What Does “Bone-on-Bone” Arthritis Really Mean?

Arthritis — or, more specifically, osteoarthritis (OA) — is one of the most common causes of joint pain and stiffness. It primarily affects knees and hips due to their nature as high load-bearing joints; however, it is known to impact nearly every joint in the body including the spine, shoulders, and wrists. Many people diagnosed with OA are told that their X-rays show “bone-on-bone” joint degeneration. This may sound quite scary and even unsolvable without joint replacement, but the current osteoarthritis research may surprise you when it comes to risk factors for pain and the effectiveness of non-surgical interventions.

Let’s use knee OA as an example: according to epidemiological data, over 50% of people with X-ray confirmed OA (loss of the cushioning cartilage that protects the knee joint) do not report experiencing pain, stiffness, or activity limitations. Furthermore, progression of OA severity on X-ray does not correlate with progression of clinical symptoms. In other words, the way someone’s knee looks on an image does not predict how much pain they will have. In fact, it is so common for people older than 30 years old to display OA on an image that practitioners have begun calling the diagnosis “symptomatic knee OA” rather than just “knee OA.” You are more than just your X-ray!

One variable that does predict the amount of pain and disability experienced with OA is one’s activity level. The cartilage that helps protect your joints requires nourishment to stay healthy; this nourishment is supplied in part by the movement of the joint. Every time you take a step or do a squat, protective fluid is forced in and out of your knees and hips. As you move more and more, the joints become healthier as more nutrients are supplied to the tissues. Even if there isn’t much cartilage left (“bone-on-bone”) the lubricating fluid can do its job more effectively when you keep the joints moving. This is the reason many people with OA start to feel better with moderate amounts of exercise!

If pain should occur, numerous research studies have found exercise-based interventions, including physical therapy, to be extremely helpful to manage OA. By increasing muscle strength, improving how well joints are being lubricated, and maximizing the health of the remaining joint cartilage, a rehabilitation program can be quite helpful to those in pain. The most important thing to remember is don’t be afraid to move!  If you are experiencing joint pain, contact Harbor Physical Therapy to learn what specific exercises can help improve your symptoms.

Written by:
Dr. Scott Newberry

Why So Sore? The Curious Case of DOMS

For many avid exercisers, delayed onset muscle soreness, or DOMS, is used as an indicator of a successful workout; however, for those unfamiliar with its symptoms or who have an underlying injury or pain condition, DOMS can be a discouraging, unpleasant, and sometimes frightening experience. DOMS is defined as muscle pain, stiffness, swelling, and weakness beginning 12-24 hours after a workout, peaking around 48 hours, and persisting up to 7 days. It is typically a subclinical condition, meaning most cases resolve without the need for medical intervention. Most people have experienced such soreness at some point in their lives — whether due to starting a new exercise routine or from pulling weeds in the garden on the first day of spring. My goal is to demystify* DOMS and provide tips on reducing your chances of having your fitness or rehabilitation goals derailed by this temporary condition. By the end, you’ll feel confident to march on with exercise despite the soreness!

*Spoiler alert: there is currently no scientific consensus on the specific cause of DOMS.

 Break Down to Build Up

To provide some context for the discussion that follows, it will be helpful to take you through an abbreviated journey (think: The Magic School Bus) from the moment you perform an exercise, such as a biceps curl, through the first few days of recovery. When you lift a heavy weight for the first time in a while, you inflict exercise-induced damage, also known as microtrauma, to the muscle tissue. While this may sound scary it is a normal, typically healthy form of “injury” that leads to desirable adaptations including increases in muscle strength and size. (Curiously, the extent of microtrauma does not seem to correlate to the severity of DOMS1.)

In the hours/days that follow, like an episode of Extreme Makeover: Muscle Edition, your body gets to work not only repairing the affected tissue but making improvements to ensure that the next time you work out you’re prepared for the challenge. It accomplishes this through the action of immune cells, inflammatory enzymes, and genetic activity. The nerves and blood vessels that supply the muscle also become more active, increasing strength and power in as few as 1-2 weeks. Within 6-8 weeks of repeated exercise, visible changes such as increased muscle mass (AKA hypertrophy) become evident.

Getting Back to DOMS

Now let’s zoom back in to what’s going on the first 2-3 days following your biceps curl when you’re so sore that brushing your teeth is a struggle. I’d like to reiterate here that researchers are not in full agreement about the mechanism of DOMS. However, it’s still worth discussing a few of the more plausible hypotheses.

