Introduction
PTA is a form of arthritis which occurs after experiencing a trauma such as severe injury and is an inflammation around the joints. Unlike other commonly understood types of arthritis which occur from years of wear and tear, PTA develops rapidly. While most people recover quickly, some cases may persist and develop into long-term/chronic issues.1
Importance of exercise in managing PTA
In different forms of PTA, exercise is important for preventing re-injury and the development of more serious conditions. Proper exercise and rehabilitation therapy after an injury may also prevent or minimize the onset of PTA.2 This outline will provide a brief overview of sample exercises and the importance of doing them after an injury.
Understanding post-traumatic arthritis
High-intensity exercises and extreme sports place an individual at greater risk of facing injuries, but they can also occur after accidents or during everyday life. While arthritis is commonly understood as the wear and tear of muscles over time, PTA is not as well understood. PTA can occur at any age and occurs from acute impact or large amounts of stress on the joints during a singular event.
However, repetitive stress placed on the joints also increases an individual’s susceptibility to developing PTA at a later time. It can resolve naturally within 2-3 months of rest and a break from physical activity. If symptoms persist after 3 months then medical attention is required, and if symptoms persist longer than 6 months, it may be classified as a chronic condition.3
Various forms of PTA
PTA is a broad term for different manifestations of the condition.
Post-traumatic osteoarthritis is a condition which develops secondarily to a joint injury, typically after an intra-articular fracture. It is thought to be a result of the initial impact on cartilage combined with pathobiological and pathomechanical changes resulting in the condition. Instability, incongruity or malalignment within the joints may also cause this condition.4
Post-traumatic inflammatory arthritis is another form of PTA commonly seen in patients with chronic inflammatory arthritis who also have a history of physical injury and/or trauma.3 These are two examples of the types of PTA seen in clinical practice, but the mechanisms behind them differ.
Causes of PTA
Several pathways and mechanisms are thought to lead to the development of PTA as it is hard to determine a precise causal factor. Joint injury is the major contributor as well as chronic conditions. Ongoing research suggests that an increased or excessive inflammatory response characterized by elevated levels of pro-inflammatory cytokines may contribute to the underlying mechanism of PTA development.5
Symptoms and impact on daily life
Listed here are common symptoms of PTA provided by Goshen Health, however; there are many other symptoms:
- Fluid accumulation surrounding the joints
- Grinding, creaking, or crunching sensation/feeling in the joints
- Joint stiffness
- Joint swelling
- Limited range of motion within the joint and surrounding area
While every individual may present differently, the most common symptom is joint pain, possibly due to the inflammation and swelling in that area.6
Benefits of exercise for post-traumatic arthritis
While it is advised to take a break from high-intensity exercise and sports after an injury, some forms of light exercise and stretches are beneficial in managing PTA.
One way to minimize the effects of PTA and to reduce the likelihood of future injuries is to lose weight if you are over the healthy range. Excess weight increases the force and load placed on joints while moving and at rest. Gradual weight loss decreases that load.
Another way of treating PTA is by participating in low-impact exercises such as swimming or biking. These exercises help keep you in shape and maintain the blood flow into your joints without placing an increased burden on your joints. They also help in reducing pain. Additionally, it is always best to seek the help of a professional such as your doctor or physiotherapist. They can recommend exercises and work with you in creating a plan that can be maintained.
The physiotherapist will provide professional guidance on ways to increase muscle strength and flexibility around the affected joint. Lastly, a brace can be easily found in many drug stores and department stores and helps reduce stress on the joint while also keeping it in place.7
Types of exercises for post-traumatic arthritis
For PTA affecting the knee, here are a few recommended exercises:
- Standing leg lifts:
- While standing, raise a leg sideways while keeping your feet and toes pointed forwards
- Move the leg outwards and inwards maintaining stability within the core
- Repeat 15-20 times on each side
- Sit and stand:
- Sit in a chair with your arms folded and slowly stand up, then sit back down
- Repeat this for a minute
- This exercise targets the glutes and quadriceps
- Kick-Backs:
- Standing straight, using a wall for balance if needed, slowly lift one leg off the ground
- Bend the knee and bring the heel to the buttocks (kicking motion) slowly
- Hold for a few seconds and then lower the leg back to the original position
- Repeat 10-25 times
Follow this link for more exercises to help with PTA of the knee.
