In this article, we want to address two of the biggest factors that affect someone’s progress when it comes to knee pain. We are going to use the example of osteoarthritis for sake of ease here, but the principles are the same for any condition.

Everything in the article is aimed to be as practical as possible, while give a brief synopsis into the key things you need to know to be able to deal with pain & flare-ups as they come about. This is particularly important to be aware of at the beginning of a new exercise program!


“He Who Treats The Sight Of Pain Is Lost”


How to manage flare-ups


Unfortunately, flare-ups happen. Sometimes we know why, and sometimes there is no discernible pattern to them. They are an unfortunate reality of chronic knee conditions but that doesn’t necessarily mean you should stop what you’re doing.

Taking note of the above quote “He who treats the site of pain is lost” helps us to lock in on one of the key concepts to effectively treating flare-ups. Essentially, by being aware that pain in a particular area of the body can be a sign of many different things & not just damage to that particular area, we can help to put our minds at ease about flare-ups in general. Check out our top 7 tips for managing flare-ups below to get a further idea of how to apply this to your situation.


7 tips for when a flare-up strikes:

 1. Don’t panic – Wait it out, be confident that it will settle, and remember that pain does not always indicate damage.

 2. Relative rest – Don’t stop everything but reduce the things that cause large amounts of pain. For a day or two, you might have to take it slower than usual, and that’s ok. It is better to keep moving within a   reasonable pain limit than to avoid things altogether.

3. Ice, Compression, and Anti-inflammatories – 3 tools to help settle pain and inflammation. Use for a couple of days when pain is at its peak, but try not to rely on them.

4. Hydrotherapy or Cycling – Getting in the pool or on a bike will work muscles in your legs without putting much stress on your knee joints. These activities can be pain-free during a flare-up and allow you to maintain some level of exercise.

5. Minimise life stress – Pain can be influenced by psychological factors. Do your best to minimise any stress in your life. A relaxing massage is a great way to reduce stress levels.

6. Get your nutrition right – Make sure you are well hydrated and consuming a wide variety of foods, especially fruit and vegetables. This is important for general health and knee health. Omega-3 fatty acids found in fish are also natural anti-inflammatories. To see more about specific changes that can made, check out our article on lifestyle HERE.

7. Optimise sleep – Sleep is essential for recovery and pain management. Poor sleeping patterns can impair the adaptations we’re trying to achieve through exercise, increase your risk of injury and also lower your threshold for pain.


Pain & Your Knees

Tying into the above concepts on flare-ups, it is worth going a little deeper into the specific of pain & how this plays into our experience.

Did you know that pain is a misleading indicator of improvement? Wherever possible you should try to focus on function, instead (sometimes easier said than done). We will explain why below.

Is knee & hip pain normal after exercise?

Once we are satisfied with your movement and the intensity of your program is increased, some muscle soreness may be experienced (also known as delayed onset muscle soreness or DOMS) after some of these sessions. This is due to a change in loading of the muscle that is outside what the muscle is accustomed to in day to day life and while uncomfortable, generally subsides in a short few days. After 2 weeks of consistent training, you should notice a significant reduction in the amount of soreness you experience in your muscles after training sessions.  

Remember it is perfectly normal to experience some knee pain after your sessions. In order to progress and improve function and movement competency, you have to challenge the integrity of the joint! 

It is not uncommon for individuals to experience some knee joint discomfort during exercise and this does not mean that the knee is getting worse. Any discomfort experienced during exercise that subsides directly after you stop is not indicative of risk of damage or injury. However, if you experience an increase in pain or swelling during or following the exercise sessions that lasts more than several hours, it may mean that the exercise program needs to be modified. Speak to your practitioner while at MTP and let us know how you are feeling during your exercises as communication is always key to ensuring the most effective intervention.

Remember that progress may take time and learning how your body responds to movement and activity is part of the process. As strength, mobility and stability increases, the joint capsule itself will experience less improper loading, leading to a decrease in pain experienced during movement. Regardless, as your strength improves, your functional capacity and ability to perform day to day movements will increase despite any pain or discomfort experienced.

Overall, long term exercise effectiveness and adherence is vital to improving your hip & knee function and progressing through your rehabilitation.

For those who like detail, read on for a bit more on the science of pain….

Pain is a long studied and misunderstood concept, however recent insights have led to greater understanding of what pain is and how it comes about. The first thing we need to realise is that pain is an output of the brain, not an input from the tissues of the body. What the tissues do is send a danger signal to the brain which it then decides what to do with. This is a difficult concept for some people to comprehend so it is best explained through the use of a few examples.

Person A is perfectly healthy with no existing issues or injuries. They inadvertently put their hand on a hot saucepan. The cells in the hand send a danger signal to the brain which then assesses the situation. The brain gets information from the eyes, seeing a saucepan over a flame, thinks back to the recent memory of you turning on the stove and thinks further back to previous experiences. It knows that fire is hot, heat can damage the skin and cause injury so it sends out a pain signal they move their hand away from the saucepan. In this scenario, pain has served its purpose as a protective mechanism.

The brain does not always follow this process. For example, Person B is an elite athlete playing in an important game. They suffer a traumatic injury, one that would normally leave them lying on the ground in agony. Despite this, they shake it off and continue playing, and it’s not until after the game that it begins to hurt and they realise they’ve injured themselves. What’s happened here is that in the state of excitement about the game the brain has received the danger signal but processed everything else that is going on and decided that the injury is not a priority (and the same is true of soldiers in battle, or other people in life threatening circumstances). The priority is to finish the game (or get out of the battle) and once that is done, then the brain will send out pain signals for Person B to deal with the injury.

Our final example is the other of the spectrum. Person C has a bad back. They injured it 15 years ago and have had intermittent flare ups ever since. Every time it does flare up, they are in pain for a while, sometimes missing out on work and are unable to play their favourite sports. Due to this constant reinforcement, anytime a danger signal comes from their lower back, their brain is so wound up about the prospect of another flare up that it sends excessive amounts of pain out to stop them moving their back. However, this becomes counter-productive because not moving their back means it gets tight and weak and when they do need to use it they are at increased risk of re-injury. Further, the brain’s pain signals are not helping so the brain increases its output of pain, to the point where any signal from the back is interpreted as dangerous and elicits a pain response. This wind-up in the pain process is known as chronic pain and can be extremely debilitating.

 So what can we do about it?

What is required is actually the opposite of what the brain wants. Person C needs to move their back, get it stronger and retrain the brain that any movement of the back does not equal danger. However, we do need to be aware of the pain process, and more importantly, realise what is appropriate and inappropriate pain. As we start exercise, pain may increase. This is normal even for someone who is uninjured. However, the pain should plateau at a manageable level and, once we finish exercising, the pain should decrease. Maybe not to baseline but it should go down. Inappropriate or bad pain is where the pain continues to worsen and becomes unmanageable. If this is the case, then we need to stop what we’re doing and either take a break or change exercise. Recognising the difference between appropriate and inappropriate pain is crucial to retraining the pain pathway and recovering from chronic pain issues.


The Team @ MTP

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