Osteoarthritis: To Move or Not To Move?

Osteoarthritis (OA), which is also known as degenerative joint disease, involves a wearing down of the flexible cartilage tissue at the ends of the bones that form joints. It is the most common form of arthritis, and it is estimated that over 32.5 million US adults are affected by it!(1) Prevention strategies of arthritis before it occurs is the most effective way to make sure it will not become an issue in your life. These strategies may include improving movement patterns, staying active, keeping your muscles strong and joints flexible, having good nutrition while avoiding processed and pro-inflammatory foods, staying hydrated, maintaining a healthy weight, and ensuring adequate recovery from exercise with enough sleep and gentle movement.

Once a joint has become arthritic, what are some strategies to keep in mind to optimize functioning, improve joint health, and mitigate the impact that this condition could have on quality of life? 

There is plenty of misinformation out there regarding arthritic joints. Even the terms used to describe OA colloquially can impact the public’s perception in a negative way. Degenerative joint disease. Wear and tear arthritis. Bone on bone! These types of descriptions bring scary images to mind, and imply that movement and exercise is actually unhealthy for joints and can contribute to joints wearing out. Certain doctors may tell their patients with OA that they should not do certain things any more- bend, lift, squat, kneel, run.

Too often, adults with arthritic joints begin to fear movement, or the pain that they may associate with movement, and will begin to exhibit compensations in the way they move. They may begin to become more sedentary, limit participation in various activities, and develop a resentful relationship with the involved body part. These changes contribute to a snowball effect, in which case the changes in mindset and behavior lead to further decline in joint function and tissue weakness, which continues the arthritic process, thereby leading to further pain, fear, and avoidance of movement and activity.

On the other hand, some people may overdo vigorous activity, which can increase inflammation and contribute to additional strain on compromised joints. It can be difficult to find the balance between too much and not enough. Lower impact, moderate activity performed on a consistent basis tends to be the sweet spot in which those with arthritis can keep their joints mobile and strong without contributing to flare ups and potential joint injury. 

Movement is absolutely essential for all of us, and especially for those with OA. If the question is move or don’t move an arthritic joint, the answer is to move intelligently and often.

As arthritic joints tend to become hypersensitized to loading, we must load the joints efficiently without strain, and allow the muscles and other tissues around the joint to get stronger. Stronger, smarter muscles will provide shock absorption and support for the joints, which helps attenuate the forces from daily life, movement, and exercise (like having your own built-in knee brace!) Movement has been shown to limit pain and improve joint motion, as well as prevent the risk of a future injury or fall. (2)
Joints that become arthritic tend to be synovial joints, meaning the joints rely on synovial fluid (the lubricating WD-40 of our joints) to move smoothly. In order for the synovial fluid to stay healthy, slippery, and plentiful, we must move the joint! Movement of joints helps to improve synovial quality and distributes the fluid around the joint so we can move without friction. Additionally, movement helps to distribute blood flow (which contains nutrients and oxygen) around the joint tissues, and can help decrease excessive muscular tension which may be associated with a pain pattern. Exercise has even been shown to activate genes that can help to rebuild cartilage!2 Cartilage has a limited potential to rebuild, but it is possible, and the cartilage that we do have can be strengthened just like other tissues. 

If you have OA, it can be very difficult to get your joint moving and begin the process of regaining strength and mobility. When joints have been painful for a long time, central sensitization may have occurred, which involves central nervous system changes in our perception and response to pain. The pain perceiving pathways may now be embedded deep into our brain circuits, including the prefrontal limbic regions, which is associated with our emotional responses. (3) Combined with structural, tissue-level changes, it is no surprise that many with OA fear movement and require guidance from a physical therapist or other health practitioner to get moving again. Fortunately, physical activity has been shown to have a positive effect on central sensitization, as it can help modulate the pain response by decreasing excitability in the motor cortex as well as stimulating the release of endogenous opioids (endorphins and other substances that are our brain’s natural pain relievers). (3) 

At the Wellness Station, we will be able to guide you intelligently and compassionately towards building strength, improving function, and opening up your life to greater possibilities.

