Do you have osteoarthritis (OA)? Your knees, hip or back hurt either all the time, or with certain movements. Youre stiff when you get up in the morning. Maybe you went to the doctor or physical therapist, they send you to get an X-Ray or MRI, and saw that theres no cartilage. You have bone-on-bone arthritis. They might have even mentioned something about a hip replacement or knee replacement surgery.

[sc_fs_multi_faq headline-0=”h2″ question-0=”How should I exercise if I have osteoarthritis” answer-0=”There are 4 categories of exercises to do for osteoarthritis, but only 2 of them are well-known. 1. Strength training 2. Stretching 3. Traction (gently pulling apart 2 bones from each other 4. Proprioceptive exercises: these are gentle exercises that improve your brains perception of where your joints are in space ” image-0=”” headline-1=”h2″ question-1=”What strengthening exercises should I do if I have osteoarthritis?” answer-1=”It depends on the joint that has osteoarthritis, but in general, aim to first find out which muscles are weak compared to their neighboring muscles. After youve identified which muscles are weak, spend extra time strengthening those. For example, if your osteoarthritis is in the knee, its usually helpful to do strengthening exercises the quadriceps, hamstrings, glutes and calves. ” image-1=”” headline-2=”h2″ question-2=”” answer-2=”” image-2=”” count=”3″ html=”false” css_class=””]

On the one hand, you dont want to go under the knife, but on the other, the pain may be tolerable now, but in a few years, you may be a candidate for that surgery, and at that point, the pain may be much worse.

What to do?

Thats what well talk about in this article: exercise for osteoarthritis (both physical and mental).

exercise for osteoarthritis
Original source: here.

But first, a little background:

A lot of our clients have OA, so we already had a pretty successful program for OA, with lots of success stories, like Carole, Pat, Anne, and others.

But because of the sheer number of clients that we see with OA, Im never really satisfied with just good enough. The standard recommendation is to just do low impact exercises. And while they avoid making OA worse, they don’t really make it better. I want to know the best possible thing you can do in the shortest period of time.

This led me to hire a scientific researcher to do a very comprehensive review of the science that exists out there that would help my team and I help our clients with OA. He just had one rule: he could only look at scientific/medical journals on this. He couldnt read mainstream books, he couldnt read magazines, and he couldnt watch Youtube videos. These had to be scientific/medical journals.

After a month of research, he came up with pretty much the most comprehensive set of strategies when it comes to dealing with osteoarthritis that are available to a personal trainer (exercise, nutrition and supplements).

It came up to 24 pages of notes, but I wont make you read all 24 pages. Here, Ill give you the bullet points both what we know, as well as what we dont know (which is important to acknowledge for the sake of scientific and intellectual honesty).

To say that Im excited about what this research means for our clients with OA would be an understatement. We already had a successful OA program, but with what my team and I have learned from this research, this really supercharges the results that we can get with our arthritic clients. It allows us to write a much better exercise program for any given client. If you want help with your own arthritis, we have created a brand new program, called Joyous Joints. If youd like to see whether you qualify for that program, just fill out the application form on our home page.

Without further ado, here are some of the most interesting notes from the entire research:

Predisposition to Osteoarthritis

  • What are some of the biggest risk factors for osteoarthritis?
    • Obesity: this ones obvious just because theres more weight compressing the joints
    • Sex: women have a 70% higher chance of having OA compared to men, according to this study.
    • Job: if your job involves repeated bending youre at a higher risk of OA.

How to Exercise for Osteoarthritis

The big 4 categories of exercise for arthritis:

Strength Training for Osteoarthritis

This is pretty much whats been recommended for OA forever. You ask any physical therapist what to do with osteoarthritis, and the first thing that they’ll tell you is that strength exercise can help with OA by improving muscle strength. And they’re right. But in my opinion, theres a right way to strength train, and a wrong way to strength train for OA. The wrong way: strengthening exercises for all muscles indiscriminately. The right way: identify which muscles are too weak relative to their opposite muscles (quadriceps and hamstrings; hip flexors and glutes, etc.), and only increase muscle strength in those that are weak. Dont increase the muscle strength in muscles that are already too strong/dominant, until youve brought the ratio back to a more desirable ratio. To identify weak muscles, its important to assess, because (say it with me) if youre not assessing, you are guessing.

Yes, strengthening exercises help, but only if you do them properly. Doing them properly means to strengthen the muscles that are too weak.

And if you want to learn how to strengthen the muscles that are too weak, just check them out on Youtube.

