People with arthritis should keep moving

Dr. Gabe Mirkin

If you have joint pains, you should still keep moving. Inactivity worsens arthritis by preventing joints from healing. If moving your joints hurts, your doctor will check for a cause such as rheumatoid arthritis, psoriatic arthritis, gout, reactive arthritis from an infection or some other known source of joint pain. If none of those are found, you will probably be told that you have osteoarthritis, the most common cause of chronic and progressive joint pain. It can eventually destroy the cartilage in joints, and is among the most prevalent chronic diseases and a leading cause of disability worldwide (JAMA, 2018;319(14):1444-1472). Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. More than 700,000 people in North America have their knees replaced each year, mostly for this condition. If you have sudden locking of your joint that gets better and then recurs, you may have “joint mice,” loose pieces of cartilage that slip between your cartilage to cause horrible pain. This can usually be cured by removing the loose pieces with arthroscopic surgery.

Osteoarthritis used to mean that your doctor had ruled out known causes of knee pain and had no idea what was causing your joint pain, but now we know that people with osteoarthritis have high blood levels of galectins that turn on a person’s immune system to cause inflammation, just as in rheumatoid arthritis or reactive arthritis (J of Immunology, Feb 15, 2016;196(4):1910-1921). Anything that causes inflammation can damage joints (Nature Medicine, published online Nov. 6, 2011), and inflammation is a more common cause of arthritis than wear-and-tear injuries (Bone, 2012;51:249–257). If your immune system stays overactive, the same chemicals and cells that are used to attack germs can attack and destroy the cartilage in your joints. A review of 68 studies showed that osteoarthritis is associated with everything that increases inflammation, such as obesity, high blood pressure, high cholesterol, diabetes and metabolic syndrome (Rheumatology, May 1, 2018;57(suppl_4):iv61–iv74; Rheumatology, Jan 1, 2016;55(1):16–24). Everything that helps to reduce inflammation also helps to reduce pain and joint damage: eat an anti-inflammatory diet, lose excess weight, exercise, lower high blood sugar levels and so forth (Ther Adv Musculoskelet Dis, 2013 Apr; 5(2): 77–94).

Arthritics Should Exercise

Many studies show that exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (BMJ, July 20, 2016; N Engl J Med, 2013;368:1675-84). Osteoarthritis almost always worsens with inactivity. Exercise increases cartilage quality in osteoarthritis (Med and Sci in Sprts and Ex, Mar 23, 2017), and a review of 55 studies showed that weight bearing exercise reduced pain and improved joint function (British Journal of Sports Medicine, September 24, 2015). Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, Aug 30, 2016). A review of six studies of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it didn’t make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203). However, you need to be guided by pain. Stop what you are doing if the pain worsens and try another activity.

Running May Make Arthritis Worse

A recent study showed that running can increase joint damage in arthritic mice by increasing inflammation (Ann Rheum Dis, 2019; 78: 787-795), and running appears to increase inflammation with resultant joint damage in mice that have inflammatory arthritis (Annals of the Rheumatic Diseases, 2018;78:6). Researchers found the same results in human runners who had osteoarthritis (PLoS ONE, 2018; 13(10): e0205191). Running is a high-impact sport, and any exercise that puts too much force on a joint can increase joint damage. People with arthritis should not run, jump or participate in sports that involve the strong impact of your foot hitting the ground. Non-impact sports include cycling, swimming, water aerobics, cross country skiing, and use of machines such as ellipticals or stair-steppers where your feet are supported by the equipment as you move.

If you have joint pains and still want to run, take very short steps and if that doesn’t stop your pain, you need to try another sport. You may still be able to run if you can markedly reduce the force of your foot hitting the ground. When you run, both feet are off the ground at the same time, causing you to land with tremendous force that can injure joints, muscles and tendons. Running at a six-minute per mile pace causes your foot to hit the ground with a force equal to three times your body weight. This force is transmitted up your legs to your hips and back, and done repetitively, it can damage joints, shatter bones and tear muscles and tendons (Br J Sports Med, Apr 2016;50(8):450-7; Br J Sports Med, Aug 2007; 41(8):469–480).

The force of your foot hitting the ground is determined most by the length of person’s stride (Scan J Med & Sci in Sports, May 30, 2018). Unnecessarily high impact can be caused by over-striding. It is not important whether you land on the front of your foot or the heel, but the more you over-stride, the more likely you are to land on your heel. A study of the 2017 IAAF World Championships showed that 54 percent of the men and 67 percent of women landed on their heels (Journal of Biomechanics, May 22, 2019). Landing on the front of your foot does not prevent injuries, it is only a marker that you are not over-striding.

My Recommendations

Exercise should be part of the treatment for most cases of arthritis because inactivity increases joint damage. Choose a non-impact sport such as cycling, swimming or cross-country skiing, or use exercise machines that support your feet and do not let you pound on the ground.

Exercise is just one part of an anti-inflammatory lifestyle that is so important for people with arthritis. You should also:

• Eat an anti-inflammatory diet that includes lots of vegetables, fruits, whole grains, beans, nuts and other seeds, and restricts foods with added sugar, all sugared drinks including fruit juices, meat from mammals, and fried foods.

• Work to lose weight if you are overweight. Excess weight causes inflammation, and obesity is a major risk factor for osteoarthritis (Int J Obes Relat Metab Disord, 2001;25(5):622-627; Osteoarthritis Cartilage, Oct 27, 2015, S1063-4584(15)01364-3; Arthritis and Rheumatism, Sept 15, 2008;59(9):1207-13).

• Keep blood levels of hydroxy vitamin D above 20 ng/ml.

• If you use non-steroidal anti-inflammatory drugs (NSAIDs) to help control pain, take the lowest dose possible. NSAIDs do not cure the problem and can have serious side effects. See my report below on NSAIDs and Heart Attack Risk.

• If knee pain becomes so unbearable that it keeps you awake at night, you may want to consider a knee replacement.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com