Physical activity and exercise represent important components of primary prevention of at least 35 chronic diseases and a recommended first-line treatment for most of the Msucoloskeletal problems. But is it safe to exercise when you have knee and/or hip osteoarthritis!
People with symptomatic OA of the knee describe deep, aching pain which negatively affect their function and quality of life. Interestingly, research shows that exercise is feasible and effective with severe arthritis. It has a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave.
Surgical treatment for total knee replacement found to be more effective in providing pain relief and improving function and quality of life, when followed by nonsurgical treatment (neuromuscular exercise training program, strength training, education, dietary advice, biomechanical interventions such as insoles, and pharmacologic treatment) . (Skou ST, 2015)
How to exercise!
General exercise, such as aerobic exercise and strength training, is generally recommended for improving overall health. General exercise is also recommended for people with OA.
Neuromuscular training, another form of exercise for patients with OA, is an active movements in synergies of all the joints in the affected extremity are included. The movements start with the unaffected extremity, initiating the normal movement and applying bilateral transfer effect of motor learning to the affected leg. To improve sensori-motor control, exercises are mainly performed in closed kinetic chains in different positions (e.g., lying, sitting, standing) in order to obtain low, evenly distributed articular surface pressure by muscular co-activation.
The level of training and progression of the exercise is guided by the patient's neuromuscular function and with regard to the affected joint structures. Strength, coordination, balance, and proprioception.
Most people experience a 10% pain increase when they start to exercise
What is safe pain?
Pain experienced after exercises should be tolerable.
If the pain did not subside, progression of training was slowed down.
There should not be any increase in pain from day to day.
Rest and physical inactivity should not be encouraged for patients with hip and knee OA
Good Life with osteoarthritis
Exercise, especially when supervised, and education provide effective long term management compared to manual therapy, deep tissue massage and muscle stretches, given by a physiotherapist, which provide only short term relief of pain for people with hip or knee pain.
Research also shows that people who exercise in groups, supervised by a physiotherapist, experience greater pain relief than those who exercise at home.
Skou, S.T., Roos, E.M., Laursen, M.B., Rathleff, M.S., Arendt-Nielsen, L., Simonsen, O. and Rasmussen, S., 2015. A randomized, controlled trial of total knee replacement. New England Journal of Medicine, 373(17), pp.1597-1606.
Ageberg, E., Link, A. and Roos, E.M., 2010. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC musculoskeletal disorders, 11(1), p.126.
Skou, S.T. and Roos, E.M., 2017. Good Life with osteoArthritis in Denmark (GLA: D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC musculoskeletal disorders, 18(1), p.72.
Fransen, M., McConnell, S., Harmer, A.R., Van der Esch, M., Simic, M. and Bennell, K.L., 2015. Exercise for osteoarthritis of the knee. The Cochrane Library.