Exercises for general arthritis
Here is a list of exercises provided by CNN which are useful in managing arthritis in general:
- Pilates: one of the most effective forms in managing arthritis due to it being low impact but an effective workout
- Helps prevent injury, protects your joints and improves strength, flexibility, and balance
- Can be done on a mat at home or on a reformer in a studio
- Walking
- Biking
- Swimming
Exercise precautions and guidelines
As with any type of exercise, make sure not to exceed your limits and push yourself to the point of further injury. Also, consult your doctor before starting a new regime to be sure that you are not risking exacerbating any symptoms.
Here we discuss some general guidelines; do not exercise an inflamed joint, but rather, maintain movement around it and allow synovial fluid to flow into the joint. This shall reduce stiffness and inflammation. Start gradually and increase the range of movement or intensity slowly. Be sure to warm up and cool down before and after an exercise.
If there are feelings of pain or discomfort, do not push past it but rather stop the exercise and allow the joint to recover. If the exercise feels fine but there is lingering pain afterwards, do not continue with the exercise and consult a doctor before resuming any activities. Stay hydrated at all times, but especially during an exercise. Lastly, wear appropriate clothing, footwear, and gear for whatever activity it is.8
Conclusion
Overall, this article has covered the key components of what post-traumatic arthritis is, some of the common causes, as well as the importance of exercise in managing the condition. While symptoms may differ between individual patients, the most common sign is joint pain occurring immediately after an injury or potential stress on the joints. If a potential injury is suspected, remember to consult a doctor immediately, especially before partaking in a new fitness regime. The various exercises in managing PTA aid in different ways but the main mechanism is to increase the range of movement which therefore increases flexibility and leaves the joints stronger. Lastly, if any symptoms become worse or persist for longer than 3 months, it is best to stop whatever activity you are doing and consult a doctor.
References
- Post-Traumatic Arthritis: Causes, Symptoms & Treatment. Cleveland Clinic [Internet]. [cited 2024 Mar 18]. Available from: https://my.clevelandclinic.org/health/diseases/14616-post-traumatic-arthritis.
- Whittaker JL, Roos EM. A pragmatic approach to prevent post-traumatic osteoarthritis after sport or exercise-related joint injury. Best Practice & Research Clinical Rheumatology [Internet]. 2019 [cited 2024 Mar 22]; 33(1):158–71. Available from: https://www.sciencedirect.com/science/article/pii/S1521694219300300.
- Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F, et al. Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. RMD Open [Internet]. 2016 [cited 2024 Mar 22]; 2(2):e000279. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013366/.
- Dilley JE, Bello MA, Roman N, McKinley T, Sankar U. Post-traumatic osteoarthritis: A review of pathogenic mechanisms and novel targets for mitigation. Bone Reports [Internet]. 2023 [cited 2024 Mar 22]; 18. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10323219/.
- Olson SA, Furman B, Guilak F. Joint Injury and Post-Traumatic Arthritis. HSS Jrnl [Internet]. 2012 [cited 2024 Mar 22]; 8(1):23–5. Available from: http://journals.sagepub.com/doi/10.1007/s11420-011-9247-7.
- Treating Post-Traumatic Arthritis & Osteoarthritis. Goshen Health [Internet]. [cited 2024 Mar 22]. Available from: https://goshenhealth.com/services-conditions/post-traumatic-arthritis-and-osteoarthritis.
- Post-Traumatic Arthritis: Causes, Symptoms & Treatment. Cleveland Clinic [Internet]. [cited 2024 Mar 22]. Available from: https://my.clevelandclinic.org/health/diseases/14616-post-traumatic-arthritis.
- Services D of H& H. Arthritis and exercise [Internet]. [cited 2024 Mar 22]. Available from: http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/arthritis-and-exercise.