Pain and swelling can hinder physical activity but exercise is important to help prevent TGCT symptoms from becoming worse.
Tenosynovial giant cell tumor (TGCT) is a condition in which tumors form in the tissues of joints, causing pain and swelling in the affected area. It can be difficult to stay active if you have TGCT, particularly if the tumor is in your knee, hip, or ankle joint. But exercising regularly is important to maintain your physical and mental health as well as relieve stiffness and help you regain strength in the muscles around the affected joint. In fact, being sedentary can actually make TGCT symptoms worse.
“Because the symptoms of TGCTs can mimic those of other joint disorders, people [who have the disease] will often reduce their activity level for fear of worsening the condition,” says Robb Seahorn, a physical therapist with CORA Physical Therapy in Knoxville, Tennessee. “The reduction of activity level can also create problems.”
According to Seahorn, one problem that occurs with lack of exercise is a disruption in the production of synovial fluid in your joints. This fluid, which increases lubrication, nutrient distribution, and shock absorption, is critical to the health of the cartilage in the joint.
“When we’re active and moving, the cartilage in our body has the ability to pull in the fluid and nourish and lubricate the joints, similar to a sponge,” he explains. “But being sedentary actually reduces the movement of this fluid and thus the function of the joint. That’s one reason we often say in physical therapy, ‘Motion is lotion for the joint.’”
So what type of physical activity is right for TGCT, and how can you exercise safely? Here are some tips to keep in mind.
1. Stay active and watch your weight.
Staying active and maintaining a healthy weight are important for your overall health and for your joints, says Seahorn. He notes that excess weight dramatically increases the impact you feel in your joints. One study published in April 2019 in The Journal for Nurse Practitioners found that for every pound of weight you lose, you can reduce the pressure on your knees when walking by as much as four pounds. In addition, being overweight has been shown to increase inflammation in your body, which can contribute to joint dysfunction, according to a study published in December 2019 in the journal Reumatologica Clinica.
Reducing the amount of pressure on the knees can be particularly important for people with TGCT, because both types of the condition — localized (the tumor occurs in a confined nodular area in the joint) and diffuse (the disease is more widespread throughout the joint) — can occur in the knee. As many as 75 percent of diffuse TGCTs affect the knee joint, according to a study published in February 2017 in the journal Orthopaedics and Traumatology: Surgery and Research.
2. Stick with your post-surgery physical therapy.
Surgery is the main treatment for TGCT, according to the National Organization for Rare Disorders (NORD). People with localized TGCT tend to have successful outcomes with surgery and experience low rates of recurrence of the disease, while those with diffuse TGCT, which is harder to treat with an operation, are more likely to experience a recurrence and may need to undergo multiple surgeries, according to the February 2017 study. For people whose TGCT is not likely to be treated successfully with surgery, a medication called pexidartinib, which was approved by the Food and Drug Administration in 2019, is a recent addition to treatment options for this condition.
Regardless of which type of TGCT you have, physical therapy can play an important role in postoperative recovery. “After surgery, a physical therapist can help a patient regain strength in the muscles around the joint and help them move again so the joint doesn’t become stiff,” says Robert J. Wilson, MD, an assistant professor of orthopedic surgery at the Hospital of the University of Pennsylvania, in Philadelphia.
A physical therapist can design a plan of care to reduce pain and swelling, restore range of motion, improve overall strength, and enhance functional mobility. “Due to inactivity and limited function, a person who has had surgery to remove a TGCT is deconditioned and has weakness in other regions of their body,” explains Seahorn. “We work closely with these people and their surgeons to ensure we address the whole body to restore their function to achieve the best possible outcome.”
Other practitioners can also help people with TGCT recover after surgery. For instance, if your hands are affected by TGCT, which is common in people with localized TGCT, according to the Orthopaedics and Traumatology: Surgery and Research study, it may be helpful to work with a hand therapist also. And an occupational therapist may help you heal after surgery while working to regain everyday skills to resume normal activities, adds Seahorn.
