Is It Safe to Exercise with Osteoarthritis?

Is It Safe to Exercise with Osteoarthritis? A Physiotherapist’s Perspective

Throughout my career as a physiotherapist, some of the most remarkable client transformations I have had the privilege to witness have been in people with osteoarthritis (OA). 

Why? Well, many folks with OA enter the clinic burdened by severe pain, declining mobility, and worst of all, the belief that these limitations will be permanent. Often, however, after a few months of physiotherapy, they feel strong, empowered, and more physically capable than they have in years. How do they get there? While OA is a complex condition, which requires a multidimensional approach, it’s one which happens to respond very well to a type of treatment which forms the centrepiece of my clinical philosophy: therapeutic exercise.

Of course, this might sound a bit bizarre. After all, for years, OA has been framed as a disease of joint “wear and tear.” On the basis of that narrative, people with OA often reflexively avoid exercise, and become less active in fear that weight-bearing will cause their joints to wear down further and make their pain even worse. How could exercise help such a condition?

In recent years, our understanding of osteoarthritis has shifted dramatically. We now have plenty of research suggesting that OA is far more than “wear and tear.” Indeed, osteoarthritis is now understood to be powerfully impacted by metabolic, hormonal, and inflammatory factors [1], the complex interplay of which contributes to disease progression and the pain experience.  

To underscore the importance of looking beyond “wear and tear,” let’s pick apart the link between arthritis and obesity. For decades, the literature has shown that obesity increases a person’s risk of osteoarthritis [2]. But we’ve never conclusively known why.

One theory – in line with our prior understanding of OA – is that the correlation is a direct consequence of wear and tear. The heavier a person is, this theory goes, the more mechanical load their joints must bear, and the more likely they are to damage their joint surfaces. While this might make intuitive sense, recent research shows there’s much more to the story than bodyweight. Obese people, it turns out, also exhibit more low-grade systemic inflammation than non-obese people, due to the secretion of pro-inflammatory molecules called adipokines. These adipokines have been shown to trigger an inflammatory signalling pathway that contributes to the breakdown of cartilage on joint surfaces. 

So is it the mechanical loading (the wear and tear), or the inflammation which puts obese people at an increased risk of osteoarthritis?  

While that question hasn’t been answered conclusively, this is but one of the many links between system-wide metabolic health and the health of our joints, which might help explain what was once a puzzling fact: that runners – who load their knee joints a ton – have lower rates of knee osteoarthritis than people who are sedentary [3]. Under the “wear and tear” theory, this would make no sense, as a lack of activity would be expected to “spare” the joints. 

Given our updated understanding of the multidimensional nature of OA, it’s likely that recreational running’s numerous benefits on metabolic health (such as reduced inflammation, improved circulation, and more) are profoundly protective of our joints.

Other Ways Exercise Helps People With OA

So, we’ve established that exercise might help people with OA by improving metabolic health, which in turn improves joint health. How else might exercise be beneficial?

First, on a short-term basis, exercise triggers the release of endorphins and other natural painkillers in the brain, which according to some research, have a pain-relieving effect similar in magnitude to that of non-steroidal anti-inflammatory drugs [4].

Another worthwhile effect of resistance exercise, in particular: it strengthens the muscles around sensitive joints. In addition to directly improving joint health and augmenting system-wide metabolic health, some experts believe that the stronger the muscles around sensitive joints, the more they can buffer stress away from the joints themselves.

In light of all this, you might be wondering: is there a specific exercise regime which is optimal for people with arthritis?

Individualized Programming is Key

Unfortunately, there’s no one-size-fits-all protocol. Many different styles of exercise have been shown to help. In general, as I often tell my patients, motion is lotion. Whether you enjoy yoga, weight training, cardio, a specific sport or activity, the key is finding something that you enjoy and that your joints can tolerate.

If you’ve been inactive for a while, or are in the midst of a very severe flare-up, low-impact exercises like cycling, swimming and bodyweight resistance training are wonderful options as they provide huge joint health benefits while being gentle on your body.

If you’re able to tolerate it, however, don’t be afraid of load-bearing exercises like walking, running, or relatively heavy weight training. As we discussed above, our joints tend to respond positively to load, as long as the dose is appropriate! 

A Caveat

While the scientific literature suggests that exercise is among our best treatment options for people with OA [5], it isn’t a panacea for everyone. As with any treatment, some people will respond better than others. For the right person at the right time, medical interventions such as steroid injections and joint replacements can provide a new lease on life and are certainly worth exploring with a trusted specialist. Every person’s situation is different, and it’s critical to work with your healthcare team to find a treatment plan that works for you.

Where to Go From Here

If arthritis is preventing you from doing the things you love, reach out and book a physiotherapy assessment. Whether you’ve been exercising your whole life, and simply need to add in a few specific targeted movements, or you’ve never stepped foot in a weight room, we are here to listen to your story, collaborate with you to design a program to suit your lifestyle, and guide you on your first step towards your goals.

If you’re curious about physiotherapy, but still unsure whether it’s right for you, feel free to book a complimentary 15 minute consultation to get the clarification you need.

References

[1] Chen, D. I., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017). Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone research, 5(1), 1-13.

[2] Coggon, D., Reading, I., Croft, P., McLaren, M., Barrett, D., & Cooper, C. (2001). Knee osteoarthritis and obesity. International journal of obesity, 25(5), 622-627.

[3] Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy, 47(6), 373-390.

[4] Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane database of systematic reviews, (1). 

[5] Skou, S. T., & Roos, E. M. (2017). Good Life with osteoArthritis in Denmark (GLA: D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC musculoskeletal disorders, 18(1), 1-13.