Here is one of my favorite, low-impact exercises for building strength and control in the lower body and core. This can be especially helpful for individuals with knee and/or hip arthritis, in which cases standing exercises like squatting may be inefficient and painful. Many people have done the “bridging” exercise. The Feldenkrais-inspired bridge is known as “spine like a chain”. It involves pressing through the feet to begin to lift one vertebrae at a time from the ground, and lowering down in reverse. This can help to strengthen the glutes and thigh muscles, mobilize the spine, and improve awareness of how we utilize the forces from the ground to move our bodies. Check out this video from Paul McAndrew to get a visual and verbal demonstration of the movement: Spine Like a Chain

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. https://oaaction.unc.edu/oa-module/oa-prevalence-and-burden/ 

2. https://lonepeakpt.com/blog/living-arthritis-move-more-or-move-less#:~:text=Moving%20is%20essential%20if%20you,helps%20your%20joints%20be%20healthier 

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074793/ 

My Feldenkrais-Inspired Journey

Almost three years ago, my life changed for the positive when I was introduced to the Wellness Station and the methodology that influences our practice. I had barely heard of the Feldenkrais Method® at this point as a PT student, and certainly had no idea how to implement its principles into my own life or into therapeutic care. This was a pivotal moment in my life in which the end of my academic journey and the start of my career was just around the corner. I knew that I wanted to bring some new ideas into the therapeutic space, as my experience with traditional physical therapy left me searching for deeper meaning. Beginning to blend my learnings of the traditional therapy model with my study and practice of yoga was extremely helpful, but I knew I had much more to learn.

Following an auspicious introduction to the Wellness Station team, I began to open my mind and body to the greater possibilities that are achievable through a Feldenkrais approach. I began to receive mentorship, attended Feldenkrais movement classes, participated in my own body explorations at home, and improved my knowledge through reading various books on the topic. Through this journey, I have achieved personal growth and a refinement in motor skills, which are gifts that keep on giving.

Below I will reflect on some of the key takeaways of my journey that have helped me feel better in my body and motivated me to share these tools with the world. 

Keenly aware of more body parts and connections between

A key part of the Feldenkrais Method is to become more aware of our body in a non-judgmental way. With a background in anatomy as well as yoga, Feldenkrais helped to deepen my self awareness to a greater level of precision. Using the spine as an example, I used to be only generally aware of my spine, more as a series of “chunks”: my low back, mid/upper back, and my neck. Through slow, controlled movements with a keen attentiveness, I have been able to expand my sensorimotor skills to be aware of specific parts of my spine, and how to move and adjust my position to feel more comfortable in these various areas. Key lessons that helped to build this ability have been the pelvic clock, as well as piano keys and spine like a chain. This idea of each vertebrae being like a piano key can allow us to move with the precision of a skilled piano player- flowing up and down the scales with ease, rather than being limited to mashing many keys all at once. These practices allow us to feel “flow” and connections between various body areas, as the spine is our center, our core, the foundation for our head, and the bridge between our upper and lower body. 

Moved away from strain and over-efforting

Many of us have a tendency to put in too much effort, which can contribute to strain and tension. In fact, we all have inefficient movement patterns, which is just part of the human experience. These neuromuscular inefficiencies may present themselves during exercise, daily tasks, occupational duties, and more. For me, this tendency may have related in some part to perfectionism and competitiveness, as well as a reflection of the overall psyche of our society: do more, work hard, no pain no gain. Certainly it manifested into the way I exercised and practiced yoga to some extent. The Feldenkrais Method teaches us to do just enough, and no more. To become aware of unnecessary effort and tension, and find ways to move without our typical patterns of strain. By practicing movement in this way, I became aware of some of my habits that may have been less than helpful. Fitting myself into a tight yoga shape that didn’t feel good, but doing it because I felt like I should be able to. Overtraining because more is always better. Judging and being hard on myself when I felt like I wasn’t achieving something perfectly. My journey with Feldenkrais has not erased all of these habits, but it has done wonders to help me become more aware of them, and has allowed me to be able to make the conscious decision to be more kind to myself and my body. This has actually done wonders for my yoga and other fitness practices. By finding ways to unlock my emergency brake (unnecessary tension), work with my body instead of on my body, as well as a refined sense of awareness and biomechanics, I have been able to find new growth in terms of the physicality of my movement practices. Better ability to move into difficult shapes with ease, strengthen my body in three dimensions, walk and run with a sense of flow, all while respecting the limits of my body in the moment. 

