Osteoarthritis & Rheumatoid Arthritis Treatment Through Strength Training
Treating your arthritis through strength training & exercise with a physical therapist
How Physical Therapy Can Help Reduce Your Arthritis Pain
A personalized strength training and exercise program, guided by a physical therapist, can be incredibly effective in alleviating arthritis pain and reducing flare-ups, helping you return to the active life you love.
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We Use Science to Help You Manage Your Pain
Coping with arthritis is a challenge on its own, and living in a high-elevation area like here in Denver can sometimes make it feel even more difficult. If you’ve sensed that your joint pain flares up with our changing Colorado weather, know that you are not imagining it. Many people feel a real link between shifts in air pressure and the intensity of their arthritis pain.
While the precise mechanisms are still being researched, there is scientific evidence suggesting a link between our weather conditions here in Colorado and the frequency and intensity of arthritis pain and flare-ups. However there is also plenty of evidence showing that you can take control of the arthritic pain.
Learn About Osteoarthritis & Rheumatoid Arthritis Treatment Through Strength Training
Colorado’s High Elevation, Weather, Osteoarthritis & Rheumatoid Arthritis Pain
Colorado’s High Elevation, Weather, Osteoarthritis & Rheumatoid Arthritis Pain
Denver’s high altitude means we all feel a lower average barometric pressure compared to sea level and less external pressure pushing against our body. This phenomenon can cause tissues within the body, including those around and within the joints, to slightly expand. This expansion also applies to our joints lubricant (synovial fluid) that ensures the joints smooth functioning.
However the expansion of the joint’s lubricant increases pressure within the joint capsule irritating any existing arthritis and resulting in joint inflammation and increased arthritic pain. In a healthy joint, this barometric pressure change might go unnoticed but in a joint already affected by osteoarthritis and rheumatoid arthritis, this slight expansion of tissue can increase tension on the membrane and irritate nerves, leading to a perception of increased pain and stiffness (1, 2, 3).
Denver, Colorado’s high altitude, proximity to the Rocky Mountains, and dynamic climate create a unique combination of atmospheric conditions that can make arthritic joint pain worse in a couple of different ways. Research has also shown the speed of the barometric pressure change matters and a sudden drop, like the kind that often precedes a fast-moving Colorado thunderstorm, forces the body to adapt too quickly, placing significant stress on the pressure-sensitive cells within the joint tissues leading to a more noticeable spike in arthritic inflammation and pain.
While large-scale, peer-reviewed studies focusing specifically on Denver’s population are still needed, if you live with arthritis and feel that your pain ebbs and flows with the Colorado weather, your experience is not only valid but also explained by the interplay between our climate and your body.
- Direct Association Between Air Pressure and Synovitis: A pivotal study by Y. Ibe et al., published in BMC Musculoskeletal Disorders in 2014,
- McDougall, J.J. Arthritis and Pain. Neurogenic origin of joint pain. Arthritis Res Ther 8, 220 (2006). https://doi.org/10.1186/ar2069
- The Role of the Inner Ear as a Pressure Sensor: Further research from J. Sato’s laboratory, published in PLoS One (2019)
The Research on Osteoarthritis & Rheumatoid Arthritis Treatment through Strength Training & Exercise
The Research on Osteoarthritis & Rheumatoid Arthritis Treatment through Strength Training & Exercise with a Physical Therapist
Despite the challenges posed by Denver’s climate, exercise, especially strength training, is an effective arthritis treatment. If you’re coping with osteoarthritis and rheumatoid arthritis then you know the painful flare-ups send an intuitive signal to the body to stop moving, avoid further pain and protect what feels vulnerable (your joints). Although short-term rest is appropriate for severe arthritic pain, long-term inactivity creates a debilitating cycle where weakened muscles fail to support joints, leading to increased arthritic pain and functional decline.
Breaking the debilitating cycle of inactivity and arthritis pain is important for improving quality of life and regaining function. Mechanically, stronger muscles surrounding a joint act as a natural shock absorber and stabilizer. By bearing more of the load during movement, strong muscles effectively offload the pressure from the inflamed joint capsule and delicate cartilage, reducing pain and protecting the joint from further stress.
Here are 3 researched studies concluding that a strategic strength training & exercise program is one of the most powerful non-pharmacological tools for managing osteoarthritis and rheumatoid arthritis pain and preserving long-term healthy function of your joints.
