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Sports Medicine

Exercise with Rheumatoid Arthritis

10/26/2010

Question:

I have severe RA and is never been under control. I love walking and walk atleast 30 minutes a day. But every time I try and increase my walks but I always end up in a major flare regardless how slow I increase. I started to increase the time, length and speed of my walks about a month ago and now I have tendonitis in my foot so my doctor told me to rest the foot. I thought that I had shin splints. Both my GP and my Rheumatologist has told me I need to slow down and get more rest. But I want to go for my walks and even increase it. The fall is the best time to walk and see all the leaves changing. But I can`t because the tendonitis causes pain and tighness in my ankle and shin within 5 minutes of starting to walk. I tell people that my mind says yes but my body says no. It is true that you don`t know what you got until it is gone. Is there any way to increase my time that I am able to walk without get a major flare despite what my doctosr say?

Answer:

Shin splints and tendinitis aren't the same as a flare of rheumatoid arthritis (RA) since, as you well know, arthritis refers to inflammation of one or more joints. Your rheumatologist is in the best position to determine whether or not you are truly experiencing a flare of your RA, with this determination based on whether your physical exam and also blood test results reveal any ongoing inflammation. If so, there may or may not be further adjustments to your anti-rheumatic medication regimen which could help.

It is of course important to be sure your symptoms are due to "shin splints and tendinitis" and not due to a different condition which at a glance may seem like these conditions... for example:

• Nerve root irritation in your lumbar spine (a "pinched nerve" in your low back) as could be due to narrowing of the space around the nerve roots, called "stenosis."
• Impaired arterial circulation to your legs ("claudication" as could be due to peripheral arterial disease or "P.A.D.").
• A stress fracture.
• An exertional compartment syndrome.

If you are not experiencing an actual RA flare and if your symptoms are indeed due to shin splints and tendinitis, then your symptoms may be due to an "overuse or overload." You may be demanding more from your body than it's capable of providing at the time.

Treatment for overuse-related conditions will usually include increasing the body's capacity to withstand imposed demands via progressive strength and endurance training, flexibility exercises if appropriate, and external supports which in your case could for example include optimal foot wear, trial use of a leg compressive device such as a "shin splint sleeve", an ankle support, and/or a walking stick/cane (which can be modified if your hand function is limited) which would serve to partially off-load one or both legs. Several sessions of Physical Therapy if not previously tried can help provide more specific guidance RE: the above (but again, only if you are not truly experiencing a flare of your RA).

In the meantime (and only if you are not truly experiencing a flare of your RA), to maximize your ability to resume a progressive walking regimen, it is important for you to engage in a progressive cross-training exercise regimen to improve your overall stamina, by determining a no-impact or low-impact (lower impact than walking) activity which doesn't aggravate your symptoms. For example, aquatic exercise in warm water, a "therapeutic pool" as may be available through the Arthritis Foundation, or an exercise bike with seat height and pedaling resistance adjusted accordingly.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University