Hi my name is Dr. Andrea Furlan. I am a
physiatrist and pain specialist in Toronto Canada. If you have been diagnosed with
hip or knee osteoarthritis, your doctor probably told you to go and do
some exercises. Today I'll show to you the exercise that I recommend to my patients
with hip and knee OA or osteoarthritis. The type of exercises for OA are lubrication,
aerobics, weight bearing and stretching. Which can be remembered as L.A.W.S I'll show
to you 20 L.A.W.S exercises today. So let's go. First it's important that you understand why
the L.A.W.S exercises are important. When people understand why they're doing the exercises
they adhere to the exercises, and feel motivated to keep doing them regularly. Lubrication is
important because the joint produces a liquid called synovial fluid. This fluid is produced
when we move the joint or we put weight on it. The synovial fluid provides
nutrition to the cartilage. The cartilage is a thin layer that covers
the bones to form a slippery surface, so the bones will absorb the shock and will
move smoothly by reducing friction. Lubrication is important, especially in the morning.
Many of my patients have morning stiffness. This is because at night they don't move the
joints and then there is not a lot of production of synovial fluid. So the fluid tends to thicken.
This is what causes stiff and creaky joints. Look at this crystallized honey, imagine
that the synovial fluid is like this. If we warm it a little bit and mix with
the spoon the honey will become liquid and smooth again. Also the more we move the
joint and put weight on it it's like producing more honey. So remember: motion is lotion.
So I recommend you to do the lubrication exercises in the morning before you get out
of bed. This will help to warm up the joint to improve the range of motion, to break
down any thickness of the synovial fluid. The other exercise: aerobics, weight bearing
and stretching, you can do during the day. Aerobic exercises are important to maintain a good
cardiovascular system, aerobic exercise are any type of exercise that increase the heart rate,
and respiratory rate. This may include walking briskly, dancing, biking, swimming. Make sure you
talk to your doctor to ensure that you don't have any restriction for this activity like aerobic
exercises. Weight bearing exercises are extremely important for people with OA. The main advantages
of weight-bearing exercises is that they reduce pain in the joint, and they also help to maintain
the calcium in the bones especially important for people who also have osteoporosis. It is very
common that people will have these two conditions: OA and OP: osteoarthritis and osteoporosis. You
may want to watch another video that i made about osteoporosis. The "S" in L.A.W.S. is stretching.
Stretching is important to maintain flexibility, to maintain a good range of motion in
the joints that have osteoarthritis. When people have joint pain they tend to protect
the joints and use it less and less. Then the muscles get shortened and stiff, the tendons, the
ligaments, and the joint capsule will all get very tight. So it is important to do gentle stretching
of the structures around the joints. At the end of this video, I will explain some movements
that should not be done if you had a recent hip replacement or arthroplasty, because some
exercises will put the hip at risk of dislocation. So let's get started. I'll show you
20 exercises today that are good for hip and knee osteoarthritis. Before you do
these exercises you may want to apply some heat like a bag of beans that you can warm up in the
microwave. You can put this two minutes in the microwave and then you leave here for about two
minutes to warm up the joint before you do this exercises. You can put in the knee, or you can use
a hot water bag like this. You fill with hot water and you also can leave about two minutes
in the joint to warm up the liquid before you do this exercises in the morning. I prefer
the water because it molds better to the joint but if you don't have those things don't
worry you can still do this exercises. So the exercise number one is for the knee. It's
flexion and extension for the knee. So you will be doing extension and flexion, that's the only
movement that the knees can make: extension and flexion. So, we'll be doing this: bend both
knees and do one at a time, you'll be doing eight repetitions for each knee. If this is too easy,
you can do 12, 15, or 20 repetitions. Do for the other knee. And this is good that you're doing
in the bed because you are doing against gravity which also helps to strengthen the quadriceps. And
if you stretch all the way up and straighten your knee you also be stretching the hamstrings
and gastrocnemius muscles here in the back of your leg and thigh. So this is at the same
time some stretch strengthening but it's most importantly lubrication exercise for the knee
so do this that's the exercise number one. The exercise number two is lubrication for the
hips. We're going to draw numbers in the air, So bend the left leg and you're going to draw
number one in the air, and draw very big number two, number three, this is movement
for the hips, number four, number five, number six, number seven, number eight, number nine, and
that's it for the right leg. Now bend the right and do the numbers with the left leg. Number
one, number two, very big. The bigger you do the better. Number three, number four, you are
lubricating the hips. Number five, number six, seven, eight, and nine. Okay. So that's lubrication for the hips. Now, the exercise number three is
a movement that the hips do is: external rotation and internal rotation. So, we'll
be doing external rotation, internal rotation, external rotation, internal rotation
for the hips, do this eight times or 12 or 15 or 20. the more you do the better. So, you
are moving your hips in and out. This helps to expand the capsule, It helps to warm up the liquid
inside of the hip joints, and the more liquid you produce in the joints, the more nutrition in
the cartilage. So, this is great for your hips. So, the next exercise is hip abduction.
