Weight loss does more for knee pain than you think!
If you could cure cancer through weight loss – would you? I hope your answer is yes, and if that’s the case, why do we settle with having knee pain instead of doing something about it?
As a physiotherapist, I was taught that excess weight will cause increased load through the knee, further damaging knee injuries. I agree with this and will always encourage weight loss. But my patients need to understand all the mechanisms at play!
Increased fat or adipose tissue not only increases the load on the joint, but it creates chronic inflammation with can drive pain the process further and slow healing. Let me elaborate on this further, I want to help you understand the connection between obesity and chronic inflammation.
What is inflammation?
Inflammation is generally considered a bad thing – but it’s a needed part of tissue healing. The only problem is when it doesn’t resolve in a timely manner. So what’s the difference between acute and chronic inflammation?:
- Acute inflammation is what you see after an ankle sprain. It will swell right up and look horrible for a couple of days, then after good management it will settle down.
- Chronic inflammation is long-term and may not be localized to one joint. This type of inflammation can be driven by obesity.
Without getting into the exact biomedical science the reason for weight gain is due to an in-balance of energy intake and expenditure. Simply put – if we eat too much and don’t burn it off with active living (I said ‘active living’ intentionally because ‘exercise’ scares people!), we WILL put on weight. Our body stores this extra energy in the form of fat cells – that muffin top look we all love!
The role of fat cells in inflammation
Medical professionals used to think that fat cells just sat there keeping us warm over the winter months. It turns out that these cells also play a role in maintaining some of our bodies normal processes including inflammation!
They are responsible for producing up to one third of some of the chemicals that begin inflammation. So, as we put on weight, there are more fat cells, which then secrete more of this chemical – creating more inflammation.
Overweight people who sustain a knee injury may have a heightened local inflammatory response due to the chronic inflammation already circulating their body. This will cause two things to happen:
- There will be more pain in the knee as the inflammatory response will be heightened.
- These people are less likely to exercise due to the pain they are experiencing – so they may even put on weight which increases inflammation.
Can you see the cycle beginning to happen? The real question is how do we break this cycle apart? The answer is to progressively load the joint with stimulus that will encourage healing and to lose weight!
The benefits of weight loss and diet!
Weight loss will help to reduce this chronic inflammation, and in osteoarthritis it has been proven that even as little as 5% weight loss can significantly decrease disability! Additionally, the more weight you lose, the more pain relief you can have. But how can we lose weight with a sore knee that hurts with exercise?
The first thing to look at, is your diet. Now this is not my field of expertise, but to effectively lose weight you need to eat less. This will create a calorie or energy deficit, meaning you are eating less than your energy expenditure (a mixture of what your body naturally burns called baseline metabolism plus any calories burned with exercise). For individual and tailored advice, I can recommend a dietician by the name of Claudia Cramer who is excellent at what she does.
Specifics on cardiovascular exercise for weight loss
In an earlier blog I spoke on load progression, but today I want to take you through some specifics for the knee. Obviously, I can only give generic advice over a blog and individual knees will require specific exercises. If you do feel like you need tailored advice, we can help you online, via a video consultation.
To get started, trial some gentle cardiovascular work to help stimulate weight loss. You want to begin with exercises that won’t load the knee too much. Two cardiovascular exercises to help this would be walking in a heated pool (hydrotherapy) and stationary biking:
- Hydrotherapy can be complicated as there are many exercises you can do in the pool. I like to start my clients just walking up and down, as fast as possible, and walking sideways and backwards. The key here is not to do massive amounts at the start. The reason is that your knee will feel great in the water but may hurt when you get out and gravity starts working again.
- Stationary bike riding can be a life-saver if you have the knee range to get a full rotation. Some tips for this, is to put the seat slightly higher than you need it. If you belong to a gym, try the recumbent bike, (where pedals are in front instead of below you) as this can be easier to begin with.
National guidelines would recommend 30 minutes of exercise a day! If you are new to exercising in general though have a look at an earlier blog on motivation to live an active lifestyle. This will help to give you some general pointers. Aim to start at even 15 minutes a day and slowly build up.
Strength exercise after weight loss!
Lastly there is evidence that as you lose weight, unless you are strength training, you will loose muscle. Now for strength you don’t have to be a part of a gym. I have uploaded a video below, of an exercise to target your quadriceps that will get you started.
Once you have mastered this you can add in some body weight squats and lunges to complement!
Weight loss will help to reduce the chronic cycle of inflammation and as a result can help with reduction in your knee pain! To begin losing weight, trial changing your diet to a calorie deficit and start some cardiovascular and strength exercise.
If your knee pain isn’t settling, it might be time to book in for an online consultation, so we can help you get on top of it. Our expertise is in knees and tendinopathies, and the best part is – we can fix you without needing to lay a hand on you. Your specific and tailored program and advice and be given through video consultation. Don’t wait to book your consultation today!
Atukorala, L., Makovey, J., Lawler, L., Messier, SP., Bennell, K., Hunter, DJ. (2016) Is There a Dose-Response Relationship Between Weight Loss and Symptom Improvement in Persons With Knee Osteoarthritis? Athritis Care Res: 68(8):1106-14
Christensen, B, Bartels, EM., Astrup, A., Bliddal, H. (2007) Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Disease: 66(4):433-9
Ellulu, M. S., Patimah, I., Khaza’ai, H., Rahmat, A., & Abed, Y. (2017). Obesity and inflammation: the linking mechanism and the complications. Archives of medical science : AMS, 13(4), 851–863. doi:10.5114/aoms.2016.58928