Causes and treatments for pain in the arch of the foot

Causes and treatments for pain in the arch of the foot

The arch of the foot is an area along the bottom of the foot between the ball and the heel. Pain in the arch of the foot is a common problem, especially among athletes. The arch is made up of three separate arches that form a triangle. Each arch is made up of bones, ligaments, and tendons.

There are many potential causes of pain in the arch of the foot. Keep reading for more information on these causes, as well as the possible treatments.

Causes

The two most common causes of pain in the arch of the foot involve injury and structural issues. Structural issues typically refer to high or low arches or other abnormalities in the foot and surrounding area.

In both cases, several factors can trigger or aggravate these issues, including:

  • aging
  • overuse
  • weight gain
  • physical stress
  • neurological conditions

Causes of pain in the arch of the foot include:

Overpronation

Overpronation refers to how a person’s foot moves while walking, running, or jogging. A person who overpronates strikes the ground with the outer portion of the heel first. As the person completes the step, the foot rolls too far onto the arch. The extra pressure causes the arch to flatten.

Long term, overpronation can damage the tendons, muscles, and ligaments. This damage can lead to pain in the arch, knee, hip, or back. It may also cause hammertoe and calluses. A person who overpronates often benefits from extra support when walking. Support can include stability shoes and prescription arch supports.

Plantar fasciitis

Plantar fasciitis is a degenerative condition of the plantar fascia and a common causes of heel pain. The plantar fascia is a ligament that connects the back of the foot to the front.

Common causes of plantar fasciitis include:

  • injury
  • overuse
  • inflammation

Anyone can get plantar fasciitis, but activities such as running can increase the risk. If a person has plantar fasciitis, they often feel pain when waking up. The pain typically gets worse throughout the day with walking and standing. In addition to arch pain, a person may feel stiffness in the heel or ball of their foot.

People with plantar fasciitis may need to stop doing activities such as running to let the foot heal. They can also consider wearing support shoes or using inserts to help take pressure off the arch.

Cavus foot

Cavus foot is a structural abnormality that causes a high arch. Causes of cavus foot include:

  • genetics
  • stroke
  • cerebral palsy
  • Charcot-Marie-Tooth disease

If a person has cavus foot, they may feel pain when walking or standing. They may also have reduced stability, which can lead to ankle sprains and injuries.

A person may have other issues related to cavus foot, including:

  • claw toe
  • hammertoe
  • calluses

People with cavus foot can consider support shoes or inserts to help stabilize their feet and avoid pain and possible injury.

Posterior tibial tendon dysfunction

The posterior tibial tendon connects one of the calf muscles to the inner part of the foot. Posterior tibial tendon dysfunction (PTTD) occurs when this tendon is injured or inflamed. If the posterior tibial tendon cannot support the arch, a person may feel pain there as a result.

PTTD pain typically occurs in the inner part of the ankle and back of the calf. The pain usually occurs while running or walking briskly and goes away once a person stops. An ankle brace or specially designed inserts can help correct PTTD.

Flat feet

Flat feet can occur in children or adults. In many cases, flat feet cause no issues, but they can also cause a person to experience pain in the arch, other areas of the foot, legs, ankles, and back.

A person may not realize they have flat feet until symptoms occur. A doctor may recommend using supportive shoes or inserts to help provide additional support for the arch.

Treatment

In some cases, home treatments and stretching are not enough to relieve pain. If this is the case, a doctor or podiatrist may recommend one or more of the following:

  • physical therapy
  • night splints
  • braces
  • casts
  • surgery
  • cortisone injections
  • prescription pain relievers (prescription non-steroidal anti-inflammatory medications)
  • prescription orthotics, support shoes, or inserts

Home remedies and stretches

While undergoing treatment, a person should still consider home remedies and stretches to help alleviate the pain. A person should not attempt these if a doctor advises them not to move the foot.

Some home remedies include:

  • Resting: Stop or significantly reduce doing any activity that aggravates the arch.
  • Applying ice: Apply an ice pack wrapped in a cloth to the arch and other tender areas to help reduce swelling.
  • Wearing socks: Avoid walking around in bare feet.
  • Using support: Consider using cushions, inserts, and support shoes.
  • Splinting: Ask a doctor about splinting the foot at night to help keep it supported while sleeping.
  • Using medication: Try over-the-counter pain relievers, such as ibuprofen.

In addition, there are a few different techniques a person can do to help alleviate pain and make the arch less prone to injury. These include:

Foot Stretch

To perform this stretch:

  • sit down
  • place the foot on the opposite thigh
  • hold the toes with one hand while pushing in and down on the heel with the other
  • gently push the toes towards the heel and hold for 3–5 minutes

Calf stretch

When a person stretches their calves, they can relieve pain and pressure on the arch of the foot. To perform a calf stretch:

  • stand facing the wall and place both hands shoulder width apart on the wall
  • take a step back with one foot
  • bend the front knee forward while keeping the back knee straight and the heel on the floor
  • hold the stretch for 20–30 seconds, repeat three times and then switch legs

Roller or ball foot massage

A person can use a small tennis ball or foam roller to perform a massaging stretch on the foot. This technique is easiest to do while sitting. To use this technique, a person should:

  • take off their shoes and sit in a chair
  • place the ball or roller under the arch of the foot
  • roll it back and forth from the ball of the foot to the heel over the arch

About the arch of the foot

The arch is responsible for several functions in the foot. Some things the arch does include:

  • helps bear weight
  • helps stabilize movements
  • allows the foot to adapt to changes in the terrain as a person walks or runs
  • helps absorb shock
  • helps maintain balance

A person may feel an injury to the arch directly in the area. It is also possible to feel pain or discomfort in other areas, including the:

  • heel
  • ball of foot
  • top of foot
  • hips
  • legs
  • knees
  • back
  • ankles

In some cases, a person may feel the worst pain in the morning. However, most people will experience worse pain during activities, including standing, that directly involves the feet.

