Four days ago on the World Osteoporosis Day (October 20) experts across the world came together to raise more awareness on the importance of maintaining bone health and preventing a disease that is likely to seriously hamper their movements and cause constant pain for the rest of their lives, if allowed to progress.
While no national survey has been done on the number of persons afflicted by millions of persons suffer from Osteoarthritis ( OA) in Sri Lanka, experts in the field believe that a significant number of Lankans ( mainly women) suffer from this crippling condition . To compound matters, the recommended traditional treatments available to them prior to 2000 which was weight balancing and gym workouts with a few pain killers like paracetamol thrown in to relieve severe pain were unsatisfactory.
However, a new study around 2003 brought fresh hope for OA patients . According to the study, combining both land based exercises with water resistance exercises ( Hydro therapy ) could definitely help increase their muscle strength and improve their bone health significantly.
The Sunday Observer asked a long experienced Chartered Physiotherapist, Head Rehabilitation Services , MJF Charitable Foundation, Dr Gopi Kitnasamy to explain to readers the specific health benefits of this new combined technique to those undergoing treatment.
The Sunday Observer asked a long experienced Chartered Physiotherapist, Dr Gopi Kitnasamy currently heading the Rehabilitation Services at MJF Charitable Foundation, how water therapy benefits OA.
Excerpts
Q. While Osteoarthritis is often talked about, not many people really know what this condition is. Explain its meaning, how it occurs and which part of the body is affected.
A. Osteoarthritis (OA) the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time. Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine. In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In OA, the cartilage breaks down, causing pain, swelling and problems moving the joint.
Q. Symptoms ? How are they initially identified?
A. Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:
Pain. Your joint may hurt during or after movement.
Tenderness. Your joint may feel tender when you apply light pressure to it.
Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
Loss of flexibility. You may not be able to move your joint through its full range of motion.
Grating sensation. You may hear or feel a grating sensation when you use the joint.
Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.
Q. What are the risk factors?
A. Risk Factors that may increase your risk of osteoarthritis include:
Older age. The risk of osteoarthritis increases with age.
Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.
Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight puts added stress on weight-bearing joints, such as your hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints.
Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis. Even injuries that occurred many years ago and seemingly healed can increase your risk of osteoarthritis.
Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
Genetics. Some people inherit a tendency to develop osteoarthritis.
Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
However, Osteoarthritis symptoms can usually be effectively managed, although the underlying process cannot be reversed. Staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function.
Q. What role does exercise play in relieving disabilities among people with OA?
A. Exercise is an integral part of any arthritis treatment program, as it helps to strengthen and stabilise the joints, preventing further damage. For patients suffering from osteoarthritis, the pain brought on by regular exercise can feel unbearable. Water Exercise is an excellent option for patients with osteoarthritis of the knees, hip osteoarthritis, and spinal osteoarthritis due to the decreased pressure placed on the joints.
Q. In what way?
A. Water provides an ideal environment for patients to exercise because the buoyant force of water counteracts the downward pull of gravity, thus reducing the weight placed on the joints. Studies have shown that up to 50% of body weight is supported in waist-deep water, while 90% of weight is supported in neck-deep water. Patients suffering from osteoarthritis are often unable to perform traditional land-based exercises due to increased pain created by the impact. In a supportive medium such as water, patients can perform similar strengthening or endurance exercises with the benefit of gentle resistance, and also a reduction in pain.
Water exercise is especially helpful in cases where a land-based exercise program is not possible due to the intensity of pain, decreased bone density, disability or other factors. Water exercise is particularly good for people with conditions such as:
* Osteoarthritis
* Advanced osteoporosis (with susceptibility to and/or pain from fracture)
* Muscle strain or tears
* Physical disabilities and Neurological disorders
In addition to those conditions, water exercise is frequently recommended as one form of exercise therapy to treat those with diabetes as well as individuals with high blood pressure. Both conditions can improve and become more manageable with water exercise.
Q. What are its benefits as shown in the study ?
A. Researchers compared the effects of a six-week hydrotherapy or regular gym exercise program vs. no exercise at all in a group of about 100 people with osteoarthritis of the knee or hip. Both of the exercise programs focused on resistance exercises designed to build muscle strength around the affected joint, and participants worked out three times a week either in the pool or in the gym.
They found both exercise programs provided valuable benefits in improving physical function. Walking speed and distance improved significantly in both exercise groups compared with the non-exercisers, while one advantage of hydrotherapy was that it increased cardiovascular fitness, allowing people with osteoarthritis to exercise to a greater degree of intensity without the harm they would experience with a gym-based program.
They noted that this may be especially important for people with severe forms of the disease.
Q. Are there certain physical properties in water that make it a more desirable medium treat OA and other musculoskeletal injuries?
A. Let me list you a few of the most important properties of water that make exercise easier and better for OA patients:
They are:
* Buoyancy: water counteracts gravity and helps to support the weight of the patient in a controlled fashion as the patient is immersed. This can aid the development of improved balance and strength. The buoyancy of water also permits a greater range of positions due to the virtual elimination of gravitational forces, particularly for exercises that require lifting the legs, the heaviest limb of the body for most people.
* Viscosity: water provides resistance by means of gentle friction, allowing strengthening and conditioning of an injury, while reducing the risk of further injury due to loss of balance.
* Hydrostatic pressure: there are powerful effects produced by hydrostatic pressure that improve heart and lung function, making aquatic exercise a very useful way to maintain and strengthen heart and lung function. This pressure effect also aids in improving muscle blood flow. Water provides 12 times the resistance of air, which means walking in water requires more effort and ultimately burns more calories than walking on land. And still it’s a great workout, as you walk, you’re really strengthening and building muscle.
Q. Are there different types of water exercises?
A. Exercises often resemble those performed in traditional land-based exercise programs. They look similar to stretching or resistance exercises conducted on land, with the exception that they use the gentle resistance of water rather than gravity to exercise muscles or joints. A few of the more popular exercises are:
* Stretching, including stretching the hamstrings and lower back by slowly raising knees to chest, or stretching the upper back and neck by standing away from the side of the pool and leaning forward with arms outstretched to grasp the pool edge
* Strengthening, including using foam barbells to complete bicep curls or lateral side raises that work against water resistance
* Water aerobics, including water walking or slow jogging in a shallow pool which loosens the lower back and hips
* Ai Chi, a hybrid form of Tai Chi developed specifically for water exercise that develops strength, balance, and joint flexibility through slow gentle movements while focusing upon relaxation and controlled breathing.
Q. What is trending now?
A. ‘Water walking’ is becoming popular. Water walking is considered easy on the joints, according to the Arthritis Foundation. You can walk in the shallow end of the pool or walk in the deep end with a flotation belt. You can walk backwards and sideways, as well as frontwards in the pool, to tone different muscles. Sitting along the pool edge and doing kicks or squats also enhance your water workout.
Q. Your message to the public?
A. Getting in an out of a pool will be very difficult for patients with OA, after hip and knee surgeries, for people with physical disabilities and for obese patients. Disabled friendly or wheelchair accessible pools are the best solution to help these patients, but we don’t have many pools with accessibility in Sri Lanka.
I also wish to reiterate what I earlier said about the wide ranging health benefits it has on patients with underlying diseases such as : advanced osteoporosis (with susceptibility to and or pain from fracture), muscle strain or tears , physical disabilities and neurological disorders.
Water exercise is also frequently recommended as a therapy to treat those with diabetes as well as those with high blood pressure. Both conditions can improve and become more manageable with water exercise.