Ask the Doctors September 2005 Issue

Ask the Doctor: 09/05

I’m scheduled for a hip replacement and am told that I’ll need occupational therapy after my surgery. What exactly does an occupational therapist do?

During your recovery period, which can last up to eight weeks, an occupational therapist can help you carry out daily activities by teaching you new ways to move safely and by providing assistive equipment for activities like bathing, dressing, cooking, and going about your daily activities. While still in the hospital, you’ll be instructed in how to sit properly, how to keep your hip properly aligned, how to use a walker, and be shown the proper techniques for getting into and out of bed, as well as how to position your hip while sleeping. You’ll find the occupational therapist’s knowledge of modifying tasks and adapting your environment to compensate for your limitations invaluable in bringing you up to speed safely and assuring your recovery success.

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I’d like to be more active, but I have arthritis in both knees and it hurts when I exert myself, particularly when I exercise. Isn’t it better to give arthritic joints a rest rather than stress them?

The short answer is no. It’s easy to slip into a sedentary lifestyle because of the pain, fatigue, and limitations caused by arthritis. In doing so, however, muscles atrophy, joint flexion lessens, and weakness can result. Without exercise—and several forms of exercise (swimming, biking, walking, Tai Chi) are appropriate for arthritic knees—you may find yourself out of shape, weaker, less flexible, and experiencing greater pain. Lack of exercise can also lead to weight gain, and being overweight puts enormous pressure on your knees. You’ve heard it before, but it bears repeating: People who are physically active are healthier and live longer than people who are inactive, and this is especially true if you suffer from arthritis.

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I’ve read that lumbar spinal stenosis is a common problem in older people. What is it, and how is it treated?

Lumbar spinal stenosis is the narrowing of the spinal canal. It is usually the result of spinal arthritis. When the spinal canal narrows, it can compress nerve roots inside the spine, and this causes pain. The pain, which typically radiates down the legs, is made worse by bending backward and is reduced by bending forward, which increases the size of the spinal canal. The fact that a patient has radiographic evidence of a small spinal canal does not mean that he or she has lumbar spinal stenosis that will need treatment, which generally means surgery. If a patient is significantly disabled, he or she is a candidate for surgery, in which case the goal is to increase the size of the spinal canal by removing bone around the spine’s neural elements.