It’s common to hear my patients say to me at the initial assessment that their knee joint is having cartilage issues or “bone on bone” problems due to doing too much activity when they were younger, such as sports, running or manual labour roles. My patient will always then begin to say that they have avoided therapeutic exercise because of this as they believed it would make their symptoms worse and they would be in too much pain the following day. While this seems to make sense to them it is always important to reiterate to my patient that not only has exercise and activity has been safe for articular cartilage (Bricca, 2018) but it may actually protect the joint cartilage through a reduction in inflammation (Fu, 2019).
I always make sure to point out to my patients that many factors mediate whether our joints wear or arthritis develops beyond joint loading such as inflammation, other health conditions, genetics etc all play a role and it normally can’t be narrowed down to just one factor.
When talking to my patients about this during the initial assessment I make sure I reassure them that exercise does not harm articular cartilage and exercise has compelling evidence for helping prevent at least 35 chronic conditions and treat at least 26 chronic conditions. Furthermore, highlighting the importance and safety of consistent appropriate exercise and the benefits it has for managing and improving osteoarthritis in the knee joints.
The initial exercise prescription needs to reflect a client’s mindset or fear avoidance of specific exercises, initial exercises to prescribe for clients managing knee pain and have doubts about exercise need to be light and non-aggravated so the client is not fearful of movements. Initial exercises can include fit ball squats, sit to stands, standing knee bends, modified split squats.
Accredited Exercise Physiologist (AEP, AES) (ESSAM)
“Mechanical loading inhibits cartilage inflammatory signaling via an HDAC6 and IFC-dependent mechanism regulating primary cilia elongation” in 2019
Bricca A, Juhl CB, Steultjens M, et al
Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials
British Journal of Sports Medicine 2019;53:940-947.