In the April 2022 publication of the Journal of Orthopaedic & Sports Physical Therapy an article was published titled, “Similar Effects of Exercise Therapy, Nonsteroidal Anti-inflammatory Drugs, and Opioids for Knee Osteoarthritis Pain: A Systemic Review with Network Meta-analysis.”

A “Systemic review” is a comprehensive review of the pertinent literature that uses specific methods to search, identify, appraise, and summarize all literature on a specific issue. It is considered the highest level of evidence possible in the hierarchy of scientific investigation for the making of decisions about interventions.

Or, as pertaining to knee arthritis pain, what is recommended for those who what to keep moving, keep living their active lifestyle, and better enable them to do so while navigating the path of pain associated with their disease.

The use of medications in the treatment of arthritis has been the treatment recommendation along with recommendation for increasing or maintaining activity. Unfortunately, many remain under the belief that exercise therapy is painful for arthritic patients and that activity only helps to slow the progression of the disease, not help to manage the pain.

What Should Be the First Line of Care for Individuals with Knee Arthritis Pain?

As the title of the article implies, the systemic review analysis showed that there were similar effects on pain modulation between exercise therapy, nonsteroidal anti-inflammatory drugs, and opioids. Therefore, if the fear of arthritic pain was the main driver for limiting or eliminating exercise from a person’s lifestyle, evidence to the contrary shows that a person can help to manage that pain through exercise.

In fact, in the study’s conclusion, it states that, “Exercise therapy ranked as the best treatment for knee osteoarthritis pain, followed by NSAIDs and opioids.” This ranking should suggest to individuals struggling with knee arthritis pain that switching to exercise therapy as the first-line treatment, as compared to pharmacological care, would yield the best results.

What Are the Risk Factors for Osteoarthritis, Especially Weight Bearing Joints?

• Old age (80% of adults over age 65 have some degree of osteoarthritis)
• Obesity (Excessive and unrelieved pressure on the joints over time)
• Being female
• Joint deformity – anatomical deviations from normal such as genu varum (bowlegged) or valgum (knock knees)
• Previous joint injury (producing joint laxity or exacerbation of a joint lesion)
• Muscle weakness (associated with a lack of joint support and stability)
• Inactivity (articular cartilage is nourished through joint movement)

Osteoarthritic Knee Pain and the Cascade of Deterioration

If pain wins out in the trial of arthritis and activity or exercise is consequently reduced or eliminated, the cascade of associated anatomical changes will increase in intensity and speed.

• Loss of muscle strength → further loss of joint stability and increased deterioration of the joint cartilage → osteoarthritis
• Loss of range of motion → less motion that is needed to reduce inflammation and increased pain from stiffness → osteoarthritis
• Weight gain → leading to increased abnormal pressures on the joint → osteoarthritis

Exercise Therapy for Knee Osteoarthritis

Aerobic, strength training, and flexibility training are all important in the treatment of osteoarthritis.

Aerobic Training

Engaging in aerobic or cardiorespiratory training will help strengthen the undamaged cartilage, ensure repetitive range of motion of the joint, and provide pain relief. A few tips include:

• Ensure that you maintain good hydration at all times, and especially during and after exercise.
• If not exercising, start with low impact activity such as walking, cycling, biking, etc.
• Start slowly and increase gradually overtime, working to eventually meet the American College of Sports Medicine guidelines for aerobic exercise to promote health and reduce the risk of disease.
• Understand that at first there may be some discomfort, maybe even pain, but overtime the pain will decrease and mobility will increase.

Strength Training

Resistance training will improve the strength of muscles, working to prevent atrophy and the associated hypermobility of joint movements that deteriorate joint cartilage. Strong muscles also help prevent against joint injury and damage. A few tips include:

• Begin with light to moderate intensity. This can simply be body weight for exercises like squats.
• Then progress in resistance overtime working to strengthen the muscles to the point they protect the joint. The pressure on the joint from resistance training is therapeutic and has been shown to promote cartilage strength and density.

Flexibility

Perform flexibility exercises to achieve or maintain normal joint range of motion. If the muscles that cross over and act upon a joint are imbalanced in their strength – the agonist to antagonist muscle groups – there will be a resulting imbalanced pressure applied to the joint surfaces and is associated with a breakdown of the cartilage.

• Yoga, Pilates and tai-chi provide movement patterns that also improve muscle flexibility and joint range of motion.
• Reestablishing a joint’s normal range of motion and proper balance of the muscles that cross over and act on a joint will help reduce pain by simply restoring the normal pressure balance that should be spread out over the joint surfaces, as compared to an abnormal amount of pressure on isolated area areas.

There are many different types of exercise one can perform to obtain the needed exercise therapy interventions that will produce positive benefits for those suffering from knee osteoarthritis. There are many resources for what these exercises are, keeping in mind that they are mostly the same exercises a person without arthritis can and should engage in.

Of upmost importance is to realize that appropriate exercise can help reduce arthritic pain, slow the progression of the disease, provide for a greater quality of life, and reduce the risk of developing a number of chronic diseases associated with reduced activity. In addition, your reduced dependence on pharmacological drugs will help save you money and any associated side effects.

I hope you will give exercise a chance in your battle with knee osteoarthritis.

Are you suffering from arthritic pain? Have you been told that you should limit your movements? If the opposite, what types of exercise do you do to maintain the health of your joints?