- The misconception that strength training and exercise could exacerbate joint damage in osteoarthritis and rheumatoid arthritis has been systematically disproven. Research has confirmed that strength training is not only safe but highly beneficial. Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis.
- A pivotal Cochrane Review, an authoritative summary of medical research, concluded that dynamic exercise programs are effective for improving muscle strength and physical function in rheumatoid arthritis patients without increasing pain or worsening disease activity. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.
- The chronic inflammation that defines rheumatoid arthritis doesn’t just attack the joints; it also triggers a debilitating condition called rheumatoid cachexia—a significant loss of muscle mass. Research confirms that even intensive strength training safely and directly counteracts this muscle-wasting complication without worsening joint damage or inflammation. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial.
When considering strength training & exercise as a osteoarthritis and rheumatoid arthritis treatment, think of your muscles as also having a built-in pharmacy and able to create and release their own natural anti-inflammatory substances (known as myokines) into your bloodstream. As explained in research by Pedersen (2011), these helpful substances (myokines) travel throughout your body to calm the widespread inflammation that defines osteoarthritis and rheumatoid arthritis. In this way strength training delivers a powerful one-two punch against osteoarthritis and rheumatoid arthritis: it builds stronger muscles to better support your joints, while also helping to put out the inflammatory fire taking place within your body.
As physical therapist, I understand that when you’re in pain, the instinct is to rest and protect your joints and it seems counterintuitive to do anything else. My goal is to show you how a smart, carefully designed strength training and exercise program can empower you to fight back against osteoarthritis and rheumatoid arthritis.
Our entire approach is built around you and your safety. We would begin together with low-resistance exercises, focusing completely on proper form to ensure your joints are always supported and protected. As you feel stronger, we will progress gradually and at your own pace. Know that our programs are adaptable and during arthritic flare-ups, we won’t push through the pain. Should we encounter moments of pain we can shift to gentle range-of-motion movements or even simple muscle tensing without movement, just to keep those muscles active without stressing them.
This is the standard of care recommended by leading experts including the American College of Rheumatology, who consistently endorses muscle-strengthening exercises at least two days a week as a core part of managing rheumatoid arthritis (Kolasinski et al., 2020).
I know the urge to become less active is strong, but the evidence is clear: embracing a consistent strength training and exercise program tailored for you is one of the most effective ways to reduce your arthritic pain, improve your function, and empower you to reclaim a better quality of life.
Joint Stability & Pain Reduction
How Strength Training & Exercise is an Effective Osteoarthritis & Rheumatoid Arthritis Treatment for Joint Stability & Pain Reduction
Strength training is a cornerstone of managing osteoarthritis and rheumatoid arthritis because it directly addresses the condition’s debilitating effects on joint stability and pain (1). The fundamental principle is that stronger muscles provide a natural brace for inflamed and unstable joints (2). By building up the muscles surrounding an affected area, the mechanical stress and burden on the joint itself are significantly reduced (3). This muscular support system effectively offloads pressure from the compromised joint capsule and cartilage, which can lead to a substantial reduction in pain and a marked improvement in overall function (4).This approach is particularly vital for the osteoarthritis and rheumatoid arthritis vulnerable hands and wrists where there can be a loss of grip strength and dexterity, making everyday tasks difficult. Strength training counteracts this by specifically targeting these forearm flexors, extensors, and intrinsic hand muscles. When a person grips or manipulates an object, strengthened muscles absorb a higher proportion of the force, shielding the delicate, inflamed joints. Your hands and wrists can be strengthened through low-impact exercises such as gently squeezing therapy putty, performing slow wrist curls with very light resistance, or spreading the fingers against a rubber band.
Similarly, when your knee becomes inflamed, the resulting pain and swelling can make it feel unstable, prompting you to favor a leg in your basic movements. However this leads to muscle imbalances and starts a vicious cycle of muscle weakening from disuse, providing less support, which in turn makes the joint even more unstable and painful. We can rebuild the muscles that support your knee by doing simple and safe exercises like straight leg raises, glute bridges, and controlled chair squats. Think of it this way:
- Stronger muscles on the front of your thigh act like powerful shock absorbers for the knee.
- Stronger muscles on the back of your thigh and in your buttocks provide stability, stopping the wobbly or unnatural movements that cause grinding and pain.
(1) American College of Rheumatology (ACR) / Arthritis Foundation Kolasinski, S. L., et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology, 72(2), 220-233.
(2) Arthritis Foundation, Exercise and Strength Training with Arthritis.
