January 2023 - Comprehensive Orthopaedics

Even Light Exercise Can Help Arthritic Knees

by Comp Ortho | Jan 25, 2023 | Anti-aging, Exercise

Even short bouts of light exercise can help the millions of people with knee osteoarthritis reduce pain and improve their range of motion.

Knee osteoarthritis, the wear-and-tear form of the disease, occurs when the cartilage between your bones breaks down, causing pain, stiffness and swelling.

Researchers in a new study compared high-dose and low-dose exercise in 189 people with knee osteoarthritis. Everyone exercised three times a week for 12 weeks. Exercises included indoor cycling and various lower body exercises such as de-loaded squats and knee extensions. De-loaded exercises use bands or pulleys to take weight off the knee joint and minimize pain.

Folks in the high-dose group performed 11 exercises in 60- to 90-minute sessions. Folks in the low-dose exercise group performed five exercises during 20- to 30-minute sessions.

The result? Everyone showed improvements on a standard scale measuring knee osteoarthrosis pain and function at three, six and 12 months. People in the high-dose group did show greater improvements in knee function during sports and recreation at six months, suggesting that a high-dose program may be better for athletes and weekend warriors.

The study, led by Wilhelmus Johannes Andreas Grooten, a physiotherapist at the Karolinska Institute in Stockholm, was published Jan. 24 online in the Annals of Internal Medicine.

Outside experts are quick to point out that the best exercise plan for someone with knee osteoarthritis should fit in with their lifestyle, goals and capabilities.

Jack Fitzgerald is a physical therapist at the Hospital for Special Surgery in New York City. He routinely designs and implements exercise plans for people with knee osteoarthritis.

Calling the new study results “music to any physical therapist’s ears,” Fitzgerald pointed out that participants in the study showed meaningful improvements in knee symptoms and that adherence to their program was excellent across both groups.

This is at least partially due to the fact that exercise was prescribed on a minimal/no pain basis, Fitzgerald said.

“Regardless of the exercise dosage, when we are capable of prescribing exercise within pain-free limits, there is more hope that patients will respond well to the treatment,” he said.

“If you are prescribing exercises for these patients with their best interest in mind, the program should be specific to the likes and goals of the patient keeping in mind loading principles to manage pain,” Fitzgerald added.

Exercise is an essential part of knee osteoarthritis treatment, said Dr. Sonali Khandelwal, an associate professor of internal medicine at Rush Medical College in Chicago.

“A component of knee osteoarthritis is weakening of the muscles surrounding the knee, and exercise strengthens these supporting muscles,” she said.

Many people worry that exercise will make knee OA worse, but this isn’t true, Khandelwal said.

“It’s important to assess a person’s risk of falls and history of exercise when prescribing a plan,” she said. “For people who have never done any exercise, just moving and walking tends to go a long way.”

Conservative measures such as physical therapy and exercise are first-line treatments for knee osteoarthritis pain, Khandelwal said. Next up are steroid or hyaluronic gel injections and pain-relieving medication like non-steroidal anti-inflammatory drugs or acetaminophen.

“When conservative measures don’t work, pain is a 10 out of 10, and you can’t perform activities of daily living, surgery can be considered,” she said.

“It’s great to see studies like this as surgery results don’t last forever,” Khandelwal said.

Dr. David Pisetsky, a professor of medicine at Duke University School of Medicine in Durham, N.C., agreed.

“For people with knee osteoarthritis, activity is important to maintain strength and range of motion,” he said. “Exercise should be easy to perform … walking is a good way to go.”

Other options include swimming, riding a stationary bicycle, and exercising with light weights.

More information

The Arthritis Foundation provides more on knee osteoarthritis, including its causes and treatments.

SOURCES: Jack Fitzgerald, DPT, physical therapist, Hospital for Special Surgery, New York City; Sonali Khandelwal, MD, associate professor, internal medicine, Rush Medical College, Chicago; David Pisetsky, MD, PhD, professor, medicine, Duke University School of Medicine, Durham, N.C; Annals of Internal Medicine, Jan. 24, 2023

Preventing and Treating Indoor Cycling Injuries

by Comp Ortho | Jan 17, 2023 | Anti-aging, Wellness

Indoor cycling is a great workout. But it can cause aches and pains if you’re not positioned on the bike correctly. Follow these tips to stay safe while cycling!

Indoor cycling has skyrocketed in popularity, and it’s not hard to see why. During the pandemic, people sought a home-based workout alternative and rushed to buy indoor cycling equipment. Today’s indoor bicycles are interactive and allow you to work with an online trainer, which makes the workout more fun and less solitary. Plus, you don’t have to worry about the weather. You can exercise anytime of year in the comfort of your own home

As a cardiovascular workout less stressful on the joints, indoor cycling can’t be beat. But it can lead to pain and injuries if you don’t follow the correct technique and form. Before hopping on the bike, learn how to pedal the right way for a pain-free workout.

Preventing common indoor cycling injuries

Just because indoor cycling is a low-impact aerobic activity doesn’t mean your joints won’t ache after a session. Specifically, your knees, back, shoulders, wrists, and feet may feel sore, mostly because you’re not correctly stationed on the bike. But you can have a pain-free ride by getting into the proper position. Here are some tips:

Knees. Do you feel pain along the inside or front of your knee? It could be because you’re sitting too low and/or too far forward on the bike. To get in the right position, raise the seat up so that when the pedal is at the bottom of your stroke the knee is bent at a 30 degree angle. Move the saddle forward or backward to position the front of the knee above the front of the shoe. You can also lower the resistance, or shorten your workout, to further prevent knee pain.

