Exercise is an under-recognized treatment modality in patients with osteoarthritis. When combined with analgesic medication and physical therapy, exercise can result in significant weight reduction, particularly relevant for obese patients with osteoarthritis of the spine, hip and knee. Loss of weight leads to diminished axial loading with reduction in stress across the joint. Exercise is also known to release endogenous opioids from the nervous system, partially decreasing the need for analgesic medications in patients who exercise routinely. Assuming proper alignment of involved structures, quadriceps strengthening has been established as a mechanism of decreasing knee pain in osteoarthritis, and is highly recommended as a treatment modality for this condition.
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