Welcome to the first live web chat presented by the Rehabilitation Department at Hospital for Special Surgery. Today’s topic is “How to Stay on the Move with Osteoarthritis”. My name is Lisa and I will be your moderator today. We are joined by the expert physical therapists from the Joint Mobility Center: Davis, Hagit, Lauren and Pawel. So let’s get started – please feel free to write in with your questions.
Herb: I am 6 wks post total L hip replacement and have progressed from walker to cane. when is good to start working out in a pool?
Davis PT: Hi Herb, congratulations on making it 6wks after your total hip replacement. Pool therapy would be allowed at this point but you need to receive clearance from your surgeon based upon the healing of your incision.
Herb: My incision staples were removed two weeks ago and sterile strips are all gone, incision appears to be closed. Can I presume if incision is closed i can move forward and what exercises are best?
Davis PT: Herb, that's great. Provided that there's no scabbing and small openings that could provide an avenue for possible infection, performing exercises in the pool like walking forward and backward, side stepping, as well as shallow squatting would be great. Are you currently receiving outpatient PT at this time?
Herb: Yes, I am getting outpatient PT 2/3 per wk and am doing ab adductor and leg press along with stretching. I do feel it in my hamstring and quad are still very tight, that is why I thought pool work would help.
Davis PT: Herb, pool exercises help strengthen the muscles of the lower extremity while de-weighting your joint from potential aggravating pressure at this time. You might receive the benefit of feeling more flexible but on-land stretching of your tight muscles will probably be more effective. You have to keep in mind that it will take some time for your body to accommodate to the new implant and the movement that it allows; that is why during the initial months of recovery, your muscles will feel tight.
Herb: So, should I do both or stick to primarily land exercises? I had a set back when trying to do straight leg raises at PT where my thigh muscle got weak and I couldn't lift my leg as I had built up the strength to do after the surgery. My PT said it was normal and that the muscles are adjusting and perhaps pushing through atrophy and scar tissue. I just want to maximize my recovery without jeopardizing it.
Davis PT: Herb, doing both would be great, but listen to your body. Recovery from such a surgery doesn't follow the "more is better" mantra. You need to provide days of rest between days of exercise to allow your body to recover and get stronger. If straight leg raises are difficult and provide long lasting residual pain, I suggest perhaps stopping it and performing other exercises. Also, ask your PT if they are familiar with the manual approach for hip flexor releases, which I've found to alleviate groin pain that follows your surgery.
Herb: Thank you Davis PT, I will ask them, which is where I learned about this chat, so hopefully they will know, and I do have to remember it will take time as I want to do more thinking I'll get there quicker.
Davis PT: Herb, good luck with the remainder of your rehabilitation!
Sheila: Is there anything that can help arthritic fingers with fine motor skills?
Moderator: Hi Sheila - For your fingers, some gentle exercise is fine. Practice picking up coins or paper clips for about 2-3 minutes a day.
Pedersen: I have bone spurs in my neck and at this time, surgery is a far option. Will yoga and general neck exercises cause me problems?
Hagit PT: Mr. Pederson, gentle yoga, range of motion, and flexibility exercises can be fine; make sure not to hurt your neck doing extreme motions that are commonly done in yoga classes. Also, talk to your yoga instructor about your concerns prior to class.
barbara: I have an appointment with Dr. Fields tomorrow and would like to know what questions I need to address with him that would help me improve my movements.
Lauren PT: Hi Barbara, thank you for your question. You should ask your physician if your movements are impaired due to weakness in your lower extremities. You should also ask if fall risks can be related to any issues you may be having in your knees or in your spine.
barbara: Hi Lauren thank you for your advice I will follow through, but have to be honest I am terrified of having surgery as the outcome might be worse. Do not expect you to answer, but did want to know if alternative treatment might be available for me to check out.
Lauren PT: Hi Barbara - i can understand your apprehension about having surgery. There are different types of alternative treatments, such as acupuncture and tai chi that may help with your condition. I would speak to your physician at your visit to determine any further conservative treatment options.
Moderator: Has anyone tried any alternative exercise classes such as Tai Chi or Pilates?
barbara: Lisa I have not but would like to when it is advisable. Will HSS offer these classes?
Moderator: Barbara - HSS offers all sorts of classes; you can explore all the classes at the HSS website under the "classes and programs" tabs or on the Wellness pages of the HSS website.
barbara: I think this CHAT IS WONDERFUL!!!
Lauren PT: Barbara - thank you so much for your feedback and questions!
Moderator: Also for everyone's information, the new course/class catalogue will be coming out at the end of July 2011.
Swim11: I received a shot of cortisone in my right hip. Is it alright to swim, bike ride, and play tennis?
Pawel PT: Thanks for your question Swim11, it is ok to swim, bike, and play tennis; I would suggest to warm up with light jog and stretching before beginning any of these activities.
Swim11: I received the shot of cortisone about 1 week ago and my hip feels so much better. How long can I expect to have this relief? I have osteoarthritis of the right hip. Is my doing these exercises going to wear off the effects of the cortisone shot?
Pawel PT: Swim11: cortisone provides relief, and research says people have relief for 3 months after the injection and some have long term relief.
liz: I am 7 weeks post op (anterior hip replacement) and still feel pain and stiffness in my lower thigh, especially after sitting. Suggestions?
Hagit PT: Dear Liz, It is normal to still feel discomfort at the hip after prolonged sitting, therefore make sure to interrupt your sitting with periods of walking. Don't sit for too long!!!!
JOAN: I have arthritis of the hip and definitely need hip replacement, but cannot take time off for another couple of months. I have severe pain, which so far I have attempted to treat with Exedrin Extra Strength, which does not help much. Is there something you can do for the pain before I have the necessary operation?
Lauren PT: Hi JOAN - thank you for your question. I would consider activity modification; you can ice the hip when the pain is severe, and you can also think about possibly using a cane to help decrease the weight bearing on your hip joint. I would speak to your physician about medication options.
jane: I am bone on bone in both knees; surgery not an option at this time. is walking or bike riding helpful for the pain? Also, if I wait too long for surgery will it have a large impact?
jane: cortisone does nothing for me!
jane: neither did synvisc
Pawel PT: Hello Jane, thanks for your question, I would suggest to do light bike riding and walking, nothing too aggressive.
barbara: Since my PT I have noticed much improvement in my neck area. Do you have any knowledge that continuing these exercises I can put off spinal surgery?
Lauren PT: The exercises will help to strengthen the muscles in your neck, and the stretching will help with flexibility of the soft tissues in your neck. I would speak to your doctor tomorrow about the severity of your neck condition and if surgery is suggested at this time.
Moderator: Thanks for all your questions so far. Keep in mind that everyone's condition is a bit different so some interventions may help for some and not for others.
jane: How long is PT recommended for after double knee replacements, and when can one resume 'normal' i.e. work activities?
Davis PT: Hi Jane, recovery from double knee replacements is very individualized, all depending on your body's response to the surgery, but typically, PTs with double knee replacements can receive upwards of 3 months of therapy, 2-3x/wk. You'll be able to perform simple activities early such as walking with an assistive device within the first couple of weeks, but other highly demanding activities such as negotiating stairs normally typically aren't achieved until 2-3 months in general. Most patients say that they don't feel they truly have the ability to perform things effortlessly until after 6-8 months.
jane: thank you Davis....is it going to be a harder recovery the longer I wait?
Pawel PT: Jane: the longer you wait should not impact your recovery after surgery. It has been shown that before surgery, flexibility in the knees has been shown to be a good indicator of motion in the knees after the surgery.
Eileen: Does prolonged inflammation in a joint predispose you to osteoarthritis down the line?
Moderator: Eileen - why has your joint been inflamed? Did you injure it in some way?