Back & shoulders. Hunching too intently over the handlebars strains your back and shoulders. But the fix is simple: Raise the handlebars or move them closer to your midsection. And always keep your torso bent at a 30-degree angle. And remember to relax your neck and shoulders as you cycle.

Wrists. You may not realize it, but you stress your wrists and hands when you lean forward or bend them too much during a ride. Try to maintain a slight bend at the elbow and keep your wrists straight when holding the handlebars. The goal is to not put too much weight on your wrists and hands. Another option is to wear gloves when pedaling.

Feet. Ill-fitting shoes can lead to a common cycling injury known as metatarsalgia. It’s also called hot-foot syndrome because the balls of your feet will feel hot. The solution is to wear well-fitted, padded shoes. Your feet should be secure in the pedals, but not so squeezed it causes pain.

Prepping for your ride

Like any other workout routine, indoor cycling requires some prep time. Exercises to build strength and flexibility in the mid-back region can get you into the right position when riding and help prevent injuries. Try these two:

Quadruped thoracic extension. Get down on your hands and knees, making sure your spine is in a neutral position. Move your elbows and forearms down to the floor and bring your hands together in a triangle. Then, lower your chest to the floor and shift your weight back toward your knees. Hold for 30 seconds.

Bird-dog exercise. Position yourself on your hands and knees, with your hands under your shoulders and your knees under hips. Keep your neck and spine in a neutral position. With your shoulders and hips parallel to the floor, lift your right leg straight behind you as you lift your left arm up with the thumb pointing up. Hold for five to ten seconds, and return to the original position. Do on the opposite side. Aim for two to three sets with between eight and twelve repetitions.

If pain persists, see an orthopedic physician who may send you to a physical therapist. They may be able to pinpoint where your positioning on the bike is off and suggest adjustments. A physical therapist can also guide you through exercises to strengthen the muscles used during a ride. And if you do suffer an injury, your physical therapist will help you recover with an individualized therapy plan. After investing in an indoor bicycle, you’ll want to get the most out of your workout, and that means a pain-free session.

How to Identify a Bicep Tear

by Comp Ortho | Jan 10, 2023 | Elbow, pain, Wellness

Bicep tears are common, but many people fail to realize that the pain they’re feeling is actually caused by their bicep, not their shoulder.

You may not realize it, but you put a lot of strain on your shoulders when lifting weights or playing common sports like baseball or football. Although the shoulder joint is strong and flexible, it sometimes buckles under the weight of overuse or a sudden injury. However, just because you’re experiencing shoulder pain, that doesn’t necessarily mean you’re experiencing an issue with the joint itself. A bicep tear can also cause severe shoulder pain.

That may seem surprising, since when you think of your bicep you likely think of your upper arm. And it’s true that your bicep muscle sits at the front of your upper arm, but that doesn’t mean it can’t cause pain elsewhere. In fact, your bicep works with your shoulder thanks to two tendons that attach the muscle to the scapula bone of the shoulder. Another tendon also links the muscle to the radius bone at the elbow. The muscle and tendons are what gives your shoulder its mobility. Although the tendons and muscle are durable, an injury or repetitive motions can lead to painful tears. At New York Bone & Joint Specialists, we’ve treated many bicep tears and can help you on the road to recovery.

What a bicep tear feels like

Bicep tears can either be partial or complete. Partial tears mean only part of the muscle or tendons are torn. In a complete tear, the bicep tendon tears into completely separate pieces.

Most often, tears are caused by an injury, such as lifting a heavy object or a fall. However, athletes who regularly perform overhead motions, such as throwing a baseball, are also particularly vulnerable to bicep ruptures. A bicep tear comes with some noticeable symptoms that can help you identify your injury as a bicep tear rather than a shoulder injury. These are:

Sharp pain. As your bicep tears, you’ll likely feel a sudden jolt of pain either near your shoulder or near your elbow. This pain occurs whether you suffered a partial tear or a complete tear.

Popping sound. Along with pain, the torn bicep may produce a popping sound when injured.

Bruising. After a tear, you may notice bruising, swelling, and a feeling of warmth in your upper arm that could extend to your elbow.

Lingering pain. A tear could develop over time due to overuse. In this case, instead of sudden, sharp pain, the pain and tenderness in the arm and shoulder will gradually increase if the tear isn’t treated.

Weakness in the shoulder and arm. A bicep tear weakens your arm and shoulder, such that you can’t perform routine tasks. One telltale sign of a bicep tear is that you cannot rotate the palm of your hand either up or down when your arm is straightened.

Abnormal bulge. When the tendons cannot hold the muscles in place, the muscles in the upper arm may bulge outward in what is termed the “Popeye muscle.” You may see a pronounced dent closer to your shoulder. too.

Bicep tear treatment

Treatment options vary depending on whether the bicep tear is a partial tear or a complete and based on the age and activity level of the patient. Tears of the tendons connected to the shoulder are most common, and are termed proximal bicep ruptures. The alternative is a distal bicep tendon tear, which occurs when the tendon attached to the elbow is injured.

Younger, active patients benefit greatly from arthroscopic surgery to repair the damaged tendon. Older, less active patients may opt for conservative therapy instead, which includes rest, icing, and non-steroidal anti-inflammatories. Once healed — whether using surgery or a conservative approach — you’ll undergo an extensive physical therapy program guided by the therapists to get your shoulder back to a normal range of motion. Although you’ll feel significant improvement in four to six weeks, a complete recovery usually takes three to four months.

Heal your bicep tear today!

An aching shoulder can greatly affect your quality of life. But the orthopedists at CompOrtho can diagnose and treat your shoulder, whether your injury is due to a bicep tear or not, and get you back to normal again. Contact us for a consultation.