3. Choose low-impact exercises.
“For individuals with joint dysfunction, we generally recommend low-impact exercise regimens,” says Seahorn, including walking, bicycling, swimming, light strength training, and stretching. Working out on an elliptical or rowing machine may also be helpful, and your physical therapist may also recommend a water therapy approach such as water aerobics. “It may be easier to start with lower-impact exercises like a stationary bike or water aerobics and transition into a walking program,” Seahorn notes. “Walking helps build strength and endurance and even promotes bone health.”
Performing movements that involve multiple joints, such as doing reps of sitting and standing and raising your arms overhead with a light weight, can help maintain strength while minimizing risk of injury, he adds. Just remember to keep your aerobic activity at a comfortable level initially and then gradually increase from a moderate to a brisk pace — at which point you’ll find it difficult to carry on a normal conversation — over time, says Seahorn.
4. Be smart about strength training.
According to the Arthritis Foundation, strength — or resistance — training helps build muscles that absorb the shock that would otherwise impact your joints, which means that working out with weights or resistance bands can be important for people with TGCT.
Any strength exercises you do, such as weight lifting, should be “low impact, which means lower weight and a higher amount of repetitions,” recommends Seahorn. For strength exercises, try to perform at least 10 repetitions. If the weight is too heavy for you to complete 10 repetitions, reduce the weight. On the other hand, if you can do more than 10 repetitions easily, you can gradually increase the weight. Begin by performing two sets and then increase the number of sets gradually.
5. Incorporate yoga and tai chi.
Activities such as tai chi and yoga can improve overall mobility, flexibility, and balance, according to Seahorn. They’re also excellent ways to relax the muscles and increase range of motion, he notes. But make sure you take precautions, such as modifying these activities to ensure you don’t overtax your body and risk injury, suggests John Theodoropoulos, MD, an orthopedic surgeon at Mount Sinai Hospital in Toronto and with the University of Toronto Orthopaedic Sports Medicine Program.
6. Try gentle, relaxed stretching.
Range of motion is simply moving a part of the body as far as you comfortably can, Seahorn says. “Stretching would be taking that motion and pushing it slightly farther to elongate the tissue and expand the movement,” he explains. “When stretching, we recommend gentle, prolonged stretches of 20 seconds.” An example of a stretch for someone with a TGCT in their hip, Seahorn says, is the knee-to-chest stretch. For this stretch, lie on your back on the floor with both legs extended straight out. Pull your right knee to your chest, keeping your left leg straight and lower back pressed into the floor. Hold this position for 30 seconds and then repeat with your left leg. Your physical therapist can help you tailor stretches like these to your individual needs.
7. Add some balance exercises.
Balance is often overlooked in exercise programs, but it’s an important area to address as you get older, according to Seahorn. As we said earlier, tai chi and yoga can help improve balance, or you can try this simple exercise: Start by standing on a firm surface and raising one foot about 6 inches off the ground. Try to maintain that position for 10 to 15 seconds. Do this a total of 10 times, alternating feet. As it becomes easier, you can challenge yourself by standing on softer surfaces, increasing the hold time, or closing your eyes, says Seahorn.
8. Think warm as well as cool.
As with any workout, be sure to perform a gentle warm-up prior to any physical activity and a cooldown after you’re done.
9. Make a plan and stick to it.
Having a plan to follow is important for any fitness routine. With any exercise you do, focus on good technique and “quality over quantity,” Seahorn says. In general, keep all movements slow and controlled. “Variety is the spice of life,” he says, and keeping this in mind when it comes to exercise can help you reduce the risk of burnout and stick to your plan.
That said, keep in mind some important precautions before embarking on your exercise plan: Don’t start a new exercise regimen without first consulting your doctor or a physical therapist, as some activities may worsen pain; listen to your body; and stop and find an alternative if you have significant pain during an activity, Seahorn emphasizes. He also recommends reducing the intensity or duration of your routines if you experience pain for multiple days after exercise. Finally, Seahorn suggests working out with a partner. “This can enhance your enjoyment of the experience and also create accountability,” says Seahorn.
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