Consider these exercises for chronic musculoskeletal conditions
Exercise interventions reduce pain and improve function in knee/hip OA, chronic low back pain, shoulder pain, Achilles tendinopathy, and lateral epicondylitis.
PRACTICE RECOMMENDATIONS
› Consider quadriceps strengthening for knee osteoarthritis with an initial period of supervision, which can provide greater pain relief than nonspecific, unsupervised lower limb exercises. B
› Consider a generalized exercise program for subacromial impingement syndrome, to relieve shoulder pain and improve function, range of motion, and strength. A
› Bear in mind that the Alfredson protocol for Achilles tendinopathy has yielded improvement in pain and function for up to 5 years, although other exercise regimens have also proven initially effective. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
From The Journal of Family Practice | 2018;67(9):534-538,540-543.
When prescribing exercises, be sure to address patient expectations regarding pain, duration, and limitations of exercise. It would be helpful for patients to know, for instance, that working through mild-to-moderate pain during exercise has been shown to shorten post-exercise recovery time and, in the short-term, improve relief from pain.43
Tailoring specific exercise prescriptions for a patient will make the regimen more satisfying for the individual and optimize adherence, which in turn will increase the potential for pain reduction and improved function. Secondary benefits would likely be weight loss and prevention (or regression) of cardiovascular disease. Continued evaluation by the physician or physical therapist should be part of ongoing management, as well as “refresher courses” to ensure understanding of, and adherence to, the exercise program. The potential benefits and limited risks of exercise, if done properly, make it a primary intervention for specific musculoskeletal conditions.
CORRESPONDENCE
Peter J. Carek, MD, MS, Department of Community Health and Family Medicine, College of Medicine, University of Florida, PO Box 100237, Gainesville, FL 32610-0237; carek@ufl.edu.
