Exercise: Pools, Spas and Arthritis
43 million Americans have some form of arthritis or a related
condition. Although there are over 100 different kinds of arthritis,
most forms are characterized by swelling, warmth, redness, pain and
stiffness of joints that can lead to loss of joint motion or
function. However, with proper diagnosis and
treatment, the signs and symptoms of arthritis can be
controlled, joint damage can be limited or prevented, and joint
motion and flexibility can be improved.
Because there are many effective and safe ways to minimize
pain and loss of motion from arthritis, you need to work with your
doctor and other appropriate health professionals to develop an
effective, individualized treatment program. Your specific program
will depend on many things such as the type of arthritis you have,
how it affects you, the severity of the disease, and the joints
affected. Your age, occupation, and leisure and everyday activities
also influence which treatment program is appropriate for you. Your
treatment will probably
include a combination of :
rest and relaxation
use of heat and warm water
use of cold
Pain in your joints may make you want to hold them very still
and avoid activity. However, limiting use of your joints will, over
time, cause the joints, ligaments and
muscles to lose range of motion and weaken. Muscles may
also shorten and tighten up, causing you to feel more pain and stiffness and be less able to do the things
you want to do.
Regular exercise helps keep
joints moving, restores and preserves flexibility and strength, and
protects joints against further damage. Exercise can also improve
your coordination, endurance and ability to perform daily tasks
(such as walking or writing), increase energy and reduce fatigue,
and lead to an improved sense of
self-esteem and accomplishment.
The soothing warmth and buoyancy of warm water make it a
safe, ideal environment for relieving arthritis pain and stiffness
and improving the range of movement of joints affected by arthritis.
Exercising in a warm-water pool or hot tub is one method of
hydrotherapy, or using water to help treat a condition. Immersing in
warm water raises your body temperature, causing your blood vessels
to dilate and increasing circulation.
Water exercise is a gentle way to exercise joints and
muscles. Water supports joints and lessens stress on them to
encourage free movement, and may also act as resistance to help
build muscle strength. Using a spa adds a third component to the
therapy - massage. Jet nozzles release a mixture of warm water and
air, massaging your body and helping you relax tight muscles. Talk
with your doctor to determine whether water exercise is appropriate
Exercise at Home :
you obtain benefits from water exercise, you may want to consider
installing a pool or purchasing a spa (hot tub) for your home. A hot
tub provides the warmth, massage and buoyancy needed to both relax
and exercise joints and muscles in the convenience of your home. The
size and shape of a hot tub will determine the types of exercises
you can do in it. Most spas or hot tubs allow for range-of-motion
exercises of joints commonly affected by arthritis, such as the knee
and hip. Warm water allows muscles to become relaxed, which can then
make it easier to perform exercises and daily tasks. Relaxed muscles
also can create an overall feeling of comfort.
a Pool or Hot Tub Safely :
The use of heat is
recommended for many people with arthritis and related conditions,
but not all. Your doctor can help you determine if it is appropriate
for you. Benefits of heat can include muscle relaxation, decreased
pain and stiffness, and greater ease when performing exercises and
Warm water is an especially good way to apply heat to joints
affected by arthritis. Extremely hot water is not safe and is not
necessary to get results; mild heat is just as effective and easier
for the body to tolerate. The water temperature should feel soothing
and comfortable, not hot. In a pool, water temperatures from 83 to
88 degrees F are usually comfortable for exercise.
If you are just
soaking or doing very gentle movements
while sitting in a spa, you can usually tolerate
slightly higher temperatures. Soaking time will vary
depending on the water temperature and your tolerance for heat. New
hot tub users should vary the temperature and length of stay until
they can determine what is most comfortable. Start slowly, and
extend the time in the spa as you feel comfortable. For most people,
soaking time should not exceed 10 to 15 minutes at temperatures
between 98 and 104 degrees F. Remember, too, that children and
elderly people are more prone to become overheated and may need to
soak for less time.
