Yoga - The Antidote to Arthritis and a Key to Healthy Aging

Forty years ago, when I first became interested in yoga and therapeutic exercise, I was assisting an older woman who was immobilized in her wheelchair by arthritis. Long before I understood the degree to which yoga can rehabilitate the body, I was helping people who were unable to dress, bathe or feed themselves independently due to the pain and stiffness in their joints. This has helped me understand the extreme suffering that can be inflicted by arthritis.

Back then, people with joint pain and swelling were advised by doctors not to move! The thinking was "If it hurts, don't move it." We now know that inactivity is one of the worst responses for someone with arthritis.

As Loren Fishman, MD, points out in his book, Yoga for Arthritis, "Arthritis restricts movement, yoga increases range of motion-these two were made for each other."

Arthritis is the leading cause of disability in this country, limiting everyday activities for millions of people. Drugs, surgeries, and steroids can alleviate some of the discomforts, but study after study has shown that exercise is most beneficial to most forms of arthritis, specifically low-impact, flexibility-enhancing exercises such as yoga.

Osteoarthritis, a painful and often debilitating condition caused by decades of wear and tear on the joints, is considered to be one the side effects of living longer. By the time we reach age sixty-five, X-rays for at last a third of us will show some signs of osteoarthritis, the most common of a group of diseases collectively referred to as arthritis.

Arthritis in its many forms affects more than seventy million (or one in three) American adults, according to estimates by the Center for Disease Control and Prevention.

Arthritis is so common in our culture that most people consider the pain and discomfort it brings to be a normal part of aging. Arthritis makes normal activities increasingly painful and difficult and diminishes or destroys the quality of life.

An Overview of Arthritis

The word arthritis means "joint inflammation." Modern medicine recognizes more than a hundred varieties of conditions that produce deterioration in joint structures. The common thread among these conditions is that they all affect the joints-those nearly 150 ingeniously designed structures located where two or more bones come together.

Arthritis-related joint problems may include pain, stiffness, inflammation and damage to joints. Joint weakness, instability and visible deformities may occur, depending on the location of the joint involved.

Arthritis is classified into two main types. Rheumatoid arthritis is a chronic inflammatory disorder, resulting in stiffness in the joints and muscles, joint erosion and pain. Osteoarthritis is a degenerative disorder that erodes the cartilage in joints, which leads to bones rubbing together. Osteoarthritis frequently occurs in people who are overweight or whose joints are painful from extreme overuse.

In spite of the prevalence of arthritis, be careful not to jump to the conclusion that your achy joints are necessarily due to it. Overuse and injuries can also result in tendonitis, bursitis, carpal tunnel syndrome and other fairly common conditions that are unrelated to arthritis.

Arthritis and Exercise

To remain healthy, muscles and joints must move and bear weight or they will lose strength. This weakness, coupled with joint swelling, will make the joints unstable. Joints in this condition are vulnerable to dislocation, increased injury and pain. Thus, regular gentle movement helps to reduce pain and to maintain mobility.

Physical movement promotes health in many systems of the body. It increases circulation, which in turn reduces swelling and promotes delivery of oxygen and nutrients to the tissues. With immobilization, a cycle of deterioration begins.

Because movement is crucial to so many physiological processes, the arthritic person's overall health tends to deteriorate without it. The normal functioning of the immune system declines, infections and illnesses occur, and the person often becomes frustrated and depressed. This cycle is self-perpetuating.

When someone comes to me with arthritis, I teach them how to practice yoga safely with the support of yoga props. For those who are new to yoga, the term "yoga props," simply refers to any object, such as a wall, a sturdy table or a chair, a folded blanket, a firm pillow, a strap or other item that makes practicing yoga safer and easier. Yoga props are especially helpful for older beginners who may have balance problems and are coping with common health issues such as arthritis and osteoporosis. In addition to common household objects that can be used as yoga props, there are professional yoga props such as a sturdy wooden bar known as the "yoga horse," yoga wall ropes, yoga bolsters in many shapes and sizes, yoga straps, special yoga chairs, yoga blocks, firm yoga blankets and more elaborate props like yoga backbenders that give people with arthritis and other common health conditions new hope and confidence.