Expansion of therapeutic toolset

One of the most important characteristics of an effective physical therapist is to walk the walk. These practices are part of my life not only for myself but also for my clients. Even though I am not currently a certified Feldenkrais practitioner, my experience with the method greatly influences my therapeutic style to provide clients with a unique approach to therapy. By practicing what I preach, I am able to share an integrative person-centered therapy that can be very helpful for those who are looking for an alternative option. While every person is very different, the tools obtained from mindful awareness practices can be applied to any person. We all have tissues, and our tissues all want attention!

At the Wellness Station, the therapist and client work together as “body detectives”, discovering neuromuscular inefficiencies that may be contributing to pain and movement challenges.

Based on these findings, lessons that are unique to each individual are taught with improved comfort, biomechanical efficiency, and fitness as the outcomes. To learn more about how Feldenkrais can be applied into physical therapy, read our Feldenkrais Method White Paper.  

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Movement Snacks

What is a movement snack, you ask? This catchy term (which I do not take credit for) describes taking brief movement breaks throughout the day. These breaks are especially important if we spend a long time sitting in the same position, such as during computer work, in the car, or on the couch. They can also be used as a way to warm the body up in the morning after sleep, or perhaps simply as something to do while waiting for the coffee to brew or the food to heat up.

Many people fall into all or nothing thinking when it comes to movement. Some less than helpful ideas out there are… “It has to be intense to be effective.” Or, “I went to the gym already today, so I checked that box.” Or, “I didn’t have time to do all my PT exercises, so I will wait to do them on a day when I have more time.” These mentalities are not so helpful, as they can contribute to moving less throughout the day, as well as equating movement to a chore that we should do as opposed to something joyful that we get to do. Rather than all or nothing, it can be helpful to shift to a mindset in which we reframe our daily movement practice into realistic, bite-size chunks, incorporating the mantra: “a little bit, very often.”

The brain and body respond well to repetition, so it is important to develop a routine that we are doing often in order to get the greatest benefits out of our practice. However, this does not mean that we have to spend a very long time all at once on our movement practices. A better strategy is to have “snacks” throughout the day in which we get our body moving in order to change positions, take strain and tension off our joints, get our blood flowing, and bring about positive changes to our mood and energy levels. Of course we want to also have “meals” regularly in which we are spending a longer period of time moving and exercising, but snacks throughout the day are an excellent way to stay moving in between these metaphorical meals, especially if we are busy.

The snacks you choose should ideally incorporate movement in more than one dimension, as well as include options for variations. Variety is the spice of life- you wouldn’t want to have the exact same snack every day! You might also choose snacks that are specifically targeted towards areas that you want to bring movement into based on what your day has been like. For example, number one below (back extension with thoracic pivot point) is an excellent way to mobilize the upper back, an area that can get stiff and stagnant after spending a long time hunched over a computer.

Here are some of our favorite movement snacks:

Back extension with thoracic pivot point-

Thigh to chest, tail wagging, circles-

Hip and shoulder extension-

Bridge gliding with figure 4 option-

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Moving is a Must: But Why?

One of the most common questions I am asked during treatment sessions as a physical therapist is “Why are we doing this?” Or “What is this doing for me?”

As the therapy provided at the Wellness Station is movement-based, it is important to understand why movement is so critical for our health, quality of life, and physical function. The movement lessons facilitated are typically targeted directly or indirectly at a biomechanical or neuromuscular issue. The specific movements may establish a refined sense of clarity and improved efficiency for someone experiencing difficulty with a daily activity, such as bending and lifting, going up or down stairs, reaching overhead, sitting for a prolonged time, and much, much more. While the rationale behind specific movement lessons may address specific individual factors (e.g. lack of muscular strength, excessive tension in certain areas, less than optimal form or alignment), sometimes overly focusing on the mechanics and the specific “benefits” of performing a movement can take away from the experience. When clients ask me those questions (e.g. “What is this doing for me?”), I often turn the question back around to them, and may ask something like “What are you feeling and sensing in your body as you do this movement? How might this relate to the issue in your daily life that you described?” For example, a lesson that involves torso side bending might make reaching overhead easier and possibly replace a prior inefficient overhead reaching movement that was a factor contributing to the discomfort. 

