Will Exercise Make My Arthritis Worse: MRI May Help Decide

By Chris Centeno, MD /

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Will Exercise Make My Arthritis Worse

I often see active patients in clinic who want to know if exercise will make their arthritis advance. They’ve seen friends be hobbled by knee replacement who drop out of high-level physical activity, and they don’t want that fate. Several studies over the last few years do support the idea that it may be possible to use certain MRI findings to answer the question, “Will exercise make my arthritis worse?”

What Is Knee Arthritis and What Does MRI Show?

Knee arthritis is diagnosed when the knee loses cartilage, develops bone spurs, and develops a toxic environment in the joint, and all of that is associated with pain and lost function. An MRI image can tell us the status of the cartilage and bone, but it can also see more. One finding that’s very interesting is called a “bone marrow lesion,” or BML. This is swelling in the bone due to microfractures. More advanced forms of MRI, like T2 mapping, use a color-coded map of the amount of water in the cartilage to provide more detail of its health.

Will Exercise Make My Arthritis Worse?

This has been a back and forth question for years, with some studies showing that high-impact exercise, like running, can make arthritis worse and some going the other way, showing that runners have less arthritis. The reason these studies go in both directions may have to do with the status of the cartilage in the subjects when the study begins. Meaning that patients with no pain or functional problems but who have unhealthy cartilage or bone may get worse with exercise while others with no such issues may be protected by exercise. Hence, if your study includes more subjects with no problems but slightly unhealthy cartilage, it shows that exercise causes arthritis versus another study that begins with more patients with good cartilage that will show that exercise protects against arthritis.

New MRI Studies Seek to Answer the Question

The new research studies actually took MRIs of the knees of patients before the study began to get an idea of cartilage health when there were no complaints of pain or lost function. One study looked at the presence or absence of BMLs, theorizing that if one was present, the health of the bone and cartilage was poor. In this study, patients with BMLs had progressive cartilage loss with exercise while patients with no BMLs had no cartilage loss. In another study, sophisticated T2 mapping of the cartilage health was performed, showing that patients with less healthy cartilage went on to lose it with exercise versus those with healthy cartilage, who kept it with exercise.

proactive_cover-1The upshot? Whether exercise will help or hurt your knees may well depend on the status of your cartilage. Given that these studies had normal healthy volunteers without any knee pain, you may not know if there’s something brewing in your knee that could predict if you’re going to have problems. Now that the age of biologics is here, should we be getting MRIs of normal healthy knees in people who want to stay active as a screening tool for future problems? Should we be treating these patients early with things like PRP or stem cells to help avoid problems? I suspect that in the future, our focus will shift from reactive (intervening only when there’s a problem) to proactive (treating small problems early). Being proactive will answer questions like “Will exercise make my arthritis worse?” and many others. You can read my book called ProActive to find out how to head little problems off at the pass and stay active as you age!

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8 thoughts on “Will Exercise Make My Arthritis Worse: MRI May Help Decide

  1. Masuma

    Hi – I have had both stemcell and PRP injections last year (2015) at the Regenexx provider in Bradenton, Florida. Now a new local facility-physmedofgainesville.com is offering PRP. They are obviously not Regenexx trained, notheless, would it be worth it to get it for recurring knee OA pain, as travel to Bradenton is not possible? Thanks

    1. Regenexx Team Post author

      Hi Masuma,
      That’s a logical question. There would be a very significant difference in the regenerative potential of PRP made in a centrifuge (like detailed on the website you sent) and the Regenexx SCP you would have been treated with in Bradenton. http://www.regenexx.com/prp-didnt-work/ and http://www.regenexx.com/what-is-prp/ If you do decide to try them, we’ve put together this guide to help patients learn what they need to know about clinics: http://www.regenexx.com/blog/top-10-questions-orthopedic-stem-cell-providers/

  2. Prof. joan P mencher

    I am very interested in learning more about stem cell therapy. In particular, I want to know if you have any experience in using it for dislocated toes, especially when surgeons want to do major surgery. Prof. Joan P Mencher (retired prof CUNY, age 86 but in general in good health.)

    1. Regenexx Team Post author

      Professor Mencher,
      The website is a wealth of information. http://www.regenexx.com. The menu accross the top will take you to the more than 1500 blogs, our peer reviewed published Research and RCT’s, the Areas of the body we treat and how we treat them, the Technology we use and Outcomes. We’ve worked with many types of dislocated joints. Is this a toe which chronically dislocates, or a toe which was traumatically dislocated?

  3. Bonnie Granahan

    Dr. Centneo,
    Reading this latest Blog leads me to want to reach out to you and tell you about my personal experience with my Painful Knees.
    Having been diagnosed with Arthritis in both I found my way to Health Link Medical Center in San Rafael, CA to Dr. Paul Handelman who is A Physician Network Provider for Regenexx.
    On June 6, 2016 I began the Stem Cell Procedure for My Right Knee and PRP for the Left one.
    Simply Stated, Everything went Very Well in Every Way.
    Dr. Handelman and his Staff are The Absolute Best in All They do.
    During the week of my treatment, I reflected on all that I read about The Regenexx Network
    that you have put together and the One Thing that Stuck in My Mind was when you said that You Only Chose the Best of the Best Doctors to work in your Network! Well, I can say that it Truly showed me exactly that when I was being treated by Dr. Handelman.
    From the Very First time I met him he explained Everything Completely and was surrounded by the Most Pleasant and Professional Staff I have ever met at a Doctor’s Office. Jessica, Laura, and Cel were All Outstanding and they keeping me Informed and Stress Free!
    it’s been a week since my Final Injections and I can honestly say I am No Longer Experiencing Pain in either knee:-) This is “Almost” too good to be true! But, I’ll take it!
    Dr. Handelman to me is One of the Best of the Best in the Network that you Speak about!
    Thank You Dr. Centeno for Leading this New Wave of Orthopedic Stem Cell Therapy!

    1. Regenexx Team Post author

      Bonnie,
      Thank you, that is wonderful to hear!! I’ll pass that along to Dr. Handleman as well! We’ll be keeping you in our thoughts as you continue to heal…

  4. Hector

    In reference to Knee Arthritis, would an MRI be able to tell me if prolonged exercise would worsen or help the symptoms? Or is it just more a test and try to figure it out?

    Great information on this website!

    1. Regenexx Team Post author

      Hector,
      B. Exercise is generally good for Knee Arthritis, to tolerance. MRI does a great job at visualizing structure but given that OA pain is about nerves and not structure, many MRI findings are red herrings. Please see: http://www.regenexx.com/blog/osteoarthritis-pain-not-related-to-structure-again/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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