Knee pain? Worried its knee osteoarthritis and whether you’ll ever run (again)?
So what is osteoarthritis? It literally means bone joint-inflammation. This differentiates the condition commonly referred to as ‘wear and tear’ from conditions that aren’t purely the musculoskeletal aspect of joint (such as rheumatoid arthritis, which involves the immune cells and tissues around the joint).
Most people imagine osteoarthritis as a progressive disease that worsens with every year; literally the slippery slope to slipping on a slope and not being able to get up again due to stiff, diseased, painful, worn out joints that need surgical replacements.
Arthritis is often referred to as a disease – which is unhelpful when you lie awake thinking about whether your knee pain is the end of your active life as you know it. In the 20th century, while new technologies such as Xray and MRI imaging were improving the accuracy of diagnosis in some body systems, they were pathologising what we now know to be normal aging processes in the skeleton.
We now know that osteoarthritis (also known as OA) is not a steady progression of cartilage wearing through, causing bone-on-bone joint rubbing and decrepitude.
In realisty, joint pain is most strongly correlated with muscle weakness, not skeletal wear and tear. The Bristol Knee OA study (a long-term large scale study of arthritis) found lower limb strength to be a stronger predictor of functional limitation than radiographic (images of the joint on xray or MRI) severity or knee pain.
So what can you do about knee osteoarthritis?
There is strong evidence from randomised controlled trials (the best method we have of researching whether a particular therapy works for the largest number of people) that strength training, in particular progressive resistance strength training, is the best technique to improve mobility, function and pain in all types of osteoarthritis.
Studies also show that strengthening the hip muscles as well as the knee muscles effectively restores range of motion in the knee joint, as well as providing significant pain relief and improving the ability to perform normal activities such as walking, climbing stairs and playing sports.
And just to be clear – muscle strengthening is not just for the young. It works even for the ‘oldest old’ (i.e. people over 80 years).
What is progressive resistance strength training?
This refers to the type of training where the load is constantly increased to take into account the fact that your muscles become stronger (known as adaptation). Excitingly, this makes you not just stronger, but generally fitter, with more stamina and better able to function.
Researchers have also found that it is possible to train the muscles that move your knee to become stronger, whilst avoiding the bending movement that often triggers pain, using isometric loading. This means activating the muscle without flexing the knee (for example, holding a squat position for a while). This type of loading has also been shown to relieve pain.
Studies show that as few as 3-5 daily fairly heavy reps (held for 5 seconds) per muscle group is enough to strengthen muscle by as much as 60%. Most patients feel very different after 3 – 4 weeks. If you are new to exercise then it is best to start with lighter loads and more repetitions, before progressing onto fewer heavier weights, as the muscle ache after exercise might be confused with your joint pain (its not!)
Physiotherapists and osteopaths can guide you through the training process providing you with immediate pain relief as well as long term management.
Latham et al. 2010 Strength training in older adults: the benefits for osteoarthritis. Clinical Geriatric Medicine
Jorge et al. 2015. Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial. Clinical Rehabilitation
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