Are there any measures patients can take to reduce or slow the progression of osteoarthritis of the knee?
Dr. Elton Strauss: That's my favorite subject, pet peeve. The first thing to do is to get more active. People who have arthritis usually tend to kind of recoil backwards. They become homebound, they sit more, they eat more, they get heavier, and I just feel that joints are made to work. Joints love not working and you need to encourage the joint to get back into function.
So therefore, if I've a patient that comes in, slightly overweight, slightly debilitated, slightly de-conditioned, I will encourage them to find something they can do to be aerobic. If they used to be a jogger, then I put them on a bicycle. If they used to be a walker, then I'll encourage them to walk with a cane, but they have to walk. They have to get out, they have to do things. And then we talk about nutrition, we talk about certain medications that might be less toxic to the body, such as one of the liniments to rub on your leg.
Dr. Sam Blic: I think that there are certain things they can do, that certainly will diminish symptoms. So whether or not, after 20 or 30 years that's going to change the outcome, it's a little harder to say. I think to change behaviors, as I said, people who have arthritis I would recommend shouldn't go back to running activities.
So modifying activities from what I would concern impact activity to something like swimming for example, where they can exercise but with the same loads on the joint. People frequently who develop arthritis are overweight and losing weight down to a normal level, again, can mechanically unload the joint and lessen symptoms, and theoretically possibly slow the progression. Well again, it's very hard to prove that.
Dr. Elton Strauss: Everybody can exercise. Not everybody can play for the Yankees, but you can find something to do. People who don't feel they can do exercise, let's say, in the park or in the gym, in the swimming pool, gravity is eliminated in the swimming pool.
There is always something you could do. You have to have the will to do it. It's like if you want to get well, you have to be part of that game plan to get well. I can't make you well if you think that I am the only person on this team. You are part of this team if you want some relief. And a lot of patients don't like what I say to them, because I will tell them that their 30 pounds overweight and they're not going to get well until they lose some of that weight.
We go through a whole strategy of how to do that. I will send the patient to a nutritionist. I'll send them to a physical therapist, but they have to go. I can only write a piece of paper out, but if they don't want to do it, it's not going to work. Medication alone will not cure them. A total new replacement alone will not cure them.
Dr. Sam Blic: Well, I think again it comes down to specific types of exercise. With arthritis, I mean, it's not something that you can push through the pain. If you are doing an activity that irritates the joint in the arthritis, it's going to hurt more and then you can't work through that.
So again running, jumping exercise is not appropriate. And generally, I have people try things and see what they can do comfortably. If riding a bicycle is comfortable then they can do that if not then they can try a swimming. So that's going to be a little bit different for every patient.
Frequently, we need to make some interventions for the patient if they're having acute inflammation to get rid of that, before they exercise or again it will probably irritate their joint. So we might put them on some medication and a period of rest for several weeks and maybe just some stretching type exercise until their pain levels diminish and then they can increase and maybe try bicycling or swimming.
But again, there are studies that show that people who do appropriate exercise, that maintain strength and flexibility in the joint, usually, actually have less symptoms than people who are very sedentary.
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