Many people with arthritis
and related conditions find that pain and stiffness are worse in the
morning. Doctors often advise soaking in warm water before beginning
your daily activities to help relieve the pain. You may find it just
as beneficial to use spas or warm water pools at other times: in the
afternoon to help relax muscles and joints after a full day of
activities, to loosen muscles before doing exercises, in the evening
before bedtime to relax you for a restful sleep. However, too much
heat can actually have a stimulating effect on some people. If this
is true for you, enjoying the warm water just before bed may not be
an ideal time.
Never use a
pool or hot tub during or after drinking alcohol or using drugs.
These may cause sleepiness, drowsiness or changes in blood pressure.
Pregnant women should not enter a hot tub without first consulting
in Your Pool or Spa
When first entering a spa or
pool, relax and enjoy the soothing water. When your muscles and
joints feel more comfortable and relaxed, slowly begin your exercise
routine. Allow enough time after exercising to relax muscles again
before getting out of the water.
Exercises can be done while sitting in a hot tub or while
sitting or standing in a pool. Consult your doctor or physical
therapist to determine which exercises are appropriate for you. The
Arthritis Foundation recommends the following guidelines when doing
the body part you are exercising.
Move the body part slowly and gently.
Begin and end with easy exercises.
Move the joint through complete range of motion if
possible. Do not force movement, but gently stretch.
three to eight repetitions as tolerated. Pain that lasts for more
than two hours after exercise may indicate overuse. Do fewer
repetitions next time. Be
aware of the weakening effects of heat when exercising in warm
water. Start slowly and don't over do. Check with your doctor or
surgeon before doing any of the exercises if you have joint damage
or have had joint replacement surgery.
Walking & Arthritis
Walking is good for anyone,
especially people with arthritis.
Its an endurance exercise, which means it strengthens your heart,
helps your lungs work more efficiently and gives you more stamina so
you don't tire as easily. As a weight-bearing exercise (one that
puts full weight on your bones), walking helps strengthen bones,
reducing the risk of osteoporosis (thinning of the bones). This is
especially important if you are taking glucocorticoids for your
arthritis, which can weaken
strengthens your muscles and helps maintain joint flexibility. For
people with arthritis, muscle and joint benefits are important
because joints become more stiff and muscles weaken with inactivity.
As walking strengthens the muscles and tissues surrounding the
joints, it helps to better protect those joints and keep them ready
for daily activities.
In addition to all the
physical benefits, walking also
brings with it a host of psychological perks. Regular
exercise helps you sleep better, controls your weight and lifts your
spirits. It can play an important part in combating the depression,
fatigue and stress that accompany your arthritis.
Walking is often overlooked
as a way to keep fit and flexible because its so easy - most of us
have done it since infancy. But the simplicity is part of what makes
walking an ideal exercise for many people. You can walk anywhere,
any time and at any level you prefer on a particular day. Walking
requires no special skills and is inexpensive. Keep these tips in
mind as you prepare to step out into the ranks of walkers everywhere
as with any exercise program, talk with your doctor to determine the
best level of intensity and length of time for your walks.
Wear shoes specifically designed for walking. The shoes
should have flexible and non-sticky soles that absorb shock well,
good arch supports, cushioned insoles and roomy toe boxes.
Make sure your walking shoes
fit correctly. If your
socks wear through in the toes, your shoes are either too short or
your foot is sliding forward with each step. Wear your walking socks
when you go to purchase the shoes to help you get a better fit.
Once you are ready to go, there are several things that
can help make your walks more enjoyable and injury-free. Take
the time to warm up and cool down by strolling for a few minutes
before and after your walk. Be sure to include some stretches in
your warm-up and cool-down periods, holding each stretch for 20-30
seconds. Be careful not to bounce when stretching. Use an assistive
device such as a cane if it eases your stride or allows you to cover
longer distances more comfortably.
at your own pace. Everyone has a walking speed
that suits them best, so find one that is comfortable for
you. Remember that your comfortable pace may vary from one day to
the next, depending on how you feel. Faster speeds put more stress
on your knees, so try not to walk too fast when you begin.
simplicity of walking makes it a favourite exercise for many people.
