Uncovering the Truth: How New Evidence is Reshaping Our Understanding of Osteoarthritis

You wake up one morning, and the day begins with a dull ache in your knee. You initially chalk it up to a poor night's sleep. Weeks pass, and the nagging pain isn't decreasing and probably worsening. After a trip to the doctor's office and following a routine X-ray, you hear those dreaded words you've been anticipating: "arthritis," "wear and tear," "bone on bone." You leave the office feeling discouraged, helpless, and worse, afraid to move or exercise.

The unfortunate truth is that dramatic visuals and harmful words like these can sometimes lead to people adopting what we therapists call a fear-avoidant behavior towards movement. The common misconception that patients assume is that returning to sports, exercise, and loading the knees worsen their condition when that is precisely what the body needs.

Osteoarthritis is Not Simply "Wear and Tear"

It's important to note that arthritis development is more than just a mechanical process. Many biological factors play a significant role when it comes to cartilage degeneration.

This includes hormones, nutrients, inflammatory mediators, and genetics, which have an enormous impact. It's not the bone on bone that causes pain; remember, there are no nerve endings here.

When you experience pain in or around your bone, it's typically due to inflammation of the bone's protective covering (periosteum), and other surrounding ligaments and soft tissues become inflamed and sensitive.

These structures are what send the pain signals.

The previous rationale was that too much exercise or loading would wear down the knees and speed up the degenerative process. The truth is OA is far more complex than we first thought.

Many more factors come into play, and the reality is that more is typically better for load management. Runners tend to have improved symptoms and decreased onset of pain compared to non-runners. As the narrative evolves, the better the understanding that more movement won't cause the knees to "wear down."

Moderate to Vigorous Exercise Intensity is Beneficial for Osteoarthritis

The current research shows that exercise can help improve cartilage regeneration.

According to the American College of Sports Medicine (ACSM) guidelines, for aerobic training, aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise every week. You can break this into sessions of at least 10 minutes each.

For resistance training, try to have two sessions per week. In each session, do two sets of 8 to 12 repetitions of each exercise. Use a weight about 60% to 70% of the maximum weight you can lift for one repetition.

Ensure at least 48 hours of rest between each resistance training session.

Incorporating this level of intensity comes with many, many benefits.

Exercise has been proven to affect our mood and cognition positively. It also helps increase insulin sensitivity and decrease glucose sensitivity, aiding in the anti-inflammatory process.

The more we participate in resistive training, the more our muscle function improves and the more support our muscles can provide to our joints and bones.

Resistive training is also shown to improve bone density. The more we use our joints, the more likely they are to produce synovial fluid in the joints, which essentially acts as lubrication for the knees.

Nutrition Plays a Significant Role

Since we now have a better understanding of the process of OA, we know that inflammation, hormones, and metabolic processes have a negative impact. As a result, nutrition matters more than ever.

Limiting foods and drinks that can increase inflammation in the body and shifting towards more whole foods, fish, and plant-based diets can have tremendous effects.

This means straying away from loaded carbs, processed foods, and excess sugars commonly found in sports drinks; not only will the emphasis on nutrition decrease inflammation, but it will naturally lead to a reduction in obesity.

The research indicates that a 10-pound loss in weight loss leads to a significant decrease in pain levels across patients.

Summary

Yes, osteoarthritis IS a progressive disease. But it CAN be effectively managed. More research suggests that exercising can assist in cartilage regeneration and that positive lifestyle changes have drastic effects.

Furthermore, it's crucial to acknowledge that knee OA is a complex condition influenced by various factors, including lifestyle, genetics, and past injuries. While it may not be possible to completely regenerate cartilage, improving joint health through exercise or other non-surgical interventions can still significantly benefit managing the condition and maintaining mobility.

Again, a progressive condition requires progressive steps to combat it. Start small and gradually develop a consistent regimen. Increase your nutritional awareness. Prioritize sleep, and don't be afraid to slowly return to your active hobbies. As you act upon these lifestyle modifications, you will dramatically improve your quality of life and reduce pain.

References:

1. Smith J. Exercise as an adjuvant to cartilage regeneration therapy. Int J Mol Science. 2020 Dec.

2. Petringa L, Roggrio F, Trovato B, et al. How physical activity affects knee cartilage and a standard intervention procedure for an exercise program: a systematic review. Healthcare Basal. Sep2 sep.

3. Maledmud C. The biological basis of osteoarthritis: state of the evidence. Curr opin rheumatol. 2015 May.

4. Lo G, Musa S, Driban J, et al. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin rhuematol. 2018 Sep.