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Knee Exercise Questions & Answers

Is it normal to experience osteoarthritis knee pain during exercise?

Dr. DiNubile responds: When you have osteoarthritis, one of the common complaints is that it hurts too much to exercise. But exercise done right shouldn't be painful. With certain exercises, you have to stick with them and build strength and flexibility back into your joints — with the end result being improved function and less pain. There may be a little discomfort, but once people know they're not doing harm, they can usually work through it.

More Exercise Questions

Are some exercises better than others for knees with osteoarthritis?

Dr. DiNubile: Overall, exercise is wonderful for joints with osteoarthritis, but not all exercise is created equal. In general, patients with knee osteoarthritis should employ lower-impact, aerobic-type activities such as walking, cycling, elliptical training or water-based exercises. Of all the options, I think cycling is one of the best for helping to build your thigh muscles. That's why stationary cycling is a mainstay of knee rehabilitation following knee injury or surgery.

Walking is also good, but some individuals with more advanced osteoarthritis have difficulty even with that. So for them I recommend water aerobics or swimming or even using a stationary bike or elliptical machine.

Strength training is also important for osteoarthritis, but one must be careful not to overload the joint. Check with your doctor or physical therapist about safe and effective exercise routines that are ideal for osteoarthritis sufferers.

For longer-term relief, Synvisc-One may also be a very good option for you. It helps to lubricate the knee joint and provide pain relief for up to six months. Many of my patients get good results from it and most importantly finding relief from osteoarthritis knee pain helps them start exercising and moving again, which is the best thing you can do for arthritis.

Does exercise help during every stage of osteoarthritis?

Dr. DiNubile: Absolutely. If you have early-stage osteoarthritis, exercise is important in terms of maintaining joint health and even preventing progression. If you have late-stage osteoarthritis, it's still a good idea. It will improve your function and even reduce pain levels if you stick with it. Even if you need knee replacement surgery, you're going to do better if you're in better shape. You're going to come out of the surgery and recover quicker, with a better overall result.

I love to run, but my husband who has arthritis says if I keep running I’ll end up with arthritis, too. Is that true?

Dr. DiNubile: As an orthopaedic surgeon, I'm often asked if running causes arthritis. Pounding the pavement, mile after mile, year after year — you'd think it would cause wear on your hips and knees, just the way tires on your car wear out as the miles accumulate.

The truth is that running does not cause osteoarthritis in healthy knees. Now, runners are usually very glad to hear that statement, until they hear my next one: If you have osteoarthritis, running will make it worse.

Running is a high-impact activity generating forces 5-7 times body weight on your knees and hips. If you already have osteoarthritis, it will accelerate the wear, damaging your joints further. If you have osteoarthritis and are overweight while pounding the pavement, you are even more likely to worsen the wear process.

I’ve heard a lot about stretching and range of motion exercises. What’s the difference?

Dr. DiNubile: Stretching primarily helps the muscles, while range of motion (ROM) exercises target the joints. They are both extremely important for those with knee osteoarthritis.

Stretching is perhaps the most neglected part of our workouts. Most of us need to stretch more, especially as we age. It's best to stretch after a good warm up and especially after your workout is concluded.

The purpose of warming up is to get blood flowing to your muscles and to raise your body temperature. A warmed-up muscle is much more likely to behave elastically when stretched and less likely to be injured or strained.

Your muscles and tendons are a lot like taffy. When taffy is cold, it is quite brittle and can be broken into many pieces. Once warmed, it's gooey and elastic. A warm up can be simply one or two minutes of calisthenics like jumping jacks, running in place or a brief ride on a stationary bike. Lower impact activities, like bike riding, are better if you have kneeosteoarthritis.

Joint ROM exercises are especially important for those with knee osteoarthritis. They help keep mobility in the joint and prevent stiffness and motion loss that is so common with osteoarthritis. To improve or maintain joint mobility, gently and slowly flex (bend) the joint as much as possible and hold 10–20 seconds, then extend (straighten) the joint and hold for another 10–20 seconds.

Stretching and ROM exercises should be static, which means no bouncy movements.

I love playing golf and tennis, even though my knees sometimes pay the price for a few days afterward. Am I just making the osteoarthritis in my knees worse? Do I need to give these things up?

