Exercising with Hip & Knee Arthritis

When your arthritis flares up, getting active may be the last thing you want to do. However, exercise plays an important role in managing arthritis pain and stiffness. 

Two of our hip and knee specialists, Dr. Michael Bates, MD, and  Dr. Drew Henderson, MD, MSc, cover the ins and outs of exercising with arthritis to keep you moving with minimal pain.

Does exercise help or hurt arthritis?

Dr. Bates: Exercise may not actually affect arthritis itself very significantly as arthritis typically takes many years to develop.  However, the secondary effects of exercise can substantially impact how arthritis affects the patient and how they respond to treatment.

Dr. Henderson: The answer to this is surprisingly complex. Exercise, with a specific focus on low-impact aerobic exercise, is helpful for patients with hip and knee arthritis. It provides:

• Cardiovascular endurance
• Muscle strength
• Maintenance of a healthy weight to keep excess stress off the arthritic joint.

At the same time, exercises of any type can irritate an arthritic joint. In mild cases, a patient can alleviate irritation by modifying their exercise, for instance transitioning from running to walking or lower-impact activities. In other cases, sometimes interventions like medication or injections can help keep the patient as active as they would like to be. 

Ultimately, a patient's ability to get out of the house and exercise, or lack thereof on account of arthritic pain, is often a driver in seeking out joint replacement surgery.

What are the benefits of exercising with arthritis?

Dr. Bates: Weight loss is a critical benefit of exercising with arthritis. Much of the knee arthritis I see is directly connected to obesity and morbid obesity. For a given degree of arthritis, carrying more weigh on the knees will increase the pain a patient experiences. I highly recommend an exercise regimen to help manage weight and control pain.

Dr. Henderson: In my office, I often use the analogy of comparing our joints to the tires on a car.  Ultimately arthritis is like wearing tread off of those tires. By maintaining a healthy weight and activity level, a patient can keep their “car” in good working order and help their joints last longer.

There is certainly some truth to the notion that putting additional miles on the “car” can lead to increased wear over time. In these instances, we often consider other interventions including injection and surgery to help the patient with their quality of life.

How can patients determine if They're safe to exercise?

Dr. Bates: This is a determination that can largely be made simply by trial and error. Low-impact exercises such as swimming or cycling tend to be easier to tolerate compared to high-impact exercises like running. If a patient can safely perform exercises without severe pain, then generally it’s safe. There may be some uncommon exceptions to this, but this holds true for the vast majority of people.

Dr. Henderson: My guideline is to ask how much does a patient compromise to achieve their desired exercise. If a patient is taking high dose medication or having severe pain either during or immediately after exercise, they likely need to have a discussion with their doctor.

If a patient has only mild aches and pains, does not require significant medication and can maintain their desired activity level, I think they can reasonably conclude what they are doing is safe.

What exercises do you recommend for patients with arthritis? What exercises should be avoided?

Dr. Bates: Low-impact exercises such as cycling, swimming and using the elliptical are better than running and jumping types of exercise.  For some patients walking on level surfaces is completely fine, but walking on inclines and declines can be painful.

Depending on the exercise, small things can make a difference.

• Avoid hills while walking
• Raise the seat height on a bicycle to take pressure off the kneecap
• Apply ice after strenuous workouts. 

Generally, explosive exercises like basketball and soccer can significantly aggravate arthritis symptoms, even if they don’t “hurt” the hip or knee itself.

Dr. Henderson: For me, exercising in the presence of hip and knee arthritis is all about achieving the best cardiovascular and muscular output with the lowest possible forces across the arthritic joint.

Specifically, running puts very high contact stress on the hips and knees. Patients with advanced arthritis often, even without a doctor's advice, end up choosing to give up running. I tend to advise against running once a patient has advanced or bone-on-bone arthritis. 

Lower-impact activities are often tolerable for patients with even advanced arthritis. Walking, biking and using an elliptical machine have lower impact forces than running and still provide good cardiovascular exercise. Exercising in a pool is another helpful modification as it takes the contact force off of lower extremity joints. 

What tips do you have for pre- and post-exercising with arthritis?

Dr. Bates: Applying ice after physical can be very helpful for patients with knee arthritis. Some patients find that cold weather aggravates their symptoms, so wearing appropriate clothing when exercising may reduce pain during cold-weather workouts.

Dr. Henderson: In terms of pre- and post-exercise, I advise taking 5 minutes to stretch before any higher-level activity. As we age, our muscles tend to stiffen up. Stretching beforehand helps to prevent aches and pains in the first place and minimize the risk of injury. 

After exercise, ice for swelling is always a good idea. Anti-inflammatory medications can also help reduce swelling and pain but should be taken sparingly. If a patient needs to take them multiple times a day, every day, it is likely time to check in with their doctor.

Michael Bates, MD, is a fellowship-trained hip and knee surgeon with OrthoCarolina University. Drew Henderson, MD, MSc, is a fellowship-trained hip and knee surgeon with OrthoCarolina Clemmons and Winston-Salem.