Eileen: My knee joint was compromised after a medial meniscal tear which was surgically repaired. However I continue to have pain and some effusion in the joint. I was told that I'm guaranteed OA in the future. However, I am a very active person engaging in yoga, horseback riding and running multiple times a week.
Moderator: Hi Eileen - prior surgery and injury to a joint is one of the risk factors for developing OA later on. It is great that you stay active, but running is a high impact activity and may accelerate wear on the joint. For a great cardio workout, try the elliptical machine instead. Its much easier on your joints.
Sue: In addition to diagnosed osteoarthritis in my knees and back, I have swelling around the joint above my left thumb and stiffness in that general area, as well as an occasional shooting pain there. Does this sound like arthritis, tendonitis, or a combination of both? I plan to see a hand orthopedist soon.
Hagit PT: Dear Sue, swelling usually reflects that something aggravates the joint or the tendon as you noticed. Shooting pain could be a sign for nerve impingement. It's better to have a specialist look and give you the right diagnosis.
Sue: Thank you, Hagit! After 16 sessions of PT for the osteoarthritis in my knees and Valgus force in my left knee, I'm continuing the regimen with 2-hr. workouts at my gym 3 times a week on equipment the PT directed (excluding the treadmill). I also do a great deal of walking (3-4 hrs./week) - without any difficulty to ward off osteoporosis. Is the walking OK for the knees?
Hagit PT: Sue, Valgus force at the knee is a mechanical problem that probably may benefit from continuation of your exercises. Strengthening and flexibility is very important to maintain a healthy joint and the surrounding tissues (i.e., muscles, ligaments, and tendons). Walking is ok as long as you are not aggravating the knees, because prolonged walking with extra weight bearing can irritate the knees. To maintain your bone density and still work your knees, you can use a bike with increased resistance.
Sue: Thanks again, Hagit. Just to clarify, I currently use the reclining bike as part of my exercise regimen at the gym. Is the reclining model w/increased resistance adequate to maintain bone density?
Hagit PT: You can use both, maybe protect your knees by walking with fast speed about an hour (again, not to a painful degree), and then using the bike against resistance to unload your knee joint. Usually, osteoporosis sites are the hips and the spine, and for hips you can also do steps and use elastic bands to resist the hip musculature and increase the tone.
Pedersen: Some years ago, I had hip replacement. Unfortunately the protheses available at that time were not good for me. In 2009 I had a hip revision at HSS and I just wanted to pass along the very positive outcome I have had. I am a senior citizen -- so advanced age doesn't justify holding off the surgery. Re my planned yoga, what really is the difference between "beginning yoga" type and the pilates?
Hagit PT: Dear Pedersen: Beginning yoga is a form of gentle exercises to improve flexibility and is designed for people who don't have experience with yoga. Pilates consists of exercises for stability and strength of the core. Both are good; you just need to make sure that the position the body needs to assume is ok for your joint.
barbara: Is the Paraffin bath for the hands helpful? I purchased a home use one but have not used it yet. I think the problem I am having now is due to the cervical arthritis.
Lauren PT: Barbara - paraffin baths are good for the hands if you respond well to heat (i.e., warm shower) to help decrease stiffness in the hands. If you feel the symptoms are coming from your neck it may be a good idea to talk with your physician about further treatment options.
Swim11: Does HSS have classes and programs in the evening?
Pawel PT: Swim11: HSS does provide classes and programs in the evening, for more info, go to: http://www.hss.edu/public-patient-education.asp
Sheila: Last fall I fell and badly bruised my knee. Now at night I sometimes am awakened with pain there. Theres no swelling and if I rub it or get up and walk the pain is immediately gone, can this be a touch of arthritis?
Moderator: Hi Sheila - As i just mentioned to Eilleen, prior trauma to a joint is a risk factor for developing OA. To be sure, you can see your doctor for an evaluation.
Moderator: This is a great discussion so far.....any more questions?
Dana: I have a question - I'm starting to use a cane, but I'm not sure if I should use it in my left or right hand?
