Osteoarthritis (OA) is the most common joint condition in adults around the world. It can affect any joint but is most commonly found in the knees (60% of all OA cases are in the knee), hips and hands. It’s really common, in fact in a global study of 291 conditions, hip and knee OA was ranked as the 11th highest contributor to disability. Add to this the fact that there has been a 48% increase in global OA cases from 1990 to 2019 and you can understand why we as physios see OA clients on a daily basis.
A Quick Comment! I know this post is a long one, but osteoarthritis is such a common problem, and doing the right things early can make such a huge difference, that we felt it was worth the extra content. We get so many clients who have stopped or drastically reduced the activity and exercise they love, only to find out later that they didn’t need to do this, that we wanted to give you the bigger picture on OA prevention, management, the role of exercise, and dispel some common myths about running and OA. We hope you find this helpful!
Don’t Believe The Myths About Osteoarthritis
Unfortunately we find that many clients have been given mis-information about osteoarthritis, and old ideas are still very common. The problem with this situation is that it means many people stop exercise and activity unnecessarily, their pain is poorly managed, their condition deteriorates faster than it should have, they become more sedentary which leads to poor overall health, and their quality of life is reduced far more than it needed to be.
So often we hear clients talk about how they have reduced or stopped doing the things they love like running, walking, hiking and doing other sports. The irony is that by reducing their activity they gradually become weaker, and loss of strength is one of the biggest factors that makes OA worse. Becoming more sedentary also often causes weight gain, which is also one of the biggest risk factors for worsening OA. Unfortunately the further down this road of inactivity, worsening OA symptoms, loss of strength and increase in weight we go, the harder it is to come back. That’s why it’s so important to manage joint pain well early.
The most common myths about Osteoarthritis that we hear as physios and exercise physiologists are;
1. I need to stop exercise because it makes my pain, and therefore my OA, worse
2. I need to stop running because it “wears out your knees and hips”
3. There’s nothing much you can do about OA – it’s just what happens as you get older
4. My mum/dad had a knee/hip replacement because of OA, so I guess I’ll need one as well at some stage
While its easy to see why these myths are so common, its really important to understand that they are wrong! A mountain of research disproves them, but before we look at the real facts lets have a quick overview of exactly what OA is.
What Is Osteoarthritis / OA?
OA is a disease that usually starts after some sort of joint injury, but may come on without a memorable joint injury. Early on the body is able to repair the damage, but as the disease progresses the repair process can’t keep up and a gradual breakdown of the joint tissues occurs. This includes thinning of the cartilage, changes in the bone underlying the cartilage, changes in the shape of the bone that forms the joint, and inflammation develops within the joint.
What Causes OA?
The exact cause and progression of OA is still not fully understood. However, several risk factors have been clearly identified. The main ones include;
1. Being overweight or obese
2, Having a history of joint injury or surgery (eg knee menisectomy), or overuse of the joint
3. Increasing age
4. Gender – OA is more common in women
5. There is a genetic link, i.e. a family history of OA
It is important to note that even if you have a family history of OA, it does not follow that you will also have significant OA symptoms. Many factors can change the situation, for example keeping a healthy weight and doing exercise that maintains good leg strength is very protective against OA. So even if you have a genetic predisposition to OA, addressing these modifiable risk factors can mean that you are not affected, while other family members who are overweight or become sedentary and lose leg strength may experience OA symptoms.
What Are The Symptoms Of OA
– Pain
– Loss of function, i.e. stopping or reducing activities due to pain
– Joint stiffness
– Weakness
– Reduced quality of life, i.e. feeling unable to do the things you love
How Is OA Diagnosed?
OA is usually fairly easily diagnosed clinically, i.e. the diagnosis can be made with a thorough history and physical exam. Imaging (x-ray, MRI) is usually not required. In fact, there is not a clear linear relationship between imaging findings and symptoms. This means that some people with significant pain and stiffness do not have many OA changes on imaging, while some people with only mild symptoms may have fairly advanced changes on imaging. Due to this poor correlation of symptoms and imaging findings, we do not use imaging routinely because it does not affect our management and is often unrelated to the level of symptoms and function.
The common clinical diagnostic features of osteoarthritis include;
– Activity-related joint pain. There may also be some joint swelling and/or stiffness.
– Gradually worsening pain and stiffness as the person gets older
– The joint usually feels better after rest or in the morning
– There may be a history of joint injury. This can be minor or more significant, and either recent or some time ago.
– Often clients report a gradual loss of function and a progressive restriction of activity over time
Physical examination findings often include a loss of joint mobility, generalised tenderness around the joint line, swelling, muscle weakness, and pain with functional tasks including squatting, lunging, stepping up/down, walking and running
Does Running Cause Osteoarthritis?
In short – NO! Running does not cause OA. In fact, research shows that recreational runners may have a lower incidence of hip and knee OA compared to non-runners or people who are more sedentary. The mechanism for this is not fully understood, but it is thought that running may promote good leg strength and consistent loading of the joint cartilage and bone in a positive way, helping to increase joint resilience.
Studies also show that running may reduce the need for future joint replacement surgery. Research found that cartilage recovers well after running if adequate recovery time is allowed, and consistently running at the right level for you can maintain good leg muscle strength and joint resilience as outlined above. More research needs to be done to clarify the effect of different running volumes, and if running competitively is different, but the bottom line for recreational runners is that running does NOT cause OA.
