Prescription for Joint Health

You can’t bring back cartilage that’s already lost.  That’s why doing what you can to preserve your joints and protect them from damage is so important to avoiding the pain and loss of function associated with osteoarthritis.

After more than twenty years as a joint replacement surgeon, here are the four pillars that I believe are essential for maintaining optimal joint health:

Lose Weight, Eat Well, Exercise, and Play It Safe.

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01. Lose Weight

Aside from genetic issues, few things shorten a joint’s shelf life more dramatically than having to carry around too much weight. Data from the first National Health and Nutrition Examination Survey (HANES I) indicated that obese women had nearly four times the risk of knee osteoarthritis as compared with non-obese women; for obese men, the risk was nearly five times greater. But it isn’t just obese people who are at risk. If you’re more than 10 pounds overweight, you’re putting an unhealthy stress on your joints.  Keeping your weight down is the single best thing you can do preserve your joints.

It helps to understand the dynamics of how your joints bear weight. Because of the muscles acting across the knee and hip joints, normal walking causes a force across the joints that is equal to approximately four times your body weight.  Therefore, if you are, say, 20 pounds overweight, the force across both the knee and hip joints is increased by almost 80 pounds. Even small amounts of weight loss will decrease this force, slow down the joint’s deterioration and decrease pain. It’s sounds almost too simple, but for many of my patients, weight loss is the essential first step in non-operative treatment of arthritis. And maintaining a healthy body weight now is one of the best ways to decrease your chances of developing arthritis down the road.

02. Eat Well

The relationship between diet and arthritis has been the subject of exploration, claims, and controversies since the 1930s, but with the exception of gout (a certain form of arthritis), there is no link between one’s diet and the development of arthritis. However, there’s no disputing that eating a proper diet, in conjunction with exercise, helps maintain a healthy weight, which, as we’ve already discussed, is critical to prolonging your joints’ shelf life.  

To that end, it’s important that you eat a variety of foods; include vegetables, fruits, and grains in your diet; control fat and cholesterol intake; eat only minimal amounts of sugar; limit your sodium intake; and drink alcohol only in moderation. (While consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body’s ability to absorb calcium, there’s no clear link between moderate alcohol intake and osteoporosis.)

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Be sure to take the recommended daily requirements of vitamins and minerals. It’s very important to get adequate levels of calcium and vitamin D. The higher your peak bone mass, the less likely you’ll be to have fractures later in life. Maximum peak bone mass depends partly on your inherited ability to make bone, the amount of calcium you consumed over your lifetime and your exercise level. In most cases, bones weaken when you have low levels of calcium, phosphorous and other minerals in your bones. The loss of bone mass, known as osteoporosis, is more prevalent in women, but men get osteoporosis too.  In fact, by age 65, men lose bone mass as fast as women do, and by age 75, one third of men have the disease. 

Premenopausal women and postmenopausal women who use Hormone Replacement Therapy (HRT) should consume at least 1,200 milligrams (mgs) of calcium and 2,000 international units (IU) of vitamin D every day. Postmenopausal women not using HRT and those at risk of steroid-induced osteoporosis should get 1,500 mgs of calcium and 2,000 IU of vitamin D daily. Men should consume 2,000 mgs of calcium every day.

Good food sources of calcium include skim, low-fat and whole milk, low-fat plain yogurt, Swiss, cheddar and ricotta cheese, kale, broccoli, canned salmon with the bones, and orange juice and other products—such as tofu—fortified with calcium. If you find it hard to get the recommended amounts of calcium from your diet because you can’t eat dairy products, for example, try calcium supplements. Supplements—even plain old TUMS–are just as effective as calcium from food, are inexpensive, and generally are well tolerated and well absorbed if taken properly.

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03. Exercise

Exercise plays a critical role in the non-operative treatment of arthritis. Strong muscles act as shock absorbers for the joints, reduce stiffness and help keep your joints flexible and stable. While exercise can help you build strong bones and slow bone loss, you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life. That said, it’s never too late to start. Studies have shown that even people in their eighties and nineties, when put on a sensible weight-training regimen, exhibit significant gains in flexibility, mobility, balance and strength.

I’d like to caution you that by exercise, I don’t mean just pounding out 30 minutes on the Stair Master. A good program will include a combination of range of motion exercises, strength training, and aerobic activities. Unfortunately, many people fail to appreciate the importance of a diverse exercise regimen, and especially the value of strength training in extending joint health. Researchers who have looked at the effects of muscle strength on the development of osteoarthritis have found that strengthening the quadriceps muscles, for example, can reduce knee pain and disability associated with osteoarthritis. One study shows that even a relatively small increase in strength (20-25 percent) can lead to a 20-30 percent decrease in the chance of developing knee osteoarthritis. And a recent 12-year study showed that strengthening the low-back muscles had an 80 percent success rate in eliminating or alleviating low-back pain. Strengthening the muscles around your joints actually allows them to pull the joints apart and reduces the grinding that can lead to further joint deterioration and pain. Strength training also builds stronger connective tissues, improves bone density, and increases joint stability.  This acts as reinforcement for the joints and helps prevent injury.

