22 Nov Exercise and Osteoarthritis
As outlined in Osteoarthritis – What is the best treatment?, exercise is one of the first line treatments for this condition.
What exercise is best?
Land-based exercise such as walking and strength training are all effective in managing OA. We recommend any exercise or group of exercises that will:
- Load the joint (weight-bearing exercises) eg. squats for hip and knee
- Strengthen muscles around the joint
- Move the joint
- Improve neuromuscular control- quality of movement and function
- Help lose weight (if required)
What does the evidence say about exercise and Osteoarthritis?
1. Exercising appropriately does not cause harm to the cartilage, and instead can improve cartilage health.
2. Exercise does not impact biomarkers that are associated with inflammation or cartilage turnover that are associated with Osteoarthritis.
3. Exercise benefits Osteoarthritis symptoms in the knee and hip more than the use of paracetamol or NSAIDs
4. Supervised and individualised exercise programs are both cost-effective and yield clinically-effective results
5. Neuromuscular exercises have shown to have a great effect in people with osteoarthritis, and therefore should be an integral part of the rehabilitation process.
6. 2 in 3 people who complete conservative management prior to a joint replacement end up delaying or not undertaking a joint replacement, therefore showing that conservative management should be trialed prior to surgical intervention (Skou et al., 2018).
How can I use exercise to treat my Knee or Hip Osteoarthritis?
At SportsFit we currently have the GLA:D program which encompasses all of the above and education. Exercises are also supervised and progressed individually which has been shown to be most effective. Read HERE for more information on GLA:D.
Depending on your physical capacity and exercise preferences, our physios in Glen Iris and Malvern East can tailor an exercise program to suit your situation.
When I exercise it hurts, so am I causing harm?
No, a recent review article on the most relevant research concluded “knee joint loading exercise seems not to harm articular cartilage in participants at increased risk of, or with, knee osteoarthritis.” (Bricca et al. 2019). The biggest key is to find the APPROPRIATE amount of exercise. Too little exercise is not enough to stimulate cartilage regeneration. Too much exercise can make your symptoms worse. Given some degree of loading (exercise) is beneficial for cartilage regeneration, it is important to find an amount of exercise that’s right for you.
Pain can be a useful guide to help determine this, as seen below.
Is it okay to exercise when it hurts?
Yes, it is okay to exercise while in pain. It is important to differentiate between muscle and joint pain. Your joint pain should never exceed your acceptable limit of pain DURING exercise. This joint pain should ALSO return back to baseline (pre-exercise) levels within 24 hours of exercise. You should lower the intensity of your exercise if joint pain goes over your acceptable limit or continues for over 24 hours.
Note: it is normal to experience a slight increase in pain at the commencement of a new exercise program
References:
Abbott, J. H., Wilson, R., Pinto, D., Chapple, C. M., Wright, A. A., & MOA Trial Team. (2019). Incremental clinical effectiveness and cost effectiveness of providing supervised physiotherapy in addition to usual medical care in patients with osteoarthritis of the hip or knee: 2-year results of the MOA randomised controlled trial. Osteoarthritis and Cartilage, 27(3), 424-434.
Ageberg, E., & Roos, E. M. (2015). Neuromuscular exercise as treatment of degenerative knee disease. Exercise and sport sciences reviews, 43(1), 14-22.
Bricca, A., Juhl, C. B., Steultjens, M., Wirth, W., & Roos, E. M. (2019). Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. British journal of sports medicine, 53(15), 940-947.
Skou, S. T., Roos, E. M., Laursen, M. B., Rathleff, M. S., Arendt-Nielsen, L., Rasmussen, S., & Simonsen, O. (2018). Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis and cartilage, 26(9), 1170-1180.
We acknowledge The Royal Australian College of General Practitioners (RACGP) Guideline for the Management of Hip and Knee OA 2nd Edition (2018)