Exercise for Arthritis
Exercise for arthritis
If you’re 40+ and have pain in your knees, hips, shoulders, thumbs, or any joint, you’ve likely been told that you have "arthritis". Perhaps you’ve heard that you should stop running because of too much impact on your joints, or that you may end up needing a total joint replacement one day.
But I’m here to tell you that if you have arthritis, you are *not* doomed to a life of pain and surgery. This is a brief primer on what osteoarthritis is, what it's not, what the research says, and what you can do today to improve your quality of life.
Osteoarthritis (OA) is a common joint disorder that leads to changes in the bone, cartilage, and soft tissue structures of the joint. These changes occur both on the microscopic, cellular level and on the macroscopic level, which can be observed on X-ray or MRI. It is distinct from other types of arthritis, such rheumatoid arthritis or psoriatic arthritis.
Some people with OA develop pain, and some people do not. A minority of people with painful arthritis go on to have surgery, but the majority of people do not. Painful osteoarthritis can be a minor life inconvenience, a major debilitating condition, or anywhere along a spectrum of severity. Painful osteoarthritis can lead to joint pain and stiffness, reduced exercise tolerance, physical function, sleep, mood, well-being, and quality of life. Risk factors for developing OA include genetics, obesity, previous injuries, and lifestyle.
Adults with painful OA are less likely to meet physical activity recommendations and more likely to suffer from other serious health problems, such as heart disease, obesity, high blood pressure, diabetes, depression, chronic pain, and sarcopenia (muscle weakness impacting daily function).
Exercise is the only treatment that can directly address OA-related pain and loss of function, AND all these other comorbidities with very low risk. Supervised exercise should be a required, first line treatment for anybody with painful osteoarthritis and physical therapy should be a leading member of everyone’s OA treatment team. Exercise can reduce pain as much as oral analgesic pain medications.
There are many misconceptions about OA and what it means for a person’s life and function. These harmful myths can steer people away from the most powerful treatment known yet, especially early on in the progression of OA: movement and exercise.
Myth #1: Your joint is “bone on bone”.
All medical professionals should stop using this harmful phrase. While OA is medically characterized by decreased “joint space” on an X-ray, it’s not necessarily true that you will have pain, even if you have decreased joint space on imaging. If you do have pain, and want to manage your pain, preserve your function, and decrease your chance of needing surgery, the phrase “bone on bone” certainly doesn’t help. It is more productive to focus on what is within control. You can control your activity level, your strength, your balance, and your function. It will be time (and money) better spent working with a physical therapist, personal trainer, in a fitness class, or on some good running shoes to invest in fitness, than worrying about your “bone on bone” knees.
Myth #2: Arthritis is a disease of “wear and tear”.
Let’s replace this phrase with “wear and repair”. Your body is a complex ecosystem that is always remodeling, renewing, restoring, with the goal of homeostasis of the joint environment. Studies comparing the knees of runners and non runners (on X-ray or MRI imaging) show consistently that runners have better looking knees on imaging than non-runners and have higher overall function than non-runners into older adulthood (https://www.jospt.org/doi/full/10.2519/jospt.2017.7137).
Myth #3: Your pain will get worse and eventually you will need surgery.
This message is very discouraging and daily management efforts, such as exercise, seem futile and perhaps even harmful. It’s also false. Only a minority of people with OA need surgery. Exercise has been unequivocally demonstrated by research to decrease pain and increase function in painful joints.
Myth #4: You must lose weight if you want to feel any improvement.
While obesity is associated with both increased risk of developing painful OA and increased loading on the joints, research shows that exercise alone is enough to create meaningful improvement in pain and function for individuals with painful OA . This is important, because losing weight is much more challenging than developing a consistent exercise regimen. While both weight loss and good nutrition combined can improve OA symptoms more than exercise alone, do not be discouraged if you struggle with weight loss. Getting moving will put you on a path to improve your OA symptoms, your overall function, and help you lose weight. Start where you can, now.
When these myths are believed and embodied, they can lead to more expensive, risky, experimental treatments, decreased physical activity, more fear of movement. The logic looks something like this:
(Bunzli et al, 2019)
Instead, let’s take a more positive, empowering approach to managing OA. Exercise is an evidenced based, powerful way of optimizing the cellular repair processes, decreasing inflammation, decreasing pain, maintaining function, and affecting mental health. Surgery is not inevitable; but even if you do need surgery, exercise is the best preparation for a great surgical outcome.
Here are some steps you can take today to get or stay on the right path:
Step #1: Educate yourself.
Here are some wonderful, free, evidence-based resources:
OA Optimism: Fantastic YouTube video series with exercise programs by Canadian physiotherapist and researcher Greg Lehman: https://www.youtube.com/playlist?list=PL8IrcLaawK51MilbxYq0y7qLwrphDrlfX
Arthritis Foundation: https://www.arthritis.org/
Osteoarthritis Action Alliance: www.oaaction.unc.edu
Step #2: Seek support and get moving.
You may need support or supervision throughout your journey managing OA. Physical therapy should be your primary resource for OA education and management if pain is impeding physical function and quality of life. A physical therapist can prescribe an individualized, appropriate exercise program and help you negotiate common barriers, such as pain or help you create a road map for your goals.
Step #3: Keep moving!
Commit to an enjoyable, consistent exercise program that suits your schedule, interests and budget. Your health, function and happiness are well worth the investment. This may include ongoing physical therapy or transitioning to a personal trainer for maintenance and ongoing education. High quality exercise classes are more economical than 1-on-1 training sessions and offer social support, accountability, and a challenge level that you may not subject yourself to. Hanuman Health Club offers two weekly Strength & Balance for Older Adults classes (full disclosure, I teach one of them) in addition to strength, fitness and mobility classes for people of all ages. Activities with a partner or with friends, such as jogging, walking, hiking, dancing, or taking fitness classes together, can help make your exercise program meaningful and more connected to people you care about.
The future of your arthritis is quite literally in your head. How you interpret your diagnosis and how you choose to manage your arthritis will determine your quality of life going forward. It could be the difference between getting surgery or not. Even if you do end up needing surgery, proactive self-management now will better prepare you for the tough rehab ahead; we call this “prehab”.
For more information, contact me at joanna.physicaltherapist@gmail.com. I am available Mondays and Tuesdays for one-on-one physical therapy sessions. Let’s discuss your OA management strategy!