Ask the Doctors September 2004 Issue

Ask Dr. Marks: 09/04

I’m 88 years old and have osteoporosis. Recently I went to a pain clinic for therapy. They took several X-rays, and then told me my bones were so porous that they wouldn’t work with me for fear of breaking a bone. Would water exercises relieve my pain or strengthen my bones?

First, I would not advise water therapy since it will not help your pain or increase the strength of your bones.

But your question includes two statements that concern me. First, you are having enough pain to consult a pain clinic. Most people with osteoporosis do not know they have it until they experience a fracture. You, on the other hand, have severe, continuing pain that has prompted you to seek medical help. It is possible that the diagnosis of osteoporosis is incorrect. Metabolic bone disease, such as osteomalacia or even malignancies, can be confused with osteoporosis. A more extensive work-up is necessary to determine the correct diagnosis. Even if you do have osteoporosis, bone pain may indicate you are experiencing multiple stress fractures.

Your second statement—that your X-rays were so abnormal that pain therapy was abandoned—would indicate that you are at high risk for fracture of a long bone, hips, or spine. Instead of water therapy, it would be advisable to get on a walker or cane and consult with an orthopaedic surgeon or bone endocrinologist. If the diagnosis is indeed osteoporosis, medical therapy should begin and an evaluation of the structural integrity of your skeleton should be undertaken. This may require an MRI or a bone scan to detect a stress fracture. If a stress fracture is located in a critical location, such as your hip, and the likelihood of it progressing to a complete displaced fracture is high, you may need surgery to internally repair the stress fracture before it displaces. Your orthopaedic surgeon will be the best person to advise you on the need for surgery.

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Does moving the joints help to contain my arthritis? If not, can it a least help to pre-vent pain? And does pain mean that I’ve placed too much stress on my joint?

Joint movement does not “contain” arthritis. I believe you mean does movement prevent arthritis from getting worse or involving other joints?

Exercises that place a joint through a range of motion do not change the natural history of the arthritic condition. Maintaining the range of motion of a joint helps reduce pain and improves the function of the joint. I frequently prescribe range-of-motion exercises along with strengthening exercises for mild to moderate osteoarthritis.

While doing your exercises or performing the tasks of everyday living, pay heed to the feedback from your joint. Pain is a protective mechanism. While soreness of muscles and supporting structures frequently occurs after exercise, joint pain is an indication that you have placed too much stress on a damaged joint. You should modify your activities at that point or seek medical help.