SCIENCE FRIDAY: BAD KNEES? GOOD MOVES

Sunny yellow bicycles. Taken by PKSenagore March 15, 2018. All rights reserved.

OSTEOARTHRITIS (OA) OF THE KNEE IS INCREASING IN INCIDENCE, according to a scientific study that compared autopsy findings in early ancestors, pre-industrial age, and post-industrial age skeletons. It’s roughly doubled in persons who were born after World War II compared with those who were born before it writes Alex Hutchinson, who reported on the August 2017 study From Harvard University, for RunnersWorld.com.
 
The Proceedings of the National Academy of Sciences (PNAS) article that described the research postulated that although a longer life and increasingly heavier bodies may have contributed to the development of this condition, there are likely other factors that explain the increase.  It could be related to the harder surfaces modern folks walk around on, or the fact that women, who are 50% more likely to develop OA than men, have taken to wearing high-heeled shoes more often.
 
But the researchers also suspect that physical INACTIVITY may be at fault as well.  “Less physically active individuals who load their joints less develop thinner cartilage with lower proteoglycan content as well as weaker muscles responsible for protecting joints by stabilizing them and limiting joint reaction forces”.
 
Chronic inflammation, which is made worse by physical inactivity, diets rich in highly refined carbohydrates, and obesity were also identified as possible culprits promoting the development of OA in modern life. This all sounds familiar.  If less activity contributes to obesity then it seems we have a central issue, too little physical exercise, from which at least 2 other problem conditions arise.
 
The Hutchinson RW article makes a point of declaring that running doesn’t cause OA but on the contrary, too little of this activity might be the problem. However, he cautions that in spite of doing all the “right” things, runners still get arthritis, so more research work is needed.
 
WHAT IF YOU HAVE OSTEOARTRITIS OF THE KNEE? What to do to not make it worse? What to do to stay physically active?  I looked for more specific advice to help with selection of daily activities; practical recommendations.
 
It happens that an October 2013 “Men’s Health Watch” article from Harvard Health Publishing addresses the difficulty of staying or becoming more active while living with OA of the knee., “Arthritic Knees: Exercise can help, but don’t overdo It”.  Although written about 3-4 years before the newer 2017 research article was published, it is one of the few that attempts to provide direction. 
 
“Do you have knee osteoarthritis and want to be more active with less pain? It turns out that the best medicine for wear-and-tear knee but you have to stick with it to get the benefit – even if it hurts a little.”
 
So says orthopedic surgeon, Dr. Donald T Reilly, from Harvard-affiliated Beth Israel Deaconess Medical Center, who is quoted in the article. It’s important, Dr. Reilly also says, to do “low-level, repetitive exercise without stressing the joint too much”, which will allow you to “gradually strengthen and stabilize the joint”. “Those kinds of exercises diminish the forces that are put across the joint”.
 
Those with severe OA may be able to do less than individuals in which the condition is mild-to-moderate, who can “work the joint a bit harder”. There will be a bit of testing to find the boundaries of what can be attempted.  Exercises that involve deeply bending the knee may be off limits for some. Alternative straight-leg exercises are encouraged, though!
 
The article discusses getting started with conditioning exercise. There is the usual caution of checking with your physician and working with a qualified physical therapist. This can be the big hurdle that some are unwilling to get over, because it takes time to schedule and make these medical appointments.  But it is the surest path to obtaining a custom exercise/stretching prescription and demonstration of technique.   Several therapy visits will allow tweaking of the program so it works without supervision. Ask your PT for recommendations to local trainers or fitness centers where conditioning and exercising can continue when medical coverage for PT sessions expires.
 
The article ends with an exercise, the “alphabet tracing routine” for “strengthening muscles that support and stabilize the knee”.  It’s not a complicated or difficult set of moves and can be done lying on the floor while watching TV,  in bed before getting out, or on the beach!
 
Learning this one convenient, love-your-knee exercise is worth the read!
 
RUN & MOVE HAPPY!
 
https://www.health.harvard.edu/pain/arthritic-knees-exercise-can-help-but-dont-overdo-it
 
https://www.runnersworld.com/sweat-science/knee-arthritis-has-doubled-and-its-not-because-of-running
 
http://www.pnas.org/content/pnas/114/35/9332.full.pdf
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