James H. Rimmer, Ph.D., Director

Last spring, I returned home to deal with a serious arthritic condition that my mother has been experiencing for the last few years. Now in her 80s, she is beginning to succumb to the pain, which limits her movement and mobility, and she moves about the house with great hesitancy and a high risk of falling. She has taught herself to navigate her small Queens apartment by holding onto the wall, a chair, a desk, etc., as she moves from room to room. In a past column, I discussed taking her to one of the best rheumatology clinics in the country (according to U.S. News & World Report's annual edition of Best Hospitals). After a 15-minute consultation with a supposedly top-notch rheumatologist and several diagnostic tests later, the severely arthritic knee was confirmed (of course no surprise to anyone). My mother was given two options: knee replacement or continue tolerating the pain. Not much of a choice, in my opinion. She opted for the latter and attended two of the physical therapy sessions prescribed by the physician. Unfortunately, because the PT clinic was too far from her home, she skipped the remaining four sessions, and has continued to decline over the past year. With a knee devoid of the padding necessary for preventing bone rubbing against bone, the sand in the hourglass continues to fall.

While many people with arthritis think that surgery is their only hope, current research suggests that various exercise regimens including leg strengthening, flexibility and balance activities, can have substantial benefits in reducing pain, increasing function, and maintaining physical independence. Moving the injured joint through a safe range of motion slowly and effectively can decrease stiffness and increase range of motion. In many cases, it can provide short-term relief from that stabbing toothache-like pain. In addition to safe movement activities, cold and warm compresses may also provide short periods of relief. Combined with the right plan for daily movement (Remember the five m's to good health: moving more means more mobility) and perhaps the use of a scooter or cane at various points in the day when the joint(s) is (are) starting to become painful, a person can add several more years of independence and quality of life.

Arthritis is the leading cause of activity limitation, affecting one out of every three adults. Of the nearly 70 million adults in the U.S. who have arthritis, more than 7 million have significant functional limitations because of it. As the population ages, the personal and economic hardships are expected to increase dramatically and will soon become one of the most significant health problems in this century, alongside cancer and heart disease. Millions of baby boomers will begin to experience symptoms in their early 50s, progressively worsening as they grow older.

In addition to causing disability in later life, arthritis is beginning to appear in many younger individuals with physical disabilities such as cerebral palsy, polio, and spina bifida. This is often associated with joint malalignment and "wear and tear" from variations in gait (ambulation) patterns that erode the cartilage between the bones. Some experts believe that it may be better for a person who has an altered gait pattern to combine walking with the use of a wheelchair or scooter. Theoretically, this may preserve the integrity of the joint for a longer period of time and give the person more years of pain-free living in later adulthood. More research needs to be done to determine how effective this would be for people with physical disabilities, as well as for individuals who are severely overweight and who also place tremendous stress loads on the hip and knee joints. It might be wiser to use a wheelchair or scooter at various times during the day and save the joint for safe and effective exercise routines using non-weight-bearing activities such as water exercise or riding a stationary bike. It makes sense to combine moving with 'scooting', rather than taking more pain medication or living in social isolation, afraid to leave the home because of the fear of falling. In the long run, it will preserve quality of life and allow people to continue to interact with their friends, family, and environment.

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