Fitness: When life is knee pain, keep moving

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If it seems like there’s an epidemic of sore knees, you’re not wrong. Osteoarthritis affects more than four million Canadians, meaning one in seven adults lives with joint pain. By 2040, that number is expected to grow to 12 million.

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Granted, not all of those people have sore knees. The hands, big toe, and hips are also common sites for osteoarthritis, but the knees account for nearly 80 percent of all cases — a number that’s been rising in recent years.

The exact cause of osteoarthritis is still a mystery, but previous knee injuries, family history of osteoarthritis, abnormally shaped joints, being overweight, an occupation that requires a lot of kneeling or squatting, and being a woman can increase your risk of being in the large cohort of Canadians who complain of sore knees.

For most, osteoarthritis hits around middle age when the cartilage in the knee begins to break down. And contrary to what you may have heard, high-impact activities like running don’t speed up onset. Being active is good for your knees, circulating more joint-friendly nutrients to replenish aging joints and cartilage. So if your knees are just starting to hurt, don’t give up exercising because you think it will make your aching joints feel better.

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That said, there’s no doubt that the symptoms of osteoarthritis can make the activities of daily living less enjoyable. Joint pain, stiffness and swelling, and muscle weakness make climbing stairs, sitting and getting up from a chair, and walking uncomfortable. The same can be said of playing tennis, sitting cross-legged in a yoga class, or squatting and lunging at the gym, which is why so many people with sore knees give up exercising altogether.

So if being active is part of the solution, what types of exercise are best for sore knees?

According to Linda Li, a professor of physical therapy at the University of British Columbia and a senior scientist at Arthritis Research Canada, a mix of strength training and aerobic exercise is ideal.

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“You want the strongest muscles possible to support a joint that isn’t healthy,” she said.

Indeed, most studies report a reduction in joint pain and tenderness and improved functional movement within a few weeks of starting an exercise program. And many subjects report that a single exercise immediately improved pain and made it easier to perform everyday tasks.

That doesn’t mean all forms of exercise are knee-friendly. Cycling, Pilates, yoga and tai chi have been shown to be particularly effective at reducing discomfort and improving joint range of motion. Li says training in a warm pool is a good place to start, with swimming, aqua fitness, and running water as possible options.

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And don’t count on running on land, even if it seems counterintuitive to pound the pavement. With the right type of program, most runners can continue doing what they love, provided they are willing to adjust their training plan based on managing their symptoms.

Speaking of pain, how do you know if an exercise helps or hurts your knees? Normally, pain is considered a red flag, with most exercise professionals recommending that you stop or at least modify your workout if it hurts.

Li says it can be challenging to find that sweet spot between just enough and too much exercise. That’s why she says it’s a good idea to track your symptoms over time, notice when the pain is worst, and how long it takes to ease after your workout. .

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“Exercise should be challenging to produce the best results, and in most cases the joint will calm down after a few hours,” she said. “If it lasts more than a day or two, that’s a sign you’ve probably pushed too hard.”

A recent article published in Annals of Internal Medicine compared the effects of a “high-dose” exercise intervention — a 70 to 90-minute workout with 11 exercises — with a five-exercise, 20-minute workout, each performed three times a week for 12 weeks. Both protocols resulted in similar improvements in knee function and quality of life, with the exception of sports and recreational activities where the high-dose exercise was found to be more effective.

Since exercise goals and pain tolerance vary significantly from person to person, it is often helpful to seek out an athletic therapist, physical therapist, or strength and conditioning specialist to achieve the proper balance of exercises to nourish and strengthen the joints. You don’t need an intense workout to benefit your knees. Regularity is more important than intensity. That said, when it comes to strength training, you need to challenge the muscles effectively, so make sure your workouts progress as you get stronger.

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Also keep in mind that everyone’s pain threshold is different. What works for some is too uncomfortable for others.

As for those who are just starting to experience a dull ache in the knees, exercise is even more important. Regular exercise has been shown to slow or prevent further functional decline. Stronger joints protect against injuries and can better support daily activities.

Maintain or improve aerobic fitness by walking, swimming, running or cycling; improve range of motion and joint stability with yoga, Pilates, or tai chi; and strengthen the muscles around the joint with resistance training using machines, light weights, or elastic bands.

And above all, keep moving.