Marc Darrow MD,JD

In this article I will be discussing the obvious advantages to walking away your knee pain and disability and how you may be able to improve your walking skills. Let’s start with a new study that suggests walking can reduce knee pain and may slow progression of knee osteoarthritis.

In individuals over 50 years old with knee osteoarthritis, walking for exercise was associated with less development of frequent knee pain

A June 2022 study (1) assessed the relationship between walking for exercise and symptomatic and structural progression in those with knee osteoarthritis. Here is what the doctors of the study did:

  • They assembled a group of patients, 50 years or older.
  • They focused on four dichotomous (being able to separate good from bad) outcomes from baseline to 48-month visits using frequent knee pain and radiographic severity on posterior-anterior semi-flexed knee radiographs:
  • They looked for:
    • 1) new frequent knee pain,
    • 2) Kellgren-Lawrence (osteoarthritis grading system) grade worsening,
    • 3) medial joint space narrowing, and
    • 4) improved frequent knee pain.

Results: Of 1212 participants, 73% walked for exercise, 45% were male, mean age = 63.2 years, and mean body mass index = 29.4 (average overweight just below obese). New frequent knee pain and medial joint space narrowing were less common in those who walked.

The researchers offered this conclusion: “In individuals over 50 years old with knee osteoarthritis, walking for exercise was associated with less development of frequent knee pain. These findings support that walking for exercise should be encouraged for people with knee osteoarthritis. Furthermore, we offer a proof of concept that walking for exercise could be disease modifying, which warrants further study.”

In an accompanying press release from Baylor University where the study was performed, Dr. Grace Hsiao-Wei Lo, the lead researcher said: ““These findings are particularly useful for people who have radiographic evidence of osteoarthritis but don’t have pain every day in their knees. . . This study supports the possibility that walking for exercise can help to prevent the onset of daily knee pain. It might also slow down the worsening of damage inside the joint from osteoarthritis.”

Movement is highly desirable and recommended in older knee pain patients

The desire to have patients move despite their knee pain is obvious among medical professionals. Beyond the impact on knee osteoarthritis there are of course the many reasons why exercise needs to be incorporated into treatment protocols.

A July 2021 study (3) investigated the long-term relationship between physical performance (via real-life accelerometry or gait analysis) and physical capacity (laboratory measurement of gait speed) in patients with knee osteoarthritis. Further the study sought to derive gait analysis measured thresholds associated with gait speed decline in knee osteoarthritis that may provide targets for disease-specific physical activity guidelines. The researchers then set out to subgroup the patients to better assess their findings. What they found was the less you did, the worse you were. This is explained this way:

  • The most impactful predicting feature for gait decline is low minutes in the performance of moderate-vigorous activity. Slower sit-to-stand performance, higher age and self-reported knee pain, and lower minutes in performance light activities also contributed to the model prediction.

Walking safely. The characteristics of knee instability when walking versus when standing and applying these findings to fall risk

A July 2022 study (4) evaluated the static (standing) and local dynamic stability (walking) of the subjects with knee osteoarthritis in comparison to normal subjects. Fifteen osteoarthritis subjects and 15 healthy subjects with matching age, weight, and gender participated in this study.  The differences the researchers found was in local dynamic stability of osteoarthritis subjects appeared to be reduced compared to healthy subjects, especially when ambulating at higher walking speeds. Study results demonstrated that both static and local dynamic stability decreased in osteoarthritis subjects.  As a decrease in local dynamic stability is correlated to an increased risk of falling, it is important that this group should receive appropriate treatment interventions to improve standing and walking stability.

Walking may not help everyone – doctors look at muscles

In a July 2022 paper, (2) researchers acknowledged that walking is considered a “gold standard” treatment option for reducing knee osteoarthritis pain and maintaining joint mobility but does not reduce pain for all adults with knee osteoarthritis pain and may induce pain-particularly when starting a walking routine. What the researchers discovered was a single 30-minute walk moderately increased pressure pain sensitivity at the affected knee among persons with knee osteoarthritis. Healthy adults showed no difference in pain sensitivity.

One explanation seen in our patients is that increased pain sensitivity is seen in deep muscle activity and is indictive of knee instability. The muscles are trying to perform two jobs, power the locomotion of walking and two trying to stabilize the knee. This provides the clue the knee ligaments are weak and damaged and it may be the answer why walking does not help some.

Treatments for knee instability that may help with your walking

Most people have an expressed interest in exercising and walking. Some people think that their best cause may be to proceeded with a knee replacement. Research has shown that knee replacement many not be the answer for weight loss and ability to exercise. I cover this at length in my article Research: Knee replacements do not help you lose weight.

Other treatments may include, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, knee tape and knee braces. Some doctors will say that a knee brace is an appropriate alternative to surgery, as they are meant to stabilize the area, preventing further injury and encouraging the area to heal. Recently, however, there has been some doubt as to how effect knee braces are as a form of treatment.  Use of a knee brace is only necessary for extreme injuries that are at risk because of activity. Those using knee braces with no affiliation with sports or high levels of strenuous activity often complain that their knee brace causes more discomfort than relief. Patients with knee braces complain of restricted mobility and discomfort, saying that it often slips out of place.

In my article Research comparing different  types of knee injections, I discuss various injections that may help. These include: platelet rich plasma (PRP), corticosteroids, mesenchymal stem cells (MSCs), and hyaluronic acid. Each injections is discussed within the latest research.

Do you have questions about your treatment options? Ask Dr. Darrow

Marc Darrow, MD. JD., discusses the treatment philosophy of the Darrow Stem Cell Institute. Transcript of video

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

References:

1 Lo GH, Vinod S, Richard MJ, Harkey MS, McAlindon TE, Kriska AM, Rockette‐Wagner B, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK. Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals with Knee Osteoarthritis: Data from the Osteoarthritis Initiative Cohort. Arthritis & Rheumatology.
2 Klinedinst NJ, Huang W, Nelson AK, Resnick B, Renn C, Kane MA, Dorsey SG. Inflammatory and Immune Protein Pathways Possible Mechanisms for Pain Following Walking in Knee Osteoarthritis. Nursing Research. 2022 Mar 21.
3 Sun R, Tomkins-Lane C, Muaremi A, Kuwabara A, Smuck M. Physical activity thresholds for predicting longitudinal gait decline in adults with knee osteoarthritis. Osteoarthritis and Cartilage. 2021 Jul 1;29(7):965-72.
4 Karimi MT, Sharifmoradi K. Static and local dynamic stability of subjects with knee joint osteoarthritis. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2022 Jul 1:09544119221102705.

 

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