But the simplicity also can make it difficult to keep motivated
unless you mix up your routine from time to time. Consider these
options to help keep your walking time more interesting:
* Change your
* If you
normally walk in a neighbourhood, try out the local mall or airport
* go to a
vacations to include good places to walk.
* Find a
partner. Having a regular partner can be a social outlet, a boredom
reliever and commitment
reinforces. And who says you can only have one partner?
* Walking with
a group can be a good way to keep in touch with old friends or make
some new ones.
Exercise and Arthritis
You may think that exercise and arthritis do not go hand in
hand. If so, you would be mistaken. It was thought for many years
that if you had arthritis you should not exercise because it would
damage your joints. Now, however, research has shown that exercise
is an essential tool in managing your arthritis.
moderate exercise offers a whole host of benefits to people with
arthritis. Mainly, exercise reduces joint pain and stiffness, builds
strong muscle around the joints, and increases flexibility and
endurance. But it also helps promote overall health and fitness by
giving you more energy, helping you sleep better, controlling your
weight, decreasing depression, and giving you more self-esteem. Furthermore, exercise can
help stave off other health problems such as osteoporosis and heart
Starting an exercise program can seem like a daunting
proposition. The important thing to remember is to start slow and
make it fun. It is always good to start with flexibility exercises,
which are basically stretching exercises that will improve your
range of motion and help you perform daily activities. Once you feel
comfortable you can move on to weight training and endurance
exercises such as bicycling. You may be reluctant to exercise
because you are in such pain. If this is the case you may want to
start with a water exercise program. In the water your body’s
buoyancy reduces stress on your hips, knees, and spine.
An exercise program can include anything from walking around
the block, taking a yoga class, or playing a round of golf. In this
section we’ve attempted to give you all the information you will
need on how to start exercising and the proper way to incorporate
exercise into the management of your arthritis.
Whatever exercise program you decide on you should always
consult with your doctor before starting out. Two other types of
health professionals that can help you develop an exercise program
that fits your specific needs are a physical or occupational
therapist. A physical therapist can show you the proper techniques
and precautions when performing certain types of exercise. An
occupational therapist can show you how to perform daily activities
without putting additional stress on your joints and can provide you
with splints or assistive devices that can make working out more
Bone and Joint Decade
By Carol Haley
knowing how your joints function when they are in tip-top shape, you
can better understand the problems you face when a joint, or joints,
are damaged or in pain.
Joints literally keep the human frame together. From the top
of our heads to the tips of our toes, joints link our 206 bones,
make our bodies flexible, and enable our muscles to maneuver into
thousands of positions. Some joints, such as those in the cranium
where rigidity is desirable, don't move at all. Others, such as
those in the pelvic area, move very little. But most joints
move a lot. Hinge joints, as in our elbows and knees,
swing back and forth like doors. Ball-and-socket joints, as
in our hip and shoulder, enable bones to twist and turn in many
directions while remaining firmly connected
to each other.
The movable joints in our bodies thrive on use and
deteriorate with disease, injury, neglect or excessive overuse. So
the adage “use it or lose it” is particularly apt - but in
moderation. Even without arthritis, joints tend to stiffen as we
age, so regular exercise and stretching become increasingly
Jaw: The jaw joints are
famous for helping us with two important activities - processing
food and talking. Because of their proximity to the ears, eyes,
nose, throat, tongue, sinuses and cervical spine, their malfunction
(disease of the tempromandibular joint) can have a profound effect
on these organs.
Spine: Literally the
backbone of the body, the spine begins at the base of the skull and
extends to the sacrum. It is composed of 24 vertebrae stacked one on
top of another to provide a flexible column of support for the
spinal cord. The movement of these vertebrae allows us to stoop,
squat, turn and nod our heads, and twist our shoulders and hips.
The spine works on the motion-segment principle: Many small
movements add up to big ones. Each individual vertebra can move only
a little in relation to its neighbours. But putting all the units
together creates awesome movement. Watch when a batter stands at the
plate and swings at the ball. The cumulative effect of tiny spinal
movements rippling up the back permits a broad, sweeping swing.
