Exercise Prescription for Arthritis and Rheumatological Problems Dr. Christopher Tong Christopher Tong – different roles orthopaedic surgery / sports medicine Proud father of two Triathlete Current Appointments • Orthopaedic Surgeon in Private Practice • Hong Kong Sports Institute – Honorary Sports Medicine Consultant • CUHK – Honorary Clinical Assistant Professor – Orthopaedic Department – Family Medicine Department What exercises should I prescribe to patient’s with joint pain ? Arthritis / joint conditions • Neck pain • Back pain • Osteoarthritis of knees • Osteoarthritis of hips (more common in caucasion population) What problems do patients with joint pain experience ? • Stiffness of joints • Weakness of muscles • Psychological problems, depression etc. – Dependent – Can’t exercise Why is exercise beneficial ? • Improve range of motion of joints • Increase muscle strength • Psychological well being • Cardiorespiratory benefits • Lower blood pressure • Weight control • Avoid unnecessary medication Traditional exercises prescribed • Swimming • Cycling • Walking • Hydroexercise • Principle of gradual progression American Geriatric Society on Exercise and Osteoarthritis American Geriatric Society Panel on Exercise and Osteoarthritis • Initial evaluation • Assessment • Exercise prescription • Re-evaluation • Monitoring in 4-6 months • Progressive increase in exercise dose Sequence of events when doing exercise • Warm up • Conditioning – Aerobic activity – Strength training – Stretching • Cool down Stretching Resistance / strength training Exercise Prescription • Aerobic exercise – 20-30 minutes per day, 3-4 times per week • Flexibility – Initial: hold 5-15 seconds – Subsequent: 3-5 stretches, hold 20-30s • Strength-training exercise – Isometric • Hold < 6 s, 20 s rest period daily – Isotonic • 6-15 repetitions, 2-3 / week Precautions in exercise prescription • Osteoporosis – Engage in low-impact weight bearing activities and resistance training • Lumbar spondylosis – Avoid extreme twisting motions of back • Knee / Hip arthritis – Avoid exercise during periods of acute exacerbation of arthritis Frozen Shoulder (she had no previous shoulder trauma) Frozen Shoulder Frozen shoulder - pathology Intra-articular view Shoulder arthrogram Frozen Shoulder - Treatment • What can you do? – Educate the patient – Analgesics / Anti-inflammatory drug – Refer x physiotherapy – Intra-articular steroid • What can I do? – Manipulation under anaesthesia (MUA) – Arthroscopic release Shoulder Injection Technique Shoulder Injection Technique Conclusions • Individualized plan • Stretching, resistance training, aerobic training • Gradual progression • Exercise is good for you !