In our Boulder Physical Therapy practice we still hear old wives tales on the harmful effects of exercise in patient’s with knee arthritis. For example, patients should avoid running to prevent worsening of their knee arthritis despite significant medical evidence to the contrary. Many of these theories are based in an outdated “wear and tear” theory of osteoarthritis when current evidence reflects the continuous metabolic factors of the disease which may be altered by exercise. Even if there was truth to the wear and tear argument most of us would prefer some knee pain instead of the more negative effects and diseases associated with being sedentary.

Cartilage is an amazing structure in our body providing cushioning and limiting shear forces across the joint. The fluids in our joints have a coefficient of friction similar to ice or about 1/5 the friction of a standard ball bearings. Other unique factors to cartilage include a lack of neural input and vascularity. Thus, cartilage requires pressure changes across the joint to provide nutrients and remove waste from the joints. Authors have used a sponge as an analogy for cartilage during this process. As pressure is placed through a joint fluid is pushed out of a joint and new fluid enters the joint upon the relaxation of this pressure. Without this fluid transfer joints become more symptomatic and may be prone to more advanced stages of arthritis. This can be seen in healthy joints subjected to long term immobilization. After a period of time these healthy joints display signs of early osteoarthritis.

The vast majority of patients with knee arthritis will benefit from activity and exercise. The type, intensity, frequency, and duration of their exercise program should be developed with a Physical Therapist to determine the optimal dosage for their current condition. One size does not fit all and each patient should be provided with a program including aerobic, mobility exercises, and strength training. These interventions are most effective in the early stages of knee arthritis with prior research demonstrating these treatments can delay or prevent the need for a total joint replacement. Patients should aim for a “goldilocks”approach to exercise and avoid the extremes of too little or too much exercise.

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