Exercise and Osteoarthritis: Science says stay active.
Osteoarthritis is usually not a mechanical wear and tear process. If you have osteoarthritis, exercise will not wear out your knee joints faster — quite the opposite. Therapeutic exercise has been proven to relieve the pain of mild knee arthritis and does not harm the cartilage. This post will dive deep into the science to support why we should start to exercise to improve knee pain associated with osteoarthritis.
How many of you have been told to rest and stop running or exercising because you have knee arthritis? Far too many people believe that arthritis is caused by mechanical wear and tear. It’s only natural that you might assume that your arthritic knee pain will worsen with exercise. Too many health care professionals counsel their patients to stop running, speed walking, elliptical, treadmill, etc. to “save” their joints. Most of the time, you need to do just the opposite. The research over the years has been unequivocal.
Running may improve cartilage nutrition
Exercise has been proven to be the most effective treatment for early and moderate osteoarthritis of our joints. Exercise improves all-cause mortality and decreases your risks associated with muscle loss, frailty, sarcopenia, and so on. We are going to walk through the current research and evidence-based recommendations for the management of arthritic knee pain.
What are the causes of osteoarthritis of the knee?
There are many potential causes of osteoarthritis of the knee. In people without prior injuries osteoarthritis is usually a biologically mediated inflammatory process…. what does that mean?!? In our joints, we have 100s of proteins, cytokines, chemicals, and other compounds which are made by the synovium, or the lining of the knee joint. When our joints are healthy, the chemicals in our joint support cartilage health and nutrition. Whether it is due to injury, or our metabolism, weight, and diet — a switch flips. Changes occur in our knee joint that is similar to the changes associated with other chronic disease states. That switch turns on genes in our DNA that increase the production chemicals that are hostile to the health of our cartilage. So over time, an increase in those unfriendly chemicals eventually cause cartilage cell injury. That weakens the cartilage and its ability to withstand stress.
If the cartilage is not functioning well, or if it becomes thinner, it can lead to pain, inflammation, warmth, and swelling. Osteoarthritis appears to be caused by low-grade chronic inflammation. This is the same chronic inflammation held as a cause of other chronic diseases such as Type 2 diabetes, heart disease, and fatty liver. Much of the chronic disease burden that affects us appears to have a metabolic etiology or cause. Exercise has been proven to decrease the concentration of proteins and compounds in our knees that are hostile to cartilage health.
Yes, there are mechanical causes of osteoarthritis. People with severely bowed knees or knock knees are more prone to developing arthritis. That’s because you are overloading one side of the knee joint if your knee is mal-aligned. If you had a meniscus removed because of a tear, you are also at an increased risk of developing osteoarthritis. Certain fractures or broken bones that involve the knee joint can lead to post-traumatic osteoarthritis. That form of arthritis is rarer, and it is due to the injury subsequent mal-alignment after the fracture heals.
What are the symptoms of knee arthritis?
The symptoms of arthritis of the knee can vary significantly. With mild arthritis, many people will have an ache associated with walking, stairs, or running. The location of the ache or pain can be on the inner side of your knee, the outer side, or even in the back of the knee. Osteoarthritis in some people will produce swelling, or what is commonly referred to as “water on the knee.” Therefore some of you may have swelling of the knee while others will not. Depending on the location of arthritis within your knee, it can feel like it wants to give way. A feeling of grinding or “crepitus” is a common complaint. When the inflammation due to the arthritis increases, you may have pain in the knee at night. That’s why you may reach for a pillow to put between your knees when you sleep. Morning stiffness of the knee, or stiffness if you have been sitting for a while is a common complaint if you have inflammation associated with knee joint cartilage degeneration.
The cause of osteoarthritis of the knee is not entirely clear. Very different clinical pictures emerge when we see people in our offices and clinics. Some of you have mild arthritis that does not bother you much. Arthritis might progress or worsen slowly over decades, or it might progress more rapidly. In some, the pain you have might be minimal, and in others, the pain might be severe, regardless of how your X-rays look. That means that we have some patients with mild arthritis on an Xray, but they have severe pain and swelling. Others might have only a little pain despite X-rays that show severe arthritic changes.
Can I exercise with arthritis of the knee?
For more than two decades, the research has clearly shown that exercise is of benefit in people with osteoarthritis of the knee. Exercise improves pain, strength, and decreases muscle atrophy. Exercise can improve your quality of life and help delay the need for surgery. So.. if someone tells you to rest because you have osteoarthritis… kindly say no.
Osteoarthritis is not caused by walking too much or low impact activities. If your arthritis pain is due to severe osteoarthritis, then you may need to consider other treatments above and beyond exercise. Exercise has significant anti-inflammatory effects. This is somewhat counter-intuitive, and I often have difficulty convincing people of this. That’s because far too many people still think the knee arthritis has a wear and tear etiology. The benefits of exercise are enormous. There are more than a dozen chronic disease states that will improve if your exercise. Most of you will feel better if you exercise. The reasons for this are complex, but the results are straightforward. You will be healthier, lighter, feel better, and often have less pain if you exercise regularly — even with mild to moderate osteoarthritis of the knee.
A proper exercise program to combat the age-related changes that we all experience will include aerobic exercise (walking, running, biking, swimming, etc.), resistance exercise, and balance exercises. These different forms of exercise help minimize the risk of developing age-related muscle loss (sarcopenia), heart disease, dementia, type 2 diabetes, hypertension, and so on. This post on our site goes into more detail about the specific exercise programs we should be interested in to optimize our lives for a longer healthspan.
Running and arthritis of the knee
Far too many people still believe that running causes arthritis and knee joint deterioration. Recreational running, even those of us who have been running 20 miles a week for 40 years has not been associated with an increased risk of developing osteoarthritis. Study after study reveals there is no conclusive evidence that running causes osteoarthritis of the knee; in fact, running may actually slow the functional aspects of musculoskeletal aging. Various initiatives have evaluated the risk of developing arthritis or the risk of worsening osteoarthritis of the knee in runners. There is no conclusive evidence to suggest that running is going to cause arthritis to worsen. We published a few posts on this website on the topic of running with osteoarthritis and meniscus tears. Feel free to dive deeper by reading those posts.
Why you should exercise with knee arthritis
For most people, aerobic activity is associated with improved arthritic symptoms, less pain and less disability. More importantly, running has not been shown to cause more advanced osteoarthritis. Even as far back as 1986 early studies on runners showed that their bone density increased (that’s good) and there were no signs of increasing osteoarthritis in male or female runners. Like other aerobic forms of exercise. There are numerous health advantages to running. For now, it appears very clear that the risk of not performing aerobic exercise is much higher than the risk of causing worsening arthritic pain. Osteoarthritis of the knee is associated with an increased risk of all-cause mortality. That means that exercise and maintaining physical activity is critically important for your health and well-being, so keep on trucking and if you need any help why not call the clinic and arrange for one of our team to assess and guide you through your fitness programme.