Stretching for Osteoarthritis

One study found stretching to be effective for OA by improving range of motion and decreasing pain. Makes sense, because stretching IS range of motion exercises. Another study found that stretching exercises help to reduce pain by 15.6% in 80 days. Pain was assessed using a questionnaire.

As for which range of motion exercises you should do to help relieve pain in the affected joints really varies joint by joint. But all you have to do is simply go on Google or Youtube and search for “stretches/range of motion exercises for…” followed by the affected joint.

Proprioceptive Training for Osteoarthritis

Youve heard of strength training and youve heard of stretching. But Ill bet youve never heard of proprioceptive exercises. Just what are those? Proprioceptive exercises are ones that enhance your sense of joint position. An example of a proprioceptive exercise for the knee is to stand on one leg, and pick up something off the ground. Thats one example. There are many other proprioceptive exercises.

  • In one study, one group did proprioceptive exercises for 8 weeks, and one group was the control group (they didnt exercise). After that 8-week period, the joint pain of the proprioceptive group decreased by 53%. In the control group, their pain increased a little bit.
    • In another study, participants were divided into 2 groups. The first group just did strength training. The second group did strength training plus proprioceptive exercises. After 8 weeks, the group that did strength training plus proprioceptive exercises had less pain, compared to the strength training-only group, as well as greater improvements in other parameters of function.

Traction

What is traction? Traction is gently pulling apart 2 bones from each other. For instance, if the arthritis is in the knee, its pulling apart the shin bone and thigh bone. If the arthritis is in the hip, its pulling apart the thigh bone from the hip bone/pelvis, etc. This part of the research had me most excited, because of all the exercise methods, this one is the fastest way to help relieve pain in the affected joints.

  • In one study, participants were divided into 2 groups. The first group received standard physiotherapy treatment: superficial heat therapy, deep heat therapy, and electric therapy. The second received the same treatment as group 1, but with 20 minutes of traction added to it (the level of tension of the traction exercise was 6% of the participants body weight, and it was held for 20 minutes). In the second group, they found that:
    • The average joint space went from 2.7 mm to 3.6 mm.
      • The minimum joint space went from 1.0 mm, up to 1.9 mm.
      • The cartilage thickness improved from 2.4 to 3.0 mm
      • Type II collagen increased in the joint space.
    • What do all these numbers mean? Basically more space inside the joint, so the bone surfaces dont rub against each other as much. Only traction accomplishes this. Strength training, stretching, and proprioceptive exercises dont accomplish this.
    • In another study, traction was applied only 7 times over 7 days. The amount of tension used was about 17% of the persons body weight as tension, and the traction was held for 6 minutes. After 1 week, their pain (in arthritis, pain is measured with something called the WOMAC scale) fell by a whopping 81%!!!

Psychology

  • Ive always been fascinated that some people can have objective evidence of joint damage (like X-Rays and MRIs), and feel no pain. Yet, other people can have the exact same degree of damage, but feel tremendous pain. In my article, titled Pain: Its All in Your Head, I listed some studies that show that 63% of people have a torn meniscus (knee cartilage); 65% of people have a torn rotator cuff, and 33% have a herniated disc. And yet, most of them have no clue that they have it. No pain, no limitations in range of motion, no decreases in strength. Why is that?
    • When it comes to arthritis, 2 personality characteristics stand out above all others when it comes to pain:
      • Self-efficacy: this is your attitudes and beliefs about your ability to control your pain. If your self-efficacy is low, your pain is high. If your self-efficacy is high, your pain is low. Self-efficacy is assessed via different questionnaires, like the Arthritis Self-Efficacy Scale, Chronic Disease Self-Efficacy Scale (CDSES), and others.
      • Catastrophizing: this is the tendency to describe the pain as worse than another person would describe the pain, as well as to ruminate on it more.
        • One of the primary questionnaires used to assess catastrophizing is the Catastrophizing Scale of the Coping Strategies Questionnaire (CSQ)
      • But whats the point of measuring something if you cant change it? Thats the thing you can change self-efficacy and catastrophizing.
        • One of the 9 strategies used in this study to improve self-efficacy and catastrophizing was very simple, but super effective. The researchers simply identified and reinforced past and present successes and accomplishments (as they pertained to arthritis management). Not just once, but repeatedly.
        • Whats the impact of a psychological-only intervention, instead of exercise/physiotherapy? Quite impressive! The same study found that those receiving training in self-efficacy improved their walking distance by 18.4%. Those in the control group declined by 4.8%. In the self-efficacy group, pain decreased 27%. In the control group, it decreased 3%. In the self-efficacy group, the use of medications dropped by 30%. In the control group, it dropped by 10%.