It might be helpful to understand a little about why we have a nervous system. While this is an extremely broad and complex topic that is the subject of many books, the nervous system can be simplified as the “control center” of ourselves as organisms. Control is necessary to achieve a preferred mode of function, and our nervous system can help correct and adapt when the preferred mode is not present (similar to the concept of homeostasis, or seeking balance). Our nervous systems allow us to react to and adjust to our environments in order to manipulate them.1 The structures of our nervous system look for order in the random, and create order when it is not present. As we move around and manipulate the outside world, our nervous system allows our muscles to move our bones, reacting to our environment to maintain order within our tissues. Our nervous systems likely evolved in the first place to allow us to move as the conditions of life required it, perhaps to move away from danger or incompatible conditions and towards resources and safety. In other words, we have a brain so we can move. Movement is a necessary condition for our life as a complex organism. If we can move more optimally, we can live more optimally.

As the modern world is an environment in which it is less of a short term requirement to move, many of us simply move less, or become sedentary. Our food? Delivered. Going somewhere? The car does it for us. Going up a level? Elevator. The cleverness of the human mind has contributed to extremely useful innovations in technology that can make our daily lives a whole lot easier, but these modern conveniences actually can rob us in the long term. If we were built to move but our environment no longer requires us to move as much, how do our bodies respond? Over the long term, not favorably! For this reason, we need to intentionally move our bodies, move for the sake of moving, and hopefully enjoy doing it!

Finding Joy

On a fundamental level, all of us can find joy in movement. Think about the sheer joy of babies, first discovering how to roll over, bring their foot into their mouth, pick up a toy, and stand up. Movement can be a richly rewarding experience. Rather than seeing exercise as a chore that we must do to strengthen certain muscles, improve fitness, etc., can we tap into the joy of movement? This enjoyment will serve as a motivating factor that will encourage us to move more often in a variety of ways, which will ultimately be more beneficial in our lives than trudging through exercises we find to be boring or uncomfortable. This might be dancing, Feldenkrais lessons, yoga, swimming, walking, lifting weights, or simply rolling around on the floor! Find something you enjoy, and do it very often.

Regulating Nervous System

As we learned, we move because we have a nervous system. Our nervous system allows us to move. Thereby, engaging in movement is an excellent way to regulate our nervous systems. Mindful movement helps us focus our attention on the present moment, increase the release of neurotransmitters and hormones that support our mood and mental health, and can help to downregulate excessive tension that we hold in our muscles. This regulation of the nervous system through movement can help bring us from a sympathetic state (fight or flight) to a more calm and pleasant parasympathetic state (rest and digest). This can positively impact our experience of pain, mental health, and the function of our organs.

Learning To Learn

Engaging in new movements is an excellent way to learn. Participating in Feldenkrais lessons is essentially learning about learning! It can be an eye-opening experience to become aware of how we react to new challenges. When we are attempting to learn something physical, are we able to maintain an open mind? An ability to be kind and patient with ourselves? Or do we have more of a tendency to push, strain, over-effort, or give up? Practicing “learning” movements can help expand our brains, which can be helpful whenever we have to learn something new whether that be a new movement, a musical instrument, a language, or something we encounter at our jobs or in school.

Nourishing Tissues

The tissues of our body are deeply dependent on movement in order to be healthy. Our joints require frequent movement in order to circulate lubricating fluid (synovium) to keep healthy, gliding surfaces with minimal friction. Our bones require weight-bearing movement in order to maintain their density. Our muscles require challenges in order to get stronger instead of weaker. Almost all tissues in our body require blood flow in order to receive oxygen and other nutrients to stay alive, healthy, and comfortable. Movement fills our muscles with fresh blood, and cardiovascular activity helps to circulate blood with more gusto throughout our entire systems. 

