As a physiotherapist, the question I answer most often is whether exercise will make an arthritic joint worse. Usually the person asking has been told to rest it. The evidence points the other way, and Pilates in particular suits arthritic joints well. But first, it helps to be sure which kind of arthritis you are dealing with, because the two get confused constantly and they need different things.
Osteoarthritis is not rheumatoid arthritis
These are entirely different diseases that happen to share a word.
Rheumatoid arthritis is an autoimmune condition. The immune system attacks the lining of the joint, usually symmetrically, so both wrists or both knees. It often comes with whole-body symptoms like fatigue, and it needs medical management.
Osteoarthritis is a local process in a specific joint. Cartilage breaks down, the body remodels the surrounding bone, and the joint becomes stiffer and sometimes painful. There is no immune attack and no symmetry requirement.
The confusion usually starts in a scan report. Reports talk about “degenerative changes”, “bony spurring”, “osteophytes” and “osteoarthrosis”. Those are all describing osteoarthritis. If you want those terms translated, we have done it in the scan report post.
One reassuring point before we go further: if everyone over 40 were scanned head to toe, nearly all of us would show these changes somewhere. Finding them on a scan is not the same as having a problem. What matters is whether the joint hurts and whether it limits you.
The five features of osteoarthritis
It is the most common form of arthritis by far. Australian government data from 2015 put self-reported osteoarthritis at around one in thirteen people, with two thirds of those female. It is rare in children and increasingly common after 40.
It is the wear-and-tear arthritis, and that phrase misleads. More on that below. It turns up most often in the fingers, thumbs, big toes, lower back, hips and knees, and it is most symptomatic in the hips and knees.
It is cartilage breakdown. Cartilage is the cushioning between the two bones of a joint. It lets the surfaces glide and it absorbs impact. When its water content and structure break down under load, you end up close to bone on bone. The body responds by changing the bone around it.
It produces bone spurs, called osteophytes. These are the body’s attempt to increase the surface area of the joint so pressure spreads over a wider region. Mostly they cause nothing at all. Occasionally they matter — a spur on a small spinal joint can narrow the space a nerve passes through, and one at the big toe can be genuinely painful. Otherwise they are a sign to read, not a problem in themselves.
It shows up as stiffness and reduced movement. Early on, pain comes after activity and settles with rest, with mild morning stiffness lasting under half an hour. As it progresses the joint can enlarge and become tender, and everyday things like walking change shape because the mechanics have altered.
Why wear and tear is the wrong way to think about it
The phrase makes osteoarthritis sound like a joint being used up, which makes rest sound like the sensible response. It is not.
A joint needs movement to stay healthy. The fluid that lubricates it is secreted in response to movement, which is why the old line “move it or lose it” is more accurate than it sounds. Rest an arthritic joint for long enough and it stiffens, the muscles around it weaken, and the next attempt at activity hurts more.
The better model is capacity against load. Cartilage’s ability to maintain itself has fallen behind what is being asked of the joint. That is a balance, and balances can be shifted in either direction — which is the whole reason treatment works at all.
What exercise does about it
Exercise is the best-supported management for osteoarthritis there is. But the detail matters more than the headline.
Get the balance right. Too much of the wrong thing loads an already irritated joint and flares it. Too little and the joint stiffens while the muscles waste. The work is finding the level you can do consistently.
Move it. Joint fluid is produced by movement. This is the cheapest thing on the list and the one people skip.
Avoid repetitive heavy loading where you can. Jogging, jumping, deep squatting and kneeling load joints in ways that add up fast. Not banned, just worth modifying rather than pushing through.
Build strength around the joint. This is the big one. Strong muscles absorb load that would otherwise go straight into the joint. Good muscle condition does more for an arthritic hip or knee than any amount of stretching.
Keep weight manageable. Nothing a knee, hip or spine likes less than carrying more than it needs to. This is the factor with the most leverage, because it multiplies through every step you take.
Why Pilates suits arthritic joints
Of the options available, Pilates has some real advantages here.
It is controlled and weighted without the pounding. There is no impact through the joint, but there is enough load to build the strength that actually protects it.
It builds the postural and deep muscles that stop the joint being loaded at odd angles. A well-aligned joint tolerates load far better than one that is not.
It improves body awareness, which matters more than it sounds. Knowing which movements your joint tolerates today, and which ones it will complain about tomorrow, is how you stop the cycle of flare and rest.
It scales. Everything can be made harder or easier, which is what makes a program sustainable through a bad fortnight.
Swimming or aqua classes are an excellent alternative, especially when a joint is too irritable for weight bearing. The resistance is real but gravity is not doing the damage.
The short version
If you have osteoarthritis or any painful joint, you need to keep moving and keep building strength, while avoiding repetitive heavy loading on the sore bits. That is not complicated, but calibrating it to your joint is where a physio earns their fee.
Chat to our physio team if you want guidance or treatment. We can also work alongside a trainer to build a program that does not set off a flare.
For a gentle start, our 30 Minute Hip and Lower Back Reset class is controlled, low impact and built for stiff joints.
For the background, read is osteoarthritis just part of getting older? or what those scan words mean.
