By Coach Matt | 6 min read

While it may sound surprising, lifting weights has been shown in numerous studies to help with arthritis, both osteoarthritis and rheumatoid arthritis. This is also what I have personally observed over many years of training a variety of clients who have arthritic joints: it feels surprisingly good to give those ornery joints a healthy dose of resistance training.

If you search "weight training arthritis" on Google Scholar, here's a peek at just a few of the results you'll get (click the arrow to expand each one):

Managing arthritis with exercise ¹

Almost half of all older adults have arthritis, either degenerative or inflammatory. Regular exercise is an important therapeutic intervention for all types of arthritis. Specifically, regular exercise can prevent deconditioning of the muscles, keep the joints stable, improve joint function and flexibility, decrease pain, enhance aerobic fitness, improve balance, and decrease falls.

Geriatric Nursing
Volume 22, Issue 3, May-June 2001, Pages 143-150

Therapeutic exercise for rheumatoid arthritis and osteoarthritis ²

Therapeutic exercise has been shown in studies to be useful in the treatment of RA and OA. Beneficial effects have been demonstrated in both conditions without apparent worsening of the underlying musculoskeletal diseases. Patients with RA and OA should be considered for exercise therapy to improve physical conditioning, muscle strength, flexibility, and well-being.

Seminars in Arthritis and Rheumatism
Volume 20, Issue 1, August 1990, Pages 32-40

Benefits of exercise in rheumatoid arthritis ³

The importance for the inclusion of exercise training in the treatment of RA is now clear and proven. Exercise in general seems to improve overall function in RA without any proven detrimental effects to disease activity. Thus all RA patients should be encouraged to include some form of aerobic and resistance exercise training as part of their routine care.

Journal of Aging Research
Volume 2011, Article ID 681640

Comparison of high and low intensity training in well controlled rheumatoid arthritis ⁴

In conclusion, high intensity exercises had more effect on physical condition, joint mobility, and muscle strength than ROM exercises and isometric training in patients with well controlled disease. No detrimental effect of high intensity training on disease activity was found during the exercise course and in the 12 weeks thereafter.

Annals of the Rheumatic Diseases
Volume 55, Issue 11, November 1996, Pages 798-805

You may find those results surprising. I can understand why someone might think that lifting weights with arthritis is about as dumb as speeding down the highway with two flat tires, because it is true that exercise can exacerbate joint pain if you abuse those joints by pushing through movements that hurt. Maybe you've hurt yourself or known others who have done so (I know I have), but that doesn't mean resistance training is inherently injurious or damaging to the joints.

Like so many things, the poison is in the dose.

Too much water can mess up your electrolyte balance and cause serious problems, even death, but I'm not about to discourage anyone from staying hydrated. A lot of misconceptions in the health & fitness industry stem from falsely assuming that if an excessive dose of something can be bad, then any amount must be bad.

It shits me to tears how many times I've heard someone say:

when what they really mean is:

I have pretty strong and healthy knees, but you know what's nearly guaranteed to make them hurt? Using too much weight with bad form! Overloading any joint through a shoddy movement pattern is a recipe for pain and injury, whether you have arthritis or not.

(I'm going to focus on squats and knee pain in this post because it's a common example many people can relate to, but keep in mind the same logic and process applies to other joints and exercises. I'm also going to focus on a practical approach to exercise selection for joint pain, but there are other factors like warming up, stretching, self-massage, etc. that can be helpful for managing joint pain)

I've seen so many people trying to squat way too much weight, either because they used to be able to go heavy years ago or they simply have an unrealistic idea of how much they should be lifting; when it causes them pain, they blame the exercise ("squats hurt my knees") instead of the excessive loading or the fact they've never been properly instructed in the lift.

The harsh truth is sometimes you need to take 100+ lbs off the bar in order to lift without pain. Sometimes you simply don't know how to squat and simply need professional instruction, even if you've been lifting for decades!

It's better to hurt the ego than to hurt your joints.

Am I saying that everyone can squat without pain just by going light? No. Even body weight squats with solid form can aggravate some peoples' knees. You know you're in that camp if whenever you sit down to a chair, couch or toilet your knees light up, regardless of how gingerly you do so.

