Management of Hip and Knee Osteoarthritis

Management of Hip and Knee Osteoarthritis

9% of the population have OA but this figure jumps to 60% once >55 years old1. However, with an ageing population and rising obesity rate this figure could increase. OA is the end result of excessive or abnormal loading of the joint surface. Previous joint injury can accelerate this process, but degenerative joint changes are a normal process for all of us.

REVOREHAB - Vol. 15 Romanian Deadlift

This exercise is important in posterior chain strengthening - recruiting mostly the hamstrings and glutes.

  1. Hold a bar at hip level with a pronated grip i.e. palms facing down.
  2. Shoulders should be back, back arched and your knees slightly bent. This will be your starting position.
  3. Lower the bar by moving your bottom back as far as you can. Keep the bar close to your body, your head and neck in a straight line with back, and your shoulders back (setting your scapular as we have shown you in previous weeks). 
  4. Done correctly you should reach the maximum range of your hamstring flexibility just below the knee.
  5. At the bottom of your range of motion, return to the starting position by driving the hips forward to stand up tall, making sure you engage your glutes.

REVOREHAB - Vol. 14 Eccentric Hamstring Curl

Eccentric Supine Hamstring Curl: 

This exercise is particularly important for early to mid stage hamstring rehabilitation. 

  1. Begin on the floor laying on your back with your feet on top of the ball.
  2. Position the ball so that when your legs are extended your ankles are on top of the ball. This will be your starting position.
  3. Raise your hips off of the ground, keeping your weight on the shoulder blades and your feet.
  4. Flex the knees, pulling the ball as close to you as you can, contracting the hamstrings.
  5. Lift one foot off the ball, with all your weight in one leg, slowly lower back down to start position. Aim to control the movement and keep hips still. 

REVOREHAB - Vol. 13 Hip Rehab

The Copenhagen exercise has been shown to significantly increase eccentric adductor strength as part of a successful injury prevention program. 

BEWARE: This is a high-level groin strength exercise that requires sufficient lateral trunk and groin strength to complete safely and effectively. 

Aim to master some simple groin exercises in stable positions and lateral plank variations on a mat prior to trying these exercises as part of the Copenhagen series to ensure sufficient technique.

 

Exercise A: Involves an isometric (static) hold with the top leg whilst raising the bottom leg under control

 

Exercise B: Involves the eccentric component on the top leg only by moving the hips and pelvis up and down throughout a comfortable and controlled arc of movement

 

Exercise C: Involves a combination of A & B.  This variation aims to lift the pelvis up first then bring the bottom leg up and squeeze under tension.  Lower the bottom leg down then pelvis down. 

REVOREHAB - Vol. 12 Hamstring Curl

This is an intermediate hamstring control exercise with some glute activation that is good as part of your general workout or those looking to rehab post injury.

  1. Begin on the floor laying on your back with your feet on top of the ball.
  2. Position the ball so that when your legs are extended your ankles are on top of the ball. This will be your starting position.
  3. Raise your hips off of the ground, keeping your weight on the shoulder blades and your feet.
  4. Flex the knees, pulling the ball as close to you as you can, contracting the hamstrings.
  5. After a brief pause, return to the starting position.

REVOREHAB - Vol. 11 Shoulder Press

TODAY WE LOOK AT A SHOULDER PRESS WITH INTERNAL ROTATION ISOMETRIC BIAS

This is a fantastic exercise to progress rotator cuff activation and strength of subscapularis that everyone forgets to train

It’s not all about external rotation!

The other vital component is the shoulder blade that has a very important posterior tilt that activates the serratus anterior to counteract the effects of gravity on the body!

Technique:

  1. Hold a single dumbbell at each end and use the arms to gently squeeze the ends together
  2. Keeping tension on the weight bring the arms in a comfortable arc above the head in a smooth motion
  3. Lower under control and repeat

Aim for 3 X 8-12 repetitions to grow more muscle

Not only is this a great variation from your regular gym programming, it’s also a higher level tendinopathy exercise and a starting point for weights overhead (2 hands for safety first!)

REVOREHAB - Vol. 10 Shoulder Rehab with Cable

This is an advanced shoulder rehab exercise which can be completed with a band or cable as we have done here.

1.     Set shoulder blade by elevating (small shrug up)

2.     The arm rotates back slowly under control using the muscles of the posterior cuff (back of the shoulder)

3.     Return to the starting position with the same level of control

Aim for 2-3 sets up to 20 repetitions for good muscle activation and endurance

Key points:

·      Don’t let the shoulder blade drop down

·      Avoid rushing and losing the technique

·      It’s better to control small ranges of motion then increase when ready

·      Start light and build resistance, as this exercise is very difficult!

This is a great exercise used at Claremont Football Club in preparation for marking overhead and spoiling after shoulder injury.

Our physios at Claremont have the ability to help tailor your rehab to the equipment next door at the gym. So call us or book in with Dan to get started!

REVOREHAB - Vol. 9 Shoulder Shrug

This is a fantastic exercise for shoulder rehabilitation, neck and upper back complaints to build control, activation, strength and muscular endurance. We're using the cable here to assist with control. 

It’s a great approach to combating the effects of gravity, slouched postures and prolonged sitting commonly seen in todays society.

This is how we do it:

  1. Hold on to a light cable on a low setting to begin with.
  2. Bring the shoulder blade back gently into retraction and maintain this position throughout the exercise
  3. With the arm straight at a 30 degree angle shrug the tip of the shoulder up towards the ear. This angle is optimal in training the upper trapezius and the assisting serratus anterior muscle.
  4. Slowly lower back down smoothly under control without shuddering or shaking

Aim for 3 sets up to 20 repetitions as a warm up exercise on each arm.

This can also be completed using light dumbbell weights, resistance bands or a barbell with both hands for variation.

REVOREHAB - Vol. 8 BOSU Landing Strength

Do you Bosu?

This is a high level landing technique using the Bosu. This involves significant single leg strength and control, high level balance and is a great return to sport exercise 

For safety: ensure that the Bosu is supported against the wall and basic gluteal, balance and strength exercises have been completed first!

  • We are focusing on jumping and landing technique with change of direction thrown in as well.
  • Jump onto the BOSU off the outside leg, push off the (opposite) inside leg and spring off the ball landing back on the outside leg.
  • Focus on a strong landing with the knee in good alignment, the hips level and a strong trunk, avoiding side flexion
  • Complete up to 8 repetitions or until the technique drops, then change sides.

Perfect Practice Makes Perfect

 Quality is key with this one!

REVOREHAB - Vol. 6 Monster Walk

THIS IS A GLUTEAL ACTIVATION EXERCISE THAT IS GOOD TO INCLUDE IN A WARM UP.

IT COMBINES LATERAL MOVEMENT AND ANGULAR WORK REQUIRED IN MANY SPORTS. IT'S ALSO A GREAT EXERCISE FOR CHANGE OF DIRECTION ATHLETES INVOLVED IN DYNAMIC SPORT SUCH AS SOCCER, FOOTY OR BASKETBALL.

  1. The band can be placed above or below the knee to begin with
  2. Push down through the back leg and away using the same stance leg for propulsion
  3. Big to bigger motion through the legs means that there are no narrow feet at any point in this exercise
  4. Trunk stays strong and upright
  5. Movement is on a 45-degree angle (across and forwards) diagonally
  6. Then completed on a 45-degree angle (across and back)

We use a 5-10m area and complete 3-5 laps back and forth

To make the exercise more difficult the band can move lower down the leg, the movement can be completed quicker (more power) or complete it with a slightly heavier band

REVOREHAB - Vol. 5 Crab Walk

Crab walks target Gluteus Maximus and Minimus and are important for hip and knee function. 

1 - Place a resistance band just above the knees tight enough so it stays up by itself. For most makes of resistance band, the colour denotes the degree of tension. Your goal is to use a tension that causes fatigue by 8 steps. As you get stronger (i.e. when can do more than 5 x 8 steps) you will need to progress to a different colour band.

2 - Open the legs to slightly wider than hip width apart and turn the feet outwards. Now stretch the band by rotating the thighs outwards, so that your knees are in line with your feet. In doing so, you should feel the glute muscles contract.

3 - Keeping the knees rotated outwards and tension on the band, lower yourself into a slight squat position, sticking  your  bottom out behind you as if you were about to sit down.

4 - Keeping your upper body still, take a half step sideways against the resistance of the band. Make sure the other leg stays still, pushing out against the band.

5 - Now take a half step inwards with the opposite leg, making sure that you do not step too far (the resistance band needs to stay tight).

Repeat this series of steps in a slow, controlled motion, ensuring the inner foot does not spring in, keeping tension in the band. When you have done eight steps in one direction, come back with the other leg leading. Aim for five, then increase distance or number.

If your gym doesn't provide Theraband or you're wanting lengths of your own, we have this available for purchase in a variety of colours and resistance.

 

REVOREHAB - Vol. 4 Wall Lunge

One Up Wall Lunge

Great exercise rarely seen in a traditional gym setting.

Most people will have seen or tried the back foot on the floor or on a bench. This wall variation allows for the back leg to work into extension providing some added stability to the exercise and a different postural challenge!

The movement:

  • Weight is lowered directly down (vertical drop versus any back and forth movement)
  • The knee doesn’t translate forward over the toes, so the shin remains relatively upright the whole time
  • Ensure the knee stays straight and doesn’t roll in to the middle
  • Also focus on keeping a level pelvis  (Don’t let the opposite side of the pelvis drop or the trunk flex to the side)
  • You will be working your quads, gluteals and trunk muscles with this one!

Comfortable range and depth only

If you’re going well add dumbbells in both hands for added difficulty

REVOREHAB - Vol.3 Gluteal Strength pt 2

Split Gluteal Bridge on the Wall:

Used as a progression from a double leg glute bridge exercise.

A nice link towards single leg activity from simple double leg exercises.

  • Push elevated foot into the wall (Like a leg press)
  • Push bottom foot into the floor (Standard bridge movement)
  • Posterior pelvic tilt to flatten the lower back
  • Drive force through both feet
  • Lift the hips to feel a glute squeeze
  • Lower under control and relax at the bottom
  • Repeat until fatigued or reduced quality

Then complete on the other side

Progression is to a single leg glute bridge exercise

 

Exercise Guidelines and the Associated Benefits

Written by Laura Howden

Part 1 – Cardiorespiratory Exercise

Time and time again we are told to exercise regularly, but how many of us are actually doing that? It can be challenging to know how much exercise to be doing, how often to be doing it, and even what type of exercise to be doing. Luckily you’ve come to the right spot. This 2-part Blog will summarize the current exercise guidelines and review the various benefits of exercise to help get you on-board to living an active and healthy lifestyle! Part 1 will focus on cardiorespiratory exercise while part 2 will focus on resistance training

Cardiorespiratory (Aerobic) Exercise

Cardiorespiratory exercises are exercises that increase your heart rate and rate of breathing. They generally involve the use of lots of muscle groups, including activities such as walking, running, cycling, and swimming. The main goal of cardiorespiratory exercise is to increase your body’s efficiency at delivering oxygen throughout the body (think of training for your heart and lungs).

It is recommended that adults engage in 30-60 minutes of moderate-intensity cardiorespiratory exercise on at least 5 days a week, or, 20-60 minutes of vigorous exercise at least 3 days a week. That’s a minimum of 150 minutes of moderate-intensity exercise or 75 minutes of vigorous intensity cardiorespiratory exercise each week. This should be accumulated in bouts of no less than 10 minutes of continuous, purposeful exercise (keep that heart pumping!).

