23/06/2025
Do you have knee pain diagnosed as osteoarthritis??
Struggling to get an NHS appointment to help?
We can help with your pain, with exercises, advice and treatment see the current research below….
Call 07488249353 to book an appointment with us today….
From physio meets science page..Just published in JOSPT 🔥
Exercise Therapy 'Wears Down' My Knee Joint: Myth or Reality?
🦵 Knee osteoarthritis (OA) is a prevalent chronic condition characterized by joint pain, stiffness, and functional limitations, affecting millions globally, particularly those over 45 years of age (Wood et al., 2023). Exercise therapy is widely endorsed as a first-line treatment to alleviate symptoms, enhance physical function, and improve quality of life (NICE, 2023).
🦄 Despite its proven benefits, a persistent misconception among patients and some clinicians is that exercise therapy may "wear down" knee cartilage, potentially exacerbating joint damage (Bunzli et al., 2019). This belief, rooted in outdated interpretations of early biomechanical studies and societal "wear and tear" narratives, hinders the adoption of evidence-based care (Radin et al., 1971; Bunzli et al., 2023).
📘 A brand-new clinical commentary by Bricca et al. (2025) critically examines this myth, synthesizing robust evidence to clarify the safety and efficacy of exercise therapy for knee OA. This summary outlines the key findings and emphasizes practical implications for therapists, integrating a three-step clinical approach to dispel misconceptions and promote adherence. (https://www.jospt.org/doi/10.2519/jospt.2025.13069)
✅ Bricca et al. (2025) refute the notion that exercise therapy damages knee cartilage in individuals with or at risk of knee OA. Drawing on systematic reviews and randomized controlled trials (RCTs), the authors demonstrate that exercise therapy does not harm cartilage structure (e.g., thickness, volume) or quality (e.g., glycosaminoglycan and collagen levels) and may enhance cartilage health, particularly in younger, healthy-weight individuals (Bricca et al., 2019a; Bricca et al., 2019b).
🐭 The misconception originates from early 1970s laboratory studies on animal models, which showed cartilage degeneration under high-impact loads, and was perpetuated by unclear distinctions between exercise therapy (tailored, low-to-moderate load exercises prescribed by professionals), exercise (structured fitness activities), and physical activity (general movement) (Radin et al., 1971; Radin et al., 1973; Caspersen et al., 1985). These findings were rapidly translated into clinical practice without sufficient evaluation, fostering the "wear and tear" narrative (Bunzli et al., 2023).
🏋️♀️ Exercise therapy is a cornerstone of OA management, reducing pain, improving function, and potentially delaying or preventing costly knee replacement surgeries (Ackerman et al., 2020). Unlike pharmacological or surgical interventions, it carries a low risk of adverse events and offers additional benefits, such as improved cardiovascular health, mood, and cognitive function (Dibben et al., 2023). However, high-impact activities like jumping may cause discomfort in some OA patients and are not universally recommended (Coburn et al., 2023).
💡Practical Consequences for Therapists
✅ To counter misconceptions and align with evidence-based guidelines (NICE, 2023), therapists should adopt the three-step approach proposed by Bricca et al. (2025):
1️⃣ Assess Patient Beliefs: Initiate consultations by asking, “Are you concerned that exercise might harm your knee joint?” to identify fears and tailor education (Bunzli et al., 2019).
2️⃣ Address Misconceptions: Use the "sponge analogy" to explain cartilage as a dynamic tissue that regenerates with moderate loading, absorbing nutrients like a sponge (Sophia Fox et al., 2009). Clarify that exercise therapy is safe, does not cause long-term damage, and supports joint and general health, countering the "worn-down machinery" narrative (Bunzli et al., 2023).
3️⃣ Promote Adherence: Implement behavior change strategies, such as goal setting, self-monitoring, and action planning, to enhance long-term engagement, as benefits depend on sustained effort (Carraça et al., 2021; Howlett et al., 2019).
🔑 Implications
🗣️Therapists must proactively challenge the harmful myth that exercise damages cartilage, as it leads to underutilization of a safe, cost-effective treatment (Hagen et al., 2016). Delayed implementation risks unethical care, increased reliance on less effective interventions, and missed opportunities for improved patient outcomes (Morris et al., 2011). By integrating clear communication, patient education, and behavior change techniques, therapists can enhance adherence, align with clinical guidelines, and optimize OA management.
📒References
Ackerman IN, Skou ST, Roos EM, et al. Implementing a national first-line management program for moderate-severe knee osteoarthritis in Australia: A budget impact analysis focusing on knee replacement avoidance. Osteoarthr Cartil Open. 2020;2:100070.
Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med. 2019a;53:940-947.
Bricca A, Struglics A, Larsson S, Steultjens M, Juhl CB, Roos EM. Impact of Exercise Therapy on Molecular Biomarkers Related to Cartilage and Inflammation in Individuals at Risk of, or With Established, Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res (Hoboken). 2019b;71:1504-1515.
Bunzli S, O'Brien P, Ayton D, et al. Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study. Clin Orthop Relat Res. 2019;477:1975-1983.
Bunzli S, Taylor NF, O'Brien P, et al. Broken Machines or Active Bodies? Part 1. Ways of Talking About Health and Why It Matters. J Orthop Sports Phys Ther. 2023;53:236-238.
Carraça E, Encantado J, Battista F, et al. Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta-analysis. Obesity Reviews. 2021;22:e13258.
Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126-131.
Coburn SL, Crossley KM, Kemp JL, et al. Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis. Sports Medicine - Open. 2023;9:56.
Dibben GO, Gardiner L, Young HML, et al. Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews. eClinicalMedicine. 2023.
Hagen KB, Smedslund G, Østerås N, Jamtvedt G. Quality of Community-Based Osteoarthritis Care: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2016;68:1443-1452.
Howlett N, Trivedi D, Troop NA, Chater AM. Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Translational Behavioral Medicine. 2019;9:147-157.
Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104:510-520.
Radin EL, Paul IL. Response of joints to impact loading. I. In vitro wear. Arthritis Rheum. 1971;14:356-362.
Radin EL, Parker HG, Pugh JW, Steinberg RS, Paul IL, Rose RM. Response of joints to impact loading. 3. Relationship between trabecular microfractures and cartilage degeneration. J Biomech. 1973;6:51-57.
Sophia Fox AJ, Bedi A, Rodeo SA. The basic science of articular cartilage: structure, composition, and function. Sports Health. 2009;1:461-468.
Wood G, Neilson J, Cottrell E, Hoole SP. Osteoarthritis in people over 16: diagnosis and management-updated summary of NICE guidance. BMJ. 2023;380:p24.
