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May 25, 2022 13 mins

Finding movement that works for you while living with joint pain can feel pretty contradictory. That is why Amanda Nelson - a Rheumatologist and Associate Professor of Medicine - joins us to share the importance of finding movement that works to both help ease joint pain and fit within a busy schedule. Especially for caregivers, fitting in time for movement can be a pain in more ways than one, but ultimately strengthening this pillar of self-care benefits our bodies and our ability to show up for the ones we love. This episode is a shorter version of our conversation with Dr. Nelson made for a shorter walk. 

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Episode Transcript

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Speaker 1 (00:00):
Hi everyone. I'm Holly Robinson, pete actor, author, advocate, do
it All mom, and I'm also a caregiver. And this
is care Walks, a podcast from My Heart Radio and
Volteran Arthritis Pain Gel. It's a show for family caregivers
who give everything to everyone and need to make time

for themselves through movement. Every episode is designed for you
to walk as you listen, so just think of me
and my guests as your weekly walking buddies. We'll hear
stories from caregivers and gain tips and insights from health
experts and advocates who know how important it is to
take care of yourself and manage joint pain due to

arthritis that often accompanies being a caregiver. Together, we'll find
community ourselves and maybe even alleviate some joint pain in
the process as we walk together and connect to the
best parts of being a caregiver. Welcome back to Kara Walks, everyone,
and thank you for taking time to join us, and

thank yourself for taking time to make your self care
a priority. As a reminder, right now you're listening to
the abridged version of this episode, but if you're looking
to get a little extra inspiration, don't miss a minute.
Check out the full length version of this episode in
your podcast feed. All right, now that's settled, let's dig

into the episode. Today, we're talking about the importance of
movement for caregivers living with ostio arthritis to help us
better understand how joint pain effects caregiving. I will be
joined by Dr Amanda Nelson, a rheumatologist and associate professor
at the u n C Thurston Arthritis Research Center. She

understands both the challenges and the best strategies from managing
o A from her experience working directly with patients, both
in clinical care and in research. But before we dig in,
us begin our walk. We're going to focus on staying
present within our bodies and within our movement. Think about

the contact you're making with the ground. What does that
feel like. Be sure to relax your shoulders as you walk,
pull them down from your ears and breathe in deeply
through your nose. Feel the sensation of your stomach and
your chest rising with your breath. And now breathe out

through your mouth and let everything in your body relax
As you breathe, be aware of the air filling in
your lungs. Can you feel your chest compressing as you
slowly release the breath. Take a beat to walk through

your five senses. What do you see around you? What
sense are filling in the air? What do you notice
about the way your body moves as you set your pace? Now,
as you settled into your rhythm. I'm going to share

my conversation with our guests, and together we're gonna learn
a little bit more about how we can all benefit
from keeping our bodies moving. Today I am joined by
Dr Nelson, a rheumatologist and Associate professor at the u
n C Thurston Arthritis Research Center. She understands both the

challenges and the best strategies for managing oway from her
experience working directly with patients, both in clinical care and
in research. Dr Nelson, thank you so much for joining
us on care walks. Oh, thank you very much. I'm
happy to be here. I'm happy you're here too. Could
you tell us a little bit about the work that
you do and how you have helped joint pain sufferers

improve their symptoms. Yeah, So, as you mentioned on my
a rheumatologist and I see patients one day a week,
and those patients have a range of arthritic conditions and
a lot of them have challenges with mobility. I also
do research primarily and osteoarthritis, which is the most common
form of arthritis, around a lot of different aspects of
risk factors, disparities, issues of imaging and bio markers, how

we might tell people do or don't have arthritis, how
it might progress, and some novel methodologic approaches to try
and understand it better for future clinical trials and clinical care.
The main recommendations around symptomatic improvement is exercise, and we
have shown in a variety of different studies that exercise
really does improve pain. Often that's not the first thing

that happens, so people have to work through some initial discomfort.
A lot of times, maybe they haven't been very active
and they have to sort of get into the routine
and get over some initial joint pain. But over time,
being regularly active does improve the pain and symptoms of
arthritis absolutely. Some of our listeners might be new to
incorporating physical activity or movement into the routine, and as

we all know, well, I mean I speak for myself,
but I think also for a lot of other people,
just the prospect of starting something like that, it seems intimidating.
So what would you say is the simplest and best
way for them to get started? I think a lot
of my patients, and certainly in our research studies as well,
people are often coming from a position of of no activity.

They're very sedentary. They might get up and go to
the store, but otherwise, you know, on the couch or
not engaged in a regular routine. And so there's a
lot of ways to approach that. It depends a lot
on where people start. So if we're starting from a
place of I do nothing but sit on the couch,
then the first thing we say might be, well, during

the commercials on the television, we're going to stand up
and we're going to move around, and we're going to
do that every single commercial, because there's a lot of commercials,
and so that can get you a long way. If
we're from a place of, well, I move around in
the house, but I don't really like to go out
and walk, you know, then maybe I say you should
walk for five minutes a day, you know, three days

a week. And I work very slowly up to a
goal of maybe thirty minutes a day for three to
five days a week, and I actually have a walking
prescription where I can write this out for people and say, look,
this is the medicine for your arthritis. The medicine for
your arthritis is to get up and walk. But it's
extremely important to meet people where they're starting, because if
I just start with thirty minutes, five days a week,

