I recently read an article by Dr. Sean Rockett in the CrossFit Journal about how it is important to keep moving if you have arthritis. Below is the crux of it. Be sure to hit the link to read the full article and to check out the reference material.
The definition of arthritis is simple, but treatment is not.
Arthritis is the loss of cushion on a joint surface. The cushion—called articular cartilage—is an amazing multifaceted structure that allows us to walk, run, jump and lift without pain. It can absorb shock, improve gliding, nourish cells of the joint and produce fluid to help lubricate the joint surfaces.
Deep to the cushion is bone. If the bone is exposed, this causes pain because nerve endings are located in the bone. When bone rubs against bone, the joint can become painful, swollen and stiff. There is no cure for arthritis, and treatment is directed toward pain relief.
Diffuse arthritis is not to be confused with a localized chondral defect—a pothole surrounded by healthy tissue. This condition can be treated by drilling holes to stimulate bone-marrow healing, placing cartilage plugs or transplanting cartilage.
The treatment plan for arthritis is tailored to the patient. That means treatment is based on the patient’s age, duration of symptoms and other treatments that have been employed.
The pain can come on suddenly or gradually. It can develop suddenly, for example, if you fall from a height and land forcefully on your feet. The femur and the tibia can collide and create an impact called a bone contusion. This can also happen if a flexed knee is driven against the ground, cement or a stair.
An X-ray might show arthritis, but it won’t show the bone contusion. An MRI can be ordered to look for a cartilage tear or bone contusion. Typically, bone contusions and cartilage tears can get better on their own. If the cartilage tear remains symptomatic, an arthroscopy can be performed. However, if severe arthritis is accompanied by an MRI that shows a meniscal tear, the arthritis is usually the source of pain, and surgery in the form of arthroscopy would not help.
After an initial diagnosis of arthritis, treatment usually starts with therapy exercises that include work on range of motion and strengthening—squatting, for example. Stronger quadriceps, hamstrings, and glutes will improve function. An arthritic joint is going to stiffen up if the joint is not exercised—meaning ligaments will shorten and range of motion will decrease. “Move it or lose it” is definitely appropriate here.
CrossFit is perfect for people with arthritic joints because it pushes the joint range of motion and also strengthens the muscles around those joints. For example, arthritic knees, ankles, and hips will benefit from work on air squats.
Sometimes the range of motion of the joint will not allow a perfect air squat. To achieve general air-squat standards, ankles have to dorsiflex (toes move toward shin), knees have to flex beyond 90 degrees and hips have to rotate and flex. If one of these joints does not move as it should due to mechanical constraints, scaling with a limited range of motion should be entertained. As always, the goal is to achieve better motion with practice and effort.
After exercise, supplements and natural anti-inflammatories such as turmeric can be tried. Creams and gels are popular as well. Medications such as acetaminophen, ibuprofen, and naproxen can decrease pain. If pain persists, activity levels decrease and X-rays show definite joint narrowing with arthritis, then injections can be entertained. These are broken up into different categories:
Cortisone—Cortisone is a tricky substance because it can alleviate pain, but if it’s given too many times it can increase arthritis. Sparing use is reasonable, especially if the joint already has terrible arthritis.
Gel—Gel injections are designed to lubricate the joint and decrease the friction between the bones.
Platelet-rich plasma (PRP)—PRP has been shown to have some anti-inflammatory properties and can be used to treat arthritis, although studies show it works better on tendonitis.
Stem cells—Stem-cell injections might cause a decrease in pain by stimulating other cells to decrease inflammation.
If none of these options work, joint replacement can be considered. After a knee replacement, recovery is evaluated based on range of motion and return of strength. Typically, it takes six weeks to three months for a decent amount of strength to return.
The main reason to have a knee replacement is severe pain from arthritis that is not reduced with conservative measures. Recovery time can be substantial, and before replacement is considered, any surgeon wants to make sure the arthritis is severe enough and the X-ray findings correlate with the level of pain. A replacement is indicated when the pain appears every day and limits essential movements such as climbing stairs, standing and walking. Knee replacements should not be performed for mild pain or nuisance pain relieved by other measures.
Knee replacement is a great surgery that allows people who have lost independence and function to regain their lifestyles. It can be a game changer for people who have been struggling and allow them a chance to walk pain-free again.
So joint replacement can make a significant difference and allow people to enjoy life and exercise again. CrossFit athletes should not be discouraged by a diagnosis of arthritis, and they should keep participating by using modifications to work around mild symptoms. When symptoms are severe, additional treatment measures can be considered, but recall that skilled trainers can modify the CrossFit program for people with any condition to help them keep moving in some way. Ceasing to exercise because of arthritis in one joint is not a wise decision, and those with arthritis are encouraged to work with doctors, care providers and trainers to find a way to stay active.