There are many, many reasons to move your body. It might be helpful and more rewarding to consider movement as a gift or a privilege that we get to do. Moving away from the “how is this helping me” mindset and tapping into appreciation of the miracles of movement may motivate us to move more, allow us to feel more human, and keep us healthy and mobile as we age.

References:

Feldenkrais Moshé. (1981). The Elusive Obvious. Meta Publications.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Stairs With Sore Knees: From Struggle to Success!

Stairs can be a major stressor for those of us with sore knees. Oftentimes, older adults begin to avoid stairs as much as they can, and even choose homes that are on one level for this very reason. When stairs are the only option, there may be extra difficulty, both because of issues with the knee joints, as well as the deconditioning of muscles that may have occurred as a result of not going up and down stairs as frequently (use it or lose it). The act of choosing to continue to use stairs as we age is a great way to maintain strength in the lower body, but this will only be beneficial if we can climb stairs with ease and efficiency. Rather than making stairs the enemy, how can we begin to see stairs as a healthy challenge that will help us maintain our strength and mobility?

Biomechanics of stairs:

It may be helpful to understand a little bit of the biomechanics of stairs, or the physics of the movement. Going up stairs is a concentric action, in which the muscles shorten as they contract, creating a force that overcomes resistance. Most of the concentric action occurs about the hip and knee joint, and key muscles for going up stairs are the quadriceps (front of thighs) that act to extend the knee, and the hamstrings (back of thighs) and gluteus maximus (large buttock muscle) that shorten to extend the hip.

We also require use of our hip flexors (front of abdomen to front of hip) to lift our foot to the next step. In addition, if we learn to ascend stairs using more of our body, muscles on the sides of our bodies can also help, including our gluteus medius (side hip muscle) and quadratus lumborum (side of waist/low back). We can rely on the integrity of our skeletal structure to help direct the forces required to go upstairs, as we can send our body weight over our supporting leg, thereby requiring less overall muscular effort to go up stairs.

Going down stairs is actually more difficult for many people, especially those of us with knee issues. The skeletal system of our bodies is extremely important for supporting and directing forces. Going upstairs, we are able to rely on our skeletal structure more reliably, whereas going downstairs requires the supporting knee to be very bent, which makes the muscles in the front of the thigh have to work much harder. Going down is an eccentric action, which means muscles have to lengthen while contracting, as they control against the force of gravity. In other words, eccentric contractions are kind of like controlled falling. These types of contractions are actually more difficult for our muscles, which is why eccentric training is an excellent way to improve tissue strength and resilience. However, if our muscles lack the strength to control our movement during gravity, we might notice going down stairs, sitting down into a chair or toilet, or lowering ourselves to the floor may turn into more of a “plop” than a smooth motion. This indicates that our muscles lack eccentric strength, and our joint tissues may be taking a great deal of strain as we do these activities. 

Another reason why going down stairs might be more difficult for some is that it tends to isolate the knee joint more than going up stairs. As described above, going up stairs can make great use of the muscles of the hips and core. In going down stairs, notice that the knee might travel far over the toes, and very little movement actually happens in our hip. As the knee travels over the toes and the quadriceps contract eccentrically, pressure builds up in our knee which can be an irritating factor, especially if we lack eccentric control or if there are other factors at play that are impacting our movement efficiency.

Strategies for a “bad day”:

Although practicing stairs is a great way to get better at stairs, sometimes we have to modify how we do it based on pain and discomfort. Think about an early morning. In the winter. Perhaps you “overdid it” yesterday, and your knee is speaking to you. Or perhaps, you had a knee replacement surgery not so long ago and your knee simply is not in shape to do stairs normally. If this is the case, here are some strategies for bringing more ease into your life:

1) Up with the strong, down with the sore:

This popular adage is well known for anyone who has had a knee replacement. Many will say “up with the good, down with the bad”, but why the negative self-talk if we could just say sore? This advice simply means to go up and down stairs one at a time, rather than your leg traveling past your other leg to the next step. Also, when going up, lead with the leg that is stronger, not experiencing as much discomfort, etc. And when going down, lead with the sore leg. This will make sure the strong leg is doing both the concentric and eccentric action to give the sore leg a break.

