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Keep Going
- Stephani Sutherland, PhD
- Apr 14
- 5 min read
Evidence suggests movement benefits those with osteoarthritis - even with pain
by Stephani Sutherland, PhD
Editor’s Note: I hike with joint pain and usually I feel better after I have moved. But I have worried that I might be making my osteoarthritis worse by using my joints more strenuously than I should. I asked my friend and fellow hiker and backpacker, Stephani Sutherland, PhD, a science journalist specializing in pain, to share her thoughts about pain and movement, and whether to keep on the trails when a person has joint pain. Her ideas here are her own and backed by research she includes for you to review if you’re curious. We both encourage you to seek the advice of a medical professional before taking up any physical activity.
Author’s note: I want to thank Lea for the invitation to contribute at Hip Hiker and for her inspiration on the trail! I am trained as a neuroscientist – a basic science researcher – and not a licensed medical professional. I have worked as a science journalist for over 25 years, specializing in pain, the senses, chronic illness, and women’s health. My work has appeared in the Los Angeles Times, Pain Research Forum, and Scientific American among other outlets. I met Lea on the trail (where else?) through mutual, like-minded friends. I also live with chronic pain, including osteoarthritis. I’m in my 50s and I live in southern California, where I spend as much time on the trail as possible, hiking, backpacking, and mountain biking. Find me at @sutherlandphd and stephanisutherland.com.
We all feel pain. Pain protects us from injury and harm by warning us of threats like a twisted ankle or a thorny plant. But when any pain lasts more than three months – whether from osteoarthritis, migraine, or even an unknown cause – it’s considered chronic pain. Nearly one quarter of US adults live with chronic pain, and our risk for chronic pain increases with age. But pain shouldn’t necessarily be a reason to hang up your hiking boots. In fact, research suggests that continuing to be active is our greatest defense against future pain.
Let’s take a look at osteoarthritis (OA), one of the most common causes of pain as we age. OA is a progressive degenerative disease that affects the joints, particularly the knees and hips, in 8% of the global population. Pain is a common symptom of OA, and people often worry that activity will worsen their OA. But studies show the opposite.
A common misconception about OA pain, and chronic pain in general, is that imaging technologies such as x-ray and magnetic resonance imaging (MRI) show a readout of damage that corresponds to the pain someone is feeling. But medical images are notoriously unreliable when it comes to explaining pain for a number of reasons. First, images show a crude level of detail, with x-rays revealing only the “hard parts” such as bones. It turns out that our joints are much more than a mechanical device – they’re a complex organ. Even magnetic resonance imaging (MRI), which images soft tissue, doesn’t tell doctors much about what’s really happening inside a joint. And second, we lack truly objective readouts, called “biomarkers,” of pain at a biological level. The only rating system we have for pain is a person’s “self report” – a subjective readout of their experience. Many factors affect how people rate their pain, even from one day to the next. Therefore, imaging isn’t a reliable readout of pain. The bottom line is, keep hiking if you can – that is, if the pain isn’t stopping you altogether.
Many people with OA worry that staying active will speed or cause damage to the joints, but research does not support that. In fact, physical therapy (PT) is the first-line treatment for OA, because a large body of research does support the benefits of exercise for OA. In one qualitative study, participants believed that OA had led to “bone on bone” contact in their knee, that it was caused by “wear and tear,” and they feared that putting weight on their knee would damage it further. Many doctors also think of joint replacement as an inevitable conclusion to OA treatment, and don’t consider exercise as a viable way to stave off disease. Due to these attitudes, exercise therapy remains under-used as a treatment for OA. But a review of many studies showed that continuing to exercise with OA did not cause inflammation or tissue damage. Recent reviews also concluded that exercise was effective for managing OA symptoms including pain – similar or even better than pain medications. That’s right – exercise actually has an analgesic effect.
Many people with OA worry that staying active will speed or cause damage to the joints, but research does not support that. In fact, physical therapy (PT) is the first-line treatment for OA, because a large body of research does support the benefits of exercise for OA.
The good news when it comes to OA is that there are effective treatments to help ease the pain when exercise is not enough. For example, some people find lasting relief from injections of hyaluronic acid, called visco-supplementation, and Lea herself has used another treatment called platelet-rich plasma (PRP) therapy, which has been found to improve pain and function. Steroid injections and non-steroidal anti-inflammatory drugs (NSAIDS) dampen inflammation and pain, though they carry risks with long-term use. Ultimately, joint arthroplasty, or replacement, offers a solution to OA, but it is a major surgery with significant risks and recovery. And while most people have success with joint replacement, about 20% of patients continue to experience joint pain after surgery.
The hallmark of osteoarthritis is the loss of cartilage, the protective tissue that provides cushioning between the bones in a joint. But research into OA at the cellular level is still in its infancy. Ongoing studies in animals and people are showing the complex interactions between nerves and many other cell types that contribute to the disease process. One day, when scientists understand the mechanisms underlying OA, perhaps we can stop the disease before ravages our joints, rather than relying on replacing them.
In the meantime, research suggests that exercise can only benefit people living with OA, and they should not fear exercise. In fact, even for those undergoing joint replacement, there’s no better preparation for surgery than movement. Of course, you want to stay safe – and upright – so be sure to stick to a safe trail, using poles for stability if needed. But get out there and hit the trail without reservations!
Stephani Sutherland, PhD is a neuroscientist who has worked as a science journalist for over 25 years, specializing in pain, the senses, chronic illness, and women’s health. Her work has appeared in the Los Angeles Times, Pain Research Forum, and Scientific American among other outlets. Find her at @sutherlandphd and stephanisutherland.com.
Disclaimer: Stephani Sutherland, PhD, is not a medical professional. The information contained herein should not be considered medical advice. Please consult your medical professional for personal advice.
