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Patellorfemoral osteoarthritis

Osteoarthritis can be very painful, often becoming more painful with time and can negatively impact function. If you’re an active individual this progression can often be very frustrating, effecting many areas of your life including sleeping, to getting to work, to not being able to comfortably participate in your hobbies.

Some people are more prone to getting OA due to theirgenetics. Some may have a defect that interferes with the production of collagen,an essential building block of cartilage which helps reduce friction and cushions joint surfaces. This genetic defect can also cause symptoms to manifest earlier, even in the 20’s. Others may have a genetic mutation that can effect a protein (FAAH) that can cause an increase pain sensitivity if not working correctly. Increased weight can put more pressure on joints causing symptoms to be more sever. Fractures and trauma can also cause arthritis due to increased cartilage breakdown. Other factors includes hemochromatosis which causes too much iron in the body and crystals forms in the joint. Another one is a disorder called acromegaly, a condition that causes the body to produce too much growth hormone. This disorder is characterized by increased height, long fingers, and a large forehead as these long bones are more affected by growth hormone. Sound familiar? Andre the giant from the princess bride had this disorder, standing at a whopping 7 foot 4 inches! Now you can impress your friends who enjoy random facts.

One common symptom with osteoarthritis is joint stiffness first thing in the morning or after periods of prolonged inactivity. Every joint has its own little supply of synovial fluid to help lubricate the joints when movement occurs. While sleeping or sitting for long periods, this fluid can settle, causing pain initially when getting up and moving. Exercise disperses this fluid around the joint better and also creates warmth as the muscles contract, helping reduce joint pain. This is often why people may feel better a few hours after waking up and starting there day.

So what kind of exercise gives you the most bang for your buck?

Quadriceps strengthening exercises were found to lead to improvements in pain and function. A meta-analysis from the Journal of Arthritis & Rheumatology conducted in 2014 showed increasing aerobic capacity aids in decreasing pain perception through the release of endorphins in the brain. They found that alternating aerobic activity and strength training between sessions rather than doing a little bit of each activity seemed to yield the best results. Alternating this way allowed more pain-reducing endorphin to be released in the brain over a longer period of time when aerobic activity was the focus of that session, while strength and muscle mass increased more with sessions dedicated to muscle strength only. The research also demonstrated patients got the most relief with an exercise regimen of three times per week for 12 weeks alternating between aerobic exercises and strength training. This was especially connected to aerobic activity with pain relief being more effective with increased numbers of sessions. The researchers also found there was no correlation between pain and severity of OA, meaning someone who has little degeneration may have high pain and someone with a lot may have none. This large analysis of multiple studies and over 4,000 participants found exercise to be an effective treatment regardless of age, gender, BMI, and baseline pain (Juhl, Christensen, Roos, Zhang & Lund, 2014). This is very encouraging for those suffering in and around our communities, as exercise is readily available to everyone! Another study agreed strength training was a valuable tool for increased function. They followed 56 participants over one year, with the group of 28 patients undergoing knee strengthening/stretching made the most significant improvement in functional ability after 3 months compared to the group of 28 participants not receiving strength training, with long-term effects lasting over 12 months and continuing even after 2 years (Medical journal of the Islamic Republic of Iran, 2015).

Research supports movement can be a very efficient tool for managing pain and improving all aspect of quality of life. By having the tools to manage pain patients can get back to sleep easier which also effects pain levels. Exercising in preparation before a busy day which allows patients to manage their pain and participate in things they may have previously put off. If you are suffering from osteoarthritis pain and would like to discuss treatment to reduce pain and improve function contact us. We would love to help you get back on your feet!  

Juhl, C., Christensen, R., Roos, E., Zhang, W., & Lund, H. (2014). “Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials.” Arthritis & Rheumatology66(3), 622-636. doi: 10.1002/art.38290

Nejati, P., Farzinmehr, A., & Moradi-Lakeh, M. (2015). The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial. Medical journal of the Islamic Republic of Iran, 29, 186.