When to see a doctor

For occasional pain, resting, ice, and stretching are usually sufficient. However, if the pain does not go away after a few days, is severe, or frequently comes back, a person should talk to a doctor.

A doctor may refer a person to an orthopedic surgeon who specializes in the feet and ankles or a podiatrist, who is a foot specialist. They can examine the person’s foot, how they walk, and other factors to determine what the underlying issue is.

An examination may include:

  • looking for inflammation, tenderness, swelling, deformities,
  • checking balance, coordination, reflexes, sensation, and muscle tone
  • tests such as X-rays, CT scans, MRIs, or ultrasounds

Once a doctor determines the underlying cause of the pain, they will recommend treatments that specifically target the underlying cause and help alleviate pain.

Summary

Arch pain is a common problem, especially among athletes. In many cases, a person can stretch, rest, and ice the arch of their foot until the pain goes away.

Problems with the arch of the foot can also cause pain in different parts of the body, including the ankle, heel, legs, knee, and back. It is essential to treat the problem early to ensure that foot problems do not lead to back or knee injuries.

If the pain persists, gets worse, or is chronic, a person should talk to their doctor about additional treatment options.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Physical Therapy For Lower Back Pain - 10 Best Exercises For Relief

Physical Therapy For Lower Back Pain – 10 Best Exercises For Relief

When you have a sedentary lifestyle, there are several problems that you might suffer. One of the most common issues is a problem with the lower back, which can be excruciatingly painful. Thankfully, a few easy exercises can offer relief. When you do them consistently, these exercises can give you long-term relief from chronic lower back pain. Here are ten exercises your physical therapist might suggest you use. Make sure you follow their instructions – these are just summaries.

Read more

Taming the pain of sciatica: For most people, time heals and less is more

Taming the pain of sciatica: For most people, time heals and less is more

Article by Steven J. Atlas, MD, MPH | Article Featured on Harvard Health

Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a person’s symptoms don’t improve, I discuss the role of surgery or an injection to speed things up.

What is sciatica?

Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.

How do you know if it is sciatica?

The key to diagnosing sciatica is a thorough history and a focused exam. Unfortunately, many patients expect an x-ray or MRI, and doctors, often facing time constraints, order one even though we know imaging tests don’t really help us treat early sciatica any better. The symptoms of sciatica are often worse with sitting or coughing, and may be accompanied by numbness or tingling in the leg. A physical exam can confirm that the sciatic nerve is involved, and I look for weakness or diminished reflexes in the legs that suggest that someone needs early referral to a specialist. (This doesn’t happen often.) With this information, I can make an initial diagnosis and start treatment.

Treating pain… and managing expectations

Many people think (understandably) that the worse the pain, the more likely something bad is going on. However, this isn’t true for sciatica. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible. If the pain is excruciating, lying down for short periods can help, but prolonged bed rest does not. So once the pain diminishes, I tell patients to get up and start walking short distances. Since sitting increases pressure on the discs in the lower back, I recommend avoiding prolonged sitting or driving. Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches may help typical low back pain, they are less helpful for sciatica. Over-the-counter pain medicines like ibuprofen and naproxen can help. When they don’t I may recommend short-term use of stronger, prescription pain medicines.

The good news is that for most (roughly three out of four) people, symptoms improve over a few weeks. Rarely, I’ll find weakness on exam, such as a foot drop, and refer for immediate surgical evaluation. For those not improving after six weeks, surgery is an option. We know surgery can speed up recovery, but by six to 12 months people who have surgery are usually doing about as well as those who decide to just give the body more time to heal on its own. Surgery involves removing the disc material that is affecting the nerve. It is generally a very safe procedure, and while complications are rare, they can happen. What’s more, 5% to 10% of people who have surgery will not be helped by it, or may have worse pain afterwards.

Patients often ask about spinal injections — where steroid medicine is injected into the affected area. It is worth considering for those with uncontrolled pain or for those with persistent, bothersome symptoms who want to avoid surgery. Injections can provide short-term relief. Like any procedure, it has uncommon risks including more pain, and it doesn’t seem to decrease the need for future surgery.

