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Exercises for enthesitis and arthritis

Regular exercise has many benefits and is just as important for young people with enthesitis. Enthesitis-related arthritis involves inflammation in the joints and the entheses, the place where tendons attach or insert into bones. This type of arthritis is also known as spondyloarthritis.

Regular exercise helps to keep our heart, lungs, bones and muscles strong. Exercise can also help to improve our mood and energy level and even help us sleep better. It is an important part of any weight loss or weight maintenance program.

You should start a new exercise program slowly and gradually increase it in intensity over time. The ultimate goal is to make exercise and physical activity part of your life every day. This includes activities like stretching, strengthening and aerobic activities. You should follow a formal exercise program at least three or four times a week.

Stretching and flexibility

Stretching and flexibility are an important part of any exercise program. Before stretching, always warm up your muscles. You can do this by walking around or riding a stationary bike for a few minutes. If you are very stiff, a warm shower or bath may help you loosen up. You should do stretching exercises slowly and hold them until you feel a medium stretch. The stretch should not feel painful.

The following stretching exercises will help you stretch your back and hip muscles and keep them flexible:

  • Lie on your back and pull one knee towards your chest while keeping the other leg straight along the floor. Hold for 10 seconds. Repeat three times with each leg.
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  • Lie on your back, and pull both knees to your chest. Hold for 10 seconds. Repeat three times. 
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  • Stand tall and bend sideways by sliding your hand down the side of your leg. Make sure that you do not cheat by lifting a foot off the floor. Do not bend forward. Hold for five seconds. Repeat five times on each side.
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  • Start in four-point (on your hands and knees). Lift one arm out to the side and look up towards your out-stretched hand. Hold for five seconds. Repeat five times with each arm.
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  • Sit back on your heels, and move your hands forward along the floor, to feel a stretch in your upper body and shoulders. Take a deep breath and walk your fingers forward a little way to increase the stretch. Hold for 10 seconds. Now, stretch one arm longer, and then the other, as you rock your upper body from side to side. Repeat 10 times.
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  • In four-point (on your hands and knees), round your back up like a cat. Hold for five seconds. Now, make your back hollow by dropping your tummy. Hold for five seconds. Repeat five times.
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  • Hold your hand and forearm at shoulder level on the corner of a wall or in a door frame. Put the leg of the same side a little bit forward. Rotate your body away from your arm until you feel a stretch in your chest muscles. Hold for 10 seconds. Repeat three times with each arm.
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  • Start in a kneeling position. Place one foot forward on the floor, so you are making a 90-degree angle with your foot. Prop up your arms on your knee to stabilize your trunk. Keep your back leg straight. Push your hips forward until you feel a stretch in your hip flexors, which are the front part of your hip. Tighten your stomach muscles to make sure your back does not arch. Hold each stretch for 20 seconds. Repeat three times with each leg.
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  • Lie on your stomach with one arm and one leg of the same side lying straight on the floor. Bend the other leg by holding your ankle and pulling it gently towards your buttocks until you feel a stretch in your thigh. Keep your hips on the floor. Hold each stretch for 20 seconds. Repeat three times with each leg.
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    • Lie on the floor with one leg outstretched through a doorway and the other leg extended straight up the wall. Try to bring your bottom as close to the wall as you can. To increase the stretch, loop a towel around the foot that is extended up the wall, and pull gently. Try to lift your heel from the wall. Hold each stretch for 20 seconds. Repeat three times with each leg.
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      Strengthening and posture

      The following exercises will help you improve the overall strength of your muscles and your posture:

      • Lie on your tummy or up on all fours (hands and knees). Lift your left arm and your right leg at the same time. Hold for five seconds, then switch your arm and your leg. Repeat 10 to 30 times in a row.
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      • Tighten your lower tummy muscles by pushing your back flat into the bed. Hold for five deep breaths. Repeat 10 to 30 times.
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      • If you want to make this stretch harder, you can tighten your lower tummy muscles and lift your feet off the bed, bringing your knees up to 90-degree angles. Hold for three to five deep breaths and lower your legs slowly. Make sure your back is flat and your tummy muscles are tight, even when you are lowering your legs. Repeat 10 to 30 times.
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      • Lie on your side with your top shoulder, hip, knee, and ankle all in a line. Lift your top leg slowly. Hold for five seconds. Repeat 10 to 30 times. You can try adding a weight to your ankle to make the exercise more difficult. Make sure your top leg is in the correct position by pretending that you are holding a glass of water on your leg. When lifting and lowering your leg, make sure that you do not drop the glass of water. That way your leg should stay perfectly sideways. 
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      Be careful using weights

      In general, you should not use resistance, such as weights, in the area of an acutely swollen joint. Until your body has reached full adult development, usually between 15 and 18 years of age, you should avoid the following exercises so that you do not risk injuring growing bones, joints and soft tissues:

      • weight lifting
      • power lifting
      • body building
      • strength training with weights.

      Aerobic exercise

      Aerobic exercise is very important for your health. It includes any activity that can increase your breathing and heart rate continuously for a long period of time. Try any activity you enjoy for at least 30 minutes a day or do longer sessions three to five times a week.

      Good forms of aerobic exercise include:

      • walking
      • swimming*
      • biking
      • hiking
      • dancing
      • hockey
      • soccer
      • roller blading.

      *Swimming is a great exercise, but to keep your bones healthy, it is important to do some activities on land like walking or running.

      Everyday tips for healthy joints and posture

      There are small things that you can do every day to improve your posture and make sure your joints stay healthy.

      • When you are at the computer, sit in a comfortable chair with your feet flat on the floor. Your knees should be at a 90-degree angle to your hips and your back should be supported by the back of the chair. Your desk or computer should be at the proper height so that your forearms or wrists can rest on the surface comfortably.
      • When you have to carry heavy books, use a knapsack with both shoulder straps. Do not carry them in a bag over your shoulder.

      Key points

      • Enthesitis-related arthritis occurs when the joints and the entheses are inflamed.
      • Stretching can help your child stay flexible while strengthening exercises can improve posture and make their​ muscles stronger.
      • To protect their growing bones, joints and soft tissues, a child with arthritis should avoid using weights until their body has developed fully, usually between the age of 15 and 18.
      • Good forms of aerobic activity include walking, biking, hiking and roller blading.

      You can read more in our Juvenile Idiopathic Arthritis Resource Centre​.

      Original authors:

      Michelle Anderson, BScN

      Shirley Tse, MD, FRCPC

      Kristi Whitney, MSc, BScPT

      Reviewed by:

      Greg Wells, PhD