It's for the hips to move open up and down. So, it's important that you keep your
toes pointing forward and pointing down, You can do this eight times for each
hip. I'm doing this for the left one. And when you do this eight times, you're
going to do now the lower leg. We're going to work on the inner thigh muscles here. This
is called adduction for the right leg. We're going to put this leg on the front one, and
we're going to move up this one eight times. This is adduction, keep your
knee straight, keep the ankle straight like that, and move the lower leg.
You're going to do this and there's this hip adduction for the left, for the right one. So if this exercise is too difficult for you you
can do a modified version which is the clamshell. Just keeping your body straight but now you're
opening/closing like this. It has about the same effect you're strengthening these muscles, you
are lubricating the hip by moving, Just try not to go backwards. Just stay upright like this, and
open and close your hips this is the clamshell. So, now this exercise is extension of the hips you're going to be on your stomach
and raise the left leg eight times. And you're going to do for the right leg,
eight times and you can do 12, 15, 20. And then, the last exercise
that you do before you get up is the same thing that we did for the other
side, but now we're going to do abduction for the right leg, keep the knees straight,
the toes pointing forward, and pointing down, and you do this eight times for the right
leg, you can do 12, 15, or 20 if you want. And the other one is adduction for
the left leg, do this eight times. You should not be doing adduction exercises if
you just had recently a hip replacement or joint arthroplasty in your hip, so this exercise is
not indicated because you can dislocate the hip, if you had a hip surgery in the last three
or six months. You should talk to the surgeon about what kind of exercise you can do So, those are the exercises that you should be
doing in the morning to warm up your joints, hips and knees to reduce the stiffness, before
you get up in the morning. The next exercises are weight-bearing exercises, you may want to do
them during your day, try to incorporate them as routine when you are cooking or watching tv. For
these exercises you will need some equipment. You need the following: you need a wall that you can
slide on, stairs or steps, a mat, a sturdy chair like this one here, without wheels, so it doesn't
slide on, and ankle weights like these ones. These, they have a 1.1 kilogram and you can attach
them around your ankles to increase the weight. So, this exercise is squating on the wall,
so we are going to squat against this wall, you can keep your feet apart and approximately
one foot distance from the wall. Now touch the wall with your head,
your shoulders, and your hips, and then you're going to start
going down, down, down, down. Stay there for five seconds, one,
two, three, four, five, then come up, and you can do this a couple of repetitions, and
you can also increase the time that you stay in that position you can increase to 10 seconds, 20,
and 30 seconds. The more you stay in that position and the more you can repeat this exercise
the better. So you can do this many times during the day anytime you find a wall in your
house, or a door, you can do this exercise. Stay there that's excellent to strengthen the
muscles around your hip and this is weight bearing because we're putting the weight of
your body on the joints of the hips and knees. So for these exercises, if you have ankle
weights, you can attach them to your ankles to increase the weights, so then, you will
be doing this exercises more efficiently. These weights, they have 1.1 kilograms. So for this exercises we're going to do
abduction of the hips, With weight bearing, when you are standing up, you need a chair that
is a sturdy chair that doesn't have wheels, so you're not going to slip, or it could be the
countertop. So something for you to hold on, your body straight, your knees
straight, the toes pointing forward, and then you're going to do opening
and closing. Knees straight, toes pointing forward, do this eight repetitions,
with the left leg, if this is easy you can do 12, or 15, or 20 repetitions, So after you do
this then you repeat with the other leg, just do the same thing body upright, don't
bend like this, or this just stay upright, holding on something here, and just open,
knees straight, and toes pointing forward. So, for this next exercise you also need the
chair, here, we are going for the hip extensors, the gluteus maximus muscles. Let's start
with the left leg, you just go like this, keep your body straight, the knee straight, and
just move your hip backwards, eight repetitions, and when eight becomes easy you can increase
to 12, 15, and 20 repetitions, and then do with the other leg. It's important that you
keep your trunk upright, and your knee straight, you're doing this for the hip, so feel the hips