they're going to have that exact reaction and I say,
there's no way I can do that, and I'm not
even gonna try. And so understanding where people are coming from,
what their barriers are, and really coming up with a
plan that's going to work for that person, anyone they're
caring for, you know, working around their schedule. All those
things are very important to getting people started and also
to maintain because you know, if they do it once

and then give up, that doesn't help. Okay, let's talk
about possible misconceptions about being physically active. Can already hear
somebody saying, well, wouldn't movement just add where and tear
to my body and potentially make joint pain even worse.
I get that question all the time because it makes sense, right,
you think, well, if the cartilage is breaking down, then

what I don't want to do is use the cartilage.
But it's not quite how it works. So the cartilage
itself doesn't have its own blood vessels. It doesn't get
nutrients from the body through the blood like a lot
of other tissues. And the way that it gets nutrients
in and waste products out is by compression. So the
actual loading of the cartilage is how the cartilage stays healthy.

If people are unloaded, you know, for example, having a
paralysis event where they really cannot walk, the cartilage degrades
because it can't get nutrients, and so walking is healthy
for the cartilage. It actually improves the cartilage function. And
so it's completely counterintuitive, and I get that, and so

I'm happy to explain that to folks. But the joint
wants to be loaded now, it doesn't want to be
It's not a jackhammer, right, So it's not looking for
high impact major activity, but it does like some periodic
loading and unloading, such as we get with walking and
what else? What are some other low impact activities that
caregivers with joint pain can do besides walking. Yeah, so

walking certainly the cheapest, easiest we can all do it. UM.
I have a lot of people who benefit greatly from
the elliptical um system. Because there's really no impact so
much as that gliding motion can be very helpful. And
for people that really have not been moving, have a
lot of pain, maybe a lot of other comorbid conditions,

a lot of times water therapy is very helpful, whether
that's a PT driven aqua therapy program or again like
our threatis foundation class at a local pool. Often the
pool is warm, the buoyancy from the water helps to
sort of take some of that weight off the joints,
but still they're being loaded in a useful way for
the physio oology of the joint itself. So there's a

lot of different modalities and it very much again depends
on what people want. If if you're terrified of the water,
then I'm not going to tell you to do water therapy,
but that certainly is a great place to start for
people that have access and enjoy that cannot workout be
too minimal to see benefits. There's two parts to that.
One is any movement is better than no movement, and

so if you're you know, just getting up during the
commercials are doing those five minute walks, that's way better
than the sitting on the couch was previous to that,
we have to start somewhere, and we want to encourage
people to start where they are and move forward from
that point, and any movement is going to be of
benefit over the longer term. There's still some debate about

how much we need, right, So there was the ten
thousand steps going around for a while, and then one
of my colleagues did a study that showed that maybe
six thousand was probably okay for people with osteo orth right,
as there are guidelines out there for how active we
need to be, that can be very daunting if we
start air, so you know, a hundred and fifty minutes
a week sounds pretty scary, but again it's it's the

essential piece of just moving. And if that's a very
small bit at the beginning, and we're working up, then
that's all we can ask anyone to do. We can't
leap straight to full maximum healthy adult guidelines and and
go from there. That's just not how it is. And
how do you know when movement pain is pushing the
limits or over extending. So I usually tell people it's

okay if you're a little sore the next day, that's
kind of again to be expected. If we haven't been
doing too much. But if it's lasting for a few days,
or it's really debilitating, like I walked yesterday and I'm
in bed today, that was either too much or there's
something else going on. If it's a joint pain issue,
we shouldn't have red, warm, swollen, angry joints, right, So
they might be a little bit puffy if we were

just up and about more, and that's okay, that should
go away. But if there's acute pain, new redness or warmth,
something that's never happened before, pain in a place that's
never happened before, those are things to look out for.
But generally, what we expect is that the joints that
hurt might hurt a little bit more after the activity,

and they might be a little sore the next day,
and then we should be back to where we were
going or even feeling a little bit better by then.
So big changes, though, or or new things that hadn't
happened should be at least evaluated. It might be okay still,
but we just want somebody to take a look and
make sure that we're not causing a new problem or
or you know, maybe our gate isn't quite right and

we're generating some new pain issue that we didn't have before,
So just being aware of our bodies, where we started,
where we're going, and what to expect. Well, thank you
so much, Dr Amanda Nelson for talking to me today
on care walks. I love the idea of the commercial
movement breaks. I think that's a great starting place. If
you're not in the habit of moving just yet, it's

important to take it in those little vice sized pieces,
you know, just to get yourself going. And I really
appreciate having this conversation with you. Thank you so much. Well,
thank you, Holly. It's been fun. I want to thank
Dr Nelson again for being my guest today. I really
appreciated our conversation and hope you learned as much as

I did about finding movement that will help your joint
pain and the physical benefits of implementing movement as well
as what it does for our mental health. That's it
for today's episode, and don't forget to come back next
week for another walk with our guest actor and caregiver
Jenny Garth. We're going to talk about her experience as

a caregiver for her father and how she now prioritizes
self care and manages her joint pain and remember keep
walking and don't forget to take care of yourself too.
Care Walks is produced by I Heart Radio in partnership
with al ter In. Our threatis pain Jail and hosted
by me Holly Robinson Pete. Our executive producer is Molly Sosha.

Our head engineer is Matt Stillo. This episode was written
and produced by Sierra Kaiser, with special thanks to our
partners at G s K Platform, g s K, Weber, Shandwick,
and Edelman
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