Dr. DiNubile: Being active in sports and exercise is extremely important for maintaining your overall health, especially as you age. Sometimes being active in certain sports can be a challenge if you have osteoarthritis in your knees. Golf and tennis are good sports for someone with arthritis. It is unlikely that they will make your arthritis any worse, and overall it might make you feel better. If you want to stay active in sports, you should try to keep your weight down and keep your legs strong. Spend a little time warming up before activity and afterwards, stretch and/or use ice on your knee. Some individuals do better if they try some acetaminophen or ibuprofen before and/or after activities. Check with your doctor about using these or other medications around activity. Also, if walking bothers you, try using a cart when you golf. If singles tennis irritates your knees, try doubles tennis on a softer surface. If symptoms persist with your attempts to stay active in sports or fitness, again, talk to your doctor. There are treatments, like Synvisc-One, that can reduce your knee pain and could help you participate more comfortably in the activities you enjoy.

I’ve been riding the bike at the gym and sometimes my knee is quite sore afterwards. Within a couple hours the pain is usually gone, but should I be concerned? Could I be making the osteoarthritis worse?

Dr. DiNubile: Cycling is a low impact activity, making it an ideal form of exercise for many individuals with knee OA. A little soreness with cycling can be expected. To help minimize discomfort, make sure that your seat is adjusted at the right height and that you also spend a few minutes warming up at a lower intensity.

If the knee pain gets worse or starts to last longer, talk to your doctor and consider other forms of aerobic exercise like swimming, which is usually very easy on the knees.

I’ve heard that it can be beneficial to build up my thigh muscles to help support my knees. Can I do that by walking or are their other exercises that are better?

Dr. DiNubile: Strong thigh muscles are essential for healthy, happy knees.

The quadriceps muscle (front of the thigh) is a very important protector of the knee, and it acts as shock absorber. To build that muscle you need to do very specific strengthening exercises. Walking or even running will not build that thigh muscle. This is especially important if you have had an injury, surgery, arthritis or any source of pain in your knee that can lead to loss of muscle otherwise known as atrophy.

Muscles also tend to weaken and disappear with advancing age, especially your thigh muscle. Once muscle is lost — something quite common with OA of the knee — it will not come back on its own. Your best bet is to do specific strength training exercises for your legs.

I often have patients who say to me, “I am on my feet all day, my legs should be strong enough.” Their intuition is completely wrong. Standing and walking will not build or rebuild those important thigh muscles. A few sessions with a physical therapist can go a long way in getting you back on track with strong legs.

I’d like to start doing some strength training, but I’m wondering if I should use free weights or the machines at the gym. Is one better than the other for my knees?

Dr. DiNubile: In general, your muscles can’t tell the difference between free weights and machines. You can even build strength with elastic tubing when used as resistance, something that has gotten very popular in recent years. Muscles will grow and strength will improve when they are called upon to do more than they do in everyday life. Both free weights and machines can provide the stimulus needed to accomplish this and build muscle. It really comes down to what you enjoy doing, and what you are willing to stick with over the long haul.

Also, what is available to you? For upper body training, I think both free weights and machines can be quite easy, and both can be very effective if done properly. In terms of your legs, I think it’s easier to target specific muscle groups if you have the correct machines available to you. Otherwise you need to use free weights or tubing to provide resistance, and this can get a little tricky at times.

Regardless, don’t forget to include exercises for your core, which includes the abdominal, lower back, pelvis and hip area. It’s helpful to do core-type exercises on a stability ball, which looks like an oversized beach ball.

Strength training is an essential component of an overall-balanced exercise program, and one that is all-too-often neglected — especially in women and older adults. Being stronger helps you remain functional with age. It prevents injury, and having some extra muscle on your frame raises your metabolic rate, thus helping with weight control.

I just joined a new gym that has a pool. I would love to do some swimming, but I’m worried that all the kicking will hurt my knees. What do you recommend? 

Dr. DiNubile: Swimming and other water workouts are one of the absolute best things you can do if you have knee osteoarthritis. This is because you're somewhat "weightless" in the water, almost like an astronaut in space, and your movements are slowed down, so you're much less likely to injure yourself.

