Excuses not to Exercise – Part 1 – Knee Pain and Osteoarthritis

 

By Murtaza Ahmed MD

As a doctor I spend a lot of my day listening to excuses as to why people can’t exercise.  As I have repeatedly reinforced in previous posts, exercise is one of the most important treatments for many common diseases we see, and as such I find it hard when I see people missing out because they feel they are not able to get involved.  My aim in this series of articles is to hopefully help you understand that there is almost always a safe to carry out some form of exercise and that a lot of the common misconceptions as to why you think you can’t exercise are nothing but a myth.

I do want to stress here that I am in no way blaming you, the patient for feeling you can’t exercise.  Unfounded ideas and misconceptions are rife in the world of healthcare and sadly these have a way of filtering into common belief and simply become accepted as truths.  When we look for any actual evidence to substantiate these claims we often struggle to find anything.  It is not only healthcare professionals who are guilty of passing on these misconceptions, but in the modern age the internet has a lot to answer for.  A lot of the information out there is unregulated, unfounded and often biased.

Here on myheart.net we have an ever growing  team of specialists who are contributing material with the sole goal of improving patient care.  The information we give is well researched, evidence based and tried and tested.  Sadly I cannot say the same for many of the other sites out there, and you should assess the validity of any material before you choose to believe it.

So back to the topic of excuses.  I want to go through some of the most common excuses that I come across on a daily basis and explain to you why they exist and more importantly why they may not be valid.

 I can’t exercise because my knees hurt

Osteoarthritis (OA) is a common condition that is becoming more prevalent in society.  The incidence of knee pain is rising.  We all know somebody who has ‘bad knees’!  Many people who have been given the diagnosis of knee OA are led to think that their knees are worn out and that their exercise ability will be forever limited.  Even more concerning is when people are told that they may in fact make their knees worse by exercising.

I’ll start by explaining a little bit about what OA is, as this is where the problem often originates.  OA is essentially loss of the cartilage and changes in the underlying bone.  The  cartilage is responsible for providing a friction free surface allowing the bones to glide on one another, so when it is lost the joint collapses and the result is bone rubbing on bone.  The smooth surface now feels more like sandpaper and as a result movement can result in pain.

So what causes OA?  It is commonly believed that it is just due to wear and tear over the years.  This however has now been shown to not necessarily be true.  People who run several marathons a year do not have an increased risk of OA, and those that live a sedentary life with minimal stresses on the knees can develop severe OA.  It seems that it is not due to simply wearing out the joint, and that there is actually a genetic component involved.

Surely if there is no cartilage left it isn’t safe to exercise as I will be doing more damage?  This is what a lot of people think, but it simply isn’t true.  Although the cartilage is worn down it takes a while for it to completely go, and even when this happens the rubbing of bone on bone isn’t necessarily doing damage.  The fact is that osteoarthritis is not wear and tear but is instead a disease process.  If you use the knee it will progress and if you don’t use the knee it will still progress.  You are not going to speed up the disease by using your knee more.

So what is the treatment for OA of the knee?  I’m sure most people are thinking the answer to this question is knee replacement.  Although this is certainly an option, it is by no means the first treatment you should consider.  Many surgeons will try to push you towards this option but be very cautious.  Surgery is not without significant risks and should be kept as a last resort when the symptoms are no longer tolerable despite all treatments.    Although the knee is wearing away, there are several things you can do do before surgery to improve the symptoms.  And surprise surprise exercise is one of the most beneficial.

As OA progresses the knee becomes increasingly weak.  This results in the joint becoming less stable and as a result increasing pain.  As a result people will often find ways to bend or use the knee less, resulting in further wasting of the important leg muscles.  This only leads to an even weaker joint and more pain.  One of the best interventions for knee OA is strength training.  A directed program, often initiated by a physiotherapist or well qualified and experienced trainer, aims to improve on leg strength and movement by progressively increasing leg strength through a variety of movements and exercises.  This intervention has been shown to significantly decrease pain in OA and should be done by all sufferers.  Just as significant is the impact it can have on mobility and quality of life.  As you regain strength you can start to do things that you thought you couldn’t do anymore.