(Debunked) Theory #1: Soreness is the result of accumulated lactic acid in the exercised muscle. This is a popular one but is not accurate. While lactic acid plays a role in the burning sensation that occurs while you are lifting weights, it is not directly involved with the development of DOMS.

Theory #2: The aforementioned muscular microtrauma results in inflammation, sensitizing nerve endings and leading to pain. While this seems plausible, several studies have shown that the level of inflammation actually increases following subsequent workouts despite decreased levels of microtrauma and soreness2. It’s worth pointing out that while inflammation often gets a bad rap, it’s an essential part of recovery — it’s your body’s modus operandi for healing tissue and adapting to life’s stresses. Certain elements of the inflammatory process may be involved with DOMS, but inflammation alone does not seem to be an adequate explanation.

Theory #3: Physical and metabolic stresses during exercise cause microtrauma to the nerves that attach to the involved muscle fibers, which are then sensitized by a number of molecules spurred into action by the repair/rebuild process. This theory is hot off the press, having been published shortly before this post (September 2020)3. The idea is that, following exercise, nerves (depicted by the green and orange lines in the image below) are traumatized in a manner similar to muscles. Then, increased levels of nerve growth factor (NGF) and other restorative compounds sensitize the injured nerve endings. These compounds are distinct from inflammation, distinguishing this theory from the one above.

Theory #2 and #3 both have merit and the truth may be a combination of these factors. Nerve growth factor has been experimentally validated as a sensitizer of nerve endings and is produced in response to exercise, so this is likely to be a factor in DOMS. However, the extent to which muscle or nerve microtrauma and inflammation are involved is unclear.

If at first you’re sore, try, try again

Even though we don’t know exactly why DOMS happens, we do know that it’s a temporary condition as part of your body’s adaptive process. By executing these steps to recovery like a well-trained military unit, your body is able to adapt to new loads with remarkable efficiency. Within 1 week, a protective buffer allows you to repeat bouts of exercise with decreased soreness. This shield of DOMS protection can last as long as 4-12 weeks post-exercise and is referred to as the repeated bout effect4. The repeated bout effect is dose-dependent, meaning the greater the intensity or duration your first time exercising, the more protection you have for future efforts. However, even low loads (as few as 2 repetitions) can reduce the risk of DOMS the next time you work out. This should be encouraging to those who may be reluctant to start or continue exercising due to DOMS.

Can I work out when sore?

Yes. Exercising a sore muscle in moderation is not harmful to the muscle tissue nor the recovery process, though you may find you’re unable to exert as much force due to the strength deficits that accompany DOMS. Aerobic exercise is totally safe and will often help reduce the intensity of soreness in the affected areas5. While there is not much evidence to say that you shouldn’t work out a sore muscle, if you’re experiencing undue pain or fatigue while doing so it may be best to target another muscle group.

Chasing soreness

While the very first workout for an untrained individual is likely to result in DOMS, the repeated bout effect protects from perpetual soreness, and individual factors such as genetics also impact one’s susceptibility6. Furthermore, certain muscle groups are more likely to experience soreness than others. The fact is there isn’t much evidence that soreness is necessary for increasing strength or building muscle7. On the contrary, there is convincing evidence that strength and size can increase without muscle soreness8. So you don’t have to go searching for soreness to make gains.

Isn’t there a magic pill I can take?

Much time, effort, and money has been spent to reduce the incidence and severity of DOMS. However, many of these remedies have been deemed ineffective by science. For instance, stretching before and/or after exercise does not prevent DOMS9. Nor does massage10, ice11, Epsom salt12, or bee venom13 (yes, that’s a real study). This doesn’t mean that a good massage, stretch, ice bath, hot pack, (…or bee sting?) won’t curb symptoms once they set in. They just won’t reduce your chances of getting DOMS in the first place or decrease the duration of your misery.

If you really can’t stand DOMS, there are a few strategies to try. Some research has found that omega-3 fatty acid, caffeine, and taurine intake can potentially reduce symptom severity14 (disclaimer: discuss dietary supplementation with a medical provider). Light to moderate aerobic exercise such as riding a bike or jogging may help reduce DOMS when used as part of a warm up routine15. However, the best solution may be the most obvious: ease your way in. A 1- to 2-week preparatory exercise phase using lower volume and intensity reduces the soreness experienced with subsequent sessions16.

