Movement Is Medicine
About This Episode
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When it hurts your joints to move, the idea of being more physically active may seem crazy. But science has shown — and plenty of people have discovered — that movement really is medicine, especially for people living with arthritis.
Research has revealed that physical activity and staying active plays a key role to managing arthritis and its symptoms — including reduced pain, increased strength, flexibility and range of motion, as well as overall better health and mood. In fact, regular physical activity is recommended by medical organizations like the American College of Rheumatology and the American Academy of Orthopaedic Surgeons to promote overall health as well as bone and joint health. And doctors often prescribe exercise or physical activity for people with arthritis.
Why is movement medicine? In this episode of the Arthritis Foundation’s Live Yes! With Arthritis Podcast, we'll dive into the science of how movement is beneficial for the joints and overall health and well-being. With the help of our guest expert, Alan H. Beyer, MD, we'll discuss the role of movement in arthritis treatment, as well as solutions to adding more movement into your daily routine.
About The Guest
Alan H. Beyer, MD, FACS
Dr. Beyer is an orthopedic surgeon currently involved in cartilage restoration procedures and early intervention, and minimally invasive surgery for osteoarthritis of the knee. He sits on the Board of Directors of Greater Newport Physicians in California, and he serves as the Executive Medical Director of both the Orthopedic Center of Excellence at Hoag Memorial Hospital and of Hoag Orthopedic Institute. A native of New York City, Dr. Beyer wanted to be a doctor for as long as he could remember. A self-proclaimed sports nut, he found that practicing sports medicine allowed him to incorporate what he loves into his vocation.
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You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, you’ll learn how you can take control. Our host is Rebecca Gillett, an arthritis patient and occupational therapist, who is joined by others to help you live your Yes.
Thanks for joining us on this episode of the Live Yes! With Arthritis podcast. We know research says that physical activity and staying active is the key to managing our arthritis and its symptoms. Easier said than done, though. Oftentimes, doctors will say, "Get moving, exercise, do some kind of physical activity to manage your arthritis." And we hear movement is medicine all the time. But why is that?
I think sometimes if we understand the why behind what we're being told to do, maybe it helps with the motivation piece and getting us started. But it always is helpful to understand how movement is beneficial for our joints and how it can improve our overall health and well-being and, therefore, maybe reduce some of the joint pain we might be having.
So, in today's episode, we're going to discuss some solutions to adding more movement into your daily routine. I'm excited to have a return guest on the show today. We have Dr. Alan Beyer. He's an orthopedic surgeon currently involved in cartilage restoration procedures and early intervention in minimally invasive surgery for osteoarthritis of the knee.
He sits on the board of directors of Greater Newport Physicians in California and serves as the executive medical director of both the Orthopedic Center of Excellence at Hoag Memorial Hospital and of Hoag Orthopedic Institute. Thanks for coming back to join us, Dr. Beyer.
Dr. Alan Beyer:
Thank you very much, Rebecca. It's a pleasure to be here.
In the episode we did with you before about arthritis pain and surgery, you even share that you've had surgery yourself, on your hip. What was that even like?
I was back in the office in 12 days. I was back doing surgery in about three weeks. It's kind of interesting to come at this problem from both the surgeon side, the physician side, and also the patient side, because they are two very, very different viewpoints. I didn't wait 12 days to move. That's for sure. Let's talk about it on a couple of different planes.
Back when I was in my residency over 40 years ago, when people had arthritis, be it osteoarthritis or some of the inflammatory arthritis like rheumatoid arthritis and others, we used to shut them down. Rest the joint, it's inflamed, you gotta’ rest it.
We've come 180 degrees in the opposite direction in the 40 years that I've been in practice. And we do everything we can to have patients move their joints as soon as possible. As a personal example: About two hours after my surgery, physical therapy was at my bedside, swiveling me to get me dangling my feet over the edge of the bed. And when they saw that I wasn't dizzy at all from the anesthetic, they stood me up, weight bearing for a minute or two, and then take my first steps, walk around the bed a few times.
