“I can’t workout. My doctor says my knee is ‘bone on bone’!” If I had a dollar for every client who told me that they needed to avoid exercise due to their arthritis, I would be very wealthy. But rather than be wealthy, I’d prefer my clients to know the truth about exercises for arthritis.
While arthritis is very painful and can be debilitating, it’s actually essential to exercise with arthritis to help reduce pain and improve function, in order to maintain independence.
This article will discuss what arthritis is, how it’s diagnosed, and what exercises are best for arthritis.
What is Osteoarthritis (OA)?
Let’s start with just breaking down the word:
Osteo– means “bone”
Arth- means “joint”
–Itis means “inflammation”
So osteoarthritis, which is commonly called “OA” and also known as “degenerative joint disease” is joint inflammation of the bones in our joints.
It is the most common type of joint arthritis.
Osteoarthritis (OA) is caused by degeneration of the bone and cartilage over time.
Common Causes of Arthritis
- Damage to the joint caused by repetitive injury/wear and tear/stress
- Aging
- Women are more likely to experience this than men
- Obesity
Which Joints Are Commonly Impacted?:
It is commonly seen in hands, back, knees, hips (i.e. joints that do a lot for us, and experience a lot of wear and tear).
How is Arthritis Diagnosed?
This condition is diagnosed based on symptoms (pain, noisy joints, stiffness, etc.) and an X-ray.
The Pictures Online Look So Painful! Is That What My Joint Looks Like?
There are different stages of OA, so your joint doesn’t necessarily look like those photos. It is likely that the joints in the really extreme photos are in Stage 4, or the “severe stage” of OA.
Stage 0: Normal knee (no damage, no pain)
Stage 1: Minor (the joint has clear wear and tear and it’s possible bone spurs have started to develop
Treatment Recommendations: Exercise and possibly taking supplements
Stage 2: Mild (More bone spurs are seen on X-ray, mild pain, especially first thing in the morning, after sitting for a long time, and joint space is normal)
Treatment Recommendations: Exercise, particularly focused on strengthening; braces may be used and/or change in footwear
Stage 3: Moderate (Increased inflammation and decreased joint space, bone spurs become rougher, leading to increased pain with activities like walking, kneeling, jogging, and popping may occur)
Treatment Recommendations: If physical therapy/exercise and NSAIDs are not helping, the client may benefit from hyaluronic acid injections. Typically, this treatment requires 3-5 injections over the course of weeks, and pain generally remains decreased for around 6 months.
Stage 4: Severe (The joint space is significantly reduced, and cartilage is wearing off, due to increased number of bone spurs, pain with movement is very severe)
Treatment Recommendations: Joint replacement1
Okay, So I’m Stage 4, I Guess Exercise Won’t Help, Right?
Wrong!
Let’s remember what the goal is- to help decrease pain and increase function.
The goal is not to get the cartilage back, because that’s impossible!
If you are at Stage 4 and aren’t going to have surgery or a joint replacement, it’s vital to continue to exercise in ways that build up the strength around the joint, as well as the muscles in other parts of your body to help reduce the amount of stress/load your joint takes.
Also, not moving joints can lead to stiffness, which causes pain, and inability to use.
Yes, it may not always feel good to exercise with a more severe level of OA, but it’s important to weigh the pros and cons.
Also! Tell your therapist if there are exercises you like that don’t cause you pain. Or challenge your therapist to find some for you- a good PT/OT will rise to the challenge!
Okay, So How Does Exercise Actually Help?
The ends of the bones that make up our joint are lined with a cartilage called “articular cartilage.” This type of cartilage does not have a good blood supply, so it relies on compression forces to get its nutrients.
How it works (let’s use the knee as an example):
We can think of the articular cartilage like a sponge that has fluid in it. It’s also surrounded by fluid within the knee joint space.
When my knee joint is compressed (i.e. when I put weight on it as I step forward) the articular cartilage is compressed, causing fluid and waste materials to leave the cartilage. When pressure in the joint is removed (i.e. when I place my weight on my opposite leg) fluid moves back into the cartilage, this time along with oxygen and nutrients. 2
So our articular cartilage likes compression!
What it doesn’t like is shear forces. Which can be caused by improper form with high impact activities like running, exercises moving heavy ankle weights through the air, and cutting activities like sports. This can cause damage to the joint over time, and can lead to breakdown of cartilage. Once the cartilage is gone (i.e. Stage 4) it can’t be repaired.
What we want to do with exercise is increase the nutrients and oxygen to the cartilage that is still there and also increase the joint space.
Increasing the joint space will allow for more of that good fluid to move into the joint and more of the waste and/or inflammation to leave the joint.
The way we increase good compressive forces at the joint and increase joint space is by building up the muscles around it.
Additionally, building up the muscles that make up our core (back muscles, buttock muscles, abdominal muscles, pelvic floor muscles) help us to stabilize better when we are performing activities, which decreases unnecessary stress on other joints.
What Exercises Should I Do with My PT?
This, of course, will depend on your stage. In therapy, we focus on increasing the compressive exercises, rather than the shearing exercises.
In the therapy world, we call this “Closed Kinetic Chain Exercises.” It’s not super important what that means, but basically it means exercises where your foot (or whatever body part you’re working on) is in contact with the ground or another surface (like a leg press).
Examples: Squats with proper form, standing, step ups, heel raises
Exercises we usually (emphasis on usually, each therapist has his/her reason for choosing an exercise, so feel free to ask!) stay away from when someone has painful OA are what we call “Open Kinetic Chain Exercises” that involve the injured joint. As you might have guessed, open kinetic chain is when the foot is not in contact with the ground or another surface.
Examples: Leg kicks with weights at the ankles, the leg extension machine at the gym
What Exercises Should I Do at Home?
Exercises that help decrease the impact will likely help decrease pain.
Walking, instead of running, for example, may lead to less pain. Swimming and biking are also great options.
Remember that sitting and in-activity can lead to more joint stiffness, so it’s important to complete your home exercises prescribed by your therapist and to get some movement in every day!
Have the Strength to Live Life to the Fullest!
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Below are links to my infographic
Sources:
- https://www.ibji.com/blog/orthopedic-care/arthritis-in-knee-4-stages-of-osteoarthritis/
- https://orthop.washington.edu/patient-care/articles/arthritis/joints.html#:~:text=Articular%20cartilage%20does%20not%20have,together%20with%20oxygen%20and%20nutrients.
- All photos created on Canva.com