(3) Shakoor, N., & Block, J. A. (2006). Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Arthritis & Rheumatism, 54(9), 2923-2927.
(4) Bennell, K. L., et al. (2011). Efficacy of a physiotherapy rehabilitation program for individuals with knee osteoarthritis after arthroscopic partial meniscectomy: a randomized controlled trial. The Journal of Bone and Joint Surgery. American volume, 93(10), 905-914.
Breaking the Cycle of Inactivity
How Strength Training & Exercise is Effective Osteoarthritis & Rheumatoid Arthritis Treatment for Breaking the Cycle of Inactivity
For many people the greatest challenge in coping with osteoarthritis and rheumatoid arthritis is breaking the vicious cycle of pain and inactivity. The natural response of leaving a painful joint alone typically results in muscle loss (atrophy), increased joint stiffness, and often, weight gain (1). Inactivity usually results in greater stress on the joints, accelerating degeneration and increasing pain, further discouraging movement. Strength training and exercise reverses this debilitating cycle by methodically rebuilding the body’s muscular support system (2).
For example arthritic pain and instability in the knees (large weight-bearing joints) discourages walking or climbing stairs, and often leads to weight gain with a more sedentary lifestyle. This causes the muscles that stabilize the knee—the quadriceps, hamstrings, and glutes—to weaken rapidly, as they bear more weight and while the joint itself becomes stiffer.
When your muscles are weak, your body weight puts a lot of extra stress on the painful joint, making the downward spiral of pain and weakness even worse. However, a program of gentle strengthening exercises, like chair squats and leg raises, can break this cycle in three ways:
- They rebuild weak muscles, turning them into a strong “living brace” that supports and protects your joints.
- The movement helps your joints lubricate themselves so they can move more smoothly.
- The activity helps with weight management, which takes even more strain off your body.
All of this works together to reduce both pain and the physical stress on your joints.
Similarly, the cycle of inactivity proves just as damaging to the small, complex joints of the hands and wrists. When pain and swelling make gripping or fine motor tasks difficult, it’s natural to be avoided. This avoidance leads to the weakening of the forearm and hand muscles, causing grip strength to decline while the joints lose their range of motion to stiffness – and a pattern of disuse ensues. Gentle resistance exercises, such as using therapy putty or light bands, directly counteract this decline, rebuilds strength and restores the muscular support system needed to make daily tasks less painful, and break the cycle of inactivity (3).
Ultimately, in addition to muscle building, strength training and exercises reverses the negative consequences that stem from inactivity, and allows you to regain function and return to a more active life.
(1)The inflammatoy response, a mixed blessing for muscle homeostasis and plasticity.
(2) strength training is beneficial for rheumatoid arthritis (RA) patients, improving muscle strength and aerobic capacity without increasing disease activity.
(3) Lamb, S. E., Williamson, E. M., Heine, P. J., et al. (2015). Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. The Lancet, 385(9966), 421-429.
Improved Function and Mobility
How Strength Training & Exercise is Effective Osteoarthritis & Rheumatoid Arthritis Treatment for Improved Function and Mobility
Our treatments are aimed to return you to enjoy your full spectrum of activities by actively restoring and enhancing your physical capabilities. Strength training bridges you to this goal, directly improving everyday function and mobility by rebuilding the body’s natural support structures. With a stronger body routine tasks like climbing stairs, lifting groceries, and all your physical endeavors will be boosted, your joints more flexible and their range of motion improved. Strength training is a bridge to gain functional mobility for large-scale movements that rely on the knees, hips, and core (1).For example rheumatoid arthritis affecting the knees can result in instability in your entire lower body making simply rising from a chair challenging. However, controlled chair squats specifically target the quadriceps and glutes, rebuilding the foundational strength you need to rise from any seat with ease and confidence. To regain the ability to get off the floor, exercises like glute bridges and straight leg raises build foundational hip and leg strength without stressing the joint. The gentle, deliberate motions of these exercises also help combat stiffness and lubricate the joint, increasing the range of motion essential for a normal walking gait.
Similarly, strength training can restore the manual dexterity that is often lost when osteoarthritis and rheumatoid arthritis affects the hands and wrists (2). Weakness and instability in these joints results in poor grip strength and the inability of the forearm muscles to stabilize the wrist under load. Targeted exercises like squeezing therapy putty rebuilds the hand muscles required for a secure grip, performing wrist curls with light resistance strengthens the forearms to prevent the wrist from painfully buckling when lifting groceries. Motions like turning a key, buttoning a shirt or typing, everyday tangible things can be strengthened with slow forearm rotations exercises.
(1) The effect of a progressive resistance training program on the reactive strength index and measures of physical function in older adults”
(2) “Strengthening and stretching for rheumatoid arthritis of the hand (SARAH): a randomised controlled trial”
Bone Health & Inflammation Reduction
How Strength Training & Exercise is Effective Osteoarthritis & Rheumatoid Arthritis Treatment for Bone Health and Inflammation Reduction
Beyond simply creating stronger muscles to support your joints, strength training offers two deeper benefits for people with osteoarthritis and rheumatoid arthritis. First, it directly improves bone health, as weight-bearing exercises are proven to increase bone density (1). Second, it helps calm the immune system itself (2). Consistent strength training can lower the chronic inflammation throughout your body, which in turn helps regulate the overactive immune response that causes osteoarthritis and rheumatoid arthritis flare-ups. This is important because many with osteoarthritis and rheumatoid arthritis face a “triple threat” to their bone health:
- the disease’s chronic inflammation
- bone-thinning side effects from medications
- and pain-related inactivity
This combination makes the two main bones of the leg—the femur, which is the thigh bone, and the tibia, the main shin bone—much more likely to become weak and brittle from osteoporosis. Strength training directly counters this threat through weight-bearing exercises like squats or lunges. This controlled stress to the skeleton, according to Wolff’s Law (3), signals bone-building cells to deposit new minerals and reinforce the bone structure. While this is happening and as noted earlier, your contracting muscles release anti-inflammatory substances known as myokines into the bloodstream, which helps to lower your body’s inflammation that attacks the joints.
While not traditional weight-bearing joints, the wrists and forearms, common sites for osteoarthritis and rheumatoid arthritis related bone erosion and osteoporosis, also benefit from these effects. The stimulus needed for bone growth here is tension, thus with resistance exercises like wrist curls, the forearm muscles pull on their bony attachment points, triggering the mechanisms that build bone density. Thus strength training delivers a two-pronged biological therapy for osteoarthritis and rheumatoid arthritis by stimulating bone growth while simultaneously producing anti-inflammatory compounds.
(3) Wolf’s Law
The Unique Benefits Working with a Physical Therapist
The Unique Benefits of Strength Training & Exercise for Osteoarthritis & Rheumatoid Arthritis Treatment with a Physical Therapist
While strengthening muscles provides vital support to painful arthritic joints, the holistic benefits on fatigue, mood, sleep, and balance are just as important for restoring quality of life. Exercise is a therapy that treats your whole wellness and not just a single ailment, important because when you have osteoarthritis or rheumatoid arthritis, it can feel like your body’s foundation is compromised. However by focusing on strength training for your legs, hips, and core, you can actively rebuild that stable base of support (1).
Each exercise that strengthens these areas helps to better distribute weight and absorb shock, taking the burden off your painful joints and empowering you to move with more confidence and less discomfort. For example, movements like squats and single-leg stands offer compounding benefits for those with osteoarthritis and rheumatoid arthritis. Beyond simply building muscle, these exercises also:
- Reinforce Neuromuscular Control: They strengthen the crucial communication pathways between your brain and muscles, leading to more precise, controlled movements.
- Sharpen Balance and Coordination: By challenging your stability, these exercises enhance your body’s innate sense of balance, helping you feel steadier and more sure-footed.
- Build Confidence and Reduce Fall Risk: This improved stability and coordination directly translate to greater confidence in daily activities and a significantly lower risk of fall-related injuries.
Ultimately, strength training empowers you to move beyond managing osteoarthritis and rheumatoid arthritis and toward actively improving your overall resilience and daily quality of life – a therapeutic journey made safer and more effective when guided by one of our physical therapist.
As physical therapist we translate the general framework strength training into a personalized strategy, tailored specifically to your body, capabilities, and health condition. We are expert navigators ensuring every squat and stand is performed with precise form, maximizing muscle engagement while protecting vulnerable joints from strain.
We understand the unpredictable nature of osteoarthritis and rheumatoid arthritis, know when to progress your training to build resilience and when to modify movements during flare-ups to maintain momentum safely – all to transform your efforts into real-world gains and life-changing reality.
What to Expect
What to Expect in Strength Training & Exercise for Osteoarthritis & Rheumatoid Arthritis Treatment with a Physical Therapist
- Personalized Baseline Assessment: As physical therapist we conduct a thorough evaluation of your current fitness level, joint motion, muscle strength and endurance, and functional capacity. This includes movement screenings and assessments allowing for the creation of a customized strength training plan tailored to the specific type of arthritis, affected joints, and individual needs and goals.