I’ve Been Diagnosed With Osteoarthritis – Should I Stop Running?
This is another question we get asked a lot. The overall answer is no, but the details will be different for each person. As mentioned above, running is a great way to maintain leg muscle strength and also keep a healthy weight, and these are two of the most important goals when managing OA. So from this perspective stopping running is really not what we want to do.
However, if running is consistently aggravating your pain then we may have to adjust some aspects of your running program. This may include;
– Running frequency (times/week)
– Distance at each run, eg mixing up some shorter and longer runs
– Run type and speed, eg hills versus flat versus intervals
Your running history can also have a big impact on how, if at all, we modify your running program. If you have a solid history of several years running consistently then your body will be well conditioned to the loads experienced during running. This means that there may be less need to adjust your program. Compare this to someone who has only recently started running and reports that it is aggravating their pain (or may even link their onset of pain with starting to run). In this case the joints and leg muscles are less used to the loads during running so we may have to adjust their program to a greater degree.
The effect of things like running shoes and surface (grass versus road, trails etc…) is not clearly understood, and we find it varies a lot with different runners. More research is needed in this area.
The Take Home Messages About Running And Osteoarthritis
1. Running does NOT cause OA. It may even reduce your chance of getting it, or needing a joint replacement later.
2. Being diagnosed with OA does NOT mean you need to stop running. However, we may need to modify your program, but not always.
3. Finally, it is important to remember that managed properly, and as early as possible in the course of OA progression, running can be a beneficial exercise for OA management
What About Other Types Of Exercise For OA?
Ok, there is a REALLY clear message here: exercise is beneficial for ALL people with OA irrespective of age, symptom severity & level of disability!
Exercise should be the core treatment modality for OA. Studies have shown that it is more effective than common pain medications for many people. But getting on the right progam for your situation is crucial.
Consistently doing the right type of exercise is among the most effective and evidence-based first-line management tools for OA. There is no generic one-program-suits-all for OA clients, so personalisation is essential. The right program brings you many major benefits including;
– Reduced joint pain and stiffness (this can also reduce the need for taking medication)
– Increased muscle strength, which protects and supports your joints
– Helps to maintain a healthy weight
– Preventing, delaying or slowing declines in functional capacity and quality of life
– Preventing or delaying joint replacement surgery
– Reduce your falls risk by maintaining strength and balance
– Overall health benefits include more energy, cardiovascular fitness, better mental health and improved sleep
Which Type Of Exercise Is Best For OA?
As mentioned above, there is no generic program that is right for every OA client. Factors such as symptom duration and intensity, any previous injury history, current fitness, previous exercise experience, other health conditions, and personal exercise preferences all have an effect. However, in general an effective exercise program for OA will include components of;
– Strength exercise for the legs, hips, pelvis and core
– Mobility / range of motion exercises
– Functional strengthening, eg squat-type movements are a common daily requirement (sit-to-stand, in-out of the car etc…) so a variation of squatting strength should be in your exercise program
– Cardiovascular and whole-body training to increase overall fitness, help maintain a healthy weight, and deliver other benefits to mental health, mood, sleep and energy
Can We Prevent Osteoarthritis?
OA is complex and multi-factorial disease, so there is no one simple prevention strategy. However, there are several things that we can do that are very effective in preventing, delaying or minimising OA. These include;
1. Treat Joint Injuries Early, Effectively And Fully – At Any Age: as discussed earlier, one of the big risk factors for developing OA is a previous joint injury, even if it was years ago. Therefore, treating and rehabilitating joint injuries at any age, and returning to full strength and function after an injury, is really important. For example research shows that ankle sprains, if not managed effectively, will often become recurrent and significantly increase the incidence of OA, and also OA onset happens at a younger age. So getting ankle sprains fully rehab’ed and minimising recurrent sprains while still playing team sports can reduce your risk of developing ankle OA later in life.
2. Being Active & Exercising Throughout Life: this helps prevent OA in many ways. It helps avoid being overweight or obese – a major factor that increases OA incidence. (Research shows that losing 5kg (or 5% body weight) reduces your chance of knee complaints by 90% after 6 years!). Depending on the type of exercise it can really help increase leg muscle strength, another way to prevent or minimise OA symptoms.
3. Prevent Joint Injuries From Happening In The First Place: as the saying goes, prevention is better than cure! This point is especially relevant for sports which have higher rates of lower limb injuries such as netball, soccer, footy and basketball. It is also especially important for women, who have a higher rate of significant knee injuries in these sports and also a higher rate of OA in general, so preventing these sporting injuries in women is a big benefit. There are several very well researched programs that have been proven to be effective in reducing injury rates in sport, eg FIFA 11+ for soccer and the Knee Program from Netball Australia.
Thanks For Making It Through A Long Post!
As we said earlier, we know there is a lot of content in this one. But we hope it helps you be more confident about maintaining exercise to prevent, manage and minimise osteoarthritis. It’s all about getting on the right exercise program for you, and not drastically cutting out things that can actually be really good for you if done in the right way.
And for you runners out there, please don’t stop running just because someone says it “wears out your hips and knees” or because you feel some pain during your runs! The research says it can actually be helpful for OA prevention and management. You may need to boost up some leg strength or adjust your run program a bit, but we have so many clients that still have a full running program despite having a diagnosis of “OA” that we don’t want you to give up something that you really love!