2) Try backwards, or sideways:

This tip is mainly for going down stairs. If one were to go down stairs backwards, mechanically, it would look a bit more like going up stairs in which we can use our hips a bit more rather than isolating the knee. For safety reasons, it is extremely necessary to practice this first before gallivanting down the stairs backwards. Try standing on the bottom step, holding on to the railing. Then slowly lower one foot down to the ground, followed by the other foot. Then come back up, practicing several times to get the hang of it. Similarly, when going down sideways, the knee does not have to travel so far over the toes. We are able to bend at the hip more to lower down to the next step. Going down sideways will also make it possible to hold on to a railing with both hands. On a bad day, consider going down backwards or sideways leading with the sore leg, just as described in the previous strategy.

Strategies for optimizing movement and preventing issues:

On a typical day perhaps if our knees are not a bother, and we would like to embrace the healthy challenge of doing stairs in an efficient and strain-free way, consider the following recommendations:

1) Root your heel to rise, bend side to side:

Rooting to rise means to take advantage of the force that the ground gives you, known as the ground reaction force. As we might remember from Sir Isaac Newton, every force has an equal and opposite reaction. When we put weight into the ground, the ground exerts an equal and opposite force back up into our skeleton, allowing our bodies to move. By focusing attention on our ability to harness ground forces, we might be able to navigate stairs and other movements with a greater sense of clarity. By placing our heel completely on the step when going up, we can actually push down through our heel as our body leans forward over our foot. By pushing down through our heel, we will rise up to the next step, thereby rooting down to rise up. The muscle that pushes our heel down is the same muscle that extends our thigh back, which is our gluteus maximus, the strongest muscle in our body. If our heel is dangling off the step, we cannot make as efficient use of ground force, and more force may be required from our knees.

When going up stairs, we can train ourselves to move partially in the lateral plane, rather than only the sagittal plane to take further stress off the knees. Put simply, we can let our body side bend help us ascend to the next step. This is a difficult concept to describe that must be felt in the body to understand. One way to think about it is relating the action to pushing down on a trash can pedal to lift the trash can lid. If the right foot presses down on the step, the left side of the pelvis will lift up, bringing the left leg to the next step. In this case, the right foot would be pressing on the imaginary trash can pedal and the left side of the pelvis would be the lid.
This action is accomplished mainly by the gluteus medius as well as the quadratus lumborum, which are muscles on the side of the pelvis and abdomen.  

One way to practice this feeling before doing it on the stairs is to try a slow march standing in place. Place hands on the sides of your waist. Begin to lift your left thigh up, thinking about pressing down into the ground through the right foot. Notice that the left side of your waist would get shorter, and the right side of your waist would get longer. Continue in a slow march, paying attention to the changing length of your side body. Imagine that the leg that is holding your weight is pressing down into the trash can pedal, and the side that is coming up is the lid.

2) Practice Step Ups and Downs:

As we learned, eccentric strength is necessary to go down stairs with ease, and concentric strength is necessary to go up stairs. A great way to improve this strength is to practice step ups and downs. On the bottom step or perhaps using a stool as well as something to hold on to as needed, place heel up onto the step and practice driving down through the heel to step up. Keep the same heel on the step, and lower down backwards with control until your other foot touches the ground. Repeat several times, noticing the activation of your thigh, glutes, and side body muscles.

For a more challenging exercise, practice going down a step facing forward. We have learned, this is the most difficult and likely to elicit discomfort of the knee. For this reason, it is important to start practicing by holding on to something, as well as starting with a partial range if you are having difficulty controlling this motion. Start standing on the bottom step, keep one foot where it is, and begin to lower the other foot towards the ground, but only a couple of inches. Then return to the starting position. The key is to lower down very slowly, to ensure you are maintaining eccentric control. Try a few more times, perhaps each time letting the foot travel a little closer to the ground as your other knee bends. Notice the tracking of your standing knee on the leg that is holding your weight as you lower down. Does your knee bend straight forward over your toes? Does it drop in towards the big toe side, or out to the pinky toe side? Does making a change to where your knee tracks impact the comfort and ease of this motion? Spending a little time each day practicing these movements will condition your body and your mind to be primed and ready for the next time you encounter stairs.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team