Every time I step into a clinic, a patient relays their frustration with pain and inability to exercise. Most patients blame arthritis for their pain and inactivity.
“X-rays show complete bone on bone.”
“The doc says I’ll never be able to run again.”
“Squatting is bad for your knees.”
Pain is frustrating and can impede on your life. Unfortunately, most patients are flooded with fallacies about pain.
Bone on bone does not guarantee a need for surgery or even constant pain.
You can run with arthritis. It may even help.
Squatting is great for your knee. Seriously.
In most cases, patients don’t need surgery or injections for arthritis. In, more exercise is often the missing link.
Arthritis is misunderstood and if you stick with me for a few minutes, I’ll clear up those misconceptions.
Understanding arthritis
The term ‘arthritis’ is incomplete and can be misleading as there are a couple of forms of arthritis. Rheumatoid arthritis, for example, is an autoimmune disorder that creates inflammation and thickening of joint capsules. When people say they have arthritis, however, they are often referring to osteoarthritis.
Osteoarthritis is the breakdown of joint cartilage — the protective covering around bones within a joint space. The most common symptoms are pain and stiffness.
Keep in mind, the severity of osteoarthritis is poorly correlated with pain. Many studies show significant osteoarthritis and little to no pain and vice versa.
Pain is complex.
Osteoarthritis is a normal part of aging. That does not mean it is irrelevant, but rather, it is not something that can be completely avoided. The speed of breakdown is highly variable, however.
Why does this matter if pain is poorly correlated?
Again, pain is complex, but osteoarthritis can contribute to the experience of pain. The key is knowing the other factors that lead to osteoarthritis being a painful condition.
Genetics and certain diseases can increase the prevalence of osteoarthritis, but I will focus on the factors we can control, such as diet, exercise, and lifestyle habits (sleep, smoking, stress). Obesity is one of the primary causes of osteoarthritis and is directly related to the previously mentioned factors we can control. Obesity, exercise, and lifestyle habits create neurologic and metabolic changes, influencing the experience of pain.
This is one of the reasons why surgery does not work for chronic pain. Instead, exercise should be the primary focus. But doesn’t exercise cause osteoarthritis, too?
Exercise is good for arthritis
Research shows people with more physically laborious jobs are more likely to develop osteoarthritis. This is not a guarantee but an observation and an average.
The issue is the repetitive nature of some labor-intensive jobs (e.g working on an assembly line).
Being physically active — provided your diet and sleep are appropriate to help with recovery — is beneficial for your overall health. If you are eating and sleeping poorly, it is challenging for your body to recover and handle the rigors of physically laborious jobs. You can facilitate recovery through switching tasks — work rotations or cross-training — and rest breaks.
What about structured exercise outside of work?
While walking can be beneficial for general health and reduce pain, exercise programs that include strengthening, flexibility, and cardiovascular fitness training are better for osteoarthritis. Furthermore, exercise can improve confidence with movement, reduce fear of activity, and tackle anxiety and depression.
Since osteoarthritis can be painful, people often use the affected joint less. This leads to weakening of muscles in the area.
For example, osteoarthritis in the shoulder may lead to degeneration of muscles in and around the shoulder. To reverse this, shoulder-specific strengthening exercises should be completed. Although, general exercises still have their use.
Cardiovascular health influences your body’s ability to heal. Research has shown lower body exercise and cardiovascular exercise can reduce pain in upper body regions.
Osteoarthritis often causes people to be less active overall, causing deconditioning and worsening of overall health. Any level of physical fitness training will improve your body’s resilience and physical capacity.
To achieve the benefits of exercise, you want to make sure you are exercising at an appropriate intensity. A personalized approach is always better than a generic one.
If you seek treatment, avoid the gimmicks
Research shows conservative treatment — including physical therapy — is effective for osteoarthritis. Injections and surgery are not the answer. They don’t treat the issues and the side effects can make the problem worse.
With that said, all physical therapy is not created equal.
If you seek physical therapy, exercise must be part of the process. You should also receive education on pain. If your treatment is primarily modalities — heat, ice, e-stim, ultrasound — or manual therapy — joint manipulation, mobilization, massage — then you should seek a new physical therapist.
Modalities and manual therapy can provide mild short-term relief, but they don’t address the issues or build your body's strength and physical capacity. Think of them as medications without the side effects. They have some benefits, but they are not the answer and should not be relied upon.
The exercise should have a purpose. You should not be going through a generic exercise flowsheet or completing low-intensity exercises exclusively. Pulleys, yellow bands, and ball rolls may help in early post-operative stages, but they do not build endurance, muscle, or strength.
Lastly, don’t worry about your posture or lifting mechanics. They don’t matter. Seriously.
Seriously. Research is crystal clear that posture is not the cause of your pain and it is not leading to the development of arthritis. Whether it is lifting mechanics or slouching while scrolling through social media on your phone, you can safely adopt any posture you like.
Exercise should focus on building endurance, strength, and resilience. This does not mean you should be exercising like you are preparing for the CrossFit Games, but you should be challenging your body.
Exercise won’t cause the elimination of osteoarthritis — it is a normal part of aging — but it can help with pain and your overall health.