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Health, Wellness, & Fitness Quarterly Summer 2016 An Update on Exercises for Osteoarthritis of the Knee Frank Kava, PT, MS, DPT, OCS, OMPT Osteoarthritis of the knee affects more than 9 million people in the United States. Without an absolute cure for osteoarthritis, the outcomes of current conservative medical and physical therapy management is to decrease pain, improve function and improve and enhance quality of life. In some cases effective treatment may prevent or delay the need for joint replacement. This update will highlight the latest research developments emphasizing the benefits of exercise and physical therapy in the management of osteoarthritis of the knee. Exercise for treatment of osteoarthritis of the knee is recommended as an effective treatment by all of the current clinical practice guidelines of the American College of Rheumatology, the Osteoarthritis Research Society International, National Institute for Health and Care Equality and the American Academy of Orthopedic Surgeons. The recommendations for exercise as effective treatment for osteoarthritis of the knee are based on several recent clinical trails and systematic reviews mostly comparing exercise with no exercise and have concluded that exercise improves function and decreases pain compared to not exercising. One of the systematic reviews confirmed that the benefits of exercise were comparable to conservative drug treatments with fewer side effects. The type and duration of exercise included in the studies varied widely but included a combination of strengthening exercise, range of motion and aerobic exercise. Greater pain reduction and functional improvement have been seen with quadriceps specific exercises. Positive outcomes were attained with approaches combining exercises to increase muscle strength, flexibility and aerobic capacity. Significant benefits can be attained from both high and low intensity exercise from individually supervised, group or home based exercise programs. Similar benefits have been seen with aquatic exercise programs. The most effective dosage of exercise is uncertain based on current studies. Greater benefits were attained from exercise programs performed at least three times per week compared to those performed less than two times per week regardless of exercise intensity or duration of each exercise session. Exercise stimulates the development and strength of the cartilage, bones and muscles and improves the lubrication and nutrition to the joints. Exercise also improves the shock absorbing capacity of the cartilage. Osteoarthritis is a degenerative condition of thinning of the joint articular cartilage with subsequent joint inflammation and thickening of the ligaments and fibrous tissue around the joint. The most sensitive component is the cartilage. Excessive mechanical forces applied to the cartilage and underlying bone over time plays an important role in the development of the degeneration of the cartilage in osteoarthritis. In healthy adults the phases of cartilage destruction are balanced by phases of cartilage reconstruction. With osteoarthritis there is an imbalance with more deconstruction than reconstruction. Controlled repetitive movement with moderate exercise stimulates the reconstruction phase and may repair some of the cartilage thickness deficits. The stimulation of the joint with exercise is related to variations in articular pressure which increases of the synovial fluid circulation of nutrients in the joint. Manual physical therapy and exercise increases the range of motion and strength thereby improving function. Patient involvement is critical in maintaining the improvement that the therapist can achieve. Patients are instructed in self-stretching exercises that can be performed by the patient at home. Specific strengthening exercises are used to improve the stability of the knee and increase the strength of muscles of the lower extremity. Our physical therapists follow similar treatment protocols used in the current published studies in the treatment of osteoarthritis. We have also demonstrated the same degree of effectiveness and success in treating osteoarthritic patients with manual physical therapy and exercise. The ultimate benefit is that exercise can improve the quality of life by minimizing pain and maximizing strength and flexibility and improve the ability to perform more functional occupational and recreational activities. Upcoming Events at Oakland Physical Therapy Tuesday August 9, 2016 at 6 p.m. An Update on Exercises for Osteoarthritis of the Knee The objectives of our upcoming community education program are: Identify the physiological benefits of exercise for osteoarthritis. Explain the advantages and importance of flexibility, aerobic conditioning and strengthening exercises. Demonstrate the correct performance of appropriate exercises. Identify the proper progression and precautions for each type of exercise. Please call (248) 380-3550 or email [email protected] to register! Team Fox in the D will host their inaugural fundraising Gala to benefit The Michael J. Fox Foundation on Saturday, September 10th, 2016 at the Westin Book Cadillac in Detroit. This