Staying patient-focused… and “hurt” doesn’t always mean “harm”

For most patients with sciatica, it’s worth seeing your primary care doctor. Patients who come in are often scared. Typically, it is pain the likes of which they may have never had. They want relief and, rightly, they want it now. That is the appeal of surgery and injections, but I also know that most will get better with time and can avoid even the uncommon risks of these procedures. When I see a patient in my office I can assess and identify the few who need immediate referral to a specialist. But for most, I try to reassure that hurt doesn’t mean harm, and that my treatments are geared to managing pain and keeping them active while the body fixes itself. For those not improving, I will get an MRI prior to referring for surgery or an injection, if the patient decides that speeding up recovery is right for them. For those who feel that they can manage the pain, I can reassure them that they can delay surgery for up to six months without risking long-term problems down the road.

Sources

  1. Herniated lumbar intervertebral diskNew England Journal of Medicine, May 2016.
  2. Evaluating and managing acute low back pain in the primary care settingJournal of General Internal Medicine, February 2001.
  3. Epidural corticosteroid injections for radulopathy and spinal stenosisAnnals of Internal Medicine, September 2015.
Scoliosis Treatment, Causes, Symptoms & Surgery

Scoliosis Treatment, Causes, Symptoms & Surgery

Medical Author: Charles Patrick Davis, MD, PhD | Medical Editor: Melissa Conrad Stöppler, MD | Article Featured on MedicineNet

What is scoliosis?

Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve in the spine seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side of the body, and the bones of the spine twist on each other, forming a “C” or an “S” shape in the spine.

Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over about 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curves from one generation to the next.

What causes scoliosis?

Scoliosis affects about 2% of females and 0.5% of males. In most cases, the cause of scoliosis is unknown (known as idiopathic). This type of scoliosis is described based on the age when scoliosis develops, as are other some other types of scoliosis.

  • If the person is less than 3 years old, it is called infantile idiopathic scoliosis.
  • Scoliosis that develops between 3-10 years of age is called juvenile idiopathic scoliosis.
  • People who are over 10 years old (10-18 years old) have adolescent idiopathic scoliosis.

More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls; the most common location for scoliosis is in the thoracic spine.

Medical literature often has more specific names or terms for scoliosis:

  • Kyphoscoliosis: a combination of outward and lateral spine curvature
  • Dextroscoliosis: curvature of the spine to the right
  • Rotoscoliosis (rotatory): curvature of the vertebral column turned on its axis
  • Levoconvex: curvature of the spine to the left
  • Thoracolumbar: curvature related to both the thoracic and lumbar regions of the spine

What are the causes of other types of scoliosis?

As stated above, idiopathic scoliosis and its subtypes comprise over 80% of all scoliosis patients. However, there are three other main types of scoliosis:

  • Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
  • Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of congenital scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan syndrome (an inherited connective tissue disease). People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
  • Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.

There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor. This can lead to a spinal deformity. In addition, researchers suggest that genetics (hereditary), muscle disorders, and/or abnormal fibrillin metabolism may play a role in causing or contributing to scoliosis development.

What are risk factors for scoliosis?

Age is a risk factor as the symptoms often begin between 9-15 years of age. Being a female increases the risk of scoliosis, and females have a higher risk of worsening spine curvature than males. Although many individuals who develop the problem do not have family members with scoliosis, a family history of scoliosis increases the risk of the disease.

What are scoliosis symptoms and signs?

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member or physician doing routine screening of children for school or sports. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes a more severe physical deformity. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously, they may notice an uneven waist, or that pant legs are longer on one side than the other.

Scoliosis may cause the head to appear off center, leaning to one side or notice one hip or shoulder to be higher than the opposite side. Someone may have a more obvious curve on one side of the rib cage on their back from twisting of the vertebrae and ribs. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.

In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain, rib pain, neck pain, muscle spasms, and abdominal pain. Additionally, there are other causes of these nonspecific pains, which a doctor will want to look for as well to rule out other diseases.

What tests to health care professionals use to diagnose scoliosis?

If someone thinks he or she has scoliosis, see a doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if there has been any pain, weakness, or other medical problems.

The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves, physical deformities, or uneven waist. The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height, leaning to one side, or if there is sideways curvature. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. A doctor may check your range of motion, muscle strength, and reflexes.

The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.

If the doctor believes a patient has scoliosis, the patient could either be asked to return for an additional examination in several months to see if there is any change or the doctor may obtain X-rays of the back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.

It is important that the doctor knows how much further growth the patient has left. Additional X-rays of the hand, wrist, or pelvis can help determine how much more the patient will grow. If a doctor finds any changes in the function of the nerves, he or she may order other imaging tests of your spine, including an MRI or CT scan to look more closely at the bones and nerves of the spine.

What types of specialists treat scoliosis?

Usually, a person’s primary care or pediatric physician notices the problem and consults an orthopedic surgeon or neurosurgeon who specializes in spine surgery. In addition, a rehabilitation specialist and/or a physical therapist may be consulted. Some patients may need a neurologist or an occupational therapist as part of the treatment team.

What is the treatment for scoliosis?

Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery. Consequently, there are treatments available that do not involve surgery, but in some individuals, surgery may be their best option.

Functional scoliosis is caused by an abnormality elsewhere in the body. This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. A small wedge can be placed in the shoe to help even out the leg length and prevent the spine from curving. There is no direct treatment of the spine because the spine is normal in these people.

Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. The majority of these people will eventually need surgery to stop the curve from getting worse.

Treatment of idiopathic scoliosis usually is based on the age when it develops.

