The Best Exercise for Osteoarthritis

About the last thing someone suffering from symptomatic osteoarthritis (OA) wants is surgery.

And with good reason.

Surgery carries with it significant risk. Of course, most of us don’t often think about that since surgery seems so matter of fact these days.

And some surgeries for OA, like arthroscopic debridement of the knee, are ineffective even though the procedure is still performed regularly.^[1]Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. S. (2015). Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br J Sports Med, … Continue reading

I’ll use the knee as an example in this piece but the same principle applies to any weight-bearing joint.

The basic problem with OA is that the strength of the joint is less than the force the joint is exposed to. Things like walking, standing up from a seated position, taking a flight stairs makes your knee hurt.

Many years ago, I came up with a method of exercise that solved this problem. I used special equipment that reduced the load on the joint essentially making you weigh less and, in most cases, loading the leg no longer hurt. One of my students referred to this as a “time machine” because it gave you a glimpse of what was possible. If you could find the load that was pain-free, then you could strengthen your leg enough to withstand the forces of everyday activity and your symptoms would subside and often go away.

I called this phenomenon Load Tolerance – your ability to withstand a certain amount of force pain-free and with good form.

But how do you strengthen your leg when things like walking and climbing stairs hurt? This eliminates exercises like squats or any weight-bearing exercise.

Because placing weight on the leg hurts, most of the exercises are done off the feet in either a sitting position or lying down. Exercises like straight leg raises, quad sets, knee extensions are often used with dosages for muscles strengthening of 10 to 15 repetitions per set.

But, at some point, you have to get up on your feet which is when many people find that their knee still hurts.

The answer is to reduce the effective weight of the body so that the applied load matches the Load Tolerance. The best option for this is to use a Variable Incline Plane (VIP) but you can also use other types of tools such as exercise bands and exercise pulley systems.

By reducing the load, you can increase the repetitions without causing the joint pain. More reps for joints is a good thing, It’s how you increase the Load Tolerance of the joint. Muscle strengthening occurs from adding resistance and using a relatively low number of repetitions. Joint strengthening comes from reducing resistance and using a high number of repetitions.

But, at some point, you have to also strengthen the leg muscles, not just the quadriceps. Of course, this is much easier to do when your joint doesn’t hurt.

The progression goes from low load, high repetitions to higher load, lower repetitions.

One of my clients came to see me from Colorado. She was a forest firefighter and had knee joint pain which made her job difficult, and at times, impossible to do.

Once we found her Load Tolerance, one part of her program began with a joint strengthening dose (she bought a VIP to use at home) performing bilateral squats (both legs) several minutes per set nearly every day. Before long, she was performing single-leg squats for 30 minutes pain-free.  We gradually increased the force as her Load Tolerance improved until she was able to perform single-leg squats upright. This translated into pain-free performance in her job duties.

Unfortunately, most doctors are prescribing pain medicine, NSAIDs or recommending surgery.

There’s a lot you can do to help yourself besides pain medicine and surgery.

The best exercise for OA joint pain is one that matches the person’s Load Tolerance with the load of the exercise or activity.

Thanks for reading.

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