Welcome to the Get Moving! Plus Exercise Series
Kat Keane, our Health Services Educator, explains the Series in the Intro video that follows.
Get Moving! PLUS is not an exercise library for ‘fitness’ purposes per se, instead, it’s an exercise library dedicated to promoting and improving the mobility and strength of joints and muscles that are affected by arthritis and other musculoskeletal conditions. Many of the mobility exercises included are low risk of injury and are easy to perform, though some are a little complex. For example, some require a resistance band, towel or other equipment, other exercises are self-assisted (using your hands to create force or a block, or to promote a specific direction of movement), while some require a certain range of motion (ROM), balance and/or coordination ability.
Unlike the Get Moving! Series, there are no ‘fitness’ profiling levels, which means that anyone at any age can perform the exercises given their circumstance and ability. These exercises are not to get you ‘fit’ but to get your joint ‘fit’ in a specific context, ie. pre and/or post rehabilitation settings, severe arthritis and/or pain. Exercises are grouped by joint and mobility attribute with a range of regressed and progressed exercises that can be used for a variety of purposes.
Please note: we highly recommend that the use of this resource is a collaborative one, ie. you work with your allied healthcare professional for exercise recommendation and assistance.
Why was it created?
Get Moving! PLUS was created out of both demand from consumers wanting exercises for specific joints and the need for freely available, high quality, joint specific mobility exercises. Get Moving! PLUS may be used to complement treatment from a physiotherapist, exercise physiologist or myotherapist for either prehabilitation or rehabilitation from a joint replacement (or other) surgery, chronic pain and/or restricted movement in the context of arthritis.
“As a physiotherapist working with patients with hip or knee osteoarthritis, I am aware that exercise is one of the most effective, evidence-based treatments available. Whilst we don’t yet have a “cure” for osteoarthritis, exercise can be powerful tool to help manage your symptoms and allow you to live a more normal life. Get Moving! PLUS is a comprehensive, free, online resource designed by Arthritis NSW specifically for people who suffer from joint pain of the hip, knee or ankle. It forms a curated collection of targeted, joint-specific exercises, designed to help alleviate stiffness, increase muscle strength and improve balance. It is very pleasing to see a resource that provides appropriate, evidence-based exercises and information whilst also being available at no cost to the consumer. In a modern world that can often be hard to find!
Whilst this resource should not be seen as a replacement for usual care – whether that be consultation with a GP, physiotherapist or exercise physiologist – it should be seen as an additional tool for both clinicians and those with joint pain. Those with more complex needs will almost certainly require an individual assessment and 1:1 guidance, particularly when first starting an exercise program. Those who are progressing well with their exercises or looking for some new joint-specific exercises and want to proactively manage their symptoms should find Get Moving! PLUS very useful.”
Andrew Wood, Physiotherapist and Service Coordinator,
Osteoarthritis Chronic Care Program (OACCP) Coordinator, Canterbury Hospital
Exercises by Joint
Please read the Get Moving! Plus in Focus information below before you commence. Click the image below to go to the dedicated web page for each joint.
Watch this space for other joint video series coming soon including shoulder and hand.
Get Moving! PLUS in Focus
Please note the following information is included in each specific joint instruction booklet on the joint links above.
Key Focus 1: Mobility
Broadly speaking, mobility is an umbrella term used to describe the act of stretching, moving and strengthening a variety of tissues that surround the joint and the joint itself. Mobility is an indication of how well and efficiently we move. Flexibility, strength, coordination, and body awareness are all attributes of mobility. Thus, mobility of a joint can be promoted a number of different ways, eg. by ‘traditional’ stretches (active static and dynamic stretches or movements), passive stretches or mobilisations (where a musculoskeletal therapist does the movement for you), balance and strengthening exercises. In this booklet, ‘mobility’ indicates the exercises targeted at mobilising the joint.
Benefits of Mobility
Regularly performing and practicing mobility attributes is key to maintaining and promoting the health of joints, regardless of their condition. In particular, mobility exercises are significant for those with arthritic conditions (especially if they have loss of motion), those who may be waiting for a joint replacement (or anything similar), and those who have undergone a joint replacement or some other kind orthopaedic surgery to treat arthritis or other musculoskeletal condition. Movement at this point is critical; engaging in exercise post-surgery can predict the outcome of quality and quantity of joint ROM in the following ways:
- facilitate range of motion and technique
- help improve and maintain joint health and function
- can be used as a warm-up routine or an active recovery exercise
- may help reduce pain and feelings of stiffness or discomfort
- potentially reduce future injury.