In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.

Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve or Cobb angle stays below about 20-25 degrees (Cobb method or angle, is a measurement of the degree of curvature), no other treatment is needed. The patient may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and the patient is still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

As explained above, scoliosis is not typically associated with back pain. However, in some patients with back pain, the symptoms can be lessened with physical therapy, massage, stretches, and exercises, including yoga (but refraining from twisting pressures on the spine). These activities can help to strengthen the muscles of the back. Medical treatment is mainly limited to pain relievers such as nonsteroidal anti-inflammatory medications (NSAIDs) and anti-inflammatory injections. These treatments are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.

What is the treatment for scoliosis? (Continued)

There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Others can be worn only at night. The ability of a brace to work depends on the person following the instructions from the doctor and wearing the brace as directed. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse with good back brace management treatment. Intermittent or chronic discomfort may be a side effect of any treatments used to slow or correct the spinal curvature.

If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person’s life, a long-term effect of the disease. If this is not prevented, the person could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are as follows: correcting and stabilizing the curve, reducing pain, and restoring a more normal curve and appearance to the spinal column.

Surgery involves correcting the curve back to as close to normal as possible and performing a spinal fusion to hold it in place. This is done with a combination of screws, hooks, and rods that are attached to the bones of the spine to hold them in place. The surgeon places bone graft around the bones to be fused (spinal fusion) to get them to grow together and become solid. This prevents any further curvature in that portion of the spine. In most cases, the screws and rods will remain in the spine and not need to be removed. There are many different ways for a surgeon to perform the fusion surgery. It may be all performed from a single incision on the back of the spine or combined with another incision along your front or side. This decision is based on the location and severity of the curve.

Surgery recovery and scar formation varies some from person to person. A doctor will use medications to control the patient’s pain initially after surgery. A patient will likely be up out of bed to a chair the first day after surgery and will work with a physical therapist who will assist him or her in walking after the surgery. As the patient continues to recover, it is important to improve muscle strength. The physical therapist can help the patient with exercises for the muscles that will also help with the pain. Typically, a young person will miss about six weeks of school and may take about six months to return to their normal activities, although recovery time varies between individuals.

As with any surgery, there are risks of surgery for scoliosis. The amount of risk depends partially on the patient’s age, the degree of curve, the cause of the curve, and the amount of correction attempted. In most cases, the surgeon will use a technique called neuromonitoring during surgery. This allows the surgeon to monitor the function of the spinal cord and nerves during surgery. If they are being placed at increased risk of damage, the surgeon is alerted and can adjust the procedure to reduce those risks. There is a small risk of infection with any surgery. This risk is decreased with the use of antibiotics, but it can still occur in some cases. Other potential risks include injury to nerves or blood vessels, bleeding, continued curve progression after surgery, broken rods or screws, and the need for further surgery. Each of these is rare.

If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the tumor is generally able to correct the curve.

People with degenerative scoliosis will often have more complaints of back pain and leg pain. This is related to the arthritis in the back and possible compression of the nerve roots that lead to the legs. Nonoperative treatment including physical therapy, exercises, and gentle chiropractic can help relieve these symptoms in some cases. People who fail to improve with these treatments may benefit from surgery. X-rays and possible MRIs will be obtained to plan for surgery. The surgery could include only a decompression or removal of bone spurs that are compressing the nerves. In some cases, a fusion will be necessary to stabilize the spine and possibly correct the abnormal curve. The cost of scoliosis surgery can be high; according to the Spinal Cord Society of surgeons, an average cost per operation (rod implants to straighten the spine) is $150,000 and may be higher or lower depending on the individual procedure.

Are there home remedies for scoliosis?

There are many home remedies that have been described for scoliosis; some involve herbal treatments, diet therapy, massage, physical therapy, stretches, certain exercises, and nutritional supplements like L-selenomethionine. A mattress that is composed of latex, memory foam, or cool gel (latex mattress infused with gel retains less heat than latex alone, also termed gel memory foam) and is adjustable (height of head and foot of bed can be adjusted) is recommended by some clinicians and patients. Patients are advised to discuss these treatments, especially exercises, with their doctor before starting any home remedies. Medical treatments are mainly over-the-counter pain medications when needed. Home remedies and medical treatments may reduce discomfort but do not provide a cure for scoliosis.

What is the prognosis for scoliosis?

School screening programs have helped to identify many cases of scoliosis early. This allows people to be treated with either observation or bracing and avoid the need for surgery in many cases. Most people with scoliosis can live full, productive, and normal lives with a relatively normal life expectancy. People with scoliosis are able to become pregnant and have children with no increased risk for complications. They may be at increased risk for additional low back pain during pregnancy. In general, as the degree of spine curvature increases, the prognosis worsens.

Newer advances in surgery have allowed for less invasive surgical methods that have less pain and shorter recovery periods. Surgery recovery time depends on the specific procedure that is performed; some may require an extended hospital stay with an in-patient stay at a rehabilitation facility (several weeks) while others may recover quickly and not require a rehabilitation facility. These techniques are still being developed, but the initial results are very promising.

