If you have knee osteoarthritis, you’ve likely been told that it’s important to exercise. Plenty of other treatments, including corticosteroid injections, creams, shock-absorbent shoes, and alternative therapies like acupuncture and food supplements can reduce pain. However, many doctors argue that physical therapy is an important piece of the puzzle.
Exercise, according to most doctors, works because it strengthens the muscles around the knee and can therefore alleviate the pain on the knee joint. However, recent research published in the Journal of the American Medical Association (JAMA) suggests that not all forms of exercise are necessary when it comes to improving knee pain. Some may even make things worse.
Biomechanics Professor Stephen Messier of Wake Forest University set out to prove in a clinical trial that strength training improves symptoms of knee osteoarthritis. He and his research team recruited 377 participants ages 50 and older, all of whom suffered from the disease. Over the course of 18 months, participants were required to complete either high-intensity strength training, low-intensity strength training, or no training at all. Of all the participants, 320 completed the study.
Both of the strength-training groups had to complete hour-long training sessions three times per week. In the high-intensity group, participants focused on rigorous exercises and heavy weight lifting. The low-intensity group performed the same exercises but used lighter weights. In the third group, participants were given “healthy living” guidance sessions, which lasted for one hour and took place once every two weeks, then once every month after the first six months. The guidance included instructions on foot care, nutrition, managing medication, and improving sleep habits.
At the beginning of the study, the researchers expected participants in the high-intensity strength training group to experience the most improvement in knee pain. However, all the participants reported lower levels of pain, even those who did no strength training at all.
Now, this doesn’t mean that knee-osteoarthritis patients should quit exercise altogether. According to Dr. Messier, the control group may have experienced a placebo effect. Or, the natural coming and going of osteoarthritis symptoms could have messed with the results. Anyone who has experienced arthritis knows that symptoms tend to flare up, then subside. When the pain gets intense, patients usually use some form of treatment. However, they may mistakenly credit the treatment with the reason symptoms subsided, even if the symptoms naturally dissipated on their own. This phenomenon makes it difficult to study osteoarthritis, as it adds doubt to the treatments that work and those that don’t.
So, what’s the takeaway? Intense strength training may not be necessary when it comes to improving knee osteoarthritis. In fact, Dr. David Felson, a professor of medicine at Boston University, told the New York Times that high-intensity training could even do some damage. Arthritic knees often bow inward or outward, he explained, which can increase the risk of injury during exercise. Dr. Felson also believed there were signs that participants doing intense strength training suffered from slightly more pain and worse function in the joint.
Dr. Messier acknowledged that weight loss can play an important role in reducing pressure on the knee joint as well. Another study he led, which appeared in JAMA in 2013, found that weight loss and exercise combined did an excellent job of reducing osteoarthritis pain.
All things considered, adding some moderate strength training to your routine is still a good idea. Helpful exercises to try, which were used in the study, include one-leg raises to the side and to the back and seated calf raises. Be sure to check in with your doctor to make sure you can do these exercises on your own.
This article originally appeared on our sister site, First For Women.