Key Focus 2: Rehabilitation
When you have knee or hip replacement surgery, your doctor will suggest you do physical ‘rehab’ afterward. Once at home, you will likely see a physiotherapist regularly to receive rehab treatment as well as do exercises on your own. Your home exercise program will include activities to help reduce swelling and increase the ROM and strength in the muscles around your new joint. This will help you move more easily and get back to your normal activities more quickly. Get Moving! PLUS includes exercises that can be used in this capacity. We highly recommend you ask your physiotherapist to help choose exercises appropriate to your individual circumstance and stage of post-surgery rehab.
Benefits of Rehab
- Restore normal movement in your joint
- Builds up strength in the joint and surrounding muscles
- Helps to ease pain and swelling
- Lets you get back to your normal activities
- Helps with circulation, particularly right after surgery, so you don’t have problems with blood clots
Rehabilitation Once You Get Home
You should aim to exercise and/or be physically active for 20–30 minutes, two or three times every day, or as much as your doctor/healthcare professional suggests. Walking may help. Start with 5 minutes and work up to 20–30 minutes, several times a day. Whether you work with a therapist or on your own, stay active for your overall health.
Pre-operative rehabilitation is exercise-based intervention prescribed before undergoing surgery. It is also known as prehabilitation or prehab. Prehab may help you to recover more quickly from the surgery, have a positive effect on pain pre and post-surgery, and improve post-operative function. This could potentially result in a faster return to work. It is often used before hip and knee joint replacements and can be performed independently or under physiotherapy supervision. A pre-operative exercise program should consist of both strength/resistance training and cardiovascular (cardio) components. The Get Moving! PLUS series includes exercises that can be used in a prehab context, although, if you require more challenging exercises then check out the Get Moving! exercise library.
Tips on How to Perform Mobility Exercises
- When rehabilitating from a recent surgery (total hip or knee replacement, anterior cruciate ligament replacement, shoulder recontruction, other joint/tissue replacement or arthroscopy), injury or you have arthritis (non-inflammatory and inflammatory), pain and discompfort in or around a joint is common, especially during movement and exercise. You can still exercise! You can expect to feel pain, however, when moving through an exercise, slow down or stop at the point of initial pain or discomfort, unless told otherwise. The pain will likely reduce with the number of repetitions performed and/or when you move out of a certain position adopted to perform an exercise. Pain will also reduce over time as you heal.
- You don’t need to be afraid of the pain, especially since you should expect it. Experiencing pain is never pleasant but, in most cases, you don’t need to worry that you are doing further damage to your said condition. Pain is normal in this context, however, it should really only last about 24–48 hours post exercise. If you experience severe pain that lasts longer than 48 hours and your condition changes and/or worsens, eg. fever and inflammation, then seek medical attention.
- If an angle, oscillation or arc/range of movement causes extreme pain or discomfort, regress the movement, reduce the range or change the angle slightly.
- Use a visual analogue scale (VAS) to measure and monitor your pain. By rating your pain on a scale from 1 (nothing at all) to 10 (extreme pain), you can monitor your pain experience so that it doesn’t reach above a 7 or 8 when exercising, or otherwise advised by your healthcare professional. See the Strength exercises section below for further details.
Speed and other performance tips
- Try avoiding moving too quickly with your in and out movements. Gently and with control, move in and out of a movement or a stretch so it feels good for you.
- Keep a normal steady breath throughout the exercises. Try not to hold your breath excessively throughout the exercises.
How the exercise should feel and exercise parameters
- The objective is to increase range of motion by targeting the soft tissue surrounding the affected joint.
- A stretch shouldn’t hurt or be painful per se, however, a little discomfort is ok. You need to stress the joint and surrounding tissues a little to ensure you illicit an adaptive response.
- Hold a stretch for 15–30sec and perform 3–5 times, or otherwise prescribed. When you first start out, you may find you can only hold a stretch for 5 seconds before you need to release it. That’s ok. Slowly and progressively build the time you can stay in one position. Likewise for the range of a stretch, that is, slowly and progressively move further into the stretch when it’s comfortable for you to do so.