Occasionally, untreated scoliosis can lead to deformity of the spine that is severe, painful, and result in the individual being unable to work or walk normally. Scoliosis may very rarely compromise breathing and cause death. Complications of pain and infections may rarely occur with treatments but may occur with surgery. Occasionally, patients are too optimistic about their treatments so patients are advised to discuss their expectations and follow up with their doctor to better understand the long-term prognosis and effects of their treatment.

The life expectancy has been reported to be reduced possibly by about 14 years in some individuals, especially those with more severe Cobb angle that is untreated but not all specialists agree with this controversial conclusion. Other clinicians either choose to avoid the controversy and say nothing while others suggest most people will have a near normal life span. Each individual with scoliosis should ask their treating physician about their life expectancy and potential for quality of life in the future with or without various treatment options.

Stem Cell Clinics Sell Bogus Cures for Knee Pain

Stem Cell Clinics Sell Bogus ‘Cures’ for Knee Pain

By Dennis Thompson | Featured on WebMD

Stem cell clinics are charging big money for knee arthritis “cures” and making extravagant claims about their therapies, a new study contends. A same-day injection for one knee costs thousands of dollars at these centers, according to a consumer survey taken of clinics across the United States.

People are paying that kind of cash because two-thirds of stem cell clinics promise that their treatments work 80 to 100 percent of the time, researchers report. But there’s no medical evidence suggesting that any stem cell therapy can provide a lasting cure for knee arthritis, said study lead researcher Dr. George Muschler, an orthopedic surgeon with the Cleveland Clinic.

“There are claims made about efficacy [effectiveness] that aren’t supported by the literature,” Muschler said. “There’s a risk of charlatanism, and patients should be aware.”Stem cells have gained a reputation as a miracle treatment and potential cure for many ailments. The cells have the potential to provide replacement cells for any part of the body — blood, brain, bones or organs. As a result, a wave of stem cell centers have opened up around the country, offering cures for a variety of diseases, Muschler said.

“It’s very sexy to market yourself as a stem cell center, so there’s been a boom of centers, probably close to 600 now in the United States offering this therapy,” Muschler said. “But the truth is that the medical literature hasn’t quite caught up to the enthusiasm in the marketplace.”

The U.S. Food and Drug Administration has expressed extreme skepticism over these centers, and in November the agency announced that it would crack down on clinics offering dangerous stem cell treatments. The “pie-in-the-sky” dream for knee arthritis patients is that a stem cell injection will produce fresh new protective cartilage in their joint, said Dr. Scott Rodeo, an orthopedic surgeon with the Hospital for Special Surgery in New York City.

“The reality is they don’t do that. There is zero data to suggest that,” said Rodeo, who wasn’t involved with the study. “The idea these cells are going to regenerate cartilage — there’s zero data.”

At best, these injections might temporarily reduce pain and inflammation by prompting the release of soothing chemicals in the knee, Rodeo and Muschler said. To get an idea what stem cell centers are promising customers, Muschler and his colleagues called 273 U.S. clinics posing as a 57-year-old man with knee arthritis.The clinics were asked about same-day stem cell injections, how well they work and how much they cost. Of the 65 centers that provided pricing information, the average cost for a knee injection was $5,156, with prices ranging from $1,150 to $12,000, the researchers found. Fourteen centers charged less than $3,000 for a single injection, while 10 centers charged more than $8,000.

The 36 centers that provided information on effectiveness claimed an average effectiveness of 82 percent, the researchers said. Of them, 10 claimed that the injection worked 9 out of 10 times, and another 15 claimed 80 to 90 percent effectiveness. The findings were presented Tuesday at the American Academy of Orthopaedic Surgeons’ annual meeting, in New Orleans. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

“Patients are being told there’s an 80 percent likelihood of improvement, which is only 10 to 20 percent better than you’d expect from a placebo effect,” Muschler said. In fact, he suspects that the placebo effect is responsible for much of the improvement patients feel following a knee injection.

“People always show up to the doctor when they hurt,” Muschler said. “If I see a patient who has arthritis in their knee and I do nothing, there’s a very good chance they’re going to get better over the coming months, anyway. There’s this natural cycle of increasing and decreasing pain that’s present in the life of someone who has arthritis.”

That’s compounded by the fact that people expect to feel better after shelling out a load of cash, Muschler added. These centers generally provide three different types of treatment, only one of which actually has live stem cells involved, Muschler said.

One treatment injects the knee with platelet-rich plasma drawn from the patient’s own blood, while another uses a slurry produced from fetal tissue and fluid gathered after birth. Neither of these contains stem cells, but they are marketed as stem cell therapies, Muschler said.

A third option involves bone marrow taken from the patient and injected into the knee. This does contain a mixture of three types of stem cells, but “the evidence that you’re doing [your knees] a favor is still pretty weak in the literature,” Muschler said.People aren’t likely to be harmed by these injections, Rodeo said, but there’s not a lot of evidence that they’ll be helped. “Patients should go into it eyes wide open,” Rodeo said. “They’re paying a lot of money out of pocket, because these are not covered by insurers.” Knee arthritis sufferers would be better off trying many of the established options for reducing knee pain, Muschler and Rodeo said.

