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Effects of Chronic Stress on Knee Osteoarthritis

12th April 2022

Stress is a continuous struggle we experience and can affect our everyday lives. In the short-term it can make you alert and proactive, but in the long-term chronic stress can have a negative impact on your health. Having knee osteoarthritis means there is an increased probability of high stress levels, considering the pain, uncertainty of disease progression and the cost or route for treatment.

Long-term effects of stress are depression, cardiovascular diseases, sleep issues and skin problems. What many don’t realise is its impact on knee OA. There is a correlation between stress and knee OA. Just as osteoarthritis can aggravate stress and anxiety, chronic stress can pave way for worsening pain and osteoarthritis flare-ups.


In this article, we explore the harmful effects of chronic stress on knee osteoarthritis.

How Does Chronic Stress Impact Knee Osteoarthritis?

When faced with stressors, the body releases adrenaline and cortisol to prepare us to fight the threat or escape it - a.k.a fight or flight response. This causes adjustments in our bodily functions, such as increased heart rate, blood pressure, and rapid breathing. Our muscles also respond to stress factors by contracting to prepare us for action. In chronic stress, prolonged contraction can increase pressure on our joints. As a result, cartilage degradation might be accelerated, and you might experience elevated pain.

Furthermore, your body might start to produce inflammatory cytokines upon prolonged stress. This inflammatory response is essential for combatting infections but can be destructive if released continuously and excessively. In fact, substantial evidence points to the fact that inflammatory cytokines could degrade cartilage and accelerate joint damage [1]. So, it is not hard to predict its implications on knee joints.

Even without the above concerns, chronic stress could still cause you to experience knee OA more intensely. Some studies show that chronic stress either can increase perceived pain (stress-induced hyperalgesia) or mediate it (stress-induced analgesia) [2]. This is a double-edged sword. While you don’t want the knee pain to amplify, the opposite analgesic effect might cause you to put extra pressure on your knees without noticing.


Chronic stress can also indirectly affect knee OA by disrupting your lifestyle. Sleep disturbances, uncontrolled weight gain, and cardiovascular complications are risk factors for knee OA symptoms.

How Knee OA Patients Can Manage Stress

Now that you know the consequences of chronic stress, you need to take action to calm your nerves. By constantly communicating with your support network and practicing mental and physical wellness, you can shield yourself from the harmful effects of stress.

  • Meditation, mindfulness, and deep breathing techniques can be combined for alleviating stress. Deep breathing exercises can signal your brain that you are safe and will therefore calm the body by slowing down the heart rate and relaxing the muscles.
  • Sleep is essential for managing stress. You need a solid sleep routine, getting 7-9 hours of sleep, going to bed, and waking up at the same time every day. For uninterrupted sleep, you should avoid caffeine, heavy meals, and excessive use of electronics 2-3 hours before bedtime.
  • Besides its numerous benefits on joint health, exercise is a sure-fire way to reduce stress and anxiety.
  • Socialising and having a support network will aid in stress-relief. You can reach out to family and friends to express your anxiety. Even if they can’t necessarily resolve your stress issues, sharing and socializing will protect you from isolation, one of the causes of chronic stress and depression.
  • If you realize that chronic stress lowers your quality of life, consider seeking professional help from a psychologist. Health professionals can help you to develop strategies to challenge your stressors actively. Cognitive Behavioural Therapy is a practical way of reframing negative thoughts, especially those revolving around your knee OA.

[1] Goldring, Mary B. "Osteoarthritis and cartilage: the role of cytokines." Current rheumatology reports 2.6 (2000): 459-465.

[2] Ahmad, Asma Hayati, and Rahimah Zakaria. “Pain in Times of Stress.” The Malaysian journal of medical sciences : MJMS vol. 22,Spec Issue (2015): 52-61.

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