If you’re new to the gym, or unfamiliar with weight training, speak with one of the trainers about developing a safe and effective exercise program that preserves muscle tone and maintains range of motion. The key to success with these repetitive weight-training exercises is knowing which muscles need to be strengthened and how to perform the exercises without overstressing your joints. Range of motion exercises and stretching will reduce the stiffness in joints and help make them more flexible. Isometric exercises—in which you tighten your muscles but don’t move your joints—and mild weight-bearing exercises should constitute the strength portion of your workout. These will increase muscle strength, which in turn will stabilize weak joints. Finally, aerobic or endurance exercises that you do for 20 to 30 minutes three times a week will improve cardiovascular fitness, help control weight, improve overall function, and can even reduce inflammation in some joints. It is important to exercise consistently, because the more inactive a person is, the more pain and stiffness he or she will suffer.

Non-impact activities: Start your exercise plan with non-impact activities that give you a cardiovascular workout and keep your joints moving through their normal range of motion. This will keep the cartilage in your joints lubricated and pain-free. Cycling and swimming are great options. Both of these activities use big muscle groups for an aerobic workout without impact on your joints. Swimming deserves special mention for those of you with advanced arthritis or injuries, and those recovering from illness or surgery. The benefit of water-based workouts is that water offers resistance, which strengthens your muscles as you push against it, while the water’s buoyancy supports your weight and significantly reduces stress on your weight-bearing joints, bones and muscles. For those with injuries, the pressure of the water also reduces swelling, and if the water is warm, the heat will relax your muscles and ease joint stiffness. Bicycling, especially on an indoor, stationary bicycle, can help you become more fit without putting too much stress on your hips, knees, and feet.

Low-impact cardio equipment: Elliptical trainers and recumbent bikes are excellent machines that are kinder on the knees than a treadmill. If you’re experiencing joint pain, I’d suggest you avoid the “old-fashioned” stair master. If your knees are already hurting, you’d do well to remember that, pound for pound, few things put more stress on your joints than running.

Exercises to Avoid: The seated leg extension machine would be one to avoid, as it places undue stress on the knee joint; lunges are a better alternative for maintaining quad strength, as long as you’re careful not to bend the knees more than 90 degrees.

It’s important to realize that certain exercises can be a double-edged sword. Remember, arthritis is often a problem of “wear and tear” on the joint, so anything that further stresses the joint, like vigorous exercise or lifting excessively large weights, may actually do more harm than good.  Too much exercise can amplify the joint force about the hip or knee and cause increased pain and more rapid deterioration of the joint.  Lifting very heavy weights is also problematic. As you get older and continue to lift significant weights, you can injure your muscle-tendon junctions and joint surfaces.  That’s because the new muscle becomes stronger than the aging tendons, in particular the patella, quadriceps, biceps and Achilles tendons.  The best prevention as you pass through middle age is to maintain flexibility, and keep the weight training geared toward lower weights and multiple reps. The shoulder is a special case; it’s imperative that you keep the shoulder joints flexible and maintain rotator cuff strength with basic exercises, especially if you want to continue activities that involve overhead arm motions, like golf.

It also goes without saying that you need to pay attention to your body’s signals.  If, after your workout, you feel unusual or persistent fatigue, increased weakness, decreased range of motion, increased joint swelling, or continuing pain that lasts more than one hour after exercising, your exercise program may be too strenuous and should be adjusted.

04. Play It Safe

We all have a tendency to overdo it at times. Baby boomers, as the first generation to try to remain physically active despite an aging frame, are especially notable in this regard.  In fact, some orthopaedists have coined a name for the injuries, ailments and day-after pain in the baby boomer generation we often see in our offices: Boomeritis.

It’s an unfortunate reality that muscle loss begins in your mid-40s, and it’s possible to lose 30 percent of your muscle mass over the next 20 years. Aging muscles also lose endurance, become more susceptible to injury and need more time to heal from an injury. Add to that the fact that, like an ancient rubber band, your tendons and ligaments often lose elasticity; this leads to stiffer joints, and more limited range of motion. As a result, people in their forties and beyond are highly vulnerable to injury when they engage in overzealous or high-intensity activities.

Therefore, an important component of maintaining joint health is to avoid engaging in high-intensity, high-impact activities that might cause injury to your joints. Sometimes the most difficult of all injury prevention techniques is self-discipline–knowing when enough activity is enough.

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Researchers looking at the effects of exercise and sports on the development of musculoskeletal disabilities, including arthritis, have found that people who participate in sports with high-intensity, direct joint impact—like football and soccer—are at risk for osteoarthritis. Sports involving repeated joint impact and twisting (such as baseball and soccer) also increase this risk.

Even if you’ve reached middle age with admirably intact joints, a single traumatic injury such as a broken bone, torn ligament, or moderate ankle sprain can promote deterioration of the cartilage and cause the injured joint to become arthritic in the future—even though the joint received proper medical care at the time of injury. When arthritis develops as a result of sport injury, it is generally referred to as “secondary” osteoarthritis.

A sizable number of my younger patients who have developing osteoarthritis first came to see me because of joint injuries they sustained while pushing themselves on the basketball court or overestimating how far they could safely run. A significant number of injuries are sustained near the end of an activity when fatigue begins to set in and balance becomes compromised.

Play it smart. Know your limits and prolong your joint health.