Kicking in the water should not hurt your knees, but I recommend that you gradually increase your program and see how you tolerate things. And while you're in the pool, don't just limit yourself to swimming up and down lanes. There are endless options for exercise in the pool such as water walking, aqua aerobics and in-pool strength training and stretching routines.

Swimming is an excellent overall activity, especially for individuals with knee osteoarthritis, but remember that it doesn’t provide everything you need — don't forget to add strength training and stretching to round out your routine.

I’ve just started going back to the gym. I’ve been walking on the treadmill but I’m wondering if some of the other equipment might be better for my knees, like the bike or elliptical trainer?

Dr. DiNubile: Congratulations for getting back in the gym! Exercise is essential in optimizing your health and it is the key to healthy aging as well. With any orthopaedic problems such as osteoarthritis of the knee, your choice of exercise routines becomes important. If you have knee OA then you would be better off with lower impact activities like walking, stationary cycling, or elliptical trainer rather than running or jumping activities. Water based exercise is also ideal for individuals with knee arthritis. Whatever you do, don’t give up exercise - it’s doing you much more good than harm.



PLEASE NOTE: The views presented herein are solely those of Dr. DiNubile, Orthopaedic Surgeon. Sanofi does not endorse Dr. DiNubile or his book, FrameWork. Dr. DiNubile is a paid advisor for Sanofi. Be sure to consult with your own doctor before starting any exercise program or health regimen.

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Dr. DiNubile is an Orthopaedic Surgeon specializing in Sports Medicine in private practice in Havertown, Pennsylvania, and is a Clinical Assistant Professor of the Department of Orthopaedic Surgery at the Hospital of the University of Pennsylvania. Dr. DiNubile has been chosen in "Best Doctors in America" as well as "Guide to America's Top Surgeons."

He is the author of the bestselling book, Framework—Your 7 Step Program for Healthy Muscles, Bones & Joints (Rodale) and is Executive Producer and host of the award winning national PBS television special, Your Body's FrameWork.

Indication

Synvisc-One® (hylan G-F 20) is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen.

Important Safety Information for Synvisc-One

Before trying Synvisc-One, tell your doctor if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to SYNVISC or any hyaluronan-based products. Allergic reactions, some which can be potentially severe, have been reported during the use of Synvisc-One. Should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, and should be used with caution when there is swelling of the legs due to problems with venous stasis or lymphatic drainage.

Synvisc-One is only for injection into the knee, performed by a doctor or other qualified health care professional. Synvisc-One has not been tested to show pain relief in joints other than the knee. Tell your doctor if you are allergic to products from birds – such as feathers, eggs or poultry – or if your leg is swollen or infected.

Synvisc-One has not been tested in children (≤21years old), pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child.

Talk to your doctor before resuming strenuous weight-bearing activities after treatment.

The side effects sometimes seen after Synvisc-One include (<2% each): pain, swelling, heat, redness, and/or fluid build-up in or around the knee. Tell your doctor if you experience any side effects after treatment with Synvisc-One.

 

View the Complete Prescribing Information for Synvisc-One

 

Indication

SYNVISC® (hylan G-F 20) is used to relieve knee pain due to osteoarthritis (OA). It is for patients who do not get enough relief from simple painkillers such as acetaminophen, or from exercise and physical therapy.

Important Safety Information for SYNVISC

Before trying SYNVISC, tell your doctor if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to SYNVISC or any hyaluronan-based products. Serious allergic reactions have been reported. Should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, or circulatory problems in the legs.

SYNVISC is only for injection into the knee, performed by a doctor or other qualified health care professional. SYNVISC has not been tested to show pain relief in joints other than the knee. Tell your doctor if you are allergic to products from birds - such as feathers, eggs or poultry - or if your leg is swollen or infected.

SYNVISC has not been tested in children (≤21years old), pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child. Talk to your doctor before resuming strenuous weight-bearing activities after treatment.

The side effects sometimes seen after SYNVISC include pain, swelling, heat, redness, and/or fluid buildup in or around the knee. These reactions were generally mild and did not last long, but in rare occasions these side effects were more severe. The most commonly occurring adverse events outside of the injected knee were rash, fever, nausea, and headache.

View the Complete Prescribing Information for SYNVISC

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Important Safety Information: SYNVISC and Synvisc-One are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee.