The answer is no, exercise doesn’t make osteoarthritis worse. It can actually be pain relieving when done right. A common misconception about osteoarthritis is that it is caused by “wear and tear” and thus, people significantly reduce physical activity levels. But, rest may be causing more harm than good. Research has shown that moderate loading of cartilage (or exercise) is necessary to maintain its health and prevent further harm. If you are not loading your joint, i.e if you have decreased your activity levels, processes that favor cartilage break down then begin. Exercise helps to keep your cartilage from further break down. The right amount and type of exercise is important though.
I was just talking with a client about this yesterday. She had mentioned that she had given up exercise the past two years and had a common question that she was never able to get answered: Does exercise make osteoarthritis worse? Without an answer, she had just given up on exercise. I find this belief SO common in people that have arthritis. Having this mindset can actually be detrimental to how we handle our osteoarthritis. Let’s put an end to this today! Does exercise make osteoarthritis worse?
Think of your cartilage just like your muscles. If you don’t use it, you lose it. Your cartilage has a job to do and works best under pressure. When we don’t challenge our cartilage, for example when we are sedentary or spend a majority of our time sitting or laying down, this can cause problems. Our cartilage then gets weaker and exacerbates our osteoarthritis pain.
First, let’s understand a few of the benefits exercise has with osteoarthritis.
- Gives your cartilage the challenge it needs. Your cartilage is meant to absorb the load that is going through your joint (i.e when doing weight bearing activities like standing and walking). Regular loading helps our cartilage become stronger. If we don’t challenge it, it becomes less effective. Think about it like this, if you used to be an accountant but haven’t done any accounting tasks for at least 10-15 years- you become less effective at it when you try to go back. Same thing with your cartilage. If you significantly decrease your activity levels, your cartilage doesn’t have to work as hard. It may start to become less effective and potentially painful. If we give our cartilage the exercise it craves, it is able to stay much healthier.
- Improves blood flow to your cartilage. This helps to clear out some of the inflammatory cells that are irritating your cartilage and bring in new, healthy cells. When you exercise, you are doing wonderful things for your blood. So what does your blood have to do with your cartilage? According to the research, exercise helps your blood flow more freely. This is important because this is how our red blood cells transport oxygen and other vital minerals to our muscles, organs, and joints. If our blood becomes thick and sludgy with higher cholesterol and other effects of a sedentary lifestyle, it makes it much harder to transport these materials efficiently.
- Makes your cartilage stronger. Research shows that exercise has been proven to increase the strength of your cartilage. This is especially helpful when you have lost some of the cartilage due to arthritis. We can actually strengthen what we do have.
- Exercise fights the inflammation. Osteoarthritis is typically triggered by a low grade chronic inflammation. This means that you have a constant state of inflammation in your body that isn’t meant to be there. There are many things that can contribute to the accumulation of this inflammation. Obesity, high blood pressure, and inactivity are a few. Research shows that using exercise can create anti-inflammatory effects. Exercise can decrease the amount of body fat (adipose tissue) which is highly correlated with the level of inflammation in your body. It can also suppress specific cells that are responsible for creating inflammation.
- Gets the bad cells out of there. It has been found that moderate intensity exercise activates a process called autophagy. This is a fancy word for a process involving cell recycling. Essentially when you exercise, it activates recycling cells in your muscle to get rid of the inflammatory cells and bring in new healthy cells. This is much like a garbage truck that comes in and picks up the garbage to take it out. Without this process, you continue to collect these “garbage cells” which can lead to more irritation and higher pain levels.
- Builds muscle strength to support your joint. Your joint isn’t meant to do all of the work. It needs support from your muscles to decrease the irritation and pain. If you were asked to do the job of three of your co-workers combined, you probably would be irritated too! There have been multiple studies that show if you increase muscular strength around an arthritic joint, there are significant decrease in joint pain and improvements in mobility.
- For the knees and hips specifically…squats are not bad for joints (when done correctly!) I teamed up with Tommy, CEO of Vekhayn to help explain the misconceptions around squats and considerations you need in order to do them correctly! The best thing to do is improve the way your joints are aligned by improving strength and fixing some asymmetries you may have! This is especially important if you notice more pain on one side than the other or one side feels weaker than the other. Both of these situations make you more susceptible to pain and injury. Read the full post here.
Exercise is one way to continue to challenge and strengthen our cartilage. We do need to make sure it is the right exercise though. If we are challenging it too much with lots of high impact activities or overloading it with too much volume, it can also start to break down. Learning how to exercise the right way though, can bring you life changing osteoarthritis pain relief.
How do I prevent pain with exercise?
Gradually increase into whichever activity you choose. If you want to start walking, cycling, hiking, swimming or lifting weights– it is important that you set a plan for yourself. Let’s take walking for example. If you want to start walking for exercise, start with once around the block or 1/2 mile. See how your joints respond.
If there is no significant pain or stiffness immediately after or the next day, you can increase by half of what you walked before. So now you can try 3/4 mile and again see how you respond.
If you notice significant pain (6+/10) or swelling afterwards, you can reduce the distance by half and try again! Don’t give up if this happens! This is just a sign that you’re joint is telling you “I’m not ready for this right now“.
The problem usually occurs when we start out exercising maybe once a month then increase to 4-5 times per week of intense exercise. Too much exercise too quickly can give our joints more than they can handle. This is when people typically give up on exercise because they tried and it caused more pain.
Just remember, no exercise can be equally as harmful.
The best course of action is to find something you like to do or want to try. Gradually work your way into it. Start with 2-3 days per week with 1 rest day in between. Try that consistently for about 1 month, then increase.
Add variety to your exercise routine. Osteoarthritis can exhibit pain when we are loading one part of our joint too much. Take for example, if you have knee pain. You may feel more pain on the inside of your knee compared to the outside. Or the shoulder- you may feel more pain in the front of your shoulder than in the back. This can contribute to cartilage overload in that area.
With this overload, continuous repetitions can potentially lead to more pain.
Variety in your exercise routine.
In order to use exercise to your advantage with osteoarthritis, variety is key. Let’s use walking again for example. If walking is your primary form of exercise, you are working the same muscles over and over again. The fronts of your legs are primarily working to propel you forward. But what about the backs of your legs, your core, and your arms? These muscles help you do movements other than walking.
Adding in other movements can help with managing osteoarthritis pain and working other parts of your joint.
I always tell people that adding in just a few simple exercises before or after your routine can make a huge difference! If you need some ideas here are a few quick videos you can watch:
When can exercise be detrimental?
It is worth mentioning, exercise can increase our pain. Like we have talked about above, overactivity is one of the main causes of this. No more thinking “no pain, no gain”. Listen to your body. If our pain levels are too high and are “pushing through” anyways, we will just continue to irritate our joint and you will have a rough night ahead.
If you are doing lots of running or jumping without previous training, you may be overloading your cartilage. This is not saying you can never do these things again. You have to make sure your joints and muscles are ready to handle that type of activity though. Making sure your balance, single leg strength, and core are ready to go is very important. If you have a goal of doing one of these higher level activities, it is best to seek out a physical therapist to clear you to do so.
So does exercise make osteoarthritis worse?
No. Exercise can make a dramatic impact on our pain when we do the right amount and type of exercise. Remember, gradually start exercise instead of going 0-100. Make sure you are adding variety to your training. Understand your cartilage loves movement but not when it is overloaded. Exercise is so powerful and can help you keep your adventure alive.
If you are looking for more secrets to getting rid of joint pain once and for all, check out this FREE ebook with the TOP 5 Secrets to Getting Rid of Joint Pain Forever.
Dr. Alyssa Kuhn is a physical therapist and founder of Keep the Adventure Alive. Her main mission is to turn frustrations from arthritis and chronic joint pain to hope and confidence. She doesn’t want you missing out on important memories anymore. Keeping your adventure alive is possible. Check out her book, Move Well Age Well: How to Rock the Later Years with Fitness and Mindset HERE.