Osteoarthritis and Exercise: Should you train through the pain? What can you do about it? 

By Nick Burrows – Exercise Physiologist

Osteoarthritis (OA) is a degenerative joint disease characterised primarily by pain, but also stiffness, crepitus (joint cracking) and reductions in strength. The most common form of OA is knee OA but nearly any joint in the body can be affected. The exact cause of OA is unknown but there are a number of risk factors. Occupational overuse and obesity are major risk factors for both knee and hip OA. It is a common conception that sport, especially running is a risk factor for knee or hip OA. There is no evidence that this is the case however, previous injuries (which often are the result of sport or running) are definitely a risk factor. 

There is no cure for OA so treatment revolves around symptom management. Whilst traditionally medication was the main method used to manage pain, recent research has shown that exercise is just as effective and does not have the accompanying negative side effects. Exercise can temporarily exacerbate symptoms of OA, which can be discouraging. However this exacerbation is unrelated to the overall disease progress and is merely a sign that you may have overdone it a bit.

Interestingly, my research showed resistance exercise can reduce pain systemically (that is across the whole body). So even if you’re knees are too sore some days, doing some upper body work will help, any movement is better than nothing.

Therefore the keys to exercising with OA include:

• Avoid or modify exercises that exacerbate symptoms too much, often repetitive dynamic loading like jumping or running downhills are very painful.
• Mobilise and strengthen surrounding joints to take as much load off the affected joints as possible.

It is also important to manage symptoms through other means:

• Maintain a healthy diet and avoid inflammation promoting substances like alcohol or tobacco.
• Some supplements have been shown to be effective in reducing inflammation. Fish oil has been well documented to reduce inflammation. There is also limited evidence that glucosamine and chondroitin may help.
• If the pain is too intense, medication may help. Panadol is safe and effective, whilst stronger alternatives such as meloxicam can be prescribed by a doctor. 

Some of my favourite warm up exercises for training with OA knees:  

• LAX Ball tack and stretch for Quads: tight quads can increase the stresses on the knee joints and increase pain with squatting. Spend 2 min on each leg finding tight areas and mobilising.
• Banded glute activation: Strengthening your glutes will create more stable hips and take some of the stress off the knees. Put a resistance band around your legs, above your knees in a hip bridge position. Push the right knee out 10 times, then repeat with the left, then perform 10 hip bridges.
• Box squats with band: Implementing greater glute activation into broader movements will reinforce these movement patterns. Keep the band around your legs and squat down to a box. Make sure your keep the shins vertical and sit back onto the box.

Nick’s thesis for his Masters of Science investigated the interactions between physical activity and pain in individuals with knee osteoarthritis. He has a published paper in Osteoarthritis and Cartilage and has presented both in Australia and the USA.