Osteonecrosis is a medical condition that affects the bones. Also known by other names, including avascular, ischemic and aseptic necrosis, osteonecrosis involves the death of bone and joint tissues and cells caused by limited blood flow. The bones, like every other cell, tissue and organ in the body, need adequate flow of nutrient- and oxygen-rich blood for optimal health and function.
Common Locations for Osteonecrosis
The most common locations in the body for bone and joint damage caused by osteonecrosis include but are not limited to the hips, knees and ankle joints, because they're the major weight-bearing joints and bones in the body. Osteonecrosis can happen to people of all ages, though it's most commonly diagnosed in those between 30 and 60 years of age. In many cases, osteonecrosis is caused by undergoing radiation therapy for cancer treatment. Exercising with osteonecrosis should involve non high-impact exercises to help promote healing of damaged bone and joints.
Symptoms of Osteonecrosis
According to a research study published in the "New Zealand Medical Journal," osteonecrosis is a complication caused by radiotherapy. General aches and pains in the affected joint or bone area is common to those eventually diagnosed with osteonecrosis, as is reduced mobility or difficulty with range of motion. Generalized aches are common after you finish exercising, but with necrosis, the pain will be in the same area every day, sometimes even while at rest. If you feel consistent pain in a specific area of the body before, during and after exercise, talk to your doctor to determine its cause.
Radiation-Induced Osteonecrosis
A number of factors may cause osteonecrosis. However, radiation and chemotherapy treatments are one of the most common risk factors for osteonecrosis according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Even in older individuals with healthy bones, new bone cells consistently replace old or damaged bone cells. However, with osteonecrosis, the bone cells break down faster than normal, and much faster than new bone cells can develop and grow, leading to a gradual breakdown of bone strength, mass and support.
Range of Motion Exercises
Range of motion exercises will help maintain health, function and mobility of the joint while offering a low-impact form of exercise. According to an article published in the "Journal of Bone & Joint Surgery," osteonecrosis may not appear for more than a decade or longer following radiation therapy. Because of the delay between treatment and onset of bone death, exercise may help maintain bone health and development and growth. One form of exercise is range of motion.
A physical therapist will take measurements of current range of motion capacity of the affected joint. Depending on severity of the condition, you may be encouraged to perform exercises involving active knee and hip flexion, as well as passive knee extensions. Climbing stairs is also suggested, under supervision. You will be asked to climb a set of stairs to determine strength and range of motion in the hips and knees, as well as knee extension and flexion capability.
Range of motion exercise puts the joints of the body through extension and flexion exercises, as well as circular motions of the joint to maintain mobility. Your physical therapist will determine specific guidelines for the type, duration and number of repetitions of certain exercises depending on the location of the osteonecrosis as well as the severity of the disease process at the time of therapy.
Weight-Bearing Exercises
Weight-bearing exercises may help promote and protect bone growth and development following radiation therapy, which may help prevent osteonecrosis. Exercising for bone health, especially through weight-bearing exercise like walking, stair climbing, hiking and strength training or weight lifting helps to maintain bone mass, also known as bone density and strength, according to the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Weight-bearing exercises also help maintain balance and coordination which in turn may prevent falls and bone fractures.
Exercise Cautions with Osteonecrosis
Strengthening bone structure and joints is the main goal of osteonecrosis therapy and treatment caused not only by radiation therapy but other bone disease processes. Gradually increase strength and endurance to help maintain bone health by engaging in low-impact exercise such as walking, swimming or stationary bike riding. Talk to your doctor about long-term exercise options before attempting high-impact exercises such as jogging or contact sports.
References
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Fast Facts About Osteonecrosis
- "Physical Therapy";: Relationships Among Severity of Osteonecrosis, Range of Motion and Mobility in Children and Adolescents and Young Adults with Lymphoblastic Leukemia;VC Marchese, et al.; Mar. 2008
- The Body- The Complete HIV/AIDS Resource: What's New in Treatment
- "The New Zealand Medical Journal": Radiation-induced osteonecrosis of the hips following genital-preserving surgery and chemoradiotherapy; JF Quinlan, et al.; Jun. 19. 2009
- "The Journal of Bone & Joint Surgery": Osteonecrosis of the acetabulum following radiation therapy - A report of two cases;HW Deleeuw,LA Pottenger ; 1988
- NIH Osteoporosis and Related Bone Diseases National Resource Center: Exercise for Your Bone Health
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