Physical activity is important for good health and is prescribed by healthcare professionals to treat a range of chronic health conditions, including diabetes, cardiovascular disease and osteoarthritis. People with osteoarthritis, as well as other types of arthritis, have long been encouraged to participate in regular physical activity. Today, exercise, in particular strength training is recommended worldwide as a key treatment for people with painful joints. Strength training consists of exercise that uses resistance such as the person’s own body weight, elastic bands or weights to strengthen muscles around an aching joint.
While being active sounds like something we all should be doing, many people find it challenging to follow this advice because of aching joints and fear that exercise may further harm their “bone on bone” joints. Not surprisingly, osteoarthritis is commonly misunderstood as an irreversible disease of the joint which is worsened by using the joint, and that can only be ‘fixed’ by replacing the joint. “If the bone’s worn, the pain will be there. The only thing to do is to cut it away”.
People’s beliefs about their joints can have a significant impact on how they use them. The belief that osteoarthritis is caused by ‘wear and tear’ can result in concerns that weight-bearing activities and particularly exercises with resistance will increase joint damage and pain. “I’ve been told I need to exercise, but wouldn’t that wear the cartilage away even more?”
Contrary to popular beliefs, exercise has been shown to reduce inflammation and improve joint health. These scientific findings indicate that exercise is not only safe, but also necessary for people with osteoarthritis. The challenge however, is to understand how one can exercise a painful joint – “if I can’t walk down the street without pain…how am I supposed to lift weights?”
It is important to understand that people that engage in exercise to treat joint pain, are likely to experience a small, temporary increase in pain. This, is not usually a sign of harm; rather, it is a sign that the joint is responding to exercise; and given time and a sensible progression, the joint will adapt and become more tolerable to load. In fact, research shows that graduated exercise can result in pain relief similar to that provided by off the shelf medication such as paracetamol or ibuprofen. In many cases of people with osteoarthritis waiting for joint surgery, exercise can reduce symptoms enough that surgery is put on hold.
Nonetheless, it is not all about having strong muscles! Joint pain is influenced by multiple factors (physical, psychological, and social). A healthcare professional’s role is to help patients build a whole-health understanding of their condition, adopt a healthier lifestyle, develop confidence to engage in strengthening exercises, and actively manage flare-ups. For people who still need surgery, this active approach is also beneficial, as it can positively influence post-surgical outcomes and satisfaction.
About the author:
Dr JP Caneiro FACP, PhD, Specialist Physiotherapist, BodyLogic Physiotherapy and Curtin University (Perth).
Dr Caneiro has over 18 years of experience as a clinician, researcher and lecturer on the field of musculoskeletal pain management. He is a Specialist Sports Physiotherapist (as awarded by the Australian College of Physiotherapists in 2013) and, as part of a research team at the School of Allied Health at Curtin University he has published over 40 research papers and presented his work in key conferences across the globe.
JP is an emerging leader on the field of chronic pain, particularly in the management of back pain and osteoarthritis. JP consults at bodylogic.physio where he reviews complex musculoskeletal pain disorders.