Losing weight is a “key factor,” Muschler said. “There’s very good evidence that if you are at a 5 on the pain scale and you lose 10 percent of your body weight, your pain will drop 2 points,” Muschler said. Patients also can use NSAIDs like aspirin or ibuprofen to reduce pain and swelling, get a steroid injection, or perform weight training to strengthen the muscles that support the knee, Muschler and Rodeo said.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

5 Best Low Impact Cardio Exercises for People with Bad Knees

5 Best Low Impact Cardio Exercises for People with Bad Knees

Article By Francesca Menato | Featured on Women’s Health

Anyone with a knee injury, new or old, will know how easy it is to feel it flair up with extreme cardio. Running, in particular, is very tough on the knees – so what exercises can you do to get the heart rate up, without hurting already bad knees?

We caught up with Lorraine Furmedge, Fitness First PT Ambassador, to find out the best workouts and exercises for bad knees.

Before you lace up your running shoes and risk another niggle, try these.

1. Swimming

If you’re on the search for cardio exercises for bad knees, head to the pool. Swimming provides a great workout that is low impact, versatile and burns calories fast. Whether you’re doing the butterfly or backstroke you’ll work all major muscle groups in your body including your glutes, abdominals and chest muscles.

Wondering which is the best stroke?

Freestyle, which tends to be the fastest stroke, can burn 100 calories every 10 minutes – more than jogging – but all of them will work your whole body.

2. Elliptical

Opt for an elliptical over a treadmill for minimal risk of knee injury. Your feet never leave the pedals, which means there is less of a chance to injure your knees, back, neck or hips. You’ll also get your heart rate up, making you work up a sweat! Increase the resistant to really test your endurance.

There’s a lot of discussion around which cardio machines burn more calories, and generally, the treadmill does tend to come out on top given you are moving whilst also supporting the full weight of your body but elliptical trainers are fantastic for getting in a great cardio workout with a bit more support.

With any form of exercise, you get out what you put in so it all depends on how hard you push and challenge yourself.

3. Stationary rowing

Rowing is a great way to burn calories without placing stress on your knee joints. Not only will you get a total body workout, you’ll also maximise your core strength with every pull.

Amp up the intensity by increasing the resistance while maintaining speed for a real cardiovascular challenge.

The more you train on a certain machine, the more stamina and strength your body will gain in that particular area, meaning the harder you have to work each time to continue challenging yourself.

If calorie burning is your main aim, switch up your routine and use a mixture of machines and freestyle training – it will keep your body guessing and will test you in different ways.

4. Cycling

Whether you prefer hitting a stationary bike indoors or riding your bicycle outside, you’ll get a fantastic fat-burning workout that will gradually improve your knee flexibility and strength.

To ensure you don’t put pressure on your knees, avoid hills and stick to a flat terrain. Raise your seat level slightly to decrease any pressure on your kneecap.

Wondering what resistance you should use? When it comes to cycling with resistance, there is no right or wrong answer.

Low resistance is great for those people who are just getting into fitness as it allows you to start building up your stamina without over-exerting yourself. Likewise, those suffering with knee injuries may find this an effective and low impact way of getting their regular exercise sessions in without causing further damage.

Medium and high resistance is more suited to those with higher fitness levels and works really well when it comes to building strength in your legs and lower body. If you’ve recently recovered from a knee injury consider using resistance to increase your strength and safeguard against any further damage.

To combine cardio and strength try some interval training and switch between low resistance sprints and medium-high resistance climbs.

Wondering about spin classes? Don’t fret. All good spin instructors will check for injuries before the class begins so let them know and they’ll be able to advise on how to best tackle the session.

Plus, the beauty of spin is that you can carry out the class at your own pace. Remember, you are in control and can adjust your pace according to your ability.

5. Step ups

For a low-impact cardio workout, turn to an aerobic step bench.

Step up onto the step with your right foot. Tap your left foot on the top of the step and then lower.

As you step up, your knee should be directly over your ankle to ensure you’re protecting your knees.

Repeat 10 times for a great calorie burn.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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The Link Between Weight Loss and Knee Pain

Article Featured on Healthline

Why does my knee hurt?

Knee pain is one of the most common complications of being overweight or obese. If you’re among the millions of people who experience chronic knee pain, even a small weight loss can help reduce pain and lower the risk of osteoarthritis (OA).

According to a 2011 report from the Institute of Medicine (IOM), of the roughly 100 million American adults who experience common chronic pain, nearly 20 percent, or 20 million people, have knee pain. This is second only to the number of people with lower back pain.

More than two-thirds of people in the United States are either overweight (with a BMI between 25 and 29.9) or obese (with a BMI of 30 or higher).

Those extra pounds increase the stress on your knees. That stress can cause chronic pain and lead to other complications such as OA.

How weight loss affects knee pain

Maintaining a healthy weight has many health benefits, including reduced risk of a number of diseases that include:

  • heart disease
  • type 2 diabetes
  • high blood pressure
  • certain types of cancers

Losing weight benefits knee pain in two ways.

Decreases weight-bearing pressure on the knees

Each pound of weight loss can reduce the load on the knee joint by 4 pounds. Lose 10 pounds, and that’s 40 fewer pounds per step that your knees must support. And the results add up quickly. Less pressure means less wear and tear on the knees. This lowers the risk of OA.