So, I was literally walking a few hours after my hip surgery. And that's what we do with people with hips and knees now. We want to get them up as soon as possible. And there's a couple of reasons for that. Number one, physiologically, when people move, that lubricates their joints — it pushes around the fluid that fills our joints, called synovial fluid, which is a natural lubricant. It makes the joint move smoother and more functionally. So, that's the physiological reason to get joints moving right away.
Physically after a surgery, the best way to control pain is to have people not just concentrate on laying there, "Oh, this hurts." Divert their attention. Make them think about: Which foot do I move first when I'm starting to walk? How do I climb the stairs? Which foot do I lead with going up or going downstairs? So physically, getting them up diverts them from thinking about just their pain. And it's very, very beneficial. And clearly restores function faster, because it gets their muscles firing quicker, doesn't allow scar tissue to start to form by continuing to move. So physically, it's very, very good to move joints right away.
And finally, emotionally, mentally, have people see, "Hey, this is going to get me back to where I want to be much faster than I thought." That's a positive feeling from the patient. When patients have positive feelings about their outcomes, we've proven many times over, the outcomes are better. By getting them moving and getting around — back to their normal life as fast as you can — that's a very, very important thing to speed their recovery.
It's a win-win, there's just no negative. As long as they're supervised properly, taught properly, what they can and can't do, and if they are compliant and don't start to get a little bit too full of themselves, thinking they can do everything on day number three. I mean, I remember one of the worst cases I've had in the last few years was a gentleman who I did his knee replacement on. He did fabulously well the first couple of days. On day seven, he was climbing a ladder, hanging Christmas lights.
I was not happy, especially when he fell from the ladder and ruptured his patellar tendon and needed another surgery. So, you know, a little is good; too much isn't necessarily good.
Yeah. You're an orthopedic surgeon, but you are also a patient, as you said, and you've experienced both sides. It's hard to, I think for most people, to understand the why behind it unless somebody can explain it. And having you have both lenses is very helpful.
With your practice, in your specialty, are most of the people you're seeing patients who have arthritis? Or do they come to you with mostly sports injuries?
Ten or 15 years ago, the bulk of my practice was athletic injuries, anterior cruciate ligament tears, torn menisci, things that people did playing sports and in activities of daily living. As I've aged, my patient population has aged with me. So, I'm finding myself doing more and more total knee replacements, as I get older, on people who maybe I did their anterior cruciate ligament reconstruction 25 years ago. And the younger guys in my practice are now seeing those younger athletes. And I predict that 25 years from now, they'll be doing the knee replacements on those people.
So, my practice has moved more towards the degenerative arthritis side of things. And it's a really exciting time for that to be the case, because the progress that we've made in joint replacement in the last 30 or 40 years is just phenomenal. When I was a resident, patients would have a hip or knee replacement, and they'd stay in the hospital for 14 days — 14 days. They stayed in until we took their stitches out and then they went home that afternoon.
Now, over 50% of our hip and knee patients go home the same day, and the rest of them go home the next day. So, we've gone from 14 days of hospitalization to zero to one day of hospitalization. The results from these surgeries are so much more phenomenal and more rapidly achieved today than they were years ago. That's made it very gratifying to be doing it at this time.
Movement is the best medicine. But it can be hard when you hurt. Your Exercise Solution is a resource to help you create a customized physical activity routine based on your specific needs and abilities. Learn more at arthritis.org/yourexercisesolution.
Sports injuries generally result from some type of movement. That might make some people a little concerned that movement is risky. And people who have arthritis pain are afraid that moving is risky and could cause, you know, further damage. How do you respond to that kind of concern?
My counsel to these patients is: A) If anything, exercising and staying strong and moving the joint is going to slow the progress of the arthritis, versus if you just shut it down and don't move at all, walk around pegleg and don't bend your knee at all. Those are the people who get stiffer. And the arthritis progresses faster than the people who continue to use their joints. Number one.
