In this installment, we will review each type of arthritis and discuss effective training strategies and exercises that can benefit those afflicted as well as exercises that are to be avoided.
As stated in part 1 of this series, osteoarthritis(OA) is the most common form of arthritis affecting over 25 million people per year in the United States. O.A. typically affects the weight bearing joints, but can also affect other parts of the body.
When we think of arthritis, we tend to think of only one type and having a basic understanding and learning about the other forms and working along side a physiotherapist can be a win/win situation.
Other Forms of Arthritis
1. Arthritis(Degenerative Disc Disease)/O.A.
2. Rheumatoid Arthritis
3. Juvenile Rheumatoid Arthritis
4. Ankylosing Spondylitis
This is a systemic inflammatory disorder that mainly affects the diarthrodial joint. It is the most common form of inflammatory arthritis, and has a substantial societal effect in terms of cost, disability, and lost productivity. The disease can occur at any age, but it is most common among those aged 40-70 years, its incidence increasing with age.
The predominant symptoms are pain, stiffness, and swelling of peripheral joints. The clinical course of the disorder is extremely variable, ranging from mild, self-limiting arthritis to rapid. An inflamed synovium is central to the pathophysiology of rheumatoid arthritis.1
Those affected with R.A. have several medical interventions that can provide pain relief and improved function. Physical therapy should be considered as the earlier an these signs and symptoms are recognized, the better the prognosis. Medically, the introduction of low-dose weekly methotrexate as monotherapy for rheumatoid arthritis provided an incremental improvement in tolerability and efficacy for many patients. Although no durable remissions were reported, results of clinical trials of methotrexate showed a consistent 50-80% clinical response relative to baseline, with long-term stabilization of functional status.2,3,4
The client that utilizes personal training is most likely apprehensive, skeptical and most of all, doesn’t know where to begin. The first thing that is critical to help these clients is education. To avoid excessive load bearing exercises on their joints, particularly their wrists and hands. To design a program that is simple consisting of utilizing machines, incorporating physioball training, aqua therapy and carefully monitoring form and fatigue levels.
Juvenile Rheumatoid Arthritis
Children with pauciarticular JRA typically present with a limp and joints that are warm and effused but not red and hot and systemic symptoms are absent. The knee is the most commonly affected joint followed by the ankle and elbow. The age of onset is defined as before 16 years, and duration of arthritis is a minimum of 6 weeks in at least one joint. This classification scheme includes three onset subtypes: systemic, polyarticular, and pauciarticular; characterized by clinical features in the first 6 months of disease. The prevalence of the different subtypes of JRA varies among different geographic and ethnic groups.5
As stated with R.A., drug intervention is one approach to help those with JRA and is always dictated by the clients’ physician. With the evolution of new medicine, it is imperative that both the patient and the health professional understand what they might be taking on a daily basis.
The JRA client is special because truly understanding your anatomy, biomechanics and periodization training, can provide optimal outcomes. Avoid excessive load bearing exercises on their joints, particularly their wrists and hands. To design a program that is simple consisting of utilizing machines, incorporating physioball training, aqua therapy and carefully monitoring form and fatigue levels.
Ankylosing Spondylitis (AS)
This is a chronic inflammatory rheumatic disease usually affecting young adults affecting the axial skeleton. Causing characteristic inflammatory back pain. The cause is unknown and there is a strong genetic link to it’s etiology. Young adults will complain with morning stiffness and difficulty with sitting, standing and prolonged activities.6
The treatment of AS is tailored to the individual patient. Pharmacological and physical therapy has shown to be very effective. When in doubt, consult with the client’s physician and physiotherapist.
When training clients with AS, it is vital to communicate with the entire rehabilitation team. The focus of training should be simple exercises that avoid axial loading(ie. shoulder press/squatting). Program design should emphasize on low volume, adequate rest periods, structural exercises, aqua therapy and gentle stretching.
Arthritis continues to affect many individuals for various reasons. Can it be prevented? One thing is certain, knowledge, prevention and early screening is fundamental. Anatomy, biomechanics and periodization training doesn’t change. Medicine and an individualized approach is the cornerstone of effective and optimal training outcomes.
In part 3, I will review ways of managing, prevention strategies, other interventions such as yoga, tai chi, pilates and holistic training methods to help clients’ improve their quality of life.
1. David M Lee et al. Rheumatoid Arthritis. The Lancet, Vol. 358. September 2001.
2. Weinblatt ME, Maier AL, Fraser PA, Coblyn JS. Long-term prospective study of methotrexate in rheumatoid arthritis: conclusion after 132 months of therapy. Journal of Rheumatology. 25: pp: 238-42. 1998.
3. Kremer JM. Safety, efficacy, and mortality in a long-term cohort of patients with rheumatoid arthritis taking methotrexate: follow-up after a mean of 13·3 years. Arthritis Rheum. 40: pp: 984-85. 1997.
4. Tugwell P, Wells G, Strand V, et al. Clinical improvement as reflected in measures of function and health-related quality of life following treatment with leflunomide compared with methotrexate in patients with rheumatoid arthritis: sensitivity and relative efficiency to detect a treatment effect in a twelve-month, placebo-controlled trial. Arthritis Rheum. 43: pp: 506-14. 2000.
5. Schneider, Rayfel. Et al. Rheumatology Disorders Clinics of North America. 28. pp: 503-530. 2002.
6. Braun, Jurgen et al. Ankylosing Sponddylitis. The Lancet. 369, 9570; Research Library. pg. 1379. 2007.
About the Author
Chris Gellert, PT, MPT, CSCS, CPT Biography Chris is the President of Pinnacle Training & Consulting Systems, LLC. A consulting and education company that is committed to create and provide evidenced based educational material in the form of home study courses, dynamic live seminars, mini-books, DVD’s and other electronic media that educates personal trainers taking their knowledge and training to another level.
As both an experienced physical therapist and certified personal trainer, a national fitness presenter at the following conferences;(Club Industry, ECA, IDEA, IHRSA, NSCA, TSI Summit), he continues to write for various publications and websites, consults and is presently pursuing an Advanced Master’s Degree in Orthopedics and Manual Therapy in Australia to be completed 2011.