Exercising with Knee Osteoarthritis - Busting the Myths
Osteoarthritis of the knee is a very common condition that affects millions of people worldwide. It is more common as one gets older, and in severe cases you can end up needing a knee replacement. Despite the common occurrence of knee osteoarthritis, there are still many misconceptions about this disease, especially when it comes to movement and exercise.
There is a common perception that osteoarthritis is worsened by activity because of a “wear and tear” effect. This would suggest that more movement or exercise would cause more damage, like your car tyres wearing over time. Over the last few decades, a lot of research has been done on how physical activity affects the progression of osteoarthritis. Recent research suggests that not only is physical activity safe if you have knee osteoarthritis, it actually can slow down progression of osteoarthritis and should be prescribed as first line treatment to improve pain and function. It is important to note that more pain does not necessarily mean more “damage” in the joint. Studies have shown that people without any symptoms can still have quite extensive degeneration when looking at their scans, while people with a lot of pain might have “better” looking scans. This means that a person’s symptoms and current level of function is more important to consider when prescribing treatment for osteoarthritis rather than only looking at their scans. This also means that while we may not be able to reverse degenerative changes on a scan, in most cases we can still greatly improve pain and function with a conservative approach.
Multiple studies have been done over the past few years to assess if running is dangerous for your knees. There is strong evidence that shows that the incidence of knee osteoarthritis is actually lower in recreational runners, and that running might be beneficial for the knee joint, having positive effects on the knee cartilage. Runners also have a lower risk of getting a knee replacement. There is, however, a trend that the risk of knee osteoarthritis might be increased among elite runners. This emphasises that runners who develop knee osteoarthritis should not be told to stop running, although it is advised to take certain precautions to promote joint health and reduce risk of injury.
The following tips can help to protect your joints if you are a runner with osteoarthritis:
Increasing your running cadence can help to reduce load on the knees. This means taking more steps per minute.
Avoid large spikes or rapid changes in your running program, like big increases in running volume or sudden changes to running on different terrains.
If you have an exacerbation of symptoms, reduce your running load and treat inflammation before returning to running, while still trying to stay active in ways that does not increase pain.
Follow a strength training program to improve strength and stability - this will reduce load on the joints and improve your quality of movement.
Maintain a healthy weight.
It should be noted that obesity is an important risk factor for knee osteoarthritis. People with obesity should be careful of how they increase physical activity so that they don’t affect the progression of knee osteoarthritis. Weight loss and initiation of physical activity should be recommended, although it is safer for people with obesity to start with lower impact physical activity before progressing to more high load activities. Even brisk walking for short periods at a time is still acceptable and will not cause progression of knee osteoarthritis.
Previous injury to the knee is also a risk factor for developing knee osteoarthritis. People with a history of knee injury should still aim to engage in physical activity, but should monitor their symptoms while gradually increasing physical activity. It is also important for these people to give enough time for rest in between physical activity to allow time for recovery.
In conclusion, a diagnosis of osteoarthritis is not a reason to stop or avoid physical activity, but rather all the more reason to engage in appropriate amounts of physical activity. Progression should always be slow and one should avoid sudden high loads of physical activity. Aim to find that sweet spot between doing too much and too little. Also remember that we should not worry too much about degenerative changes on a scan. A “bad” scan does not necessarily mean more pain and need for drastic intervention! Book an appointment with your physiotherapist or other health professional today to start working on a plan to get active and keep your joints healthy.
Voinier D, White DK. Walking, running, and recreational sports for knee osteoarthritis: An overview of the evidence. Eur J Rheumatol. 2022; 10.5152/eurjrheum.2022.21046
