Exercise as a means of pain relief for patients with osteoarthritis

Exercise is one essential aspect of the treatment regime for patients with osteoarthritis of the knee and hip, according to current guidelines in developed countries. New strategies presented at the EFORT Congress in Istanbul underline the key role of exercise in relation to orthopaedic surgery. Exercise needs to be tailored individually for patients, and motivation is vital to success. Neuromuscular training is the frontline therapy.

Istanbul, 7  June 2013   – Together with weight loss, where appropriate, and information on the condition, exercise is standard treatment for osteoarthritis in Europe and the United States. It can also play a key role in relation to orthopaedic surgery for this condition, said Prof Ewa Roos (Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences,   University   of   Southern   Denmark,   Odense).   A   well-designed   programme   of exercise prior to referral for orthopaedic surgery will help cut waiting lists and lead to better selection of patients likely to benefit from surgery.

It  is  paramount  that  patients  with  osteoarthritis  of  the  knee  and  hip  be  given  exercise regimes  tailored  to  their  individual  needs,  said  Prof  Roos  at  the  14th   Congress  of  the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul. “The 50-year-old man with a prior knee injury and the 75-year-old obese woman need very different exercise programmes,” she said, “while these programmes also need to be individually adjusted as patients improve.”

Prof Roos also emphasised the benefits of a training programme as regards pain relief, and the  consequent  effects  on  postponing  total  joint  replacement.  This  aspect  of  an  exercise regime on osteoarthritis treatment is currently frontline research in Scandinavian countries and there are several randomised control trials underway at the moment. “Exercising twice weekly for six weeks has an effect two to three times greater than that of full dose of pain killers  and  anti-inflammatory  drugs,”  said  Prof  Roos.  “It  should  also  be  remembered  that these  drugs  have  dangerous  side  effects  on  the  stomach  and  heart,  whereas  the  ‘side effects’ of exercise, improved physical function and better mood, are solely positive.”

Motivating patients matters

Motivating patients to adopt an exercise regime is vital. This is an area in which the role of the orthopaedic surgeon is particularly important, said Prof Roos. “The orthopaedic surgeon is a very important person in the osteoarthritis patient’s life, and it is important to increase awareness   among   surgeons   that   they   have   a   role   to   play   in   helping   their   patients understand the vital role of exercise in pain relief, improved physical function and better general health.” Osteoarthritis patients need to be made aware of the general benefits of the exercise  programme,  since  their  condition  can  mean  a  shortened  lifespan,  particularly  in cases where personal mobility is impaired. But there is a need to recognise that for some patients adopting an exercise programme may be a  significant lifestyle change. “For long term adherence, it is important to find activities and exercise options the patient likes and feels comfortable with,” said Prof Roos. “Patients with osteoarthritis are first and foremost

people, and lifestyle changes are even more difficult when you have painful joints and are advised to exercise.” Success generally depends on supervision of the patient’s efforts, she said, usually by a physical therapist.

A  fitness  regime  and  strength  training  are  generally  good  for  everyone,  but  for  those suffering  osteoarthritis  neuromuscular  training  is  a  particularly  promising  approach,  said Prof Roos. “Neuromuscular training uses a biomechanical approach and was especially developed for patients with hip and knee osteoarthritis.” Recognising the need for each individual patient to progress to their own ability, she also emphasises “safe pain measurement” in helping a therapist assess when a patient may move to the next level of difficulty.

Recommendations:  a  6  week supervised individual exercise regime for  all osteoarthritis patients

Speaking  from  personal  experience,  Prof  Roos  said  osteoarthritis  patients,  even  severe cases,  generally  tolerate  and  do  very  well  with  exercise,  often  much  to  the  surprise  of surgeons. “The current evidence supports exercise as a safe and effective intervention for osteoarthritis patients. Based on that evidence and clinical experience I would recommend a 6 week supervised, individualised exercise programme for all patients with hip and knee osteoarthritis, together with information on their condition and weight loss where relevant.” Exercise should be prescribed both before and after total joint replacement and has a role in avoiding athroscopic surgery. Prof Roos also said with the rapidly increasing number of osteoarthritis patients worldwide, the positive role of appropriate exercise regimes cannot be  overemphasised. “Orthopaedic surgeons and  physical  therapists should  collaborate for optimised treatment of the osteoarthritis patient, and a great majority of patients should be treated in primary care,” said Prof Roos.


The   European   Federation   of   National   Associations   of   Orthopaedics   and   Traumatology (EFORT) is the umbrella organisation linking Europe´s national orthopaedic societies. EFORT was founded in  1991 in  the Italian Marentino. Today it  has 42 national member societies from 43 member countries and six associate scientific members.

EFORT   is   a   non-profit   organisation.   The   participating   societies   aim   at   promoting   the exchange  of  scientific  knowledge  and  experience  in  the  prevention  and  treatment  of diseases and injuries of the musculoskeletal system. EFORT organises European congresses, seminars, courses, forums and conferences. It also initiates and supports basic and clinical research.

Source:  EFORT Instructional Lecture: Training as non-operative treatment of patients with osteoarthritis of the hip or knee

Back to top