Number two: I would never tell somebody, “Don’t go play tennis or don’t go play racquetball, or golf or pickleball” — that's the big one now: pickleball; everybody plays pickleball — “because it's going to make your knee wear out faster.” I don't buy that wear-out-faster concept either.
I'm taking care of the whole patient, not just their knee. I'm taking care of their brain, too. And if they feel good and it makes them happy to play pickleball or play nine or 18 holes of golf, or tennis, or whatever, do it. It's better for you as a person, the whole you, even if it's a little bit deleterious to your knee, if it's better for the whole you: Take care of the whole you. We can fix the knee when it gets to that point. But don't shut your life down and just become a couch potato because you've got some arthritis in your knee. That's just not the right way to go.
Maybe moderate a little bit. Maybe play nine holes of golf instead of 18. Maybe play two sets of tennis instead of five. So, you can accommodate a joint that's painful, but don't shut it down and stop using it, because that's a surefire way that we're going to be taking care of you sooner rather than later.
If it's something that makes you happy, it doesn't mean you have to stop that movement or that activity. Maybe you do it less. Or maybe you have to adapt or modify how you do it. Or you use a different tool, right?
Well, we have a lot of tools that we can use short of the surgical tool to prolong people's ability to still do things before the ultimate joint replacement, let's say. We have lubricant shots, we have braces, we have an occasional cortisone shot, oral anti-inflammatory medications. There are a lot of tools we use to keep people functional until the time, the correct time, for the surgery comes.
The correct time is a shared decision between the doctor and the patient. It's not the doctor saying, "You must have it now." It's not the patient saying, "I want it now, I don't care what the X-rays show." When it’s inhibiting your life to the point that you can’t do the things you want to do, and the conservative measures aren't cutting it for you anymore, that's when it's time to make the decision.
You've said staying moving and staying active and keeping your muscles strong to support your joints is, even though it seems counterintuitive, is a treatment, right? To keep that lubrication in the joint. So, a way to prevent having any surgery or conservative options that may be not working is to stay moving, right?
Absolutely correct. The best protector of our joints are our muscles. So, the stronger that we can make our muscles, they take up the force to bypass the joints. So, not as much stress is put on the joint when the muscles spanning that joint are strong. And there are a lot of ways that you can keep your muscles strong without going out onto the tennis court, or doing whatever you do.
Aqua therapy, I mean, buoyancy of water, is a phenomenal aid in being able to exercise, but not having the full effect of gravity work on you. You get that buoyancy of the water, plus you get the resistive effect of the water against your muscles as you're using them.
Yeah, so you're talking low-impact type of movement is still beneficial.
And, you know, for a very long time, even still today, the recommendations are 150 minutes a week of moderate exercise, yada, yada, yada; we hear 30 minutes a day, right? But more and more, we're hearing researchers and clinicians saying basically, “Just move, any movement, just move.”
I agree. I don't believe in a time or frequency-specific prescription. You do what you're comfortable to do when you want to do it. If you're going to do a significant workout, I don't think doing that day after day after day is necessarily appropriate. Our bodies need time to recover and rest from a particularly hard workout.
So, you're letting the areas recover for a day before you go back and use them again. Do something different on the off days. Ride the stationary bicycle on the days that you're not working with weights in the gym. You're letting the parts that you just worked hard yesterday rest a little bit before you work them again tomorrow.
We know that movement can play a role in preventing injury. But giving time to rest as well can actually help.
Movement, i.e., doing something that involves weights or some kind of activity like that, is very important. But as we get older, what becomes more and more important is stretching rather than strengthening. We all tend to get tighter as we get older. Our muscles and tendons contract and shrink a little bit as we get older. Our bones get a bit more osteoporotic. They have a little less calcium in them as we get older.
So, stretching before you go out and play becomes much more important than it was when you were a 20- or a 30-year-old. If you ever watch a football game, you see the guys on the field. What are they doing an hour before the game? They're stretching. But we go out on the golf course in our 60s or 70s, and go right to the first tee, and take our first shot of the day without stretching for 30 seconds. Absolutely crazy. And I tell every patient this, but I'm guilty of it myself just as well.
Stretching is movement, by the way. Stretching is not just locking the joint and not using it. It's moving that joint sometimes against a little bit of resistance from the flexologist or the trainer, who's ever working with you. So, I think that all of these things are movement. Movement is not just strengthening in a stationary bike and weights, it can be stretching. And the older we get, the more important that stretching becomes.
Yeah, and as an OT, I’ve often taught patients, you know… I love your golf analogy. A lot of people like to garden, or they like to bake. Think about those activities. When you garden, you're squatting up and down, you're lifting. When you're baking, you're standing for a long period of time. Maybe you're kneading dough or whatever it is that you're doing, but you're using your body. So, I always like to tell people: Warm your body up before you do that in the way that you're going to be using it. That's dynamic stretching.
Like, before you do a walking program, maybe you march in place first before you actually start walking, right? After you're done gardening, and you're sore the next day, and you're wondering like, "Oh, what did I do yesterday?" Well, how many squats did you do?
That's exactly right. Squats in the kitchen count just as much as squats in the gymnasium. They’re still squats. And the rule of thumb, again, is warm up before you exercise and cool down afterwards. So, ice is your friend after stretching, after exercising. Warm up before, ice down afterwards, to keep the joint from swelling.
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When somebody is just getting started and they haven't been moving, maybe they've had a surgery, and they are coming out of that and starting to get back to a routine, what do you recommend to people to start out doing, just to get moving, if they've been sedentary?
I don't think that people should just go to Google, to an untrusted source, to try to find a program to get them going. I have a coffee cup that a patient gave me a while ago that says, "Your Google search doesn't know as much as my medical degree." And that's very, very true, because you don't know what the source of the information is on Google.
So, I think if you're starting from scratch, either after a surgery or after an injury, after a stroke or some kind of medical thing that made you cut back your motion, your movement, you've got to get a professional to get you going, whether that's a physical therapist or just a trainer that you know and trust. Or have your physician refer you, if he or she have internet sources that they trust and have developed with their input in mind, to guide you. Because to just do this on your own by looking something up and saying, "Show me some quad and ham stretches." That's just a recipe for failure.
I think that, seek the professional help to get you started. I'm not saying you have to go to the trainer or the stretch person a million times. But at least to get you started and lay out something programmatic, because what you need is a program, and you’ve got to follow it.
Yeah, and I always like to say: Get a referral to your occupational therapist or your physical therapist, and they can help you adapt whatever that physical activity is. A physical therapist who can help you modify the activity that you enjoy doing is part of getting that planning together, right?
Absolutely. It is important in the care that you take in picking your physician.
I think one of the hardest things about movement for some people, Dr. Beyer, is like, “Well, if somebody is going to give me a prescription of physical activity and exercise, I hate exercise…” What is your response to that?
Well, you know, it's very akin to dieting. You have to have goals. They have to set achievable goals, first of all. Don't set a goal that you have no chance of making, because you're going to quit if that happens. Second of all, I think one of the greatest things the last couple of years has been the advent of all these Fitbits and the iWatch and all those things that can monitor your activity level, monitor your number of steps. All those things are great data points for people to be able to use and self-monitor, and see themselves improving in terms of how many steps they can go, that their heart rate doesn't go up to the sky anymore when they're walking or using the stationary bike. Use those tools.
And the beauty of it is, just like stepping on the scale and seeing that you’ve lost five more pounds, using your Fitbit to show that you burned X more calories is a very, very motivating thing. Take advantage of those tools that are really available to us now.
I like seeing how many steps I did versus yesterday. Sometimes it's awful embarrassing. Other days, I'm like, “Oh, look at me, I didn't even know I did that many steps today,” even though I sit at a computer and work from home all day. Sometimes, if you have a desk job, you forget; you’re stuck in meetings all day, that kind of thing. It’s a great way to give yourselves little reminders as well.
