Personal Fitness Professional - Spring 2017 - 17
flammation. This may reduce pain and restore
some function. If the former cannot be controlled by reducing inflammation, pain management techniques (usually pharmaceutical)
can also include acupuncture, mind-body techniques, ice, heat and other modalities. For the
latter - restoring function - therapeutic exercises are implemented. Depending on the extent
of joint damage, the success of the medically-managed inflammation and pain, and the
nature and degree of joint dysfunction, a fitness professional may have a role to play here.
The fitness professional's guide to
helping clients with arthritis
to consider. For simplicity sake, we will address
the two most common types of arthritis - inflammatory/auto-immune and OA. Metabolic
arthritis is caused by disruptions in physiological
processes sometimes related to diet or genetic
predisposition. Infectious arthritis obviously depends on the source of infection and one's ability to avoid it. But autoimmune arthritis, most
prevalent of which are rheumatoid arthritis (RA)
and juvenile arthritis (JA), is mostly a function
of a genetic and environmental factors. OA is a
wear-and-tear condition, with increasing prevalence with aging, prior use or disuse or abuse,
injury, family history and more commonly, even
in younger people, being overweight or obese.
In this light, OA may be both the least and the
most preventable form of arthritis.
Treating and managing arthritis
First, treatment for any form of arthritis depends on its proximate causes. While it may
not be possible to cure many types, a medical
provider will initially attempt to reduce the in-
Since we are not directly a part of the medical
paradigm, we must recognize our limitations.
First, we cannot properly diagnose an arthritic
condition even if we can visually, palpably and
otherwise observe through movement analysis that a joint is not working properly. Staying
within our professional bounds requires that
we refer to a medical provider before undertaking any exercises that will engage the affected joint(s).
Second, we cannot prescribe specific treatments. That is, even though it is intuitive to
suggest the client take an over-the-counter
non-steroidal anti-inflammatory (NSAID), without a comprehensive and thorough medical
education and license, the fitness professional
would be putting him/herself at risk for liability
issues, not to mention putting the client at risk
for adverse effects.
Third, we cannot undertake therapeutic
exercises unless we are operating within the
medical paradigm, such as under the auspices
of licensed practitioner, e.g. chiropractor, physical therapist, doctor, etc. The therapist will,
after efforts are made to reduce inflammation
and pain, attempt to restore range of motion,
generate nerve signals to keep muscles "alive"
for that time when either remission occurs or
inflammation is well-managed, and eventually
work to restore function. Function may take
many forms, and will be individualized to what
the patient requires, e.g. activities of daily living, work, recreation, etc.
But the knowledgeable fitness professional
can resort to implementing an exercise program
specifically designed for a client, or specific class,
that has arthritis by resorting to the fundamentals
of any exercise program: cardiovascular, strength,
flexibility and balance training. Modifying each
according to the abilities of the client(s).
First, the fitness professional should modify
either the frequency, intensity, duration or most
importantly the type of cardio exercise the client
performs. Instead of walking on an arthritic lower extremity, try cycling or the elliptical.
Second, the fitness professional should modify the strength training routine to use lesser resistances (elastic tubes vs free weights) or even
the type of contraction: isometric versus isotonic.
Isometric exercises can be performed at a client-self-regulated tension within a range of motion that does not cause pain. Furthermore, the
fitness professional could strengthen unaffected
joints or peripherally-affected muscles to support
continued functionality overall. Thus, core work is
still valuable for those with OA of the knee or hip.
Third, educating and reinforcing proper
stretching for all the joints, especially the affected ones, is within the purview of the fitness
professional. In some states, manual stretching
is legitimate within reason so long as it is not
under the pretense of therapeutic. Thus, assisted stretches such as proprioceptive neuromuscular facilitation (PNF) stretching or long-duration manually-assisted hamstring stretches are
worthy of a fitness professional's talents.
Finally, balance and stability work, where
"safety first" is the motto, is within the fitness
professional paradigm. Avoiding positions or
movements that aggravate or exacerbate pain
is foremost; performing simple, static balance
movements can only help facilitate function
once the pain and swelling abate. And, should
a joint replacement be in the client's future,
this kind of work will pay off dearly.
Arthritis comes in many forms, with many
causes and a large variety of treatment and
management protocols available to the medical professional. But fitness professionals are
not relegated to the sideline if the client with
arthritis seeks to create a more active lifestyle
or prepare for the eventual surgical intervention. Knowing our limits and our obligations
to the client should not be a source of fear
so long as we educate ourselves on the nature and consequences of the disease. In that
case, we enhance our career potential as we
enhance the lives of our clients.
Irv Rubenstein, Ph.D. in exercise science (Vanderbilt-Peabody
TN), is the founder and president of STEPS Fitness, Nashville's first personal fitness
training center (1989). He is
certified through ACSM-EP, NSCA-CSCS, NSCACPT, NSCA-CSPS, and ACE-CPT. Learn more about
him and read his fitness and exercise blogs and
newsletters at www.stepsfitness.com.
SPRING 2017 | WWW.FIT-PRO.COM | 17