Areas of Further Research

Some things about osteoarthritis are very well studied, like different exercises and supplements (which Ive written about in my article on the top supplements for joint pain). But other things are very poorly studied. Either because its believed that their impact is fairly low, or for other reasons. However, until such research is done, the best we can say is we dont know, as opposed to we know. The impact isnt significant.

One area where Id like to see more research is hormones, and their relationship to osteoarthritis. One observational study found a link between menopause (the lowering of estrogen and progesterone) and arthritis. But just because theres a link between low hormones doesnt mean that they cause arthritis. By their nature, observational studies, well observe. They dont manipulate any variables the way that randomized controlled trials do. To really assess the impact of hormones on arthritis, youd have to take 2 groups of women, both of whom have equally low hormones. Give one group estrogen and/or progesterone, and give the other group a placebo. Then observe what happens to different measurements related to arthritis (pain, strength, walking distance and speed, range of motion, etc.).

Despite the best efforts of my researcher, such a study has not yet been conducted to our knowledge. So the best we can say right now is theres a link, but beyond that, its a big we dont know.

Nutrition

While supplements are very well-researched for osteoarthritis, food is not. Also, unlike rheumatoid arthritis, where nutrition is also well-researched, thats not the case in osteoarthritis.

The research that exists currently on nutrition for osteoarthritis is only observational. Again, no variables are manipulated. We know that an anti-inflammatory diet (like the Mediterranean diet) is correlated to less joint inflammation, but again, correlations dont give you the full story.

To really assess the impact of diet on joint pain, youd have to take 2 groups of people with equally bad arthritis. Make one group eat a certain diet or food, and another group can eat whatever they want. At the end of a reasonable period of time (like 2-3 months), assess arthritis-related measures. Though in this case, a single study wouldnt even do it justice, because theres more than one difference between the studies. Youd have to do follow-up studies where one group of people eats the experimental diet, and another group eats the same calories, protein, carbs and fats, just different foods. And youd have to test further variables to really understand it.

At the present time, that kind of research simply doesnt exist to our knowledge.

Other Questions

As well studied as exercise is, there are still a number of unanswered questions, like:

  1. We know that knee misalignment is a risk factor for knee osteoarthritis. So the logical question is whether correcting knee misalignment with exercise would decrease osteoarthritis symptoms. We know that improving knee alignment with surgery and knee braces potentially helps. Does using exercise to improve alignment help? The research simply hasnt been done conclusively enough to give a definitive answer. Having said that, improving joint alignment is a key feature of our exercise program with our arthritic clients, and we get great results. So although the scientific research isnt there yet, I can say from my empirical/anecdotal research with dozens of arthritic clients that improving alignment with exercise has huge potential.
  2. Research has established traction to be very effective, but just as with anything we want to know the dose. There are 2 variables to really know:
    1. The minimal effective dose. Whats the lowest frequency, duration and intensity that you can do traction, and still have it be effective. The research shows that even at 6 minutes a day, in 7 days there are big improvements. So what if someone did 4 minutes, or 2 minutes? And instead of 7 days, they did it 5 days, or even 3 days a week? Would it still be effective? Less effective? Not effective? The research has yet to determine that.
    1. The optimal dose. Whereas the minimal effective dose aims to answer whats the least you can do and still see progress, the optimal dose aims to answer whats the best you can do to have the greatest reductions in pain in the shortest period of time? So youd have to test different durations, frequencies and intensities against each other.

I hope you found this article beneficial, and you can take a tip or two from here to help you or a loved one with your or their arthritis. Or, if youre a fitness professional, you can help your clients with their arthritis (I guess your clients count as loved ones dont they? They do for me. I love my clients.). I certainly had a lot of eye-opening experiences reading through this research, and it helps my team and I further expand our ability to help people with osteoarthritis.

If you have joint pain, and you want the most comprehensive approach to help you with your own arthritis, so that you can:

  • Reduce your joint pain
  • Keep doing the activities that you enjoy, whether its hiking, golf, gardening, or playing with your grandkids
  • Delay or even avoid surgery

We have created a brand-new program, called Joyous Joints, on the basis of this research. This really supercharges our already-successful arthritis program for people with osteoarthritis, and takes it to the next level. If youd like to see whether you qualify for that program, just fill out the application form on our home page.