Absolutely true. And I’ve also seen a lot of people starting to use those little pedal things that look like little bicycle pedals that go under your desk, and you can actually pedal while you’re sitting at the desk. And, you know, that counts.
Yeah, it counts.
That’s using your quads in your hams[trings]. That counts. Anything that you can find to aid you and accommodate whatever you do day to day, by all means, take advantage of it.
That’s right, every little movement counts. So, what about if somebody has been sedentary? They start on a new plan they’ve put together with their health care team. They’re at a good pace. But one day, they have more pain than normal; it lasts longer. How do they know if it’s pain from the actual condition they have? Or is it because of overdoing the activity? How can you tell the difference?
If the pain is in the area that they’ve been actively exercising and then they’ve recently changed what they’re doing, i.e., walk the further distance, cut down the amount of time to go a certain distance, raise their pace, something like that, that’s a key cause of a lot of people getting injuries, or even just a mild muscle strain. So, if you change something in your training regimen, back off a little bit. That’s the first step.
With anything acute that comes on, my advice always — across the board — is shut it down for a day or two, but let’s stress that, only a day or two. If it doesn’t get better with a day or two of rest, you probably should talk to your doctor about it. A day or two is not an unreasonable amount of time, barring suddenly you can’t put any weight on your leg. That, to me, you don’t wait a day or two on. If you can’t bear weight, stress fractures and things like that can happen as people get older. That should be seen and evaluated right away.
The worst place to go with a musculoskeletal injury that’s come on suddenly is the emergency room or urgent care. Unless it’s midnight on Saturday or Sunday and you’ve got an obvious deformity, a fracture that needs to be seen right away, obviously the ER is your place to go. But for a routine thing, “Gee, I was walking four miles and at mile three-and-a-half, it started to hurt me in my Achilles area. That’s something new for me,” don’t go to urgent care or the emergency room. All they’re going to do is give you some anti-inflammatories and take a bunch of tests that you probably don’t need. And you’ll get a phenomenal bill.
Go to the musculoskeletal doctor, be it a non-orthopedic; a primary care sports medicine doc, your regular orthopedic surgeon. Go to somebody who that's their expertise. It's just going to save you a lot of money. And you're going to get to the right answer a lot quicker.
The most important thing when you're starting out is start slow. You're not going to set the world on fire the first week. Start slow and just add a little bit each day, and you probably won't get into trouble.
We have this great tool, Your Exercise Solution, on our website. If you go to our website at arthritis.org/yourexercisesolution, we have videos of different exercises and how to do them safely, whether you're standing or seated. And they're modified based on whether or not you have an issue with that particular joint. So, check it out. It is a great way to get started and get moving.
And then there's additionally some stretches in there as well, and videos to show you lower body stretches and upper body stretches for you to do. But it's a great way to just get started, get moving. And if you need to start some of those movements seated, we have those videos on there for you as well.
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Dr. Beyer, we have a new segment where we ask a question on social media, and we get some comments and feedback from our listeners. And so, I wanted to go through a couple of those and just have you respond to them and see your thoughts on them. So, the question was: How has movement helped you manage your arthritis? And so, we have one response from someone named Mike who says, “Movement has saved me not just from pain, but from depression. I know it’s so hard to get going. But once you start, you will notice the difference within 24 hours.”
I concur with that 1,000%. That goes back to what I said about treating the whole patient, not just their knee or their hip. Getting them moving, getting them back to their life, as they know it and they want it to be, is a surefire way to decrease depression. Our slogan at Hoag Orthopedic Institute is: “We get you back to you.” And I think that's what you want to do after an injury or a surgery.
Somebody named Zaraya says, “I’m doing dumbbells of three pounds. My arms used to be arched, folded and now they are straight. It really helps.”
