a bus for a few blocks, because she couldn't stand to see me limp; at that point, I had to admit that my way wasn't working." After weighing the options, she chose to go for hip replacement, a decision some 773,000 people are now making every year.
"My surgery was on a Friday, and I was in less pain on Saturday," Melkerson-Granryd says. Within 6 weeks, she was teaching again (with some modifications), and 4 months later, she had the other hip replaced. Today she still teaches multiple classes each week, including Zumba, cycling, and yoga. And everyone with arthritis should be able to say, as she does, "I'm getting stronger and more flexible every day."