If you try all of the above and still get a case of the DOMS, do not fear. Father Time will take care of the soreness and your body will ensure that the next time you work out, the pain won’t be quite so bad. Trusting in your ability to repair and adapt will allow you to reap the numerous benefits that exercise has to offer.

Written by: Dr. Scott Newberry

You can’t go wrong getting strong…no matter your age!

Strength training, also known as progressive resistance exercise, is a safe and effective way to improve your health, regardless of age. In fact, research has continued to support that strengthening is safe and effective for older adults*.

The benefits are far greater than simply improving aesthetic appeal (though this is a favorable side effect). They include:

  1. Counteracting age-related declines in muscle strength and function
  2. Increased muscle strength and power to help maintain or improve function, reduce disability, and maintain independence
  3. Increased bone mineral density, helping to combat osteopenia and osteoporosis
  4. Reduced fall risk
  5. Reduced risk of serious injury if a fall should occur due to improved tissue and bone health
  6. Improvements in psychological health, cognitive function, and sense of well-being

All of these add up to an increase in healthy lifespan and overall quality of life!

Despite all of these benefits, it can still feel intimidating to get started on a strengthening program. Strength training induces fatigue and muscle soreness, both of which can be uncomfortable and discouraging for a novice. However, with repeated training sessions over several weeks, you will find that such discomforts will give way to boosts in energy and improvements in function. Likewise, the soreness that occurs early on will typically improve and become less severe as your body adapts.

Here are a few tips to get you started:

  1. Anything is better than nothing. Start small and gradually build the amount and intensity of exercise. Strengthening 2-3 days per week is adequate to make improvements.
  2. Muscle soreness that begins the day after you exercise and persists for 2-3 days is normal and necessary to build strength. Don’t worry, the soreness will pass!
  3. Keep it simple. Many of the best exercises are those that have withstood the test of time including squats, push-ups, lunges, biceps curls, and arm raises.
  4. Have fun! Get friends and family involved, track your progress in a journal, or follow along with a YouTube video to keep things interesting.

If you need help developing a program, our staff at Harbor Physical Therapy can help you get on your way to a stronger, more resilient body!

*One caveat to the above: if you have a medical condition, orthopedic injury, or are generally uncertain about the safety of strength training for you, be sure to consult a medical professional before beginning a program.

Written by Dr. Scott Newberry

COVID-19’s Got You Inside?

As we are advised to stay home to avoid the spread of the virus, that doesn’t mean that we should stop exercising! There are many exercises you can do from the comfort of your home to increase your strength and endurance. Here are a few exercises below:

  1. Standing Marches: While standing, lift your knee in the air so that it is even with your hip. Return to the floor. Perform on the other side. Repeat for 2 minutes.

  1. Heel Raises: While standing, push through your toes to lift your heels into the air. Hold for 3 seconds. Slowly return your heels to the floor. Repeat 20 times.

  1. Sit-to-stands: While seated in a stable chair, cross your arms across your body and stand up. Slowly return to a seated position. Repeat 20 times.

  1. Plank: Lay down with your stomach on the floor and place on your body weight on your forearms.  Push up on your forearms and bear weight through your feet, while maintaining a straight line between your shoulders, hips, and feet, hold this position for 1 minute.

As you become more comfortable with each exercise, you can begin challenging yourself to perform each exercise for longer or for more repetitions. If you begin exercising and find that you have pain or feel unsteady, we would love to work with you at Harbor Physical Therapy! Call us at 443-524-0442 to set up an evaluation today.

Written by: Dr. Chloe Smith

Three Exercises to Decrease Back Stiffness

Stiffness and pain in the middle and upper back is a common issue seen by physical therapists. There can be multiple causes of this including postural deficits, decreased strength, increased muscular tightness, and decreased mobility in the thoracic spine. There are many different exercises that can help to directly address these deficits. Here are a few that you can try at home.

1. Side-Lying Book Openers

Lie on your side with your knees bent. Keep your hips still while rotating your upper body. Follow your hand with your head. Hold for 10 seconds and repeat 10 times on each side.

2. Cat-Camel

While on your hands and knees, sink your back toward the floor and lift your head up. Next, tuck your head in while arching your back up. Hold for 10 seconds in each direction and repeat 10 times.

3. Child’s Pose Stretch

Sit back on your heels while reaching your hands as far out in front of you as possible. Hold this stretch for 30 seconds and repeat 5 times.

