I have known people do heavy exercises thinking it will help their arthritic knee. Most of them tell me the exercises did not help. In fact, the pain in the knee actually got worse. I tell them exercise is good but the level of exercise intensity can make a big difference whether the knee will feel better or worse.
For our patients with degenerative joint disease of the knee, we start them with mild and gentle range of motion (ROM) exercises . An example is heel slides on the mat. Heavy, weight bearing exercises such as squats, and lunges are done a few weeks later, depending on the severity of the arthritis of the knee. Each person has his own level of threshold that when crossed will result in an inflammatory flare up. Our rehab program focuses on staying below this threshold. As the knee gets stronger and more flexible, this threshold goes up therefore allowing heavier exercises to be done without flare up. “No pain, no gain” does not apply here. This increase in threshold varies from person to person but it definitely improves with exercise.
In our practice, we document every session the level of exercise our patients did. If ever this threshold is crossed, we know exactly how much exercise this patient can tolerate. We then go near it but not past it. Eventually, patients see their progress and learn the proper way of advancing the exercises. By the time we discharge them, they not only have a home exercise program but they have the knowledge of correctly doing and advancing the exercises. Eventually, with better strength and flexibility, function improves. Getting up from a chair will no longer be such an effort. Getting in and out of car, stepping up on curbs or stair climbing will be easier. Because the knee has a higher threshold for physical activity, flare up does not happen. Patients stay pain free doing what they want and need to do.
Patients consult their doctors when something is hurting. In the case of knee arthritis, they are given anti inflammatory medicines for their, well, inflammation. For some who are referred to us, they show up in our office with persistent inflammation. We have modalities just for this problem. In addition, they are educated on strategies to minimize strain on their joint . They are instructed, just to give a few examples, to avoid prolonged walking, to avoid stepping up on curbs, or to use their hands when getting up from a chair.
In closing, I would like to share a joke.
So there was this athlete who was being interviewed by a sports caster.
Sportscaster: Can you tell us how you train?
Athlete: Well, I climb Mount Everest. Then I swim the Ganges river. And then I jog the Sahara desert.
Sportscaster: Wow! That’s quite a workout!
Athlete: Yes, and I do all that in one week.
Sportscaster: Amazing! So what do you do the rest of the year?
Athlete: I lie in bed sick.
Let us not be this athlete. If you happen to need physical therapy, call us. We have two locations: One in Land O’Lakes and the other in Zephyrhills, Florida. Stay well.
– Dino Lontoc, P.T.