Shoulder: The series of
joints from the shoulder to the fingertips makes our arms extremely
flexible. The shoulder's ball-and-socket joint enables us to move
the arm in almost any direction. The rotator cuff - a common site of
injury in baseball pitchers - is composed of muscles and tendons
that hold the shoulder joint in place and allow us to lift an arm
and reach overhead. Shoulder injuries caused by excessive overhead
arm motion are common, and can be caused by activities such as
painting or hanging curtains.
Elbow: The elbow
operates as a simple hinge that bends and straightens the arm.
Although the joint allows some twisting and turning of the forearm,
most of the forearm's movement results from rotation of the radius
and ulna, the bones of the lower arm.
Wrist: Two major
arteries, three major nerves and 20 tendons pass through the
eight-bone wrist. Today, conditions such as carpal tunnel syndrome -
in which cumulative micro-injury results in compression of the
median nerve - focus considerable attention on the wrist.
Hand: Truly a marvel, each
hand is built around a skeletal network of 19 bones connected by a
multitude of complex joints. At the base of the fingers are saddle
joints, some allowing movement (those at the base of the thumb and
the fourth and fifth fingers) and some more fixed (those at the base
of the second and third fingers). The remaining finger joints are
modified hinges, enabling the fingers to bend over toward the palm,
but not toward each other.
For years, engineers have tried to build a robot that can
mimic the human hand. But the hand's movements are too complicated
to copy exactly without feedback from the eyes and touch-sensitive
skin. Robot hands are used in factory production lines very
effectively for single tasks. While human hands can paint, weld,
drill, screw, adjust and assemble, a separate robot hand and arm
design is required for each of these diverse jobs.
Hip: Watch a ballet dancer
perform and you will note what an incredible range of movement the
hip joints permit. As the junction of the femur with the socket of
the pelvis, the hip is the leg's equivalent of the shoulder,
although its much stronger. It is also more stable to allow it to
withstand the stresses of walking. For example, during normal
walking, the force placed on the hip is three to four times our body
weight; in running, it is five times.
Although stronger than the shoulder, the hip is much less
mobile. Large movements, such as drawing the leg back in order to
kick, are possible only because the whole pelvis tilts over the
other hip. When a hip is damaged severely enough to limit activity
hip replacement surgery can often make it possible to resume a more
active lifestyle. In 1996, the last recent year for which figures
are available, some 130,000 Americans underwent hip replacement
Knee: The knee works like
the hinge joint in the elbow, allowing us to fold our legs under
when we kneel or stretch them out to take a big step. It can swivel
only slightly, helping turn the foot to point the toes out or in.
The biggest and heaviest joint, the knee carries nearly half the
body's weight and works like a hinge to move the shin and foot
forward and backward. Inside the knee, extra ligaments and cartilage
stabilize and support the joint and prevent its moving from side to
side. Still, the knee is injured more often than any other joint. In
1996, the most recent year for which figures are available, 245,000
Americans had knee replacement surgery.
Ankle: The ankle is a
hinge joint linking the lower ends of the tibia and the fibula (the
bones of the lower leg) to the talus, the topmost of the tarsal
bones in the foot, allowing the foot to make up-and-down movements.
Foot: Though the wrist is different from the ankle, the 26 foot
bones share the same arrangement as the corresponding bones in the
hand. Hand bones are more delicate and their joints more flexible,
while the foot is designed for bearing weight.
Our feet transport most of
us more than 100,000 miles in a lifetime - equal to about four trips
around the world. Women generally average 10 miles a day,
outdistancing men who walk an average of seven miles a day. With
each step taken by a person weighing 130 pounds, the foot absorbs
500 pounds of pressure, which comes to about 5 million pounds of
impact on the feet in an average day. Its no surprise then, that
nearly eight out of 10 Americans will experience some foot and ankle
Carol Haley is an
Atlanta-based freelance writer.