moving, feel the hips, the tension in the capsule, you're distending the capsule, so you're moving
the hips in this position. So, for this exercises, we're going to do for the knee exercises,
we're going to do weight bearing for the knees, we're going to do knee flexion /extension. So,
again hold to the chair and with the upright trunk just bend the knee backwards, and try to
touch the knee has farther than you can, and at the end if you can even do some stretch here that
would be good because they will be stretching the quadriceps, these muscles here at the front, but
if not, just try to go up, as far as you can, do this eight repetitions, and when this becomes
easy you increase to 12, 15, 20 repeat, with the other leg, you're doing this for the knee, you are
flexing and extending the knee, extend completely, flex completely, and if possible pull a
little bit here to stretch the muscles. So, this is movement for the
knees, do eight repetitions or 12 or 15 or 20 repetitions, so you can
do this in a counter top in your home. Anything that you have or a sturdy chair like
this. So, for this exercise now, we are going to do seat and stand, so get the chair
that we were doing the exercise before and you are going to do a stand, and sitting, try
to sit at the edge of the chair, and if you can, just touch the chair, and stand completely,
touch the chair and stand, touch the chair and stand, this is exercise for the quadriceps for
the hamstrings, and when you go down when you are sitting try to do very slowly, because then you
are strengthening the hamstrings here, and then if this is too hard for you you can do a
complete seat, and then go up. A complete seat and then go up. So, this exercise is for the
knees. The muscles that we have inside of the knees here are called vasos medialis obliquos, the
quadriceps have four heads, the vasos medialis is the head more medialy, internally here, in
people who have osteoarthritis of the knees this part of the quadriceps is usually weak, so,
we have to strengthen this, and how do we do this? So, with the ankle weights that we just
put on our our ankle, we're going to do straighting of the knee and then you just do flexion of the knee, flexion/ extension,
at this position here, so you can come close to the back of the chair, just straighten
your knee, and just lower about 30 degrees, lower and up, down up, and do this many repetitions
with ankle weights so you are strengthening the vasos medialis obliques here, this muscle,
which is very important to stabilize the knee, and then do for the other leg here 30 degrees. So, do eight repetitions, when eight is too
easy increase to 12, 15, and 20 repetitions. So, this exercise, we're going to do
in the stairs, if you don't have stairs you can use the steps, make sure that you have
railings, so then you don't lose your balance, we are going to do right foot up, right foot
down, right foot up, right foot down, we're going to do this for one minute, or you can do this 20
times, keep doing this, keep your body straight. And after you do this 20 times for the right
leg you're going to do this for the left leg, so now we're going to do for the left left up, left down, left up, left down, so you're doing
this weight bearing exercises for your hips, for your knees, you're strengthening
the muscles, you're moving the joints. Left down, left up, left down, and this exercise
is on the side, you go up, and down, on your side, so left up, right down, just keep
doing this, and you do for one side, it's important to do this for the lateral
muscles, the ones on the sides of your hips, once you do this for one side, you can do
this for the other side, the same thing, and you feel the muscles here on the side
of your hips, moving, and your hips moving, so this is important you can
do this 20 times for each side. So now we are going to do this stretching
exercises, and we are going to use a mat, but you can do this on your carpet, or on
the floor at home, or even in your bed. These stretching exercises. I recommend you
to do before you go to bed to sleep at night, because if you do this then your joints will
be less stiff in the morning when you wake up. So, this next exercise will be pelvic tilt and
bridges. Pelvic tilt, to do this exercise the knees are bend, the feet are flat on the on the
floor, and then you're going to move the pelvis in, tuck the stomach in, touch all the vertebras
here, the lumbar spine touching the floor, and relax, so you do this, so you do this
movement with the pelvis, down and up, down and do this 8, 12, 15, or 20 repetitions,
you feel the muscles stretching here in your lower back, you feel your stomach
coming tucking in, contracting, this is the pelvic tilt, and then in the
same position you're going to do the bridge. Bridge you just raise the pelvis, keeping
the shoulder, hips and knees like a straight line, and you stay there in their
position, ideally you keep this for one minute, but you start with 10 seconds 20, 30, 40,