 

Written by: Dr. David Reymann

Tips for Exercising in the Heat

As the COVID-19 outbreak and the summer heat, humidity, and thunderstorms continue, you may feel less motivated to get outside and exercise. Here are a few tips to get you motivated for exercising in the summer:

1. Exercise early in the day or later in the evening to beat the heat and avoid crowds.
2. Bring water with you.
3. Take breaks when you feel tired.
4. Wear supportive shoes.
5. Wear light and moisture-wicking clothing.

What if I am having pain with exercising?

Stop the exercise! The next time you work out, try that exercise again to see if it causes you pain. If it does, stop the exercise again. On the third trial, if the pain has not gone away, it is time to get that pain checked out.

Harbor Physical Therapy is here to help! You can schedule an appointment directly with us. We will analyze your movement patterns and help to address areas of weakness and tightness to get you back on your feet in no time. Happy exercising!!

Written by:
Dr. Chloe Smith and Dr. David Reymann

So you Started Walking More……

In these unprecedented times, many people are turning to walking outside to relieve stress, spend some time outdoors, and maybe even to walk off a couple extra pounds they’ve gained while staying home. Walking is a great way to improve your cardiovascular health, boost your mood, and increase your endurance. It is a low-impact activity, so it is gentle on your joints. However, a sudden increase in repetitive physical activity can lead to the development of pain or injury. As you spend more time being active throughout your day, make sure you slowly build up your mileage/the time in which you are walking each day to prevent overuse injuries. If you are not used to walking for long periods of time, start with 10 minutes a day and slowly increase the amount of time you are walking until you reach your desired length (30 minutes per day is a great goal). You can even break up your walking into shorter, more frequent walks throughout the day to limit fatigue. As you walk, it is important that you wear supportive shoes to prevent the development of pain from poor alignment or poor body mechanics. If you have recently developed pain from an increase in exercise, have questions about the proper footwear for your body part, or are interested in learning more about other exercises you can do as you stay home, please contact our office to schedule a physical therapy evaluation today!

Written by; Dr. Chloe Smith

What is a Trigger Point?

A trigger point is a painful spot within a muscle which becomes painful when pressed upon.  When pressed on, trigger points feel like “knots” or tight bands in the muscle, and are usually tender. Healthy muscles usually do not contain knots or tight bands and are not tender to pressure.

There is not conclusive research on the definition of a trigger point.  However, many characteristics have been observed for decades by researchers all over the world. There are many mechanisms by which we develop trigger points. Some of those mechanisms include poor posture, injury to a muscle, muscle overuse, and repetitive stress overload. Trigger points limit range-of-motion and cause muscle fatigue.

Physical Therapy is a common treatment option for trigger point pain. Physical Therapy addresses trigger points by identifying and treating the primary driver of the trigger point.  This is done through trigger point release techniques, massage, dry needling, therapeutic exercise, and posture re-education.  If you are interested in learning how physical therapy can help with your trigger point pain, make an appointment at Harbor Physical Therapy.

How to Relieve Lower Back Pain

Many people will experience lower back pain during the upcoming winter season. It may be from shoveling, decorating, or your usual daily activities. A common reason people experience lower back pain is due to muscle tightness. To help decrease muscle tightness, try these stretches below.

  1. Lower Trunk Rotation– This stretch helps to decrease muscle tightness located at your lower back and upper butt region. Perform 10 repetitions and hold for 5 seconds each.

  2. Single Knee to Chest stretch– This stretch helps to decrease pressure on your spine by creating flexion. Perform 4 on each side and hold for 30 seconds each.

  3. Seated Hamstring Stretch– This stretch helps to increase hamstring flexibility. This will decrease the hamstring muscle from pulling on the back musculature causing pain.

If you continue to have pain, please contact Harbor Physical Therapy for a thorough evaluation to determine the source of your back pain and an appropriate plan of care.

Stretching 101

To get the most out of stretching to prevent injury and muscle soreness, dynamic stretching should be performed before your workout and static stretching performed after your workout.  If you perform a static stretch before you workout, there is more potential to tear a muscle due to the lack of blood flow at the muscle.

To get the most benefit out of static stretching, make sure you hold the stretch at a point you feel a pull within the muscle. The stretch should be held between 15-60 seconds.  Perform 2-3 repetitions of each stretch on both sides of your body. If a stretch is painful, you should decrease the range of motion of the stretch.

If you are unsure what muscle groups to stretch in association with your workout, contact Harbor Physical Therapy.  Our physical therapists can create you a customized stretching program.