“Go home and rest your knee. Wait for your total joint replacement. Then, after your total joint replacement, rest your knee. Walk, but don’t exercise too much. Don’t wear it out.”
These statements are awful, out-of-date responses to arthritic knee pain and flat out wrong. Here’s why:
If you have arthritis, going home and resting your knee produces muscle atrophy, bone loss and loss of balance and coordination. It also increases obesity and leads to depression.
Exercise designed to protect the arthritic joint — while simultaneously building the muscles around it and the rest of the body — increases function and decreases the forces across the joint surface. It improves balance and coordination (limiting falls), helps control weight and improves one’s sense of well-being. So the logical treatment for arthritis is a program of smart, progressively increasing exercises.
Exercising alone, however, is not as effective as exercising under the guidance of a physical therapist or trainer.
Objective measurements of your progress, instruction in new exercises, safe and efficient techniques and a competitive motivation to improve all drive our progress. Meanwhile, the increased circulating testosterone, pheromones and adrenaline generated by the exercise drive well-being. Exercising in front of a TV or while reading a book actually decreases the effectiveness of the exercise. Only by feeling the limits of your heart rate, the strain in your muscles and the sweat on your brow do you extend your fitness limits.
These feedback channels are suppressed if the mind is not focused on one’s physical goals and the process of reaching them. So never waste your exercise time with digital distractions.
Exercising outdoors has an improved wellness value over indoor exercise. Most outdoor exercises require balance, expose the skin to sunlight (needed for Vitamin D production and bone formation) and are mentally expansive. If you like using gym equipment, move your set-up outside or find outdoor fitness stations.
After artificial, partial or complete joint replacement, the advice is the same. We have never seen a well-placed artificial joint replacement worn out from exercise. The most common cause of wear is loosening of the cement interface with the bone. This is most likely caused by a weakening of the bone with aging. The only known way to increase bone mass is by resistive exercise. So increase your walking, hiking, skiing and weightlifting to save your artificial joints.
The most common question we hear about sports and joints concerns running. Be advised: Our views on this subject are not shared by all doctors.
First, a question. Which has more force on the knee joint: running a mile or walking a mile? The answer is that the quantity of force is about the same, due to the fact that you take fewer steps when running. Because the peak forces are higher (especially with poor running form, or on hard surfaces), Stone Clinic makes make the following recommendations:
If you must run, use “Chi running” techniques. This involves short strides, mid-foot landing, soft surfaces and new running shoes. While running in general is not our favorite sport for artificial joints — and since most people with severely arthritic knees gave it up years ago — we prefer to encourage other activities like skiing, hiking, biking and weightlifting, all of which load the bones and muscles without high peak impacts. Some running is so pleasurable, however, and so unlikely to cause damage that the benefits outweigh the potential risks for our addicted runners.
So go home and start exercising. Live long by being active.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.