Published on December 11, 2014
Osteoarthritis is one of the most common diseases affecting the joints of the body, particularly the hip and knee. Hibernating and rehabilitation of hips and knees in the winter season is a common theme in our practice. It is during this cold time of year, when patient’s seem to have less of an issue doing surgery as they are stuck at home battling the snow, and can be ready and moving for the upcoming summer. Many believe that surgery is a quick fix and the recovery time is quite fast, however; this is far from the truth. Major surgery is a traumatic event, which takes much time and effort to heal and recover from. Even the simplest form of arthroscopic repair, requires a progressive rehabilitation program both before and after surgery in order to prevent future injury.
There are many factors to consider before taking the step towards surgery. Nutrition is a key component to consider, as evidence suggests that the frequency of osteoarthritis is accelerating likely because of the ageing population and the increasing risk factor, obesity (Sowers et al, 2012). It has been shown that every additional pound above ones normal body mass index, is equivalent to approximately five pounds of pressure to the knee. Not only is osteoarthritis a wear and tear condition, it is also shown that it exists in the highly metabolic and inflammatory environments of excess fat tissue.
Maintaining a lean body mass with strong healthy muscles and bones will help prevent painful arthritic changes to the knee. It is important to have a good strength ratio between the quadriceps and hamstrings, as this is crucial to helping unload the knee joint. Research conclusively demonstrates that strong hip muscles take pressure off of the knees by supporting the lower kinetic chain, helping prevent abnormal knee mechanics. The gluteal muscles are the keystone of the pelvis, which supports the spine and extremities. Weak hip muscles can cause abnormal biomechanics which will contribute not only to knee pain, but hip and lower back pain as well. Therefore the two most important muscles to focus on as part of your rehabilitation program are the gluteus maximus and the medius. These muscles help stabilize and balance the knee joint from the pelvis. The gluteus maximus muscle is primarily responsible for propelling us forward as we walk while the gluteus medius muscle creates pelvic stability to ensure we are well balanced.
If you have any knee pain, you can do the following corrective non-weight bearing exercises with the help of a clinician/therapist. This will begin to strengthen the muscles of your hip, quadriceps and hamstrings in order to unload and rehabilitate the knee.
- Aqua Therapy: Increases the blood supply to the joints by approximately seven times. Deep water running and leg exercises can be done, utilizing the resistance of the water to help strengthen the muscles of the hip and knee without impact. The best part of the water is that it creates resistance throughout the entire range of motion helping to strengthen not only the muscles but all the tissues surrounding the joints in the body.
- Cycling on a Recumbent Bike: It is a very comfortable, non-weight bearing and can be used to strengthen the quadriceps muscles without any impact. It is somewhat like doing a seated leg press without any direct loading to the knee.
- Straight Leg Raise: Lie on your back with one knee bent and the other leg straight; slowly raise the straight leg upwards strengthening the quadriceps.
- Clam Shells: Lying on your side with your knees together and a band around your knees slowly raise the top leg approximately 30 degrees and slowly release. Strengthen the gluteus medius muscle for pelvic stability.
- Gluteus Bridge: Lie on your back with both knees bent; lift the hip upwards bringing them off the ground to strengthen the glutes and hamstrings.
- Glut Extension on all Fours: Simply do one leg lift and extend to target the gluteus maximus muscles.