Knee arthritis exercises can go one of two ways: providing you do them right they could nix ongoing pain for good, but do them wrong and you could exacerbate your symptoms. The good news is that doing them correctly can be so beneficial that even the NHS now prioritises exercise as a form of arthritis treatment, over painkillers.
The advice comes from the National Institute for Health and Care Excellence (Nice) who published new evidence showing that people with osteoarthritis (there are several kinds of arthritis, including rheumatoid and psoriatic) who exercise regularly may experience reduced pain. Music to the ears of the +10million people in the UK who have arthritis (according to the NHS), we imagine.
Of course, arthritis can affect the knees, hips and other joints such as the hands, but an average of 2,400 of you search for knee arthritis exercises every month, so this article will focus mainly on exercise for knee arthritis. Here’s everything Dr Amal Hassan, Sport & Exercise Medicine Consultant Physician at The Institute of Sport, Exercise and Health, wants you to know.
Can exercise treat knee arthritis?
Knee arthritis is a form of osteoarthritis – the ‘most common kind in the UK’ which causes painful and stiff joints of which Nice's research is based upon, so the answer is yes.
‘Exercise, particularly strength training, should form part of the first-line treatment of pain and disability associated with a diagnosis of knee arthritis,’ Dr Amal says.
There's a lot to the way in which knee arthritis exercises work to reduce pain and alleviate symptoms, but know that ‘the muscle-strengthening and balance-improving effects of exercise can greatly influence the forces transmitted through joints, improving pain, increasing mobility and enhancing balance’.
Take this example: ‘A single-leg balance (unilateral) exercise might improve lower limb muscle strength and joint range of motion. These features mean that you'll be better able to distribute forces transmitted through the ground and lower leg, into the knee, as your lower leg muscles will be stronger, and so you'll reduce the physical burden on the skeletal knee joint itself.’ It's about the muscles and joints surrounding the skeleton picking up some of the slack.
Knee arthritis exercises could also be particularly beneficial ‘when there’s an association between obesity and symptomatic knee arthritis,’ says Dr Amal. ‘Exercise can then reduce pain and disability through weight loss, if medically indicated.’
Benefits of knee arthritis exercises
Dr Amal wagers that all of the following benefits could come into fruition:
Better joint range of motion
Mental health benefits
She goes as far as to say that, ‘Exercise interventions for knee arthritis can either stave off or reduce the need for injections or surgery. Similarly, if surgery is being considered, being fit and strong enough to recover by exercising beforehand is key.’
Best knee arthritis exercises
The formula is three-fold: to strengthen your lower leg muscles, to improve joint range of motion and to reduce pain.
The best knee arthritis exercises that do this usually incorporate the following, says Dr Amal:
Bending and straightening the knee, with use of hamstrings and quadriceps
Facilitating range of motion at the knee
Improving endurance of stabilising pelvic muscles e.g. glute bridges
Increasing endurance of the calf muscles
‘Bending and straightening the knee can be done as an isolated movement on a chair or bed, lying on your front to activate your hamstrings, or sitting on your bottom to activate your quadriceps,’ Dr Amal recommends. ‘The knee can be supported with a towel underneath when you first begin, particularly when pain is limiting.’
‘Then try incorporating bending and straightening in compound movements, such as a mini lunge or mini wall-sit.’
Versus Arthritis also recommends the following knee arthritis exercises:
1.Straight-leg raise (sitting)
'Sit back in your chair, with a straight back. Straighten and raise one of your legs. Hold for a slow count to 10, then slowly lower your leg. Repeat 10 times with each leg.'
2. Step ups
'Step onto the bottom step of stairs with your right foot. Bring up your left foot, then step down with your right foot, followed by your left foot. Hold on to the bannister if necessary. Repeat with each leg until you can't do any more. Rest for one minute and then repeat this another two times. As you improve, use a higher step, or take two at a time.'
'Sit on a chair. Without using your hands for support, stand up and then sit back down. Make sure each movement is slow and controlled. Repeat until you can't do any more. Rest for one minute then repeat another two times. If the chair is too low, start with rising from a cushion on the seat and remove when you don't need it anymore.'
4. Quads exercise with roll
'Sit on the floor, sofa or bed, with your legs stretched straight out in front of you. Put a rolled-up towel under one knee. Push down on the towel as if straightening your knee. Pull your toes and foot towards you, so that you feel your calf muscles stretch, and so that your heel lifts off the floor. Hold for 5 seconds, then relax for 5 seconds. Do this 10 times, then repeat the exercise with the other leg.'
5. Leg cross
'Sit on the edge of a table, seat or bed and cross your ankles. Push your front leg backwards and back leg forwards against each other until your thigh muscles become tense. Hold this for as long as you can, then relax. Rest for one minute and then repeat another two times. Switch legs and repeat.'
As for how difficult knee arthritis exercises should feel, Dr Amal says that the rate of exertion should increase with time and practice. Always start easy, and gradually build up.
How often to do knee arthritis exercises
‘It’s about focussing on endurance and pain-free movement in the early phases,’ Dr Amal says. ‘Not allowing pain to shift to the moderate-severe end of the scale, either during or after the activity, and on into the next morning. Most people will be able to stick to three sets of 10 reps of each exercise, three times a week, but remember that this is individual to each person, your pain and the demands of your day-to-day life.’ See a physiotherapist if you’re unsure.
When to avoid knee arthritis exercises
For any of you who’ve been suffering with pain from knee arthritis for as long as you can remember, chances are you’re chomping at the bit to have a go at these exercises but know that there’s no one-size-fits-all route to pain-free life. As always, it’s about listening to your body. Here’s when you should ease off, and exactly what you should do:
If you have moderate-severe pain during activity, modify your activity to reduce pain by doing less reps or not going as deep into the movement
If you have moderate-severe pain returns after activity and the morning after, modify your activity further to reduce pain by doing less reps or not going as deep into the movement
If pain is severe during activity, stop exercising on that day and try again the next – if it’s still severe, wait until the pain is at a mild level
If pain is consistently triggered by any form of activity, look to see a musculoskeletal specialist to determine if you require more specific advice
On the whole, it’s promising advice from Dr Amal. ‘It’s unlikely anyone with knee arthritis would need to avoid exercise altogether, as exercise can always be modified, and muscle activity can usually protect against pain, so even low-level isometric exercises such as mini lunges can be useful in line with other treatment such as injections if pain is severely limiting.’
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