Ask the Doctors April 2018 Issue

Ask The Doctors: April 2018

Q: How can I strengthen my core muscles? Any machines at the gym I should use?

Dr. Steven Maschke

Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

A: You are right to want to strengthen your core muslces (the muscles in the abdomen, back, hips and pelvis). These muscles stabilize the body, helping maintain good posture. They keep you balanced and provide a brace for movement. When you stand up, turn, twist, reach or participate in any physical activity, the action begins in your core. Weak core muscles can lead to pain and problems with mobility.

To strengthen your core, Cleveland Clinic physical therapist Mary Morrison, PT, DScPT does not recommend sit-ups, which encourages rounding of the upper back and may not target the core muscles. She advises against using machines where you stand and bend forward against resistance. This also is unlikely to target core muscles. You don’t need machines at all.

To start, lie on your back with knees bent. Draw your navel toward your spine, contracting your stomach muscles. Hold for three seconds (continue to breath), keeping your back flat on the floor. Relax and repeat several times. Once this has become second nature, try these:

1. Sit in a chair and contract your stomach muscles (your low back may flatten against the chair). March up and down with our legs.

2. Lie on your stomach. Raise yourself up so you are resting on your elbows and forearms and knees. Your spine should be in a straight line and your head even with your upper trunk. Contract your stomach muscles and hold, then lower your body back to the floor. Hold for five seconds and repeat five times. Build up to holding for 30 seconds three times. Once this is easy, rest on your toes instead of your knees.

A physical therapist can recommend other specific exercises for you.

Q: I’ve had one cortisone shot in my arthritic knee. It’s hurting again. How many of these can I safely get?

A: Injections of cortisone (also called corticosteroids) have a role in treating knee osteoarthritis (as well as arthritis in other joints), but only as part of a multimodal management plan. First, make sure you have an established diagnosis of osteoarthritis and that you and your doctor have created an action plan about treatment. That plan is individualized for each person, and takes into account the causes of pain, how much symptoms are interfering with daily activities, and your goals.

A comprehensive treatment program might include weight loss, exercises, anti-inflammatory pain medications (if you do not have a history of stomach ulcers or kidney problems), a knee brace and a cane. A cortisone shot will be used in conjunction with, not instead of, these measures. Another type of injection therapy, viscosupplementation, may also be part of the treatment plan.

Cortisone suppresses the body’s inflammatory response. Injecting it directly into an arthritic joint reduces inflammation and can take away pain temporarily. Pain relief can last several months, but responses can vary. It’s generally considered safe to have three or four cortisone injections a year. At Cleveland Clinic, we use cortisone shots cautiously because when repeated too frequently they may increase the risk of infection and potentially damage joints. If after having two cortisone shots you don’t get relief for more than a month, revisit your action plan with your doctor and discuss possible next steps.

If you decide to have joint replacement surgery, wait at least three months after a cortisone shot to reduce the risk of infection.

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