That said, before you toss squats or any other exercise into the nope-bin, it's important to try significantly lighter loads and alternative variations. There are many different versions of the squat, so just because one hurts that doesn't mean they all will.

If deep barbell squats aren't feeling great, even with light loads, here are some variations I might have a client try instead:

• Squat to a box
• Barbell front squat
• Dumbbell goblet squat
• Squat with counterbalance

In the unlikely event that none of those feel good, sometimes training one leg at a time is a great way to train the legs without knee pain:

• Reverse lunge
• Split squat
• Step-up
• Sled push

Are the above bilateral and unilateral variations all aggravating your knees? That's extremely rare in my experience, but we can always try a couple machine variations to see if the added stability helps:

• Hack squat
• Leverage squat
• Leg press

Most people can handle several exercises from the above categories without any pain. The key is to focus on what you CAN do instead of lamenting what you can't do, especially since building proficiency in one exercise often "unlocks" another, similar exercise that you weren't able to do before.

For example, let's say split squats put too much stress on the back knee as you near the bottom of each rep, but reverse lunges feel just fine. It's not uncommon to find that after a few weeks of progressing your reverse lunges, the splits squats no longer hurt! Just because something doesn't feel good now, that doesn't mean they can never feel good again. This process looks a lot like exposure therapy for psychological anxiety, just applied to gradually increasing physical stressors. The mind and body are both resilient and adaptable, so long as we're careful not to exceed tolerable dose.

Let's say your knees just hate all of the above squat variations because they simply involve too much stress and movement in the knee joint. Does that mean it's time to throw in the towel? Not at all! We haven't even considered all the hip-dominant deadlift variations that are even less likely to aggravate the knees:

• Conventional deadlift
• Sumo deadlift
• Trap bar deadlift
• Romanian deadlift

There are also several more free weight and machine exercises that emphasize the hip muscles with minimal stress to the knee joint:

• Hip thrust
• Good morning
• Hamstring curl
• Cable pull-through

This general strategy of trying out a myriad of exercises that put different kinds of stress on your achy joints is not limited to the knees. If barbell bench pressing hurts your shoulders, even with light loads and changes to form, there are several different kinds of free weight and machine presses you can try, as well as various push-ups.

The most important point I want to stress here is whether you have zero joint problems or you've been struggling with arthritis for 20 years:

If it hurts, don't do it!

A great trainer isn't going to push you through exercises that hurt your joints; they will try multiple exercise variations and carefully coach your form until you've identified several different lifts you can do no problem, and over time the amount of exercises you can perform painlessly is likely to increase. That's the same process I used to overcome serious soft tissue damage and pain in my own knee.

When I was a teenager, I dislocated my left knee several times over the span of a year. The first time, it swelled up to the size of a cantaloupe! I was bed-ridden for several days of excruciating pain. When the swelling went down, I saw a doctor and wasn't surprised to hear there was a lot of damage done to the meniscus and cartilage. I had persistent aches and sharp pains for many months, but eventually I started strength training after talking to a trainer who told me it would likely help.

I carefully progressed my strength, on whichever deadlift and squat variations I tried that didn't hurt, until I could eventually lift several hundred pounds on a wide variety of movements without any pain whatsoever. I literally fixed my "bad knee" with intelligent strength training, and now, almost 20 years later, there isn't any leg exercise I can't do because of pain; that includes high-impact activity like running, jumping and kicking heavy bags.

I've seen similarly incredible improvements in more clients than I can remember over 15 years, including several who had arthritis so bad they were getting regular steroid shots from the doctor to manage their pain and were visibly limping as they showed up for our initial consultation.

The totality of evidence is overwhelming; a healthy dose of resistance training can help you move and feel better, even if you have degenerative damage to your joints due to injuries and arthritis. There's no need to push through agonizing joint pain, you just need to discover which exercises feel fine when using appropriate loading and proper form.

Flat tires may not be capable of fixing themselves, but the human body has an astonishing capacity for positively adapting to the right amount of stress over time. Whether you experiment on your own or hire a professional to guide you, you'll be surprised by how much you can accomplish when you focus on improving what you CAN do.

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Of course you should always consult with your doctor before starting any new strength training program, whether you currently have issues with your joints or not.

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