- Stretches can be performed frequently. Every day is safe or as needed. In fact, you may be told to stretch many times per day, every day of the week depending on your situation.
- The objective is to increase muscular strength and coordination.
- Strength exercises (isometric and isotonic exercises, body weight and weighted) must be challenging to illicit muscle adaptation. However, timing is key. Strength needs to be built progressively and in this context, when your joint (and related tissues) are ready. Your physiotherapist, or other healthcare professional, will give you the green light when it’s ok to start lifting heavier weights.
- When you engage in strength training, you may find your muscles feeling fatigued and may struggle a little to finish your reps/sets. You may even find your breathing and heart rate increases, and/or you may experience discomfort or slight pain. These are good signs that the weight you are using is challenging, that is, challenging enough to achieve the benefits of strength training.
- Using a Visual Analogue Scale (VAS) can be helpful to monitor discomfort/pain felt when exercising. Very briefly, a VAS score of 1–2 will feel very easy, no pain or discomfort. On the other hand, a VAS score of 9 or 10 may be extreme pain where you cannot go on or perform the movement – it’s too much that you have to stop. Generally, you want to keep your VAS score around 6-8. You want to feel discomfort or a little pain, as if the exercise is ‘doing’ something; as if you’re working the muscles.
- When performing a strength exercise, eg. squat or hamstring curl, try performing 2–3 sets of 10–15 reps or as otherwise prescribed. Initially, you may find you can only perform one set or only 5 repetitions and that’s ok. Slowly and progressively build the number of sets and reps.
- For exercises where the position is held still while under tension, try performing 2–3 sets of 5sec holds, then 10sec, 20sec, 30sec and so on as you progressively increase time held and/or increase the set range, or as prescribed.
- Depending on context, strength exercises should be performed at least 2–3 days per week. Unlike stretches or mobility exercises, it’s important to have at least one full day rest between strength sessions.
Mobility/range of motion
- The objective is to increase joint range of movement by targeting the joint itself.
- Similar to stretching exercises, mobility exercises shouldn’t cause excessive pain but can be uncomfortable, and that’s ok. You need to stress the joint and surrounding tissues a little to ensure you illicit an adaptive response.
- Try performing 2–3 sets of 10-15 reps or as otherwise prescribed.
- As compared to strength training, rest is less important with mobility exercises and so can be performed every day, multiple times if needed.
- The objective is to improve movement, control and proprioception.
- Like strength exercises, balance exercises need to be challenging to illicit adaption.
- You don’t need to always perform specific balance exercises to gain benefits. Depending on your situation, standing from a seated position, walking up and down stairs, squatting or lunges all require balance ability.
- You can hold certain positions for time or perform 2–3 sets of 10–15 reps or as otherwise prescribed. To make any exercise challenging, close your eyes. Your healthcare professional may give you other ideas to help make balance exercises harder.
- It’s ok if your joint, eg. ankle joint, wobbles a little when performing a balance exercise (or any other exercise). That’s a good sign your ankle is working hard to stabilise you. If, however, your whole body wobbles and you feel like you’re going to fall, ensure you have something stable to hold on to and/or reduce the complexity of the task.
- For safety reasons, ensure there is a stable prop, bench or wall nearby to use for support.
- Rest is less important and so, like mobility/range of motion exercises, balance exercises can be performed every day if needed.
- Your doctor/surgeon or physiotherapist may not want you rotating or moving a recently reconstruction joint in a certain direction or degree and with force/resistance. If you are unsure about what mobility exercises to do and how to perform them safely, please do not attempt the included exercises and ask for professional guidance first.
- The guidelines provided here are conservative so they can be generalised for a variety of conditions/contexts. Please clarify with your physiotherapist or exercise physiologist about time, sets and repetition (rep) parameters for any and/or exercises in the Get Moving! PLUS exercise library.
- Supine: position whereby you are lying on your spine ie. face up
- Prone: position whereby you are lying on your stomach ie. face down
- Isometric: strength exercises where your muscles contract while you hold a still position
- Isotonic: strength exercises where your muscles are contracting – shortening and lengthening
- Repetitions (reps): a rep is the number of times you perform a specific exercise
- Sets: a set is the number of cycles of reps that you complete, eg. you may complete 10 reps of bicep curls (on each arm) and repeat that rep range 3 times (sets).
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