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Is it SAFE to walk with Knee Arthritis?



I get asked these questions ALL the time. Is it safe to walk with knee arthritis? Am I going to make the arthritis worse the more I walk? What if I have pain when I walk? I’m going to answer these questions with data from a recent clinical study. The goal is to convince you that yes it is safe to walk with knee arthritis. No you are not going to make the arthritis worse, in fact quite the opposite, walking is likely protective against arthritis. And can you walk if you have pain? Well, that one’s a little bit more complicated.


Knee osteoarthritis is a debilitating condition that can progressively get worse if left untreated. And when someone has pain from bone on bone osteoarthritis, the only solution left may be a knee replacement surgery. And while most people do well, the outcomes of these surgeries are not always ideal. To make things worse, the prevalence of knee osteoarthritis is increasing every year and outcomes are actually getting worse over time. This is indicated by the number of knee replacement surgeries rising across the board in every country.


There are many reasons for this trend, but one of the most common is the fact that many people are simply not getting enough physical activity. People just aren’t walking. In a previous video, I combed through scientific data to get you the optimal number of steps to take per day to stay healthy. This includes benefits to all cause mortality, cardiovascular disease, mental health, cognitive function, immune function, weight loss, and more. You can achieve all of these benefits simply by walking. And as a hint, you don’t have to reach the often-touted goal of 10,000 steps per day to get these benefits. Check out the video to learn more.


So if you have knee or hip osteoarthritis, you may be wondering if it is safe to walk or if you will cause further damage. In the past, some doctors may have advised people with arthritis to stop exercising altogether. However, newer research has shown that walking can actually be protective against arthritis and is associated with less overall pain.


This observational study was designed to assess the relationship between walking for exercise and symptomatic knee osteoarthritis. They also wanted to see whether walking for exercise had an impact on the progression of arthritis. The authors took data from the Osteoarthritis Initiative and assessed four different outcomes which include frequency of knee pain, worsening radiographic severity of knee osteoarthritis, progression of medial joint space narrowing, and improvement of knee pain. The study included 1,212 participants over 50 years old with a mean age of 63.


They found that people with knee osteoarthritis who participated in walking for exercise had a 40% decreased odds of new frequent knee pain compared to people who didn’t walk. They also found that walkers were less likely to have progression of medial joint space narrowing with an adjusted odds ratio of 0.8. Interestingly, worsening radiographic severity of knee arthritis and improvement of knee pain did not show statistically significant increased odds in walkers compared to non walkers.


The authors go on to conclude that “our study supports the idea that walking is beneficial in patients with knee osteoarthritis in terms of both structural modifications and symptom improvements. Specifically, we found that those who walked for exercise were less likely to develop new frequent knee pain and that walking may be an effective treatment to slow the structural progression of knee osteoarthritis.”


Ok so this study really helps to dispel the myth that if you have knee arthritis, you can’t walk. It’s quite the contrary. There is robust evidence that walking can help reduce the frequency of knee pain and even slow down the progression of arthritis.


This is consistent with data from a recent systematic review and network meta-analysis looking at treatments for knee arthritis. This study included 35 systematic reviews including 445 randomized controlled trials. The authors report that exercise was the largest studied category of all treatments for osteoarthritis. Moreover, the benefits of exercise therapy were large and had consistent effects across follow up time periods. This is also why medical societies such as the American College of Rheumatology, the European Alliance of Associations for Rheumatology, and the Osteoarthritis Research Society International all recommend exercise therapy as a core treatment for osteoarthritis.


So exercise can not only reduce pain, but it can also decrease the progression of arthritis. There are several reasons for this, but one of the main factors may be exercise’s impact on weight management. This study was a systematic review that investigated the association between weight gain and knee osteoarthritis. They found that weight gain was associated with increased cartilage damage, increased bone marrow lesions, increased meniscus damage, and more overall inflammation with effusions and synovitis. Patients who put on more weight also had significantly higher likelihood of getting a total knee replacement.


So to answer the questions from the beginning of the video. Is it safe to walk with knee arthritis? Absolutely yes. Are you going to make your arthritis worse the more you walk? No, you’re going to PREVENT the arthritis from getting worse by walking more.


And what if you have pain when you walk? Well, that one is more complicated. Are you having pain because of inflammation from the knee arthritis? If yes, you may need to calm down the inflammation first before getting back into walking. Alternatively, we know people with osteoarthritis tend to have a variety of biomechanical problems related to weak muscles. Are your glutes not activating which is leading to knee pain? Do you have a tight IT band? Or perhaps are there myofascial trigger points in the vastus lateralis, the VMO, the rectus femoris, or the medial and lateral heads of the gastrocnemius?


You can see how it becomes very difficult to answer this question. This is why I typically recommend taking a multimodal approach to treating symptoms related to knee osteoarthritis.

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