Should you work out when in pain? One arthritis sufferer’s road to recovery after knee replacement shows exercise relieves discomfort

Ten years ago, Hongkonger Franky Chan Ming-tsun started to experience problems walking. His legs curved outwards, putting pressure on his knees with every step.

Over time he noticed that he could not stand for long without his knees swelling and his legs feeling like they were about to buckle.

His posture was affected, with his back undergoing tremendous strain as he tried to compensate for the discomfort in his knees.

For a month he had to walk with the help of a Zimmer frame but his knees felt “hot” and “uncomfortable”.

We are generally told to avoid physical activity if in pain, but Chan, who is now 67, was keen to exercise following his operation and worked with personal trainer Kyle Liu Kim-man – a joint, pain and movement specialist and co-founder of Qintensity Fitness, in Hong Kong.

Chan was already a client of Liu’s, and a few months before his knee replacement had employed the latter’s services in the hope that exercising would speed up his recovery after surgery.

The goal of the programme was to slow down muscle loss and enhance Chan’s overall strength and endurance so that he could go about his day free of pain and with little to no risk of falling.

Following surgery, Liu adjusted the programme to help Chan recover faster and increase his muscle strength so that he could start walking again. It included exercises such as seated leg extensions, seated marching, and the “pillow squeeze” – in which one squeezes a pillow between one’s legs to work the inner thighs.

The training sessions took place in Chan’s home.

“I’d never exercised prior to this,” says Chan, whose position as the owner of a jewellery business saw him mostly confined to his desk or crouched over a gemstone-polishing machine.

“My wife suggested I take up exercise before my knee replacement surgery. She exercises regularly and told me how good it makes her feel.”

After his procedure, Chan couldn’t move much because of the pain, but still tried his best to walk using his Zimmer frame, and ride his sitting pedal cycle, which he says allowed him to move his knees without straining them.

Three months later, his knee pain was no longer as intense, and now he can stand and walk for longer periods without needing support or feeling discomfort.

“Being physically active improves our blood circulation, strengthens our muscles, boosts our mood, and enhances our flexibility and mobility,” Liu says.

“These are just a few benefits of exercise, and they all help with pain management as well as allowing the body to move more freely.”

He adds: “One of the main causes of chronic pain is physical inactivity; holding the same posture for a long time without movement can overload our joints and muscles, depending on the area, and increase our risk of developing various pain-related diseases.”

Not everyone who is in pain finds it easy to move; they might even think that physical activity is out of the question, especially if they’ve just had surgery or are injured.

“It’s important that those in pain work with a professional who can help them modify these movements according to their restrictions,” she says.

“Movement should alleviate pain, not add to it.

“I also often use resistance bands around the knees to support weak hips or behind the knees for Spanish squats.”

Liu advises not to go overboard with exercise if in pain, and that overworking muscles, tendons and ligaments may cause inflammation and worsen the discomfort, and in some cases even tear your ligaments – a problem that requires surgery.

“Very rarely, we also see cases of rhabdomyolysis, when the muscle breaks down from working out excessively without rest. The toxins produced by this breakdown process then travel to the kidneys, where they can cause serious damage.”

For those in pain and wanting to resume physical activity or start an exercise programme, or those who’ve recently had surgery, Liu recommends first seeing a doctor.

According to Liu, which activity you choose depends on the level of pain you’re experiencing and the pain’s location. If the pain is not too intense, finding the exercise that interests you the most should be a priority because, ultimately, your goal is to build a lifelong exercise habit.

“If you’ve had knee-replacement surgery like me, it’s important to move, especially during the initial two to three months, even if it’s the last thing you want to do,” he says.

“You need to keep the muscles around your knees flexible, otherwise they will tighten.

“When you start walking again after your surgery, you may not be in that much pain any more but your knees will stiffen up.”