I was listening to another podcast about longevity and the doctor talked about "weekend warriors". People who sit at a desk for eight-plus hours but exercise a few times a week and don't really think of themselves as sedentary. She said research suggests that these gym sessions don’t completely undo the negative effects of sitting for long periods. Her solution was to get up out of your chair every hour and do ten air squats. Apparently, this is all I need to do to live to 150*.
So the reason … …why you see a break mid-sentence is because my alarm has gone off and I’ve just done my air squats and all you could hear over the overheated PC fan is the creaking of my knees as I bobbed up and down, with the dogs unsure whether it was time for walkies.
I’ve been told that my crunchy knees are partly down to degeneration, but not to worry as they don’t hurt me. All that crunching did get me thinking about what happens when knees do hurt, because our instinct is often to protect them.
If squatting hurts, stop squatting. If bending your knee deeply hurts, don't bend it deeply. If walking makes it ache, walk less. It sounds entirely sensible: something hurts, therefore doing it must be making it worse.
But when it comes to something like osteoarthritis, it isn't quite that simple. Osteoarthritis used to be thought of as simple “wear and tear”, as though our joints gradually wear out the more we use them. We now know it’s more complicated than that, involving changes to the cartilage, bone and other tissues within the joint.
Exercise is actually one of the core treatments recommended for osteoarthritis. It helps maintain mobility and strengthens the muscles that support and move the joint. Despite the temptation to move less when joints hurt, not moving can contribute to more stiffness.
So what do you do if movement is important but movement hurts?
I think the useful answer is: change the dose.
Change The Dose
We tend to think about movement as rather binary. I can do Chair Pose or I can't. I can squat or I can't. I can walk three miles or I can't.
Imagine you bend your knees into Chair Pose and your knee hurts. You could decide that Chair Pose is bad for your knees and cross it off the list forever. Or you could bend your knees less. You could hold it for five seconds instead of thirty. You could use a wall. You could practise sitting down onto an actual chair and standing back up again. You could do it twice instead of ten times.
Same movement. Different dose.
And this isn't really about yoga. If a forty-minute walk leaves your knee throbbing, perhaps twenty minutes doesn't. If ten squats are too much, perhaps five are fine. If getting down onto the floor is difficult, you don't need to keep getting up and down throughout your practice. Do your standing poses together, then come down to the floor once.
You can change the range, the load, the repetitions, the amount of time, the speed or the amount of support. There are far more choices available than DO IT or DON'T DO IT.
But What About Pain?
This is where it becomes a little more complicated, because pain is useful information, but it isn't a little damage-meter telling us exactly what is happening inside the joint.
With osteoarthritis, some discomfort when you begin exercising or increase what you're doing doesn't automatically mean you're damaging your knee. NICE actually tells people that therapeutic exercise may initially cause some discomfort, but that regular and consistent exercise can improve pain, function and quality of life. That doesn't mean gritting your teeth and pushing through pain either; it means listening to the information and adjusting accordingly.
One of the useful suggestions in the arthritis material is to start with less than you think you can do, then notice not only what happens while you're moving but what happens afterwards. If that dose feels manageable, you can gradually build the intensity and duration.
I like that because we can be rather impatient with our bodies. We remember what we used to be able to do, or look at what somebody else is doing, and decide that's where we should be. But your body doesn't particularly care what you used to do, what the person next to you can do, or what you think your knee ought to be capable of.
It only knows what it can tolerate today.
And if we continually protect a painful knee by doing less and less, there is another problem. Muscles need resistance to stay strong. If we remove every movement that challenges the legs, we can gradually lose strength and then ordinary things such as getting out of a chair, climbing the stairs and walking become harder too.
So perhaps the question isn't "Can I do this?"
It's "What version of this can I do?"
Reduce the range. Add support. Do fewer repetitions. Slow it down. Take a break. See how you feel later. And if that dose becomes comfortable, perhaps you can gradually ask for a little more.
Of course, not every painful knee is arthritis, and persistent or unexplained pain, significant swelling, locking, giving way or a sudden inability to comfortably put weight through the leg deserves proper assessment rather than a diagnosis courtesy of a yoga teacher on the internet. But if you already know you have osteoarthritis, your knee isn't necessarily a fragile object that needs protecting from movement.
Sometimes it just needs a different dose.
*I may have slightly embellished the doctor's longevity claims. Ten squats an hour are unlikely to get me to 150. I shall report back in 2076
If you fancy disappearing down a knee-shaped rabbit hole, I wrote a whole blog about why knees crack, what the menisci do, some very random knee facts and ways of modifying yoga poses. You can read Knees & Their Knobbles here.
FOR YOGA TEACHERS
Do you teach students with knee osteoarthritis? I’ve also put together The Dodgy Knee Cheat Sheet: Teaching Students with Knee Osteoarthritis, with practical ideas to think about when someone arrives in class with a dodgy knee.
A version of this first appeared in my weekly newsletter. If you enjoyed it, I send a thoughtful, sometimes slightly cheeky email every week. Sign up here.
Sources:
NICE: Osteoarthritis in over 16s - diagnosis and management
NHS: Osteoarthritis - treatment and support
Photo by Bob Brewer on Unsplash