Reduces inflammation in the body

For years, OA was considered a wear and tear disease caused by prolonged excess pressure on the joints, particularly the knees, which, in turn, caused inflammation.

But recent research suggests that inflammation is a key OA risk factor, rather than a consequence of OA. Being overweight may increase inflammation in the body that can lead to joint pain. Losing weight can reduce this inflammatory response. One study suggests that just a 10 percent reduction in weight can significantly lower inflammation in the body. Another study found that even simply overeating triggers the body’s immune response, which increases inflammation.

The link between weight gain and OA

Being overweight or obese significantly increases a person’s risk for developing OA.

According to John Hopkins Medicine, women who are overweight are four times more likely to develop OA than women who are a healthy weight. And men who are overweight are five times more likely to develop OA than men who are a healthy weight.

But losing even a small amount of weight can be beneficial. For women who are overweight, every 11 pounds of weight loss can reduce the risk of knee OA by more than 50 percent. Men who drop into the overweight category (BMI below 30) and men who drop into the normal weight category (BMI below 26) can reduce their risk of knee OA by 21.5 percent.

Easy ways to lose weight

There are steps you can take to start shedding pounds, including:

  • reduce portion sizes
  • add one vegetable to your plate
  • go for a walk after a meal
  • take the stairs rather than the escalator or elevator
  • pack your own lunch instead of eating out
  • use a pedometer

Taking the necessary steps to manage your weight can help protect your knees from joint pain and reduce your risk of OA.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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What are shin splints?

Article Featured on HealthLine

The term “shin splints” describes pain felt along the front of your lower leg/shin bone. Shin splint pain concentrates in the lower leg between the knee and ankle. Your doctor may refer to the condition as medial tibial stress syndrome (MTSS).

Shin splints frequently affect people who engage in moderate to heavy physical activity. You may be more likely to develop shin splints if you participate in strenuous physical activities or stop-start sports such as tennis, racquetball, soccer, or basketball. Sometimes the pain of shin splints can be so intense that you must stop the activity.

Shin splints is a cumulative stress disorder. Repeated pounding and stress on the bones, muscles, and joints of the lower legs prevents your body from being able to naturally repair and restore itself.

What causes shin splints?

The pain associated with shin splints results from excessive amounts of force on the shin bone and the tissues attaching the shin bone to the muscles surrounding it. The excessive force causes the muscles to swell and increases the pressure against the bone, leading to pain and inflammation.

Shin splints can also result from stress reactions to bone fractures. The constant pounding can cause minute cracks in the bones of the leg. The body can repair the cracks if given time to rest. However, if the body doesn’t get time to rest, the tiny cracks can result in a complete fracture or a stress fracture.

Who is at risk for shin splints?

Various activities and physical attributes can put you at risk of getting shin splints. Risk factors include:

  • an anatomical abnormality (such as flat foot syndrome)
  • muscle weakness in the thighs or buttocks
  • lack of flexibility
  • improper training techniques
  • running downhill
  • running on a slanted surface or uneven terrain
  • running on hard surfaces like concrete
  • using inappropriate or worn-out shoes for running or working out
  • participating in sports that have fast stops and starts (like soccer or downhill skiing)

Shin splints are also more likely to occur when your leg muscles and tendons are tired. Women, people with flat feet or rigid arches, athletes, military recruits, and dancers all have an increased likelihood of developing shin splints.

Symptoms of shin splints

People with shin splints will experience some of the following symptoms:

  • a dull ache in the front part of the lower leg
  • pain that develops during exercise
  • pain on either side of the shin bone
  • muscle pain
  • pain along the inner part of the lower leg
  • tenderness or soreness along the inner part of the lower leg
  • swelling in the lower leg (usually mild, if present)
  • numbness and weakness in the feet

See your doctor if your shin splints don’t respond to common treatment methods or if you’re experiencing any of the following symptoms:

  • severe pain in your shin after a fall or accident
  • a shin that feels hot
  • a shin that’s visibly swollen
  • pain in your shins even when you’re resting

How are shin splints diagnosed?

Your doctor will usually be able to diagnose shin splints during a physical exam. They’ll ask you about the types of physical activities you participate in and how often you pursue them. Doctors may prescribe diagnostic tests such as imaging scans and X-rays if they suspect that you might be suffering from bone fractures or a condition other than shin splints.

Treating shin splints

Home remedies

Shin splints normally require that you take a break from certain physical activities and give your legs time to rest. The discomfort will usually resolve completely in a few hours or at most in a few days with rest and limited activity. The suggested amount of downtime is typically about two weeks. During this time, you can engage in sports or activities that are less likely to cause additional harm to your legs. These activities include swimming or walking. Your doctor will often suggest that you do the following:

  • keep your legs elevated
  • use ice packs to reduce swelling
  • take an over-the-counter anti-inflammatory, such as ibuprofen, naproxen sodium, acetaminophen
  • wear elastic compression bandages
  • use a foam roller to massage your shins

Check with your doctor before restarting any activities. Warming up before exercising is also a good way to make sure your legs aren’t sore.