Physicians are increasingly advising regular gentle exercise for people with arthritis because it tones muscles and reduces stiffness in joints. Yoga is an ideal form of exercise for this because its movements are fluid and adaptable. Yoga loosens muscles that have been tightened by inactivity, stress and tension. In yoga we progress gradually, beginning with simple stretches and strengthening poses and advancing to more difficult postures only as we become stronger and more flexible.

If necessary, you can begin with gentle movements while sitting in a chair or lying on the floor. You can gradually add weight-bearing standing postures, with the support of a wall, counter or table, wall ropes, chairs, blocks, and other props.

The weight-bearing yoga standing poses are among the key poses for safely increasing range of motion in all the joints as well as increasing strength and flexibility.

It's important to note that weak muscles are considered a risk factor for osteoarthritis. Be especially aware of weakness in the quadriceps, the large frontal thigh muscles: The weaker the quadriceps, the higher the risk of developing osteoarthritis in the knee. Yoga standing poses are valuable for strengthening the quadriceps without wear and tear on the hip and knee joints.

Practicing yoga can help improve respiration throughout the day. Calm, slow, rhythmic breathing helps to release both physical and emotional tension by flooding the body and brain with oxygen. The regular, daily practice of deep relaxation is restorative to every cell of the body.

I encourage those of you with arthritis to seek the help of an experienced teacher who can help you learn to distinguish between good pain and bad pain and to make yoga part of your daily life.

The positive effects yoga can have on mood and overall outlook are especially important to someone with arthritis. A yoga class offers positive support and the opportunity to connect with people who are health-minded and have experienced the benefits of yoga. Numerous studies emphasize the value of group support in coping with health challenges such as arthritis.

With arthritis, as with any injury or disease, listen to your body with focused attention to avoid injury and determine which movements are most healing. Take classes with a teacher who is knowledgeable about arthritis. If you are new to yoga, I recommend a few private lessons, if possible, or start in a small group class with individualized instruction, where you can practice at your own pace.

Guidelines for Practicing Yoga in Class and at Home

1. Respect pain. All yoga students, but especially those with arthritis, must learn the difference between the beneficial feeling of muscles stretching and the pain that signals harm. Learn to distinguish between the normal discomfort of moving stiff joints through range of motion, and the pain caused by a destructive movement or an excessive demand on a joint. Sudden or severe pain is a warning. Continuing an activity after such a warning may cause joint damage.

In general, if pain and discomfort persists more than two hours after a yoga session, ask a knowledgeable teacher to check your alignment and help you modify the pose. Try moving more slowly, practicing more regularly and experiment with how long to stay in a pose. There is no set answer to the perennial question "How long should I stay in the pose?" Stay long enough so that a healthy change has been made but not so long that your body stiffens from staying in a position too long.

2. Balance work and rest. Balancing activity and rest applies to yoga as well as to other daily activities. Do not exercise to the point of fatigue. Stop before you are exhausted! Weakened, fatigued muscles set the stage for joint instability and injury. Balance your active yoga session with yoga's deeply relaxing restorative poses. Restorative poses are passive poses that help your internal healing processes to work. If you are fatigued, practice restorative poses first. You will benefit more from active, more challenging poses, if you are well rested.

3. Practice with focus and awareness (pay attention to how you feel) and breathe properly. Avoid mechanical repetitions and counting while exercising. Watch the flow of your breath and your body's response to a particular pose or exercise. Without fully expanding your lungs, the muscles you are exercising cannot be adequately supplied with oxygen. Holding your breath while stretching inhibits relaxation. Smooth, peaceful, rhythmic breathing through the nose reduces pain and tension and increases the feeling of deep relaxation that follows a yoga session. Learn to tune into what your body is telling you.

4. Learn to use yoga props. People with arthritis may already be quite stiff by the time they start yoga. The use of props helps improve blood circulation and breathing capacity. By supporting the body in a yoga posture, props allow the muscles to lengthen in a passive, non-strenuous way. Props help conserve energy and allow people to practice more strenuous poses without hurting or over exerting themselves.

Yoga for Arthritic Hips and Knees

The areas most commonly affected by arthritis are the hips, knees and hands. With decreased movement, the muscles and soft tissues around the hip shorten, putting additional wear and tear on the gliding surfaces. If a person becomes more sedentary in an effort to minimize pain, bones and cartilage receive less weight-bearing stimulation. Bone spurs may even develop to further limit movement.

Lack of exercise also weakens the thigh and calf muscles. Their strength provides stability and support for the knee. When the soft tissues of the joint swell, this causes compression and reduces space in the joint even further.

Standing poses are crucial for stretching and building supportive strength in the hips, buttocks and thighs. Moving the head of the femur in the hip socket helps distribute synovial fluid, thus lubricating the joint and all points of contact.

The same standing poses recommended for hips are also critical for knee rehabilitation. They create more space in the knee joint for synovial fluid circulation and develop the strength of the thigh and calf muscles for better support.

Sit on the Floor Every Day!

I encourage all my students, especially those with osteoarthritis of the knees, to sit on the floor every day, in various cross-legged and other bent knee positions, as part of their daily life routine. This helps assure that you do not lose the ability to sit comfortably on the floor. Sitting with the legs crossed loosely is a simple, natural position that helps remove stiffness in the hips and knees. To help you sit comfortably on the floor with your back straight, sit on one or more folded blankets, a firm bolster, large dictionary or other height. Avoiding sitting on the floor will only make your hips and knees stiffer with the passage of time.

Hint: If there is pain in the knees, try increasing the height under the buttock so that your pelvis is higher than the knees, and place folded blankets or yoga blocks under the knees. A knowledgeable yoga teacher can help you adjust your props so that sitting on the floor becomes easy and comfortable. Increase the length of time you sit gradually, and be sure to cross your legs the opposite way (opposite leg in front).

Caution: Do not strain your knees by attempting to sit prematurely in more advanced, bent-knee positions such as the classic Lotus Pose. Forcing your body into any position can result in serious injury. STOP if you feel pain, and consult a knowledgeable teacher.

Knee Braces For Football

The anterior cruciate ligament is one of the most commonly injured ligaments in the knee.

The function of the ACL is to prevent excessive forward movement of the lower leg in relationship to the thigh, as well as limits rotational movements at the knee joint.

The ACL ligament is one of 4 important ligaments that stabilize the knee and prevent excessive or abnormal range of motion. Football, due to its high impact and high contact movements makes it one of the most common sports with ACL ligament sprains and tears. The question then arises that if there are so many of these types of injuries, why is there not more attention addressing the need for protective bracing.

Over the last decade, there has been more awareness of the need to protect the knee during these types of high contact and high impact sports. Many professional football players have utilized rigid knee braces following ACL surgery to continue their careers. As more studies are done, and the technology improves regarding the materials used in brace construction, it has become apparent that more athletes, both amateur and professional are wearing knee braces for both preventative purposes and after ACL surgery. More coaches and trainers have recommended braces to their players, especially those with previous knee injuries or instabilities.

Most ACL braces for football usually are metal or carbon fiber framed braces. This provides the maximum support level that can be obtained, without restricting movement of the knee joint. Fabric hinged braces are available for ACL protection, but they are limited in support, due to the flexibility of the material.

It must be understood that braces do not prevent injuries. Like airbags in a car, they reduce the severity of the injury. So if an athlete is going to be injured, the idea is to reduce the severity of the injury with additional support, thereby improving the prognosis and recovery period.

There have been arguments regarding the use of braces causing muscle atrophy, bone loss and weakness due to wearing knee braces. Although prolonged use of a brace can have such implications, there is no data to demonstrate that short term use during play or practice causes these types of complications. The risk of injury and surgery usually far outweigh any potential issue of short term muscle atrophy.

There will always be controversy regarding the use of these devices and the true effectiveness in protecting and stabilizing the knee during football. It is strongly advised that you consult with your physician, coach or trainer to determine if you would benefit from a knee brace.

Comparison of Health Insurance Schemes for Senior Citizens

It is absolutely vital that as one approaches old age, one has a substantial health insurance cover. The probability that one's health care expenses would increase substantially is almost a given. In this piece we look and compare the different health insurance plans that are available in the market for senior citizens. While every health insurance company wants to insure the young (and almost by definition, more healthy), there are very few plans which provide health insurance to people beyond 60. Another interesting thing to note here is that most of the health insurance plans for senior citizens is offered by the public sector general insurance companies.

The health insurance plans available for senior citizens are:

1. Varistha Mediclaim by National Insurance


2. Senior Citizen plan by Oriental Insurance


3. Mediclaim for Senior Citizens by New India Assurance


4. Senior Citizen Plan by United India Insurance


5. Red Carpet Plan by Star Health Insurance

Varistha Mediclaim by National Insurance: This policy can be bought by anyone between 60 and 80 years of age. Renewals can be done upto the age of 90. Between the age bands of 76-80, premiums have an added factor of 10% and between 80 to 90 years of age, premiums are grossed up by 20%. The sum insured under this policy for hospitalization is Rs 1 lakh. For critical illness, the sum insured is Rs 2 lakhs. Under the critical illness cover, diseases such as cancer, renal failure, stroke, organ transplants etc are covered. If the person has already been insured for 3 years through a health insurance policy, then he or she does not have to undergo a medical test, else there has to be a medical test under the prospective customer's costs. For domiciliary treatment, the maximum claim is fixed at 20% of the sum insured. Ambulance charges upto Rs 1000 are covered under this policy. For a mediclaim cover of Rs 1 lakh and a critical illness cover of Rs 2 lakhs, the premium varies between Rs 6200 (for a 60-65 year old) to Rs 9200 (for a 75-80 year old). One interesting feature of this policy is that pre existing hypertension and diabetes are covered from the 1st year itself of the policy by paying 10% additional premium for each of the two diseases. Pre existing is of course not available for the critical illness policy. Other pre existing diseases are covered after 1 policy year. Dialysis, chemotherapy and radiotherapy for preexisting ailment is never covered. Claims are paid only for events that occur within India. Claims which occur within the first 30 days of the commencement of the policy will not be covered, unless in the case of the person being insured with an Insurance Company without break for the past 12 months. For the purpose of this policy, pre existing diseases such as cataract, piles, fistula, hernia, benign lumps, joint replacement etc will not be covered in the first 12 months. War related medical claims, vaccination, spectacles cost, plastic surgery, corrective dental surgery, venereal disease, vitamins and tonics which are not part of the treatment, nuclear disaster related health claims, alternative treatment like homeopathy etc are excluded.

Opinion: We think it is one of the best policies for senior citizens, except that the sum insured is low. They are quite generous as far as the norms for entry age and pre existing diseases are concerned.

2. Senior Citizen Specified Disease Plan by Oriental Insurance: In this plan, the policyholder has the option to choose sum insured of Rs 1 lakh, 2 lakhs, 3 lakhs, 4 lakhs or 5 lakhs. One restrictive feature of this policy is that 20% of any claim amount has to be co-paid by the insured. Cashless payment through TPA is restricted to Rs 1 lakh. This plan covers 10 specified diseases: cancer, renal failure, heart diseases, liver related diseases, COPD (lung ailment), stroke, prostrate, orthopaedic disease, ophthalmic disease, accidental injury and knee replacement. The amount that one can claim for a particular disease is restricted as a percentage of the sum insured (for e.g., 50% of the sum insured can be claimed for cancer, while 20% of the sum insured can be claimed for stroke). A sum insured of Rs 1 lakh will cost Rs 4500 for a 65 year old, while it will cost Rs 6400 if one is eighty years old or beyond. While this may seem cheaper than National Insurance's Varistha medical scheme, it is less wide in scope. This policy has an interesting refund of premium clause if one withdraws from the policy: if the policyholder gets out of the policy within the first month, 75% of the premium is returned and if he opts out between 3 to 6 months of the policy, 25% of the premium is returned. In this policy, pre-existing diseases are not covered for a period of 2 policy years. Other exclusions are very similar to those of National's Varistha medical scheme.

Opinion: a good scheme in terms of the level of sum insured and price, but the scope of diseases covered is restrictive. Another issue is that pre-existing is covered only after 2 policy years.

Mediclaim for Senior Citizens by New India Assurance: This policy is available for senior citizens between 60 and 80 years, and the sum insured can be Rs 1 lakh or Rs 1.5 lakhs. Pre existing diseases are covered after 18 continuous months of coverage, while for diabetes and hypertension to be covered, additional premium needs to be paid. Pre hospitalization is covered for 30 days, while post hospitalization is covered for 60 days. An insurance of Rs 1 lakh for a 65 year old will cost Rs 3850 while it will cost Rs 5150 for an 80 year old. Thus, premiums are very competitively priced. If one wants to extend beyond 80 years, then loading of 10% or 20% has to be paid. For pre existing diabetes or hypertension, an additional premium of 10% each has to be paid. One interesting feature is that there is a 10% discount if one's spouse is also covered under this policy. This policy also has the same partial refund norms on cancellation as Oriental's Specified Disease Plan. Claims would be paid only for medical treatment in India. The exclusion conditions are standard, and are very similar to National's Varistha Mediclaim.

Opinion: Attractively priced. Sum insured ceilings are low. The product brochure is silent on co-pay, and thus there is no co-pay requirement in all probability.

United India Insurance's Specified Disease Plan: In this policy, sum insured of Rs 50,000 to Rs 300,000 is available to people between 60 to 80 years of age. Sum insured of Rs 1 lakh will cost Rs 3715 for a 65 year old, and Rs 8613 for an 80 year old. So while it is cheaper for the younger age bands, it is a bit expensive for the older age groups. An interesting feature of this policy is that there is a hospitalization cash payment from the 3rd day of hospitalization on payment of a particular additional premium. While other exclusion features of this policy are comparable to that of the previous 3 policies that we have discussed, the biggest problem of this policy is that this has a pre-existing waiting period of 4 years.

Opinion: Pre -existing waiting period of 4 years is restrictive

Star Health's Red Carpet Plan: This plan has been a good marketing success. While one barely gets to hear about the reasonably broad, well priced schemes of the 4 nationalised companies, the market is quite excited about Star Health's Red Carpet scheme. The sum insured under this policy can be for Rs 1 lakh, Rs 2 lakhs, Rs 3 lakhs, Rs 4 lakhs or Rs 5 lakhs. Age of entry is restricted between 60 and 69 years. Pre existing diseases are covered from the 1st year itself, except for those preexisting diseases for which the insured received payment in the preceding 12 months. Subsequently, these pre-existing diseases are covered. There are sub limits under this policy wherein different diseases have different limits as a percentage of the sum insured. Sum insured of Rs 1 lakh will cost Rs 4900 at entry, while a sum insured of Rs 5 lakhs will cost Rs 20000.. The biggest catch in this policy is that there is a 50% co-payment for pre existing diseases and 30% co-payment for other diseases!! Other exclusions are very similar to what is there for the nationalized companies.

Opinion: Simple, well marketed claim. But the co-payment terms are a huge negative! The ceiling for maximum age at entry is quite low (69 years), though the guaranteed renewal feature is a big positive. Also, the sum insured levels of Rs 5 lakh is quite high and attractive in these days of escalated medical costs.

In summary, we feel that National's Varistha Plan is the widest in scope. The only issue with the plans of the Nationalised Insurance companies is that the sum insured levels offered might not be adequate for today's high healthcare costs. On the other hand, they are at least offering senior citizen health plans. It is very difficult to locate any meaningful health insurance scheme for senior citizens offered by any private health insurance company, except Star Health. The only problem that we see with Star Health's Red Carpet plan is that of the Co-pay restriction.

Osteoarthritis and Its Biochemic Treatment

Joint pain is a common complaint. It is often associated with aging process. However, it can also occur in children, young adults and middle-aged people. Arthritis is not a disease but a symptom, which indicates that "something", is wrong in a joint. Arthritis occurs at all ages but is more common in the elderly. It is least serious among the elderly while it can be serious, crippling and sometimes even life threatening in young women and children. Of the various types of arthritis, osteoarthritis and rheumatoid arthritis are the most common. Today we will discuss about osteoarthritis.

What is osteoarthritis?
Osteoarthritis is destruction of the smooth cartilage covering the ends of the bones. This destruction is similar to the - wear and tear of moving machines. Over time the cartilage may wear away entirely, and the bones will rub together and in that stage may cause severe aching pain. It usually starts in the middle age without any specific cause. It may affect all joints but mainly the knee joint,elbow joint, hip joint. Of the joint pains, pain in the knee joint is the most common.

Osteoarthritis of knee joints
In early stages there is pain or catch in the knee while getting up from sitting position or changing position of the knee after a period of rest in one position. In later stages, pain is almost constant and becomes worse. On exertion at this stage rest; painkiller medicines; or oil massage relieves the pain. In advanced stage, walking is difficult and often needs a lot of effort. Going up and down the stairs is especially very difficult. The shape of the leg changes and the knee bows outwards. At this stage, the gait changes and there may be sideways lurch at every step.

What are the causes of osteoarthritis?
Common causes of osteoarthritis are: Wear-and-tear of cartilage due to prolonged use of the joint (This is the commonest cause of osteoarthritis); Defect in quality of the cartilage such as in a disease called pseudogout; Defect in alignment of the articulating surfaces; Loose structures inside the joint such as a loose cover of the meniscus; Old injury; and Previous infection. Excess Weight is one of the main causes of osteoarthritis. Excess weight puts extra stress on the weight-bearing joints, especially the knees and hips and quickens the wear-and-tear of the cartilage. If you already haveosteoarthritis, losing weight may reduce stress on your joints.

Symptoms:
1. Aching pain, stiffness and swelling of the joints.
2. Stiffness aggravates after rest and ameliorates by moderate movement.
3. Extensive movement of the joint worsens the condition.
4. Most people with osteoarthritis in knee joint complain of pain and/or creaking sound in the knee.

Traditional treatment:
Osteoarthritis is not curable. Once it starts, it remains for rest of the life. Painkillers are given to relieve pain; however, it does not reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of medication that help reduce pain and swelling at different doses. Cortisone may be injected into the joint to relieve severe inflammation. Cortisone is a steroid that reduces swelling as well.

Biochemic Treatment:
There is very good treatment option of osteoarthritis in Biochemic Therapy. Biochemic medicines are efficient enough to control the inflammation, swelling and pains and can control the disease in a natural way. Biochemic medicines are nothing but mineral salts found in our tissues. That is why there is no side effect of Biochemic medicines at all.

Free Golf Tips to Improve Your Golf Swing

For instance how your hips might be rotating during your swing, where your hands are on the golf club or maybe even how your knees are bent before you get into your swing. All of these seemingly little things factor in when trying to develop a perfect golf swing, but most of them are overlooked.

Almost everyone who has ever attempt this game has failed miserable the first couple of times out on the golf course, mostly because their ego gets the best of them and they believe it is an easy sport to master. On TV the pros like Tiger Woods and Phil Mickelson make hitting 300+ drives down the fairway and 50 foot puts look easy, but that is as far from the truth as can be.

Playing the game of golf takes a lot of skill and concentration, especially around huge crowds like the pros are used to, but it all starts with a good, solid swing. A lot of people who just start off playing golf usually come up to the tee and try knock the ball into next week much like a baseball player would when he is up to bat, but developing a perfect golf swing takes a mixture of fitness and power, but more so control and concentration.

There are a few simple golf tips you can use when you are just starting out on the links. One is to never take your eye off the ball during your swing or you will hit the ball into God knows where. Keep your eyes fixed on the ball, shoulders square, arms straight with your left arm being like your cross hairs for the ball if you are right handed. Now that you have the form down when you swing you don't want to twist your wrists during the swing until after impact. Once you have made contact follow through with the swing motion until the club is behind your back and the ball is headed down the fairway.

What Patients Need to Know on Total Knee Replacement

The concept of knee joint replacement continues to offer patients a significant increase in mobility and motion as well as a decrease in pain and discomfort. Joints commonly replaced are those of the knee and the hip. Joint replacement remains an elective procedure and requires a high degree of patient understanding, education, and cooperation. The patient must assume responsibility for physical therapy, exercises and weight control.

Usually joint replacement is done especially for severely destroyed joint surfaces as in arthritis, necrosis and other degenerative diseases. When the pain is increasing in severity, doctors would recommend this procedure. Moreover, it is done when there is decreased mobility and when a person has an inability to perform activities of daily living. Persons with irregularities of the joint surface such as following a fracture or instability of the bones are good candidates for a joint replacement.

Knee Arthroplasty or Total Knee Joint replacement is a medical procedure wherein the distal femur, proximal tibia, and articulating surfaces of the patella are replaced with prosthesis. Infection is a disastrous complication in knee replacement, so prophylactic antibacterial medications are administered and aseptic technique is strictly followed.

This procedure requires a considerable amount of patient compliance. The emphasis is on progressive exercise and prevention of complications. Following surgery, the knee is immobilized and the exercise program started as soon as possible. Many patients begin continuous passive motion using a mechanical device that flexes and extends the knee at a set range and rate. These are gradually increased as prescribed by the physician.

The goal of the exercise program is to achieve more than 90 degrees of flexion and full extension. Most patients remain on the machine when not ambulating. The continuous range of motion to the joints decreases postoperative pain, bleeding and possibly the incidence of deep vein thrombosis.

As the patient goes out of the hospital, it is of utmost importance to continue with the exercise regimen. This is to prevent scarring and instability. The wound will be monitored on follow-up checkups. However, it is the person's responsibility to monitor any signs of complications like infection especially at home. Contact sports or any activities that would involve pressure and stress on the operative site is prohibited. The recommended exercise is swimming because it increases muscle strength and at the same time prevents any pressure on the joints.

Home medications must be complied properly. In the future, when the patient will undergo other elective surgery or procedure, he must inform the physician that he has an artificial joint or knee. This is due to the fact that the prosthesis can be a good area for possible infection. Aside from the medications, the patient must take note of his diet to control his weight. Increase in weight can place pressure on the joints and thus would complicate things.

There are many things that the patient needs to know especially when it comes to total knee joint replacement. These important details will enlighten the patient about the procedure and also be informed of the things that he needs to do and the things that he must not do.

How to Recover Faster After Joint Replacement Surgery for Arthritis

Findings from a recent study indicate that for osteoarthritis patients, an exercise program will allow a faster recovery following joint replacement surgery.

Researchers from Harvard Medical School (Boston's New England Baptist Hospital, and Beth Israel Deaconess Medical Center) studied 108 men and women with severe osteoarthritis scheduled for total hip or knee replacement surgery at Boston's New England Baptist Hospital. Patients were typically in their late 50s to late 60s.

The researchers randomly split the patients into two groups.

Patients in one group followed a six-week exercise program before their operation.
The other group was not asked to exercise before surgery.

The exercise group performed workouts three times weekly for six weeks and were monitored carefully to make sure the exercise was commensurate with their physical condition.

For the first three weeks, patients in the exercise group worked out in a pool, the reasoning being that the natural buoyancy of the water made water workouts easy on the joints. The patients stood in chest-deep water, exercising all of their joints.

For the last three weeks, patients exercised in a gym on recumbent stationary bikes or elliptical machines. These particular pieces of equipment are low impact.

Patients also did strength training and stretches for flexibility during the program's last three weeks.
A physical therapist supervised the workouts, which lasted 30-60 minutes and were held at a community fitness facility.

Prior to the study, patients rated their ability to do normal chores and activities. They also took tests of balance, mobility, and leg strength. These tests were repeated right before surgery, and also afterwards.
Exercisers having hip replacement surgery improved their function and pain scores before surgery.

Patients in the exercise group, both hip and knee replacement patients, increased leg strength by an average of 18% to 20% (leg-press scores) pre-surgery. Post-surgery, the exercise group reduced the odds of being discharged directly to a rehabilitation facility rather than going home by 73%. Similarly, 76% of the exercisers were able to walk 50 feet on the third day post-surgery compared with 61% of non exercisers. The researchers also noted that patients who exercised reported being well prepared mentally for their rehabilitation. This was in part because they were no longer afraid of exercise and they understood from first-hand experience how important it was.

Sixty-five percent of the exercisers were able to go straight home, compared to 44% of the non-exercisers, the study showed.

Exercisers who got total hip replacement also showed a significant advantage in their pre-surgery function -- based on their own ratings of their ability to handle routine activities -- compared to the non-exercisers.

However, no functional benefit was seen in exercisers who had their knees replaced.

The reasons for that aren't clear, the researchers noted, although they said the difference may have been related to the joint location. A longer period of exercise may be needed to help knee function was one hypothesis put forth by the researchers.

The conclusions were that "an appropriately designed program of water and land-based exercise involving cardiovascular, strength training, and flexibility activities can be a safe, tolerable, and effective approach to improving muscle strength in middle-aged and older adults with severe osteoarthritis of the hip and knee."

Author's note: it is important that any exercise program be OK'd by your physician, designed by the orthopedic surgeon or another representative of the surgical team, and supervised by a physical therapist.

(Rooks DS et al. Effect of Preoperative Exercise on Measures of Functional Status in Men and Women Undergoing Total Hip and Knee Arthroplasty. Arthritis Care & Research. 2006; 55(5): 700-708).

This article was adapted from a news release from the Arthritis Foundation.