50, in 60 seconds, increasing gradually, the more you stay there the better, when
you're doing this exercise tighten your glutes, tighten your abdominal muscles, relax
and don't forget to breathe normally. And come down. So now we're going to do stretching for the
gluteus muscles, and what we're going to do is we're going to pull the hips here, i usually don't
recommend doing this, because you put too much strain in the knee, so you can pull like this,
so let's start with the left hip, pull the this knee towards the left shoulder, so, you do this
oh you're stretching all of these muscles here, and then you're going to pull this
towards the opposite shoulder, so pull the left knee towards the right shoulder,
you're stretching, and you can put some force here, so then you're forcing the
knee to stretch, you feel the stretching here, and once you do for the left leg you're going
to do for the right side, so again pulling this to the same side, so the right knee
you're pulling towards the right shoulder, and now you're going to pull towards the opposite
shoulder, so you feel stretching here the gluteus, the piriformis muscles, so this is
a good stretch, and you can do this, repeat for this, the other side, into this side,
and repeat for this leg here, and this one. So, now we're going to stretch specifically
the piriformis muscle, so this leg straight, and this knee on the top of the other one,
and we're going to pull the knee to this side, and you're feeling stretching the
piriformis is this muscle here, And now you do for the other side,
this one straight and this one here, and you feel stretching the
piriformis is a tiny muscle here, but it's very important and sometimes it's tight,
and can cause pain that goes down your leg. so you repeat this many times for each side. So the next group of muscles that we're
going to stretch is the adductor muscles, these are the muscles that are in the inner thigh
here, so you're going to sit, and sit upright, put your feet together, plant to plant, flat,
and then just relax your knees, try to go down, down, down, down, down, relax when you breathe
out you relax more, and when you breathe out, and relax you can stretch with a little bit of
force here, to force them to go down, if you can't do this if your knees are here that's fine,
stay here, and but if you can relax and go down, like this, and you can do some movements, like
butterfly, it helps to relax the adductor muscles, and stretch them. So this next muscles that
we are going to stretch are the hamstrings, the muscles that are behind our thigh, and
they also they bend the knee, and they also move the hip, so to stretch the hamstring
muscles, there are many different techniques, i'm going to show you one, that i do on
the floor, so for me it's easier if i bend one leg, and now i'm going to stretch the
right leg, so what I do is keeping the big toe pointing towards your nose, and you
are going to try to touch your big toe, so the lower you go the better, you see that i'm
very tight, because i spent the whole day sitting, so the more you are sitting during the day,
the tighter are these muscles and the more you need to stretch, so, then you touch the toe, of
that leg and try to lower your head if possible touching your head to the knee, I can't do
that, but that's because i need to stretch more, and you can do this, relax, and breathe,
come back slowly, now do for the other leg, here, and come back, so you feel when you do
this, you feel all these muscles here stretching, So now we're going to do a stretching
for the quadriceps muscles, for this one you are lying down on the mat, on your stomach, and
you're going to bend the knee here, and then pull with your hands, and try to bring the heel
touching your butt area, so if you do this you feel stretching at the front of your thigh, then
you can relax, your head and pull, pull, pull, and let go, and pull here, let go, and
do this for the other side, let go, and pull and you feel the muscles in front
of your thigh stretching, stretching, I prepared a document with a summary of all these
20 exercises. Go to the description of this video below, and you will find the link to the document
to download, if you had a recent hip replacement your doctor may have told you to take some hip
precautions, these are certain movements that may cause the new hip to displace or dislocate, these
movements are the following: crossing the legs, bending your hips above 90 degrees, so this
is 90 degrees, so not bending more than this, and also twisting around the hips, so doing this
movements or twisting. Please remember that this video is for educational purposes only, if you
have been diagnosed with osteoarthritis of the hip or knee please ask your doctor or physiotherapist
if these exercises are appropriate for you, if you like this video don't forget to like it,
to subscribe to this channel and to turn on the notifications, I also tweet, I have a facebook
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or comment, thank you for watching, bye.
