You Have Arthritis

With a look of resignation my patient explains that their family doc told them their knee pain was arthritis and they could only manage it with anti-inflammatory meds and eventually surgery. I asked them, as I ask many patients, “what do you think arthritis actually is?”. Most patients look at me, somewhat perplexed, and give a variety of answers hovering around the idea of joint damage. In the most simplistic terms osteoarthritis is excess wear and tear on a joint, it’s not congenital, auto-immune, infectious or most importantly it is not an uncontrollable condition. For the average person (average meaning without major trauma, surgery etc) it’s the result of their sports, work and day to day activities compounded over their lifetime. Excess wear and tear.

Early signs of arthritis in the knee

Patients actual xrays with subtle loss of space between her femur and tibia. Thicker white lines on the joints surface of the femur and tibia.

Luckily this patients had been referred for knee xrays, so we took a look at her films together. I showed the patient the space between the bones in her knees and where I’d look to see bony indicators of degenerative change. We could both appreciate that the changes were subtle. We read the report together, “signs of early arthritic change” was the key line in the two sentence report on otherwise normal knees. So I asked another question “do you think arthritis is still the only reason you might have knee pain”. With a little more optimism she started to question the original diagnosis. For the sake of comparison the image on the right shows moderate to severe osteoarthritis.

This is more significant arthritic change. There is an obvious difference when comparing to our "arthritic" patient.

This is more significant arthritic change. There is an obvious difference when comparing to our “arthritic” patient.




Let’s look back at that simple definition, osteoarthritis is the result of excess wear and tear. Excess wear and tear is often the result of poor joint movement. Maybe the balance of leg/hip strength, flexibility and coordination has forced or allowed her knee to move poorly and now painfully. Maybe she wasn’t feeling the pain of worn cartilage but the pain of stressful movement.


What’s the point?

Worn cartilage and arthritis feels very much out of our control. Strength, flexibility and movement is something we can control, work on and ultimately improve. Arthritis is an effect of poor joint movement.  If you feel like throwing in the towel because you’ve been told or think you have arthritis it might be time to reconsider your understanding of this process. Take charge by truly understanding the source of your pain, not just the symptoms. Invest time moving your body and getting stronger.

Basics of gym strength training

This is a conversation I have regularly with people who are experienced with strength training at a typical gym (Goodlife, the Works, MAX, reps etc). They’re picking exercises they feel they can execute safely and correctly but aren’t sure how to organize their workout, sets, reps, etc. Here are some key points that I try to convey in that conversation.

1. Intensity

This refers to how many repetitions you can perform of an exercise based on the movement, resistance, speed/tempo and rest time. To keep things simple I consistently give this rule of thumb for appropriate intensity:

With appropriate intensity it should be challenging to complete an exercise 10 times

This means you’ve picked a movement, weight and rest time that allows you to complete it 10 times in a row where the last few repetitions were far more challenging than the first few. More intensity will allow fewer repetitions, once you pass 10 repetitions the intensity may be too low to stimulate muscle growth. High intensity requires more rest time and has a higher risk of muscle strain. Lower intensity allows less rest time and lower risk of muscle strain.

2. How many sets and exercises

Your muscles respond well to the stress that comes from at least 15 sets of exercises for a body region. This doesn’t mean 15 sets of one exercise. I’d suggest spreading that out over 2-3 sets of 4-6 exercises per body region.

3. Recovery time between exercises

This is an important part of training with a lot of numbers thrown around by trainers, bloggers etc. It relates back to intensity and your own aerobic fitness. As a simple rule of thumb I’d expect at least 30 seconds between the sets of any exercise. If you are still catching your breath from an exercise give yourself longer. If the next 10 repetitions at the same intensity become very difficult that may dictate your recovery time as well. Don’t assume every exercise needs 2-3 minutes rest between every set. You may be cheating yourself out of a great cardiovascular challenge with too much recovery time between sets.

4. Recovery time between workouts

An incredibly important factor that is often missed. This refers to the between workouts for a particular body part. Your muscles need 48-72 hours to appropriate repair and improve before they’re stressed again.

5. How do I gauge progress?

Gauge success by knowing you completed the desired volume of training 2-3 set of 4-6 exercises and with an intensity that challenged you to complete 10 repetitions. Over the coming weeks maintain the volume and see the intensity start to creep up and hopefully your required recovery time between exercises lower down closer to 30 seconds. Don’t base your success on how sore you’ve made yourself.


In summary a good organization for weight training would involve 2-3 sets of 4-6 different exercises for a body region. For each exercise aim for an intensity that makes 10 repetitions challenging. Give yourself 30 seconds or more to recover between sets and 48-72 between complete workouts for a body region.

My strength training is cardio

People at the gymI’ve had this conversation with numerous patients. We talk about the need for strength development and their response is “I go to the gym already”. I ask them to describe their work out and its something along these lines “20 minutes on the treadmill, 20 minutes on the elliptical and 10 minutes on the stepper”. I’ve come to learn that its a common assumption that anything that happens within gym walls will make you stronger. Here are some key concepts I pass along to patients:

1. Time under Tension

Tension is a major stimulator for strength changes. Enough tension in a focused period of time produced through a muscle contraction and you’ll get a cascade of events that lead to larger muscle fibers. The right amount of tension varies for every muscle and every movement but here is a simple rule of thumb.

With appropriate tension it should be challenging to complete an exercise 10 times

It can be that simple. From the opening example 20 minutes on the treadmill gives about 2000-4000 footsteps (people range from 100-200 steps per minute). To accomplish 2000 steps your body is generating far less muscle tension than is required to stimulate growth and your body uses many passive spring like tissues to supplement the muscle work.

2. Muscles become fuel

A very relevant point about cardio focused training is that if you calorie intake is less than your workout demands you will start breaking muscles fibers down to fuel the run. In a pinch proteins from muscle will give you about the same energy as the same volume of carbs. Once you burn up those energy reserves you’ll switch to a catabolic state when muscles are broken down for fuel rather than built up for strength.

3. Range of motion

The last point about strength is range of motion. Even if we ignored the effects of tension and muscle catabolism, cardio moves you through a very specific motion. If strength gains could be made they’d only apply to that movement meaning it won’t make you stronger to lift that box on to a shelf or smoke someone in a pushup contest.

That’s the usual discussion. If we have time I’d certainly expand on why strength is essential to good musculoskeletal health and the basics of a gym training program.