OA & Exercise Prescription Flashcards
What is OA?
OA is the most common form of arthritis, affecting the cartilage of a joint. It’s a degenerative disease.
What is the pathophysiology?
Cartilage degradation, bone remodeling, osteophytes formation & synovial inflammation
What is the pathophysiology?
Cartilage degradation
Bone remodeling
Osteophytes formation
Synovial inflammation
Main risk factors?
Age
Genetics
Joint injury or overuse
Gender (female>50yo ++)
Obesity
Which body functions & structures are affected by OA?
- Pain
- Range of motion
- Muscle weakness
- Balance
- Bone enlargement
- Fatigue
- Sleep disturbances
Which types of exercise should compose the program for patients w/ OA?
- Range of motion & stretching
- Muscle strengthening
- Aeorobic exercise
- Recreation
On what should OA management be based on?
- Pain relief
- Function & independence
What is recommended for OA patient?
- Exercise (Balance,strengthening)
- Weight loss (knee & hip OA)
- Self-efficacy & self-management programs
- Tai chi ( Knee & hip OA)
SMART in OA
S : start low, slow, then progress radially
M : modify activity
A : activity joint friendly (walking, cycling, dancing)
R : recognize safety (group class?)
T : talk -> specialist, health care professional
FITT for strengthening exercise in OA
F : min 2d/w
I : w/ resistance -> enough to challenge muscle in a pain free ROM
T : 1 set of 8-12 reps
T : strengthening exercise
FITT aerobic endurance exercises in OA
F : 150 min / week
I : moderate (Talk test)
T : 10 min intervals/day
T : low impact aerobic ex ( walking, biking, swimming, water aerobic..)
FITT flexibility exercises in OA
F : 3-5d/w
T : 5-10 reps/day, hold 15-30s
T : Flexibility -> ROM exercises
What are the symptoms of OA?
- Pain surrounding groin/ant hip
- Stiffness (morning++)
- Worst at the end of the day (if standing or walking ++)
Hip OA test cluster
- Reduced PROM hip (<25°)
- (+) Scour test
- Squatting aggravates symptoms
- Pain w/ active hip extension
- Lateral pain on active hip flexion
(+) test if >4/5 (+) signs
How to assess improvement?
-HOOS
-WOMAC
Example of muscle strengthening ex for hip OA
-Standing : hip extension, abduction, flexion, hamstring curls
-Supine : bridging
-Side lying : clam
- W/ or w/o support : Squat, Sit-to-stand, heel raises
In which side of the knee is OA more frequent?
In the medial compartment
Main risk factors for Knee OA
- Trauma
- Obesity
- Impaired muscled function
Clinical signs & symptoms of knee OA
- Persist knee pain, worst w/ activities & relieving w/ rest
- AM stiffness
- Possible joint effusion
- Loss of knee ROM
- difficulty in functional activities (STS- walking..)
X-ray indicates joint space narrowing/&/or osteophytes
What exercise or PA is recommended in management of knee OA?
- Tai chi
- Yoga
- Cycling
- Walking
- Aquatic ex
- Strength training
- Neuromuscular training
Knee OA common muscle strengthening exercises
- Straight leg raise
- Squats
- STS
- Knee extension from sitting (using elastic band) -> Quadriceps
- Knee flexion (up, supine..) -> Hamstrings
How many repetitions for muscle strengthening in knee OA exercise?
Dépends on each patient, ask patients to try until it gets too difficult, monitor quality of their mvt, stop if they are not doing the mvt correctly anymore
NEMEX program
→ Neuromuscular training programme for severe hip or knee OA
1. Warm up (cycle ergo meter)
2. Circuit program :
Type -> -Core stability/ postural function
- Postural orientation
- Lower extremity muscle strength (OKC & CKC ex)
Time -> 1 or 2 ex for each circle, 2-3 sets of 10-15 reps
-> 3 levels of difficulty
3.Cool down
What’s the difference between NEMEX & common strength training programs?
Core stability > no WTB ex
Lower extremity muscle strength > isolated muscle training
FUnctional WTB ex > some multiple joint WTB ex
Quality > quantity
Signs & symptoms of Hand OA
- Deep aching pain usually at base of thumb
- Stiffness
- Swelling
- Deformities (Bouchard’s nodes, Hebeden’s node)
- Difficulties w/ ADLS -> weak grip & reduced pinch strength
Risk factors in hand OA
- Female gender
- Aging -> After menopause
What are the goal of hand OA exercises?
- Maximizing a stable & pain-free functional ROM of the finger joints
- Incr. functional strength
- Maintaining joint stability
- Preventing or delaying the dvlp of fixed deformities
Exemples of hand OA exercises
- Making a hook fist
- Making a full fist
- Wrist extension & flexion
- Thumb flexion, ADD, ABD, opposition
- Finger ABD, ADD
- Forearm supination
- also incorporate ex for shoulder girdle & upper arm
Which shoulder ex can you give to complement hand OA exercise?
- Shoulder extension (sitting w/ elastic band)
- Biceps curl (standing w/ eb)
- Shoulder flexion (up w/ eb)
Hand OA dosage exercise
3x/week
1 set of 10 reps for 1-7 ex -> for 2 weeks
Incr. reps to 15 over the next 10 weeks
Moderate intensity, gradually incr bad resistance over time