Surgery

Surgery is rarely used to treat shin splints. However, if your shins splints are causing severe pain and symptoms last for more than several months, your doctor may recommend surgery. This surgery is known as a fasciotomy. In this procedure, your doctor will make small cuts in the fascia tissue surrounding your calf muscles. This can potentially relieve some of the pain caused by shin splints.

Can shin splints be avoided?

Steps you can take to avoid getting shin splints include:

  • wearing shoes that fit well and offer good support
  • using shock-absorbing insoles
  • avoiding exercising on hard or slanted surfaces or uneven terrain
  • increasing exercise intensity gradually
  • warming up before exercising
  • making sure to stretch properly
  • engaging in strength training, specifically toe exercises that build calf muscles
  • not attempting to exercise through the pain

Any intensive exercise program requires strengthening of all surrounding muscle groups. Workouts should be varied to avoid overuse and trauma to any particular muscle group. You should refrain from any intense exercise program if severe muscle pain or other physical symptoms develop.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

orthopaedic, doctor, albuquerque

Caring for Someone With Arthritis

Article by Brett Sears | Found on VeryWell

Caring for a friend or family member with arthritis can be a challenging—yet rewarding—experience. Your loved one may have difficulty managing various components of the disease process, and being available as a trusted ally in their care can make a positive difference. But what are the best ways to help someone with arthritis?

If you have arthritis, then you know how the stiffness and pain can limit your ability to move and function properly.

The pain from arthritis can prevent you from walking properly, using your hands and arms, and enjoying your normal work and recreational activities. Encouraging family members and friends to help with your care can ensure that you manage your condition well and remain functionally independent as long as possible. Read more

Exercises That Are Easy On Your Joints

Exercises That Are Easy On Your Joints

Having rheumatoid arthritis doesn’t give you a pass to escape working out. In fact, regular exercise can keep your joints and muscles strong. It can also improve your heart health. That’ll make you better equipped to deal with complications that may crop up.

Other benefits of regular exercise include:

  • Less pain
  • More stability in your joints
  • More energy
  • Improved physical function and performance
  • Better bone health
  • Improved quality of life

Stretches

To ease joint stiffness and widen your range of motion, you need to stretch your muscles. Morning is a good time for gentle stretching or yoga. It’s also a good idea any time before exercise.

Leg/hamstring stretch: While standing, lean forward as far as you comfortably can and reach toward your toes. Make sure you bend your knees a little to keep your legs soft. Hold it for 10-20 seconds.

Finger/wrist stretch: Bend your fingers forward, then backward, holding each stretch for 10–20 seconds each time. Then do the same with your hand to stretch your wrist muscles.

Cross-body arm stretch: Put your arm across the front of your body and gently hold it for 10-20 seconds, then switch to the other arm. Next, reach up to the sky with one arm and then the other, tilting each arm slightly over your head to stretch your shoulders.

Neck stretches: Drop your head forward gently, and then roll it slowly toward one shoulder and back toward the other.

Yoga Poses

Cobra: Lie face-down on the floor, keeping your toes pointed away from you. Press your palms into the floor and slowly raise your upper body. Keep your elbows close to your side.

Extended leg balance: While standing, put all your weight on one foot. Use a chair or table for support and slowly lift your leg and hold it with one leg on the outside of your knee. For an even better stretch, rotate your leg out to the side from that position and hold.

Seated spinal twist: Sit up tall in a chair and put your hand on the outside of the opposite thigh. Gently twist in the direction of your arm and hold. Then, switch to the other side.

Strength Exercises

RA can slowly take away muscle mass. So, it’s important to work out your muscles to help them stay strong.

If you have swollen joints, you can do isometric exercises. They hold your muscles in one place. They also don’t make you move your joints.

If your joints aren’t swollen, isotonic exercises (movements that work against resistance, like weightlifting) are good for building up muscles.

Talk to your doctor before you start any kind of strength training.

Abdominal contractions: To do this isometric exercise, lie on your back and put your hands on your stomach muscles. Lift your head and hold it. You can continue this exercise by squeezing the muscles that lifted your head without actually picking it up, too.

Palm press: This is isometric, too. Hold your hands so they face each other. One hand should have fingertips up and the other should have fingertips down. Press your palms together and hold.

Bicep lifts: While you sit in a chair with your arms resting on your thighs palms up, hold light weights in your hands. Then, raise them toward your shoulders, bending at the elbow.

Seated knee lift: With a resistance band over your legs in a seated position, raise one leg slowly, then switch sides.

Exercises for Endurance

Your heart muscle needs a workout just like your biceps or quads do. Aerobic exercises raise your breathing and heart rates. Your best bets are exercises that get your blood pumping and are easy on your joints.

Walking: Daily walks are an easy way to get into the exercise groove. Start with slow and short strolls if you’re new to regular exercise. Then work up to longer, faster walks as you get stronger. Be sure to stretch before you start and after you finish. Drink plenty of water, too.

Cycling: A stationary bike takes away your risk of a fall. Again, start slowly if you’re a beginner, and go faster as you get better.

Swimming: Water workouts are great when you have RA. They take weight off your joints. They also raise your heart rate. Water also acts as resistance against your muscles. That can make you stronger.

You can swim laps or join a water aerobics class. Use water weights for some more muscle work.