Osteoarthritis (OA), a wearing down of the joints, can be debilitating. The pain and stiffness that come with OA can limit everyday activities such as walking, going up and down stairs, squatting, doing housework and playing sports. OA can follow a previous surgery or injury, but it is often a result of aging.

What Can Be Done for Osteoarthritis?

The good news is there are several treatment options. Today we’ll look at exercise.

People with OA commonly have weakness in the muscles around the affected joint. With knee OA, for example, the muscles in the front and back of the thigh often become weak. A large body of research shows that targeted exercise for these muscles can reduce pain and stiffness and make daily activities easier.

Why Dosing Matters

It may seem counterintuitive to exercise a joint that is painful and stiff. The key is a physical therapist who knows how to dose exercise properly. Exercise works a lot like medication: too little won’t help, and too much can do harm. The dose has to be right to get the best effect.

Image spot (optional): therapist adjusting resistance on a leg exercise

What the Research Says

A recent review looked at how the intensity of knee exercise affects knee OA. It concluded that moderate-intensity exercise is the best choice for people with knee OA.

There are other factors you and your physical therapist will consider, such as whether the joint is currently inflamed, your previous activity level and how severe your symptoms are. A thorough history tells your therapist where to start, with the goal of progressing to moderate-intensity exercise.

This article is for general education and isn’t a diagnosis or a substitute for care from a licensed provider. If your symptoms last or get worse, see a physical therapist or your doctor.

Low back pain is a common and often debilitating problem. The pain is often short-lived, and in some cases it resolves on its own, but many people need treatment to find relief. Physical therapy can be an effective, practical solution that helps people avoid surgery or long-term use of medication.

Physical therapists follow research-backed treatment guidelines and make treatment decisions together with their patients. Current research suggests that a combination of exercise, manual therapy and patient education is the preferred way to treat low back pain, particularly when the pain keeps coming back (1, 2).

How Can Physical Therapists Help?

Devise an Exercise Plan

A physical therapist can recommend the exercises that are safest and most effective for the type of pain you’re having. Exercises can be done during physical therapy appointments and as part of a home exercise program. For pain that has lasted less than 3 months, exercises that target the back or abdominal muscles may be most helpful. These exercises isolate the muscles that control and stabilize the spine.

Image spot (optional): core stabilization exercise

When pain lasts longer than 3 months, general exercise such as strength training, aerobic exercise and aquatic exercise often helps relieve low back pain.

• Strength training uses weights to improve how specific muscles perform.
• Aerobic exercise uses large muscle groups and gets your heart rate up, such as running, walking or cycling.
• Aquatic exercise takes place in a pool. It is a highly effective, low-impact alternative to traditional exercise that reduces pressure on bones and joints, while the water’s natural resistance still strengthens muscles.

Pilates-based physical therapy has grown in popularity in recent years. Pilates-trained physical therapists combine the targeted and general exercises that define Pilates with their knowledge of low back pain. This combination can help people with both acute (recent) and chronic (long-term) low back pain.

Manual Therapy

Physical therapists use manual therapy techniques such as massage and joint or soft tissue mobilization. Manual therapy helps reduce pain, which lets patients exercise with fewer restrictions and makes daily activities easier.

Soft tissue mobilization includes massage techniques and myofascial release. Fascia is a layer of tissue over the muscles that can become stiff, restricting movement and adding to pain. Myofascial release addresses the stiffness that commonly comes with low back pain.

Joint mobilization is a technique in which a therapist moves a joint by hand. It can improve joint mobility and reduce pain. Physical therapists tailor these mobilizations to each patient, and they can be directed at the vertebrae to help relieve back pain.

Image spot (optional): therapist performing hands-on manual therapy

Provide Patient Education

An important part of a physical therapist’s role in managing low back pain is helping patients understand pain itself. Pain science has evolved in recent years, and studies show that physical therapy combined with pain science education can be especially helpful for chronic low back pain. Teaching patients good posture and positioning, such as how to sit at a desk or lift an object from the floor, can help ease pain or keep it from coming back.

This article is for general education and isn’t a diagnosis or a substitute for care from a licensed provider. If your symptoms last or get worse, see a physical therapist or your doctor.

I’ll never forget one patient from my first year of practice. She came in with an MRI report in hand, halfway to tears. She didn’t have an appointment. She had come right off the streets of Manhattan, fresh from her visit with her orthopedist, and asked to speak to a PT for some clarity on her imaging results.

A patient had canceled, so reception called me to the front. I gave my standard line, that I was a PT and not a radiologist, but that I would take a look at her report. It said she had multiple severe disc herniations and stenosis throughout her lumbar spine.

Treat the Person, Not the Image

As I read, I noticed something. She was shifting from side to side, pacing and moving with a lot of frantic energy, which is how most of us would react to news we thought was terrible. I stopped reading and asked how she felt right now. She started jumping and squatting to show me how well she was moving. She said she had pain at times but was able to keep up her daily routine.

I reassured her that evidence shows many of us past a certain age will have findings on a lumbar MRI, and that research at the time supported treating the person, not the image. I told her about PT, and she came in for an evaluation with a colleague. By their report, she was a straightforward case! I firmly believe imaging is a powerful tool that helps countless patients, but research shows it shouldn’t fully guide our treatment.

Image spot (optional): patient moving freely during an exercise session

What the Research Found

A recent article in Physical Therapy (PTJ) explored how the severity of structural lumbar spinal stenosis relates to response to exercise-based PT. The study compared improvements in pain, disability, strength, medication use and function after PT-led exercise interventions, with patients grouped by the severity of their stenosis.

The authors concluded that patients improved by the same magnitude across all structural severities of spinal stenosis. I immediately remembered my patient, how terrified she was of her MRI and how mobile and functional she was.

How many patients avoid being active because of the harm they believe their imaging findings mean? How many never see a PT who could improve their mobility or quality of life, because they’ve been told their spine is too far gone?

What We Can Do

We can keep educating our patients, and those around us, on the importance of focused, purposeful exercise to improve their function, and help them avoid putting everything into their imaging results.