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Healthy Living

Healing Moves for Aching Joints

stretch

The surprising answer to arthritis pain: exercise

For Liz Fell Kelly exercise is more than a matter of staying fit or staying sane. She works out to protect her ability to move without excruciating pain. A prefessor of physical education at Monroe Community College in Rochester, New York, and the mother of a second-grader, Kelly is only 40 years old. But for more than ten years she's been among the nearly 16 million Americans living with osteoarthritis, a disintegration of cartilage in one or more joints that leads to painful grinding of bone against bone. The disease, which strikes three times as many women as men, saps confidence and youth as it stiffens joints.

When she felt the first raw jab at the base of her neck in 1988, Kelly figured maybe she'd pinched a nerve, and that the pain and stiffness would soon recede. They didn't. Over the years every movement brought a twinge. And the less she moved, the more debilitated she became. "By last year," she says, "I had a great deal of difficulty opening doors, writing on the blackboard, and swinging a golf club. There was pain and numbness down my arm."

Kelly at last sought help from a neurosurgeon, who diagnosed her as having advanced osteoarthritis. The shock-absorbing cartilage in her neck was shot. Surgically fusing several vertebrae brought relief, but only for a time. To Kelly's surprise, the doctor said her best defense against continued deterioration was not less exercise but more.

That prescription may sound sadistic. Yet increasingly, research indicates that if arthritis is to be slowed -- or, in some cases, even reversed -- the right kind of exercise is the key.

"We're absolutely not saying that arthritis patients should push their bodies so hard that they hurt more," says Nicholas DiNubile, an orthopedic consultant to the Philadelphia 76ers and the Pennsylvania Ballet. "And there are some exercises, like hard, regular running, that just aren't going to help arthritic joints. But a well-designed program of aerobic and resistance training, flexibility, and joint-mobility exercise not only will reduce the discomfort of osteoarthritis but can actually improve the condition of the joints."

Within the body's every hinge, the tips of opposing bones are covered by cartilage that cushions the moving parts. A syrupy liquid, synovial fluid, acts like oil in an engine, lubricating the works.

But inside a joint afflicted with osteoarthritis, for reasons still little understood, the cartilage withers away, producing an inflammation that breaks down hyaluronic acid, the main chemical in synovial fluid. This loss of lubrication leads to further cartilage disintegration, perpetuating the cycle.

Though its origins remain mysterious, the condition's not an inevitable part of aging. Trauma and overuse seem likely instigators; professional football players and housekeepers are known to develop more than their share of achy knees or hips, and doctors speak of "bus driver's shoulder" or "bowler's thumb." Likewise, obesity aggravates the problem, taking a special toll on hips, knees, and ankles.

Whatever triggers the degeneration, it continues because of a universal quirk of anatomy: No blood vessels run through cartilage, so it depends on frequent sloshes of synovial fluid for its supply of oxygen and other nutrients. Physical activity fosters that sloshing and also prompts the spongy cushion to ooze more lubricant.

As Liz Kelly guarded her sore neck and shoulder, the cartilage within was literally starving from lack of nourishing movement. As the normally smooth bones scraped each other, they developed pits and spurs that snagged soft tissue, further restricting her range of motion and increasing her pain.

Though some doctors still prescribe rest for their aching and hobbled patients, that approach is misguided, DiNubile says. One of the most convincing studies compared the effects of aerobic exercise, weight training, and health education on adults aged 60 or older who were disabled by arthritis of the knee. After 18 months those who and participaged in either of the exercise programs could walk farther than those who'd spent their time in the health class. They could also lift and carry weight more easily, get out of a car faster, and climb stairs more quickly -- with less pain.

Physical therapist Chris West sees much the same thing in the younger, more active crowd he treats in his Boulder, Colorado, practice -- patients in their thirties and forties. "We may not get them totally pain-free," he says, "but if they stick to the exercise program they can do the things they want to do with a minimum of discomfort."

The idea, specialists say, is to develop a routine in which every aspect strengthens and stabilizes joints instead of taxing them. Walking, bicycling, in-line skating, and swimming or other pool-based activities all fit the gentle-but-challenging bill while building cardiovascular fitness. Both DeNubile and Kelly swear by the new elliptical exercise machine, a hybrid stair-climber/cross-country-ski device that boost endurance without jolting the legs or spine. Also, routinely icing a sore joint after any vigorous exercise will help prevent painful swelling.

Weight lifting can help ease the stress on a joint by balancing the strength of surrounding muscles. To lift safely, start out with light weights and do ten to 15 repetitions in each set, only very gradually increasing the weight hefted.

Stretches are great for helping stiff limbs regain their flexibility, but some of the most popular moves are the worst. For example, the usual hurdler's stretch -- in which you sit on the floor with one leg straight before you, the other bent sharply at your side, heel touching tush -- unduly twists the knee. To get all the gain without the pain, bend the leg in, rather than out, placing your foot against the knee of your outstretched leg.

For all stretches, there's a right way and a wrong way. Each should be done slowly -- just to the point at which you feel a slight pulling sensation in the muscle -- then held for 15 to 20 seconds. "No bouncing," DeNubile warns.

Many local chapters of the Arthritis Foundation offer excellent exercise classes, he says. (Call 800/283-7800 or visit http://www.arthritis.org.) Because proper form is crucial, he also advises anyone with arthritis to consult a professional when first devising an exercise plan. "A good physical therapist will tailor a workout for your specific problems and make sure you are doing the exercises correctly," he says. "After that it's up to you to be consistent."

Liz Kelly has followed that advice with big results. She spends 45 minutes on an elliptical trainer six days a week, and lifts weights three times a week. She stretches daily and does stomach crunches to strengthen abdominal muscles that help support the spine.

"Yes, exercising takes time, and yes, it's something I'll have to do for the rest of my life," Kelly says. "But it does work. I'm largely free of pain now."

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