Aerobic (cardiovascular) exercise is just as important in the treatment of OA for some people as strength training.  As OA progresses, the pain and restriction felt causes one to exercise less.  This inactivity can result in steady weight gain, and as a result a lot more pressure on the knees.  This increased weight can significantly worsen the pain felt.  If you suffer from knee OA, imagine picking up 2 heavy shopping bags and going for a walk.  I’m sure that just the thought of it makes you feel pain in your knee(s).  Now imagine if you not only took away those bags, but also the equivalent in excess bodyweight.  I don’t have to convince you that your pain would be significantly reduced.  By doing regular exercise (remember it is safe in knee OA and not damaging the joint) you can help prevent the extra weight gain from happening and also reduce any excess you already have.

And lets not forget the fact that exercise has far more health benefits associated with it than improving knee pain, such as reduction in diabetes, heart disease, stroke and many more conditions.  So if you are using your knees as an excuse to not exercise, you are actually increasing your chance of suffering from several other diseases and actively damaging your own health.

It is all very well me telling everyone with knee OA to get out there and exercise, but some of you will be thinking what about the pain???  Knee OA can be a very painful condition, especially when advanced.  Some people will find it difficult to go out for a walk, whilst others are less restricted.  It is certainly true that as knee OA progresses people will become more restricted in what they can comfortably do, but what is important is that you realise that there is always a way to exercise.

Strength training is great because you can vary the weight and range of motion to ensure it is within your comfort levels, and as you improve, so will the pain and you will be able to do more and more.  Any physiotherapist or good trainer will be able to tailor a program to suit, and if they say you shouldn’t be doing anything because of your knees then they are no good and find a new one.

Aerobic training can become a little more tricky.  There are certain activities such as running that some people will never be able to do again, but this should not dishearten you.  Regular walking, with a stick if necessary, is a great way to get out and exercise.  Gyms are now full of fancy equipment and machines such as the cross trainer provide many of the benefits of running without the impact, and incorporate the upper body as well allowing you to do more.  Cycling at a low resistance is a great way to help the knees and cardiovascular system, and some gyms even have arm cycles so you can leave out the legs altogether.  In a well equipped gym you will always be able to find something you can do, just ask the staff for assistance.

As knee OA is a progressive disease, eventually you may find yourself at the stage where your pain is so severe that after discussion with your surgeon you decide on operative treatment with a knee replacement.  At this point you may feel that there is no point starting or continuing with exercise as you just need a new knee, but this is not the case.  In reality the opposite.  Although a knee replacement will provide you with a new joint, to get the best, or even a good result, a pre-operation exercise program is mandatory.

Just replacing the bone is not enough to ensure a good result with a knee replacement.  A joint is made up of many different structures and amongst the most important are the muscles.  As I have explained OA can often result in weakening of the muscles secondary to reduced usage.  If you then simply do a knee replacement, although the joint is nice and new, the muscles that power it are weak.  This can result in a poor outcome after the operation and people not gaining their anticipated results.  It is very important to spend several months before a knee replacement strengthening the muscles around the knee as this will improve the result you get from the operation.

Also the period after a knee replacement is crucial to the result you will end up with for the rest of your life.  It often involves several exercises on a daily basis.  If you have invested the time before surgery mastering these exercises and getting used to them, it will be a lot easier to conduct them after the procedure as you will be familiar with what is required, which will result in a much better outcome.

It is also important to remember that surgery often requires a general anaesthetic, which carries its own risks.  One of the ways to reduce this risk is to lose any excess bodyweight before the operation.  This is another reason why exercising is very important, as together with a good diet it can go a long way to helping you lose weight.

So I hope after reading this article you now realise the importance of exercise in the treatment on knee pain and osteoarthritis.  It is beneficial in reducing pain, increasing function, maintaining independence, preparing for surgery and recovering from surgery, as well as providing all the general health benefits that come with regular exercise.  Everyone has their limitations but there are always ways around them and there is rarely a reason why someone can’t exercise at all.

So if you suffer from knee OA, don’t use it as an excuse to allow your health and knees to deteriorate further.  Don’t be scared to get out there and exercise, and if you are unsure what to do, find a good trainer or go and see your Physician who can point you in the right direction.