A few weeks ago, I was walking around the Sunnyvale, CA Farmers market and saw a woman in her 40s walking with a cane. As I observed her walking (like a typical physical therapist), I overhead her telling someone she had osteoarthritis in her knee and was contemplating surgery. Before I could make a helpful suggestion, I lost her in the crowd.
Osteoarthritis is often lost in the world of disease, but it is the most common rheumatic disease. Osteoarthritis primarily affects the articular cartilage and the subchondral bone of a joint, eventually resulting in joint failure. People with progressive symptomatic knee osteoarthritis experience pain and increasing difficulty with daily functional activities. In fact, knee osteoarthritis bears more responsibility than any other disease for disability in walking, stair climbing and housekeeping.
Currently, no cure for osteoarthritis is known. However, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to exercise therapy. Exercise therapy takes a multitude of forms and results in numerous systemic and local effects, some of which have been investigated among people with knee osteoarthritis. Therapeutic exercise covers a range of targeted physical activities that directly aim to improve muscle strength training, neuromotor control, joint range of motion, and aerobic fitness. One of the main aims of exercise is to improve muscle strength, given that weakness is common in knee osteoarthritis. Strength training of sufficient dosage can address muscle weakness by improving muscle mass and/or recruitment. Pain must be considered and may be a barrier, hence leading to underdosage of the strength stimulus. Enhanced strength of the lower limb may lessen internal knee forces, reduce pain and improve physical function.
Increased muscle strength may modify biomechanics, resulting in a decreased joint loading rate or localised stress in the articular cartilage, thereby playing an important role in delaying progressive knee osteoarthritis.
Fransen (2015) reviewed the entire body of research regarding osteoarthritis exercise programs and concluded the following:
- High-quality evidence suggests that land-based therapeutic exercise provides benefit in terms of reduced knee pain and improved quality of life and moderate-quality evidence of improved physical function among people with knee osteosteoarthritis.
- It can be assured that any type of exercise programme that is performed regularly and is closely monitored can improve pain, physical function and quality of life related to knee osteoarthritis in the short term.
- The magnitude of immediate treatment effects of exercise on pain and physical function increases with the number of face-to-face contact occasions with the healthcare professional.
- Mediating effects of exercise dosage and disease severity on the effectiveness of exercise could not be ascertained because of large variability in reported data.
Clearly, more research is necessary, but until more research is done, keep these 5 tips for osteoarthritis exercise programs.
- Combine Aerobic and Strength Training: Too often strength training is avoided in people during osteoarthritis exercise programs. Strength training is an essential aspect for improving strength, but also improving biomechanics and reducing knee joint loading. If you are deconditioned or in pain, start with isometrics. Isometrics are great for activating the muscles without movement. Also, start with only one set of a few repetitions (4 – 6) to become familiar with the motion.
- Avoid Pain: This may sound obvious, but it isn’t! Too many times strength coaches and physical therapist will push the osteoarthritis exercise programs into pain. Instead, ease into the program and if there is pain, ease off. There are plenty of exercise alternatives, don’t settle for pain!
- Consider Nutritional Consultation: Research suggest reducing weight in people with osteoarthritis greatly reduces knee arthritis discomfort. Like all weight loss programs, nutrition plays a vital role. Ensure you’re tackling the condition from all angles.
- Having a Flare-up? Work Another Area: Too often it is all or none. If someone is in pain, then the entire osteoarthritis exercise routine is stopped. Instead of completely stopping the program, work on another area. If the knees are flared, work on the shoulders. If the neck hurts, work on the lower body with the neck in a neutral position. Exercise provides numerous benefits, so don’t simply stop exercise if you’re in discomfort, work around it!
- Don’t Forget the Muscles: Osteoarthritis is a condition within the joints, but if the muscles surrounding the joints are tight, they can increase joint stress and discomfort. There are many soft tissue tools for improving muscular discomfort. Work on improving these areas and see if the joint pain reduces.
Summary of 5 Tips for Osteoarthritis Exercise Programs
If you have osteoarthritis, get started with an exercise program! Many studies show it can help reduce pain and symptoms! Just remember to keep these 5 osteoarthritis exercise program tips in mind and start reducing your pain and living a healthier life today! If you know someone with osteoarthritis, find them a strength coach or physical therapist who can help them reduce pain, improve function, and live a healthier life!
- Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL.Exercise for osteosteoarthritisrthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015 Dec;49(24):1554-7. doi: 10.1136/bjsports-2015-095424. Epub 2015 Sep 24.
Written by Dr. John Mullen, DPT