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Sunday, February 26, 2023

Fitness: When life is a pain in the knees, keep moving - Ottawa Citizen

Giving up exercise won't make your achy joints feel better in the long run.

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

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Admittedly, not all of those people have sore knees. The hands, big toe and hips are also common sites for osteoarthritis, but knees account for almost 80 per cent of all cases — a number that has been increasing in recent years.  

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The exact cause of osteoarthritis is still a mystery, but previous knee injury, family history of osteoarthritis, abnormally shaped joints, excess weight, an occupation that requires lots of kneeling or squatting, and being female can increase the risk of being in the large cohort of Canadians complaining about sore knees.

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

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That said, there’s no doubt the symptoms of osteoarthritis can make the activities of daily life less enjoyable. Joint pain, stiffness and swelling and muscle weakness make going up stairs, sitting and rising out of a chair and walking uncomfortable. The same can be said for 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 on exercise altogether.

So if being active is part of the solution, which types of exercise are best for knees that ache?

According to Linda Li, professor of physical therapy at the University of British Columbia and 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’s not healthy,” she said.

Indeed, the majority of studies report a reduction in joint pain and sensitivity and improved functional movement within a few weeks of starting an exercise program. And many study subjects report that a single bout of exercise improved pain right away, as well as making 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 exercising in a warm pool is a good place to start, with swimming, aqua fitness and water running as possible options.

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And don’t discount running on land, even if it seems counterintuitive to pound the pavement. The right type of program will allow most runners to continue doing what they love, provided they’re willing to modify their training plan based on managing their symptoms.

While we’re talking about pain, how do you know whether an exercise is helping or hurting your knees? Normally pain is considered a red flag, with most exercise professionals recommending stopping or, at the very least, modifying your workout if it hurts.

Li says finding that sweet spot between just enough and too much exercise can be challenging, which is why she says it’s a good idea to track your symptoms over time, noting when pain is at its worst and how long it takes to abate after your workout.

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“Exercise needs to be challenging to produce the best results, and in most cases the joint will calm down after a couple of hours,” she said. “If it lingers for more than a day or two, it’s a sign you 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 — to 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 recreation activities in which the high-dose workout proved more effective.

Given that exercise goals and pain tolerance vary considerably between individuals, it’s often beneficial to find an athletic therapist, physiotherapist or strength and conditioning specialist to help achieve the right balance of exercises to feed 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 effectively challenge the muscles, so make sure your workouts progress as you get stronger.

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Keep in mind, too, 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 physical activity has been shown to delay or prevent further functional decline. Stronger joints are protective against injury and can better support the activities of everyday life.

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.

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