tremendous event is being organized by our long time patient Donna Rajkovic. Guest speakers will discuss the most current research and treatment and will include Dr. Kristie Kava. The evening will include cocktails, a delicious meal and dancing. For more information, check out the Team Fox fundraising page at http://www2.michaeljfox.org/goto/teamfoxintheD or call 248-231-3343. Staying Fit Through The Hot Summer Months May Be Easier Than You Think! Linda Erickson, MS, PT, OMPT Many residents of Michigan seek opportunities to be outdoors during the glorious days of summer. Combining the yearning to spend time outside with the desire to participate in regular exercise provides a number of palatable options. Many fitness buffs continue with their year round pursuits which might include jogging or biking. Others may choose to engage in more seasonal activities such as golf, tennis, or roller blading and water-related activities such as swimming, kayaking, canoeing, paddle-boarding, and water skiing. No matter where your interests may lie, exercising during the summer months require some additional planning and consideration. First of all if you have not participated in your chosen activity for a while, be sure to warm your muscles and perform gentle stretches prior to beginning. Make sure your shoes and clothing fit well and that your equipment is safe and in good repair. If it is hot and humid, you will need additional fluids to replace those lost while sweating during activity. To prevent overheating with vigorous activity, consider exercising early in the morning or later in the evening. What if you do not like to “exercise”? All summer fitness pursuits do not require athletic process and can still accomplish a goal or provide Daily Activity Given Time Period Calories Burned some relaxation and fun. An article in Mowing the Lawn 8 minutes 52 calories Pushing a Stroller 20 minutes 59 calories the Huffington Post in 2013 listed a Playing Catch with the dog 15 minutes 50 calories series of activities that burned 15 minutes 51 calories approximately 50 calories in a given Fishing Playing Croquet 20 minutes 57 calories time period. See chart on the right. Grilling on the Barbeque 19 minutes 50 calories Water sports are also fun and healthy ways to exercise. Water sports enthusiasts were able to burn approximately 50 calories in 12 minutes while paddle-boarding, treading water, or performing water aerobics. Similarly, kayaking for 10 minutes burns 59 calories. However, being that it is summer, why not take advantage of your local pool? Along with lap swimming, aquatic exercise also has many benefits. According to Julie Mulcahy, PT, MPT, writing for an American Physical Therapy website, submersion in waist to chest deep water makes the body more buoyant and reduces stress on joints, cartilage and ligaments patients with musculoskeletal problems find that this weight reduction allows them to move more freely and assists with range of motion exercises. Being in the pool is also safer if you have a minor balance problem, reducing the risk of falls and injuries. Weight-bearing exercises such as marching, side-stepping, side-kicks, lunges and single leg balance can all be components of a water exercise program. Water also acts as resistance which helps to strengthen muscles. Water gloves with webbing, kick boards, inflatable balls and Styrofoam weights provide a variety of tools for water exercise. The speed of your movements can determine resistance. Slow movements create less resistance than quick movements. Pool exercises can also help to improve flexibility, balance, agility and strength while providing a safe exercise medium. As you can see there are many opportunities to stay fit during the summer months. Simply pick your favorite (or must do) activities and get moving! 26850 Providence Parkway Phone: (248)380-3550 Fax: (248)380-1620 Suite 365 E-mail: [email protected] Novi, MI 48374 www.oaklandphysicaltherapy.com Our Therapists: Frank Kava, PT, MS, DPT, OCS, OMPT Kristie Kava, PT, MS, DScPT, OMPT Linda Erickson, PT, MS, OMPT Kristen Decker, DPT, OMPT Cathy Jamrog, MPT Elizabeth Burkel, DPT, OMPT News and Updates Dr. Kristie Kava recently presented at the 2016 International Performing Arts Medical Association Symposium in New York City. This event combined the fields of performing arts medicine, sports medicine, and medical education to address artists and performers with injury issues. Dr. Kava’s presentations included the topic of therapeutic exercise for musicians injuries and a case study presentation of an injured violinist. Dr. Kristen Decker recently completed a 2 year graduate certificate program in orthopedic manual Physical therapy (OMPT) at Oakland University. This program offers advanced courses in theoretical and clinical training, emphasizing manual therapy techniques. By completing this program, Kristen has advanced her manual therapy skills, which will allow her to provide Oakland Physical Therapy patients with greater care. Physical therapists on staff have advanced training and are certified in orthopedic manual physical therapy, a process that requires years of experience and academic and clinical education beyond the doctorate degree level.