Exercise prescription. A physiotherapist's bread and butter.

But a patient's understanding of why an exercise is important for joint health can often be limited. It sometimes seems counterintuitive to 'put more pressure' through a painful joint. Most people are worried that they may cause more damage. So why is exercise so important? And how do these exercises actually help decrease pain and stiffness? 

Firstly, movement of a joint stimulates the production of synovial fluid which is a  joint's very own lubrication. This fluid allows the bones to move smoothly past one  another. Think of it like the oil in a car's engine. Without it, your joints can feel stiff.  

Exercise also supplies this joint fluid with more nutrients as it increases blood flow  and metabolic processes. These nutrients are key for repair and maintenance and  a process called 'autophagy' which is the breaking down and removal of damaged  cells within a joint. Think of it as exfoliating the dead cells out of your joints! 

So which exercises are best? Now of course, I would encourage everyone struggling with joint pain to see a physiotherapist who can prescribe an exercise  programme tailored to an individual's needs. This article contains some of my go-to exercises for arthritic/mechanical joint pain. I'm sure my patients will know them very well! 

Best Exercises For Ankle Pain

The ankle is susceptible to arthritic changes. After all, it takes the weight of our  entire body with each step we take. But how can we make it stronger? 

1. Calf raises. Whatever age, whatever activity level and whatever your goal is, calf raises should always be a staple in any exercise regime. Why? The calf complex, which comprises of the gastrocnemius and soleus muscles, is incredibly important for stabilising both the ankle AND knee joint during the walking gait cycle. A weak calf muscle can lead to decreased fluidity in gait, equating to increased pressure through our ankle with each heavy-footed step we take. 

2. 4-way ankle range of movement. If stiffness is a barrier to fluid ankle mobility,  then completing active movement in all 4 planes of movement is vital. Ensure your knee is static throughout each movement so that it is only the ankle that is moving.  

Best Exercises For Knee Pain

Strength and stability around the knee is vital for any weight-bearing activity. If you  want to stand, walk, run or jump without pain then you need knee stability!  

1. Straight leg raises. The ultimate quad-focused exercise. You’d be surprised at  how tricky these can be even for regular gym-goers. Your knee must stay straight throughout the entire movement and slowly does it! Maintain control and move slowly to hold that time under tension! 

2. Side-lying clams. Some may question why we’re strengthening a muscle around the hip joint when we’re aiming for knee stability? Well, the glute medius and minimus are PARAMOUNT for controlling the position of your knee and preventing knee valgus.  

Best Exercises For Hip Pain

Our hips are the meeting point for our lower body and our trunk. As a ball & socket  joint, the hip gives us mobility but must also be incredibly stable. We must learn to  use good technique to hinge, rotate, pivot, flex, extend, adduct and abduct (and  combine these movements during functional tasks); all whilst avoiding  compensatory movement patterns which undoubtedly lead to pain and discomfort.  

1. The bridge. Now we can’t not mention this exercise. The ultimate exercise for glute activation and pelvic stability. Ensure knees stay in line with hips and don’t arch your back at the top of the movement! 

2. Side-lying abductions. This exercise strengthens similar muscles to the clam but it avoids the compressive forces that may irritate conditions such as bursitis so I prefer it when working specifically on hip health!  

Best Exercises For Lower Back Pain

Now I’m sure you know someone who suffers with a ‘bad back’. There are many  reasons why someone might suffer with low back pain and here are some of my  go-to exercises to offload and support it. A healthy back requires a strong core so  that is where we’ll start! 

1. Posterior pelvic tilts. The starting point for most Pilates workouts and my  favourite exercise to understand how your core and pelvic floor work as one. Think of your hips like a bucket of water. You want to pour water out the back of the bucket by pressing your lower back down into the floor. Draw up your pelvic floor simultaneously.  

2. Counterpoise. Bird-dog. Superman. This exercise has a variety of names but it’s another favourite of mine for activating that core. The anti-rotational muscle contractions ensure stability is achieved. When the muscles surrounding the spine feel well-supported, they’ll stop spasming! 

Best Exercises For Shoulder Pain

The shoulder is another ball and socket joint but unlike the hip, its structure favours mobility over stability. Therefore, the muscles surrounding the joint MUST be strong to avoid pathology.  

1. Scapula squeezes. We’re activating the muscles in between the shoulder  blades here. These muscles are often too long and too weak due to 21st-century living. Next time you’re out in public, check everyone’s posture as they crone over their phones and laptops! You want to think of squeezing a pencil between your shoulder blades during this movement!

2. Wall plank protraction/retraction. Here we are bringing mobility back to the  shoulder girdle which must be in rhythm with the shoulder joint in order to provide stability. Think of separating your shoulder blades and rounding your upper back to protract, followed by a squeeze to bring your shoulder blades back together to retract.  

Best Exercises For Neck Pain

The neck or the cervical spine is another area prone to postural deformities. Bad  posture doesn’t necessarily equal pain but it certainly can contribute! It’s important  to activate and strengthen the muscles that help hold the head directly on top of  the body. Our head is very heavy and holds very important cargo after all!

1. Neck retractions. Think of giving yourself a double chin. This movement lengthens the back of the neck and opens the joint space between each vertebrae in the cervical spine so is vital for decompression!  

Although these are some of my go-to exercises when prescribing programmes for  my clients, they may not work for all. Therefore, I want to reiterate that it is so  important to seek a thorough assessment from a qualified health professional with  musculoskeletal expertise. Without an individualised programme, you may not  reach your goal and eliminate the problem. 

Lots of us experience joint pain at some point in our life and with the lengthy NHS  waiting lists, it has never been more important to get on top of your joint health! 

This blog is written by Lauren Jackson BSc (Hons) Physiotherapist HPC Registered. 

Lauren graduated from the University of East Anglia with a first class honours degree in Physiotherapy in 2020. After completing professional placements in a variety of specialities, she completed her last year of study working in the USA in a busy outpatient clinic, using innovative and advanced methods to treat a multitude of clients including athletes and post-operative patients.

Lauren incorporates manual therapy, therapeutic massage, rehabilitative exercise, gait re-education & valuable advice and support to address all kinds of conditions, to treat & prevent further musculoskeletal issues from arising.

Lauren is also a qualified gym & Pilates instructor and has qualifications in sports massage and sports taping which she utilises to aid her patients’ recovery. She has an avid passion for fitness & exercise so understands the importance of returning to full health as quickly as possible. Lauren is proficient in person-centred practice to ensure that her Physiotherapy treatment is tailored to her patients' goals and lifestyle.

Note: This article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.