Did you know that a 2008 study estimated that nearly half of American adults will develop osteoarthritis in at least one knee in their lifetime? That’s surely an eye-opener for those of us in our 40s and 50s who experience soreness and stiffness in knee joints from time to time. 
More alarming is the finding in the same study that the lifetime risk of osteoarthritis of the knee escalates to between 60% and 70% among those who have had past knee injuries, those who are obese, and those who are physically inactive.
To deal with persistent knee soreness and discomfort, many people resort to pain relievers, but these just mask the underlying issue. Further prolonged use of such pain relievers has been shown in past studies to increase the risk of vital organ damage. Over the past 15 years, the use of dietary supplements including glucosamine sulfate and condroitin sulfate has exploded as an alternative treatment option to relieve pain and support healthy joint function. While many people find these natural ingredients helpful, not all people find them beneficial.
So what other alternatives are there to reduce the likelihood of developing arthritis and limiting the severity of the condition if you already have it?
According to a study published in the Medicine & Science in Sports and Exercise (MSEE), lower limb resistance training combined with creatine supplementation may offer a compelling choice. 
To begin, many previous studies have demonstrated that a regular program of lower limb resistance training (weight lifting) strengthens the muscles of the leg, increases lean body mass, and reduces knee pain. You see, when we become less physically active, our muscles weaken and we end up placing more of the stress of movement on our joints. Further, the longer we are inactive but still consume the same volume of food, we tend to gain weight. Excess body weight combined with weakened muscles heightens the amount of stress we place on our joints when moving around. So improving muscle strength and shedding excess body weight are two powerful ways you can reduce your risk of developing arthritis (and reducing the pain associated with the condition). In fact, a 2010 report from the U.S. Centers for Disease Control and Prevention indicated that losing as little as 11 pounds of body fat reduces the risk of developing osteoarthritis in women by 50%! 
Creatine, a natural amino acid found primarily in the meat we consume, has been shown in past studies to assist healthy older adults improve their ability to engage in greater physical activity by enhancing muscle strength and power. According to the MSEE study authors, creatine helps provide rapid energy to muscles during physical activity, which in turn, improves muscle strength and function.
In the MSEE study, 24 women (average age of 57) were enrolled and divided into two groups. Twelve of the women participated in the lower limb resistance training program and received daily doses of a powdered creatine supplement. The other 12 women participated in the same resistance training program but received a daily placebo powder (dextrose) over the course of the study.
All the women received 12 weeks of supervised resistance training. Exercise sessions were held three times weekly and involve three specific lower limb weight lifting exercises (leg press, leg extension, half-squats). The study subjects were required to perform four sets of 8-12 repetitions of each exercise (there was a one week buildup period at the outset of the study where subjects performed two sets of 15-20 repetitions of each exercise at a lower resistance level). Over the course of the study, the weight resistance for each participant was increased once they achieved 12 repetitions on a given exercise.
The creatine group received 20 grams of creatine monohydrate powder for the first seven days of the study divided into four equal doses of 5 grams (taken at breakfast, lunch, dinner and 10 p.m.). Thereafter, they received 5 grams per day (at lunch) for the duration of the study. The placebo group received the same volume of dextrose powder and the same usage instructions. Both groups were instructed to mix the powder with their juice of choice.
At the outset of the research program, the study team evaluated both groups’ leg strength, body mass, and other physical diagnostic measures. In addition, each subject completed two different health surveys that provided information on self-perceived pain and functionality. At the end of the study, both groups’ received the same battery of diagnostic tests/surveys. The researchers then compared the baseline and post-study measures within and across the two groups.
The study findings clearly showed beneficial effect of combining creatine with the resistance training program on a number of the diagnostic evaluations. For example, on a diagnostic test to evaluate physical function known as the stands-time test (counting how many times a person can stand from a seated position in 30 seconds), the creatine group improved by 15% between baseline and post-study tests while the placebo group remained flat. Comparing the two groups at the end of the study, the creatine group performed 19% more “stands” on the test than the placebo group. This result is particularly interesting because both groups experienced similar increase in quadriceps muscle strength by the end of the study (11%-12%).
On the health surveys, the creatine group reported significantly reduced knee pain (44% lower), less knee stiffness (50% lower), and less limitation of physical function related to arthritis (40% lower). While the placebo group also showed improvement on all three measures, the degree of improvement was not as pronounced (33%, 16% and 32%, respectively).
The study authors concluded, “The main finding of this study was the positive effect of CR [creatine] supplementation on physical function in women with knee OA undergoing a resistance training program. Interestingly, there was evidence that CR supplementation also improved quality of life and lower limb lean mass. Collectively, these findings reveal a novel therapeutic application of CR supplementation in enhancing several well-known benefits of strengthening exercises for knee OA patients.”
So for those concerned about nagging knee pain (whether you have been diagnosed with arthritis or not), consider starting a lower limb resistance training program and combining it with creatine supplementation. The MSEE study authors noted that creatine at the dosage levels in the study produced no adverse side effects among the study participants.
If you are not familiar with the lower limb resistance training exercises highlighted in the study, we recommend you consult a certified fitness instructor at your local health club or community center. Not only can they show you the proper techniques for each exercise, they can help design a resistance training program based on your current level of physical condition. Many of these fitness instructors will provide an initial consultation free of charge.
 Murphy L, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008 Sep 15;59(9):1207-13.
 Neves Jr M, et al. Beneficial Effect of Creatine Supplementation in Knee Osteoarthritis. Medicine & Science in Sports & Exercise, 2011 Feb 8. [Epub ahead of print]
 Morbidity and Morality Weekly Report. Centers for Disease Control and Prevention. October 8, 2010; 59(3):1262-1265.