This article first appeared in The Irish Times here
Why walking is the enemy for knee osteoarthritis
Geraldine is 54 and has osteoarthritis (OA) in her right knee. Following a dedicated amateur sporting career she had a few surgical procedures on the knee back in the late 1990s. While she is unsure on the exact details of the surgery, she certainly remembers having part of her meniscus (knee shock absorbers) removed. She also had some cartilage damage in the knee. Right now Geraldine is determined to avoid getting a knee replacement but she fears the worst. Her pain levels have significantly increased in the last 6 months, seemingly out of nowhere. She had been trying to walk regularly (twice weekly) with her two friends but sadly it became apparent that she was holding them back. This really affected her mood. She tried to bounce back by heading out for walks on her own. On these attempts, she walked carefully and a little more slowly but ultimately the pain levels remained the same or even slightly worsened. Now the knee pain is waking her at night. She has stopped walking and has also gained weight in recent months (3kg). Her mood is generally not good and she is frustrated that her knee won’t respond, regardless of her determination. In truth the repetitive walking has meant the knee has no time for the OA inflammation to settle.
Geraldine has to keep exercising but using different methods
Geraldine is no different to the vast majority of patients with knee OA. At first her knee pain appeared rather suddenly, just with a simple twist when walking her dog. In the immediate aftermath she had to be helped to walk by a friend and got a fright that something was seriously wrong. In the following days she became guarded about fully bending, straightening or weight bearing on the knee for fear of causing further damage. A couple of weeks after this episode, people who met her commented that she was limping, which she found hugely frustrating. She wasn’t aware that her limp had become noticeable. She also noticed that she was leaning heavily on the bannisters when walking down the stairs, which never used to be the case. Geraldine has a compromised knee at the moment, there is no doubt. While her surgeon told her that the knee would some day become arthritic she figured she may have gotten away with it up until recently – evidently not! Currently all the signs and symptoms are suggesting that Geraldine takes a break from walking – but crucially – not from exercise!! She just needs to use different methods for a few weeks – primarily strength training and aerobic exercise that involves partial or minimal weight bearing. There are many important reasons for this change in approach.
Improved circulation, reduced inflammation and increased strength
As soon as Geraldine stopped exercising her general circulation dis-improved. She already knew this and was hugely frustrated as a result. However she could not solve the problem by attempting to walk it off, so she she reluctantly gave up. This also caused a weight gain which further exacerbated the issue in her knee joint. Geraldine actually needs to exercise vigorously for 75 minutes per week according to the American College of Sports Medicine (ACSM) guidelines for exercising with OA. But she needs to perform this exercise in a way that is not impactful on her knee joint. Therefore aerobic exercise at a relatively high intensity (on a static bike or cross-trainer) will be quite effective for improving circulation within the knee joint. Working in these higher heart rate zones ensures that oxygenated red blood cells are transported all around the body. This has many health benefits, but in this case the inflamed knee is a particular beneficiary, as the joint capsule gets nourished and reinvigorated without causing further pain. Low impact strength training is the other vital component part of Geraldine’s new training regime. Geraldine needs to train all the large muscles supporting the knee to become stronger. The combination of vigorous aerobic exercise and low impact strength training is proven to regenerate synovial fluid, which has a big impact in reducing inflammation in/around knee cartilage. Geraldine’s knee will start to bend and straighten more easily. She will be able to bear weight more easily and gradually eliminate that limp. If Geraldine manages this programme for a minimum period of 6 weeks she significantly improves her chances of returning to walks with her friends!! What a result that would be!!
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