- Ensuring Proper Form and Preventing Injury: One of the most important aspects of strength training for arthritis is proper form(1). As physical therapist we demonstrate correct technique for each exercise, minimizing stress on vulnerable joints and preventing injury, which is especially important where “bone on bone” movement may occur. A physical therapist can advise on starting with light weights or resistance bands, focusing on slow, controlled movements.
- Targeting Specific Affected Body Parts: Osteoarthritis, the most common type of arthritis, often causes discomfort in the neck and back, knees, hips, and shoulders. Rheumatoid arthritis can affect smaller joints like fingers and wrists. As physical therapist we design exercises that specifically strengthen the supporting muscles around these areas, such as: Knees and Hips: Squats (chair squats, air squats, wall squats), hip extension and flexion, seated leg extensions, leg lifts, glute bridges, clam shells, and step-ups. We can guide on appropriate depth and weight to avoid locking out joints. Back and Shoulders: Overhead and lateral arm extensions, single arm dumbbell rows, facepulls, rear delt fly’s, single arm dumbbell bench presses, and kneeling shoulder presses. We generally advise avoiding above-the-shoulder exercises if arthritis is present in the upper body, or modifying them. Core exercises like planks and side planks also support spinal stability. Hands and Feet: As Physical therapist we recommend specific hand exercises and the use of resistance bands instead of dumbbells if grip strength is an issue.
- Gradual Progression and Pain Management: As Physical therapists we understand the importance of starting slowly and gradually increasing intensity and duration. We help patients differentiate between normal muscle fatigue/mild soreness and sharp or worsening joint pain, which serves as a red flag for inflammation or improper technique. During flare-ups, we can guide you to gentle activities or isometric exercises that produce muscle contraction without joint motion.
- Holistic Approach and Adherence: As physical therapist we integrate strength training with other important elements like aerobic exercise, flexibility/mobility work, and manual therapies. We emphasize consistency, which is key for long-term benefits. We can also offer strategies for self-care, like applying heat before exercise and ice afterward. Perhaps most importantly, the guidance of a physical therapist is an investment that pays lifelong dividends. You don’t just complete a course of treatment—you gain the skill set and confidence to safely and effectively manage your own strength and well-being for years to come, empowering you to be the primary expert in your ongoing journey with arthritis.
Treatment Plan
Strength Training & Exercise for Osteoarthritis & Rheumatoid Arthritis Treatment Plan
Contrary to common belief, a progressive weightlifting program is one of the safest and most effective ways for a person with arthritis to build strength and support their joints (1). While every treatment plan is meticulously tailored to the individual after a comprehensive assessment, the general framework of the therapeutic journey typically unfolds in three distinct phases.
Phase 1: Building the Foundation (First Month)
The initial goal is to activate muscles without stressing painful joints. This is done using isometric exercises, where you engage the muscles without movement. Examples: Holding a wall squat or a gentle plank for 15-30 seconds. Purpose: To create a stable base and prepare the body for more dynamic work, ensuring strength can be built safely from the start.
Phase 2: Adding Weight and Movement (Next 2-3 Months)
Once a solid foundation is set, the focus shifts to dynamic strength training. This involves moving your joints through a full range of motion with light weights, such as dumbbells, kettlebells, or resistance bands. Examples: Performing chair squats, leg lifts, glute bridges, and light dumbbell rows. Structure: Typically aiming for 2-3 sets of 8-12 repetitions for each exercise. Purpose: To build muscle tissue that acts as a natural “scaffolding” to support and protect your joints during daily activities.
Phase 3: Lifelong Strength & Function (Ongoing)
With a strong base established, the final phase focuses on long-term management and real-world strength. This involves two key principles:
- Progressive Overload: You will continue to gradually increase the weight or resistance over time. This ensures your muscles are always being challenged to grow stronger.
- Functional Movements: The exercises will increasingly mimic daily life activities to improve your functional capacity.
Example: Performing a “farmer’s carry” (walking while holding weights) to build the core and grip strength needed for carrying groceries.
The ultimate goal of this guided regimen is to empower you with a stronger, more resilient body that can better manage the daily challenges of arthritis.
(1) The Centers for Disease Control and Prevention (CDC): The CDC explicitly recommends strength training for adults. The Arthritis Foundation also strongly suppost strength training.