Less pain, more gain: Spring training for people with arthritis

By Bob Isler, P.T., O.C.S., physical therapist, Providence Scholls Rehabilitation and Providence Raleigh Hills Rehabilitation

Spring is finally here – at least according to the calendar – and the garden and great outdoors are calling. If you have mild osteoarthritis, don’t let the fear of increasing pain keep you from answering that call – inactivity only makes things worse. Getting outside and gently bending, stretching and moving your body could do you a world of good. 

It may be tempting to avoid using painful joints, but remember that your joints are made to move. Exercise keeps your joints healthy and slows the progression of osteoarthritis in several important ways:  
  • Movement bathes the joints in lubricating fluid.
  • Load-bearing exercise creates a “squeeze and release” action in the cartilage that pads the joints, bringing nutrients into those tissues and sending waste products out.
  • Strength-building activities strengthen the muscles that surround the joints, which helps to control and cushion the loads that you place on your joints.
  • Stretching exercises help you maintain flexibility in your muscles and joints, which protects the joints by keeping loads evenly distributed.
Avoiding exercise deprives the joints of lubrication and nutrients, which makes them stiffer and more painful. It also weakens the muscles, which further reduces your body’s ability to protect your joints. On the other hand, overdoing it and putting too much stress on arthritic joints can increase inflammation and further break down joint padding. The key to getting the most benefit from exercise is to find the right balance of activities that you can perform comfortably and safely. 

Starting your spring training  
If you are starting an exercise program for the first time, or after a long, inactive winter, talk to your doctor or physical therapist first to set up a safe plan. Then start slowly and pace yourself. To avoid increasing inflammation, you might start with just five minutes of exercise every other day, increasing gradually over several weeks until you can do 30 to 45 minutes of exercise three or more times per week.  

A balanced exercise program should include three types of activities: vigorous activities that increase aerobic conditioning, exercises that build strength, and stretches that improve flexibility.  

Aerobic exercise  
In addition to its importance for cardiovascular health, aerobic exercise lubricates the joints. It also can help you reach and maintain a healthy weight, which reduces stress on your knee, hip and ankle joints. And it’s the perfect way to warm up your joints prior to doing strength and flexibility work.   

You might need to stay away from high-impact activities, such as jogging, tennis and step aerobics, which can jar the joints. But there are plenty of low-impact activities that provide a great aerobic workout. The following examples put less stress on your joints and can frequently be done without pain:  
  • Walking
  • Swimming
  • Water aerobics
  • Riding a stationary bicycle
  • Using an elliptical trainer
Build your aerobic exercise capacity slowly, starting with five minutes and adding one or two minutes per week. Focus on your comfort level and aim for the longest time, not for speed or resistance. 

Strength training  
Strength training is important for stabilizing the joints by building strong, supportive muscles. Some of the best ways to strengthen muscles without stressing the joints are: 
  • Using weight machines set with low resistance
  • Using elastic exercise bands
  • Doing water-resistance exercises in a pool
A physical therapist or fitness trainer can teach you proper form, which is very important to protect your joints, and can show you how to modify exercises in the beginning to allow your joints and muscles to ease into new exercises without increasing pain. Weight lifting and other exercises designed to build strength should be done at low to moderate resistance. To make sure you don’t use too much weight and over-stress your joints, choose a weight that allows you to do three sets of 10 to 15 repetitions comfortably.

Flexibility training  
The goal of flexibility training is to reduce stiffness and to maintain your ability to move your joints and muscles through their full range of motion. Depending on the extent of your arthritis, you may need to take this very slowly, starting with stretches that focus on partial range of motion. Arthritic joints that have become stiff will not move through their full range of motion, due to adhesions.  

Gently stretch the joint to the point of mild discomfort, but not pain. If you start with a gentle stretch, the discomfort should stop upon release, and you shouldn’t notice any increased pain or stiffness later. Often, the discomfort experienced with stretching eases with repetitions. If pain or stiffness increases, back off and do gentler stretches the next time.  

For stiff joints such as the knee, try repeating a knee-to-chest stretch, applying gentle pressure to bend the knee further. Repeat 10 times, holding for one or two seconds each time. Tight muscles surrounding the joints often can be stretched without straining the joint. This requires longer stretches that are held for 20 to 30 seconds. Some useful leg stretches include:  
  • Standing calf stretches
  • Seated hamstring stretches
  • Prone or standing quadriceps stretches
Your doctor or physical therapist can show you how to do these stretches properly. See the links at the end of this article for more information on exercising safely with arthritis.  

Experiencing pain? Don’t put your whole program on ice.  
Using ice on your arthritic joints for about 10 to 15 minutes after exercise will help minimize any increases in pain or inflammation. Over-the-counter pain medicines and creams also can help control joint discomfort, but take care not to double up if you are also taking prescription medicines. Taking too much acetaminophen can cause liver damage.

Be sure to monitor your after-exercise symptoms. If your pain worsens, it means that you need to let up a little bit on your exercise duration, frequency, range of motion or load. Don’t stop altogether – just adjust until you find your proper exercise prescription, and then keep it up. A regular, appropriate and balanced exercise program can help you function better, decrease pain and stiffness, protect your joints from further damage, and get out in your garden or the great outdoors – with pleasure.  

For more information: