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Pursuing pain-free flexibility

By Audrey Millar, American College of Sports Medicine

This is an excerpt from Action Plan for Arthritis.

Because stiffness is one of the hallmarks of arthritis, flexibility is a crucial component of your exercise program. Arthritis patients tend to limit movement because of pain and stiffness; they lose both flexibility and joint motion as one of the earliest results of such restriction. Once again, the notion that if you don’t move it (a muscle or joint), it won’t hurt does not apply to arthritis. If you do not move an involved joint, muscular tightness increases and joint motion is lost. The joint becomes stiffer and more painful--the exact opposite of what you want. The lost range of movement can only be restored by stretching the tight muscles. Regular motion of each joint leads to a decrease in stiffness and an associated reduction in pain. I cannot guarantee pain-free motion, but you can significantly diminish pain and stiffness with a regular flexibility program.

The benefits of flexibility are even more evident in the context of a total exercise program. Studies have connected proper flexibility to reduced potential for muscle injury, decreased low back pain, and better biomechanics. Other benefits of a regular stretching program include reduced anxiety and lower blood pressure. Stretching and range of motion activities are components of well-designed warm-up and cool-down periods.

An elderly lady I know had arthritis in her hands, hips, and knees. Although she did not have a formal stretching program, whenever she started to feel stiff, she would do some gentle range of motion exercises. She said this practice especially helped her hands and enabled her to keep up hobbies like crocheting. Even at 90 years of age, she had no loss of motion in her hips or knees, which meant she could dress, bathe, and do other activities that are often compromised when joint motion is decreased. The exercise habits she had developed much earlier in her life allowed her to keep active and enjoy her later years.

One young man, only 31 years old, reported that he had started having serious problems with his shoulders while still in high school. He was a competitive swimmer and did lots of heavy weightlifting; he was diagnosed at that time with osteoarthritis. After finishing high school, he decreased the weightlifting and started doing range of motion exercises for his shoulders, under the direction of a physical therapist. He has now combined his flexibility work with regular aerobic exercise and a resistance program that uses body weight. He still does the same range of motion routine and is virtually free of pain. Even when he does have pain, he is able to control it with Tylenol and glucosamine. He is able to maintain full range of motion in his shoulders, except during very wet weather.

Flexibility and joint range can be restored if the loss is temporary, but the longer the impairment lasts, the more difficult it will be to regain your motion. Therefore you need to get started on this an aspect of your program, even if you do not currently have any loss in motion. Remember the adage, “An ounce of prevention is worth a pound of cure.” Every year patients are referred to physical therapy for treatment of “frozen shoulder,” a loss of motion in the shoulder that occurs when parts of the joint capsule adhere to one another. Many of these patients could have avoided a trip to therapy if they had maintained their upper extremity activity. The most common factor leading to this problem is shoulder pain, which causes the person to stop moving the shoulder. Instead of ceasing all motion, modify the activities you are doing, see your physician, and implement a strengthening and flexibility program.

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