Stiff knees, aching hips, and persistent joint discomfort are frequently dismissed as an inevitable consequence of ageing. However, medical professionals argue that our approach to treating and preventing osteoarthritis, the world's most prevalent joint disease, is fundamentally misaligned with scientific evidence.
The Power of Movement: A Medicine Beyond Pills
The most potent remedy for chronic, disabling conditions like osteoarthritis isn't found in a prescription bottle or on an operating table – it is physical activity. Despite its proven efficacy, a startling number of patients across various health systems are never directed towards this vital therapy.
Research spanning Ireland, the UK, Norway, and the United States reveals a consistent and troubling pattern. Fewer than half of individuals diagnosed with osteoarthritis are referred to exercise programmes or physiotherapy by their primary care provider. Conversely, over 60% are prescribed treatments not recommended by clinical guidelines, and approximately 40% are sent to a surgeon before non-surgical options have been properly explored.
Why Exercise is Essential for Joint Health
To grasp the significance of these statistics, one must understand what exercise does for our joints. Osteoarthritis currently affects more than 595 million people globally, with a Lancet study projecting this figure could near one billion by 2050. This rise is driven by longer life expectancies, increasingly sedentary lifestyles, and growing rates of obesity.
Contrary to the outdated 'wear and tear' analogy, joints are not like car tyres that simply grind down. Osteoarthritis is better understood as a prolonged process of wear and repair, where regular movement is critical for healing. The cartilage protecting our bones lacks its own blood supply; it depends on compression from activities like walking to squeeze out waste and draw in fresh nutrients, much like a sponge.
We now recognise osteoarthritis as a whole-joint disease, impacting:
- The joint fluid and underlying bone
- The supporting ligaments and surrounding muscles
- The nerves that facilitate movement
Therapeutic exercise targets all these elements. For instance, muscle weakness is an early sign of the disease and a risk factor for its progression, both of which can be addressed with resistance training. Programmes like GLA:D® (Good Life with osteoArthritis: Denmark), delivered by physiotherapists, focus on movement quality, balance, and strength to improve stability and confidence. Participants show significant improvements in pain, function, and quality of life for up to a year after completing the programme.
Tackling Inflammation and Rethinking Surgery
Exercise acts as powerful medicine for the entire body, with documented benefits for over 26 chronic diseases. For osteoarthritis, it works not only mechanically but also at a molecular level. Obesity is a major risk factor, not just due to extra load but because of high levels of inflammatory molecules that degrade cartilage. Regular activity can lower these inflammatory markers and even alter gene expression.
Critically, there are currently no drugs that modify the course of osteoarthritis. While joint replacement surgery can be transformative, it is a major procedure and not universally successful. Exercise, with far fewer side effects and numerous additional health benefits, should be the first-line treatment and maintained throughout every stage of the disease.
In conclusion, osteoarthritis is shaped by muscle strength, inflammation, metabolism, and lifestyle. Regular, targeted exercise addresses these factors simultaneously, protecting cartilage, strengthening the joint, and enhancing overall health. Before considering surgery, movement remains one of the most potent and overlooked treatments available.
