Move It or Lose it

Osteoarthritis can stop you cold — but only if you let it. Here’s how to mitigate your risk factors and reclaim your quality of life.
by Patti Verbanas
Ann Zielinski loved to swim. “I swam for my cardio health, usually doing the breast stroke,” says the Bridgewater resident, who logged about a quarter-mile each day. “What I didn’t realize was that my whip kicks were slowly eroding the cartilage in my knees.” While still in her 40s, Zielinski was diagnosed with osteoarthritis.

Osteoarthritis is a progressive, incurable condition in which the cartilage, the natural cushion of the joint, breaks down, causing new but irregular bone formation and loss of normal joint mechanics. The result is stiffness and pain. It affects an estimated 27 million Americans — most of them women, especially over 55. The disease is most often brought upon by age (primary osteoarthritis), but, as in Zielinski’s case, can manifest in a joint that has had prior injury or experienced other trauma (secondary osteoarthritis). While the precise cause of increased instances in women is unknown, some contributing factors may be hormones and a woman’s anatomy. “The occurrence of osteoarthritis in the hips and knees might be partially explained by the shape and orientation of the female pelvis, since altered joint geometry places different mechanical stresses on the hips and knees,” says Elliot Rosenstein, M.D., director of the Center for Rheumatic and Autoimmune Diseases at Saint Barnabas Medical Center in Livingston.

Secondary osteoarthritis can occur at any traumatized joint; primary osteoarthritis typically manifests in the hips, knees, toes, neck, lower back, base of the thumb, and the two knuckles farthest from the palm. While some risk factors, such as normal aging and genetics, are unavoidable, being aware of them will allow you to seek treatment that can help you maintain your quality of life. For example, if your mother suffers from osteoarthritis — especially in the knuckles — there’s a strong likelihood you will inherit the same condition. Repetitive use of a joint, as in Zielinski’s whip kick, is another risk factor. “This results from unusual stress on the joint in a repetitive fashion,” Rosenstein says. “However, there is no strong evidence that commonplace activities, like typing, predispose a person to osteoarthritis.”

Beyond age, gender, and genetics, the biggest risk factor is fortunately one we can control: our weight. “Even minor decreases in weight can have beneficial effects on joints,” Rosenstein says. Current research suggests that losing weight might also have a beneficial anti-inflammatory effect since fat is a source of inflammatory mediators.

Receiving an early diagnosis allows you to investigate the myriad of pain management treatments and lifestyle changes that can help you live with osteoarthritis. While most patients find relief through a combination of treatments, there is one common thread: exercise. “When people develop joint pain they tend to baby the joint and avoid using it. That may actually be counterproductive,” Rosenstein says. “It’s important to keep the joint moving. Cartilage does not have a blood supply; it gets its nourishment from the joint fluid. The joint needs to be used to transmit the nourishment into the cartilage.”

“When people are in pain, it’s very difficult for them to wrap their head around the idea of exercising,” says Kathy Geller, exercise specialist at the New Jersey chapter of the Arthritis Foundation. “So unless they’ve been told otherwise by their medical professional, we encourage people to move their joints. The secret is finding the right kind of moderate exercise, beginning at a low level, and slowly working your way up.” (Visit for the Arthritis Foundation’s exercise programs.)

Zielinski is a model of how effective exercise can be. When she was first diagnosed with osteoarthritis in her knees, her doctor prescribed three months of physical therapy three times a week, to be followed by daily maintenance exercises — a regimen she has continued faithfully for two decades. “I started lifting one-pound weights on each ankle,” she says. “I’ve progressed to lifting 15-pound weights with a leg extender three times a week. These exercises have developed my quadriceps, which relieves the pressure on the knees. I have no pain in my knees, and my legs are incredibly strong.”

Clinically, the best that doctors can do is manage the symptoms and pain through treatments such as injectable medications. “Cortisone-based injections are good for symptom control but have not been shown to alter the condition long-term,” says Rosenstein. “There is some experimental evidence that hyaluronate-based injections may slow the progression of the disease in addition to decreasing pain.”

Zielinski, who was subsequently diagnosed with primary osteoarthritis in her knuckles and hips four years ago, tried hyaluronate-based injections but found more success with prolotherapy, a homeopathic treatment in which a dextrose (sugar water) solution is injected into the ligament or tendon where it attaches to the bone. The resulting inflammation increases the blood supply and stimulates the tissue to repair itself. “You’re battling against maturing. As your body ages, it breaks down, and you need to help it repair that worn-down tissue,” says Zielinski’s physician, John Kripsak, D.O. “However, it’s important that you don’t take any anti-inflammatories since they interfere with the reaction that you’re causing.”

“The injections help with the pain management, and I have noticed that the swelling has stopped growing,” Zielinski says. “My flexibility has increased. I have no problem buttoning the tiny buttons on my grandchildren’s clothes.”

The potential pain management techniques you can try are bountiful, including yoga, acupuncture, chiropractic, bracing to help support affected joints, and, yes, swimming. ?As for Zielinski, she’s returned to the water, but this time with a different goal: aquatherapy. “The buoyancy is liberating,” she says, smiling. “And it’s so great to be back in the pool.”

Further Reading

» Smart Moves: Arthritis Exercise Programs, Exercising with Osteoarthritis

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