A blog by Riley Owen
Exercise is dangerous and damages joint cartilage
Despite common beliefs, therapeutic exercise is safe and does not cause further damage or degeneration of the cartilage within the joint. Research conducted over 45 studies with 4607 participants did not report any significant adverse events as a result of exercise (Fransen et al., 2015).
On the contrary, exercise can actually improve the health of articular (joint) cartilage. Cartilage has a poor bloody supply, so it relies on the sponge-like action of loading/unloading to receive nutrients. This is why recreational runners actually have lower levels of OA than people who are physically inactive. Exercise also helps manage pain by assisting to maintain a healthy body weight, which reduces systemic inflammation within the body.
It is also important to consider the negative implications of physical inactivity. While rest may provide some short-term pain relief, avoiding physical activity will ultimately lead to increased pain levels. Prolonged inactivity will cause the muscles around the knee to decondition. This means that your knee will be less supported when you return to your previous activity levels, and your pain will likely be worse.
Our OA program utilises a combination of neuromuscular, strength, and aerobics exercise to target the specific deficits caused by OA.
My scan said that joint is bone on bone, so I need surgery
Scans are actually poorly related to pain and disability. Research has proven that increased cartilage degeneration on imaging has a low correlation with increased pain levels in patients with OA (Bedson & Croft, 2008). In fact, up to 43% of pain-free individuals over the age of 40 have features of OA shown on MRI scans (Culvenor et al., 2019).
So what else contributes towards pain? Pain caused by OA is not solely related to bone on bone contact, but is also related to increased inflammation within the entire joint. Higher levels of inflammatory markers in the blood were associated with increased pain and reduced joint movement. (Jin et al., 2015).
However, increased inflammation was not linked to increased degeneration shown on X-ray, indicating that inflammation plays a significant role in symptoms related to OA. This is why weight loss is so effective in managing symptoms from OA. Not only does weight loss reduce joint forces, it also serves to reduce overall inflammation within the body which has a positive impact on pain levels.
My knee is really sore, so my arthritis must be bad
In the same way that scans are poorly related to pain and disability, severe pain does not always mean your joint has severe degeneration. While there are some structural changes with OA, there are many other factors that contribute towards the overall pain experience. Luckily, many of these are modifiable!
Some of the other factors that can contribute pain are listed below:
- Muscle weakness
- Physical inactivity
- Poor sleep hygiene
- Being overweight or obese
- Stress, anxiety, depression
- Pain related fear and activity avoidance
- Joint injuries or trauma, or excessive overload
Bedson, J., Croft, P.R. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskelet Disord 9, 116 (2008). https://doi.org/10.1186/1471-2474-9-116
Culvenor A. G., Øiestad B. E., Hart H. F., et al. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine; 53:1268-1278 (2019).
Fransen M., McConnell S., Harmer A. R., van der Esch M., Simic M., Bennell K. L. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015; 1:CD004376.
Jin, X. et al. Circulating C-reactive protein in osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2015;74:703–10. doi:10.1136/annrheumdis-2013-204494