 Photo by Jacob Ammentorp Lund/iStock / Getty Images

Photo by Jacob Ammentorp Lund/iStock / Getty Images

Moderate-intensity exercise should be completed at 64-76% of your heart rate maximum (an estimate of your heart rate maximum = 220 - age). You can think of this intensity as 3-4/10: fairly light to somewhat hard. It will take some effort but you will still be able to talk while exercising. Vigorous exercise should be completed at 77-95% of your heart rate maximum, or an intensity of 5-7/10: somewhat hard to very hard. Exercising above this level would be a near maximal exertion that would be impossible to maintain for more than a few minutes (high intensity exercise utilizes a different energy source, becoming anaerobic rather than aerobic). For the general population, moderate-intensity exercise could be considered a brisk walk, while vigorous would become more of a jog or a run.

 

If you’re short on time, you can combine the two: 10 minutes of vigorous exercise is equivalent to 20 minutes of moderate exercise. The more you challenge yourself, the greater the training effect (based on the principle of overload, you need to sufficiently challenge yourself to improve your fitness). There is a dose-response relationship between activity levels and health outcomes, such that the more active you are the greater the health benefit.

So what are the benefits?

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 Photo by Sasha_Suzi/iStock / Getty Images

Photo by Sasha_Suzi/iStock / Getty Images

Sounding good so far? Inactivity is the on of the highest modifiable risk factors for disease prevention; yet more than 50% of Australians are insufficiently active. Challenge yourself to be active on a daily basis! If you aren’t usually active, ease into it. Gradually increase how much you are doing each week. Doing something is better than doing nothing, and will still provide benefit.

The last thing to consider is how much time you spend being sedentary or seated. Regardless of how active you are everyone will benefit from sitting less. Prolonged sitting is associated with increased cardiovascular risk, independent of time spent being physically active. Interrupting prolonged periods of sitting with short-bouts of standing or activity helps to improve metabolism and decrease negative health outcomes. Try to regularly break-up long periods of sitting by standing up for a quick stretch or going for a short walk.

Bottom line: Lets get moving!

Laura is a Physiotherapist and Pilates Instructor at our Cottesloe practice with a keen interest in exercise rehabilitation Post/Pre Op as well as getting patients fit for life.
Reference:
Garber CEBlissmer BDeschenes MRFranklin BALamonte MJLee IMNieman DCSwain DP. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-59. DOI: 10.1249/MSS.0b013e318213fefb

REVOREHAB - Vol 2. Glutes

Vol. 2 - Glutes

Glute Bridge 

 - This a great exercise for activating the glute muscles. It can be used as part of a warm up & is particularly good for those of us with lower back pain. 

Lie on your back, with your knees bent and feet flat on the ground. Keep your arms at your side with your palms up. 

Lift your hips off the ground until your knees, hips and shoulders form a straight line. Squeeze the glutes. Make sure weight is evenly distributed between feet and is predominately in the heels of your feet. 

Hold your bridged position for a couple of seconds before slowly lowering back down. 

If this causes some back pain, don’t lift hips so far off the ground. 

Perform 3 sets of 10-12 reps.

REVOREHAB - VOl. 1 - Balance

The Y Balance Exercise: 

A dynamic single leg balance test

This is a simple and reliable test to compare left and right sides for ankle flexibility, core and lower limb control as well as single leg strength

It can be used as a return to sport test or as part of a single leg balance/ proprioception program. 

How to do the exercise:

·      Place hands on hips

·      Bring one foot forward as far as possible, tap the ground without losing balance and return to the starting position

·      The athlete then reaches 45 degrees in a posterolateral direction and completes the same toe tap then returns to the starting position

·      They then reach 45 degrees in a posteromedical direction (bowling pose) and return to the start

·      Compare the distances of left and right in each direction

·      As an exercise athletes can complete 3-5 reps on one foot, then complete on the other side

Make sure each direction is symmetrical to reduce your risk of future injury and a safe return to sport!

Check out an earlier blog from Dan on the importance of ankle mobility here.

 

REVOREHAB - Intro with Dan Webster

Join Dan & Anna in a weekly series of videos as they take you through some simple to more advanced rehab exercises in collaboration with our mates at Revo Fitness Claremont to get you back doing what you love sooner and stronger. 

Anna has appointments at our Cottesloe and Claremont clinic. Dan is strictly available only at Claremont each day of the week. Booking is easy via this website or our Claremont clinic page here.