Davis PT: Hi Dana, contrary to popular belief, the cane or assistive device should be used on the opposite side of your painful/involved leg. This way, you are able to de-weight your problematic leg and shift your weight to your stronger leg. The cane will help to support your stronger leg.
Dana: Thanks Davis! Is heat or ice better for my knee?
Davis PT: Dana, that's a great question. With new onset injury or exacerbation of pain, ice would be the most beneficial to help manage associated pain and swelling. If the issue becomes chronic then either heat or ice can be beneficial and would require trials to see which would suit you and your issues best.
Dana: Thanks again Davis - how long would I use ice versus heat? Can I just use a regular heating pad?
Davis PT: Dana, when using ice, place a light cloth on the area to be iced to protect your skin. Ice for 10-15 min but no more. Wait a minimum of 20 min before reapplying ice if you are going for repeated applications. If not, several times a day would be beneficial for new onset issues. When using heat, the same parameters would apply. A regular heating pad would serve just fine. There are also over-the-counter heating agents such as Thermacare pads. They have a light adhesive that will allow you to apply to your target area and allow you to use it on the go. The heat typically lasts 6-8 hrs.
JMCisthebest.com: I have currently been doing PT at the joint mobility center at Hospital for Special Surgery and I am their number one fan. I have to say that the therapists have amazingly positive attitudes and I cannot wait to see them every single day I come.
Moderator: Thanks JMC is the Best - we really appreciate your feedback! We all love what we do, helping people reagin their mobility! :)
barbara: I was sitting next to a lady on the bus who was wearing a rubber bracelet with a magnet - and she told me it was to help her with balance - does anyone have knowledge that this might work?
Lauren PT: Barbara - We have no solid evidence with research that the balance bracelet works. You can challenge your balance by doing different balance specific activities/exercises.
barbara: Hi Lauren I do challenge myself every day and try when home not to depend on the walker or cane - but never do I substitute the exercises given to me - I guess I was just looking to add more. When I was 20yrs old I was told that apple cider vinegar was good after drinking gallons I can tell you it does not work and I cringe just thinking about it. But am not sorry I tried. >:D<
clemensa: I heard the same thing about apple cider vinegar.
Lauren PT: Hi Barbara - it is great that you are challenging yourself with different activities and exercises. Keep up the great work! I would speak to your physical therapist about adding more exercises to your program.
Hagit PT: Barbara, why did you drink the apple cider? Maybe you can teach us all about the benefits of it?
barbara: It was an old wives alternative - I think I might still have the book - but Hagit it did not work for me - the best so far is the exercises as I do not respond well to drugs. I will look after the chat to see if I have the info and bring it in next week. I did this some 40 years ago when treatment for OA was limited. #:-S
Moderator: Hi everyone, we have about 10 minutes left in the chat; any last minute questions?
Sheila: Thanks for the chat it was quite interesting
Hagit PT: Thank you too Sheila!!! Have a great day and healthy joints
Sue: Thanks, Hagit, and to you all for this very informative/helpful web chat. I use the HSS doctors, etc. for all my orthopedic needs and think you're all terrific. I hope you will continue these web chats and please put me on the mailing list so I can join in again.
Hagit PT: Dear Sue, Thank you for this wonderful last statement. I do agree that the medical professionals here are the best for orthopedic related issues! If you need any future assistance please feel free to contact the Joint Mobility Center - we are the physical therapist experts.
Sue: Thanks, Hagit -- will do!
Moderator: Thanks everyone for joining the chat and making it such a success! We will let you know when the next chat will be, but in the meantime, if you have any questions you can email them to email@example.com or call us at 212-606-1213. Good luck to everyone and keep moving for healthy joints!
Moderator: We will also be posting the chat on hss.edu/OA if you want to check it out.
Moderator: Thanks Everyone!
Sheila: Great hospital great therapists
barbara: Have a great week and weekend to all you wonderful therapists.
Davis PT: Barbara, you too!!