With weights, as little as three pounds on an extended arm, that actually is a significant force. I mean, if you try to hold that three-pound weight out fully extended for a period of time, you can't do it for very long, but it does give you a passive stretch of your elbow joint. And that's probably what happened here. She probably had a little bit of a flexion contracture of her elbow, couldn't straighten it all the way. And just that three pounds, which doesn't sound like a lot, but it is, applied over a period of time, would stretch out her elbow flexors, and she fixed herself.
Yeah. You talked about aqua therapy earlier, and somebody mentions aqua jogging and hydrotherapy really helps. “Swimming and a smartwatch to keep an eye on my metrics, my step count and my sleep quality.”
I think the worst thing to ever happen to mankind is when our prehistoric ancestors came out of the water. Being in the water is the best place to exercise and do these things, whether it's swimming, whether it's even just walking in the pool for somebody coming back from, say, a hip fracture, who can't put full weight on it yet. Walking in the pool, fabulous exercise. The more time people spend exercising in the water, the better off they're going to be.
Yeah, that's so true. As one more person says, “When I keep moving, I feel better. When I stop moving, I feel worse. There's a crystal-clear correlation I can’t ignore. On harder days, it’s a gentle walk. On better days, it’s weight training or a more intense hike. The intensity doesn’t matter as long as I move consistently.”
I think that makes a lot of sense. And I hope that she's doing the gentle walk and the heavy exercise on alternating days, because that's perfectly in line with what I said earlier. But just getting out and moving. You can accommodate your exercise even if you're in a locale where the weather isn't outdoor weather 365 days a year.
Yeah, there's a lot of rec centers and gyms that have indoor tracks you can walk. You can go to the mall and walk, you know.
Definitely avail yourself of those whenever you can.
I think we've had some great feedback from everybody on social media. And thank you to everybody who did submit some comments. There were a couple of years’ stretch where I was super active and walking and hiking a lot. And my inflammation markers were at their lowest; I felt at my best. And so, I know myself from personal experience, that movement definitely is medicine for me.
We all have setbacks, but I think getting started is key. And like you said, finding that motivation of what’s going to keep you happy and keep you moving. So, before we go, Dr. Beyer, I wanted you to share your top three takeaways from our conversation about why movement is medicine.
I think that the best thing was the thing we started with: in that it covers every aspect of your well-being, from the physiological to the physical to the mental. So, I think that that's really important. Anytime you can hit all three of those buttons when doing one single thing, that's a homerun as far as I'm concerned. So, it's just going to make you better as an individual, from stem to stern, as long as your only movement isn't opening and closing the refrigerator door. You don't want to just couch potato it, and it's just a steady downhill progression if that becomes your attitude in terms of what you're going to do with yourself. And never give up.
I love watching those shows where they have a 650-pound person who's turned their life around and lost 400 pounds. Those are motivating shows. Don't ever let yourself get in that place where it just becomes a downward spiral. You just need a support group. There are groups for that. Get help. But don't give up. Don't ever give up.
Just keep moving.
Well, thank you so much, Dr. Beyer, for joining us again in this conversation. We appreciate you and all that you do for the Arthritis Foundation as well. I just want to remind our listeners: A great way to get moving and motivated and connect with other people is by downloading our app, Vim. It's a pain management tool. Thanks to our partner, TYLENOL, for sponsoring Vim.
You can download the app and create goals around movement and get tips and advice, and strategies, on how to get moving and some ideas on how to move. You can also connect with other people who are probably in the same shoes that you are right now and maybe challenge each other to a little bit of movement. So, download our app, Vim, anywhere you can in your app store.
And then don't forget: You can go to our website to look up our show notes for this episode to get additional resources. And don't forget to check out that Your Exercise Solution on our website to get some videos and get started and get moving.
Thanks so much for joining us, Dr. Beyer. Have a wonderful day.
As part of their support of the Arthritis Foundation, this episode was brought to you in part by TYLENOL. To learn more, visit arthritis.org/pain. The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation, to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to arthritis.org/podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!
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