When I talk about the nature of joint aches and pain such as hip pain, knee pain and shoulder pain, I explain that the human body is basically a biological (living) machine. Like a machine, it has moving parts comprised of levers connected by some kind of mechanism that redirects force. Think car engines, certain power tools and watches.
In the human musculoskeletal system, those levers are the long bones such as the femur and ulna, and the connecting mechanism/ force redirectors are the joints. Like a machine’s mechanical components, joints will gradually wear out with use. The more hours/years of use, the more likelihood of breakdown. Think football players and those in heavy labor jobs.
When a moving part of a machine gets prematurely damaged from an accident like dropping or overloading, it gets repaired—a replacement part is installed and/or a mechanic puts things back together and makes necessary adjustments. However, the machine is never the same. The accident typically causes moving components to misalign ever so slightly, which results in more friction and accelerated wear and tear, leading to impaired efficiency and eventual breakdown again.
Similarly, if you twist and injure your knee, hip or other joint and get it repaired surgically, or by a chiropractor or physical therapy/ rehabilitation it is never quite the same—most people will lose some degree of functionality because the natural alignment has been permanently altered. You may lose a few degrees of arc of motion; hear some clicking sounds with movement (called crepitus), and lose some strength in the affected joint. Worst case, you will experience chronic pain.
Your joint health obviously plays a huge role in your quality of life. The good things in life involve movement, which depends on joint function. Your joints must be able to first of all exist without pain. They must be able to move your body in the manner you wish to move, without mechanical limitations. And, they must be able to withstand forces while they move your body parts– jumping, climbing, lifting, carrying, etc. That’s the best case scenario.
But what if you are one of the millions of people who have some form of joint pain; either from wear and tear, or from an accident such as a sports injury, work injury, fall, or car accident? These things happen to almost everyone at some point.
It depends first of all on how bad it is. How much structural damage occurred will determine the extent to which your joint can be rehabilitated/ returned to normal.
Unfortunately, the tissues that comprise joints are of the type that do not regenerate very well. This includes tendons, ligaments, cartilage and muscle. As I wrote before, tendons, ligaments and cartilage are classified as connective tissue, which does not contain many living cells, per unit mass. They are mostly protein filaments (collagen, elastin) embedded in a special matrix whose main function is structural. The few cells found in connective tissue are mostly dormant (chondrocytes, fibrocytes) and can effect minor repairs and maintenance: tiny tears of collagen can be repaired, but large tears cannot. Tears/injury to cartilage, such as a meniscal tear or rotator cuff tear, are either repaired by surgical reattachment, or left alone to become chronic leaving the individual with a certain percent loss of function.
Compare this to skin tissue, classified as epithelial tissue, which can heal relatively fast due to the high density of cells (they divide in number to create new tissue) and blood supply. Think of the last time you got a cut– how relatively fast it healed, and is no longer noticeable.
So if you are fortunate to not have joint pain, think proactively now to keep it that way.
If you are experiencing any level of joint pain and/or dysfunction, learn things that you can do to reclaim some of that function AND slow down the progression, which is what I can help you with. Even chronic cases of joint pain can be improved, so don’t give up hope. You may not be able to make the pain go away entirely, but if you can reduce the severity of your pain by 50% and/or increase range of motion by a couple of degrees, that can translate into a dramatic improvement in your quality of life.
The Two Main Approaches to Maintaining Joint Health
Let’s review the main joints involved in everyday movement patterns.
First of all, the weight bearing joints of the lower extremities: hips, knees, ankles, foot joints. We can also include the lumbar spine (low back). These joints have the dual task of bearing the body’s weight (and more than your weight if you do high impact activities) while allowing ambulation—running, walking, climbing, etc. and are therefore larger in terms of surface area contact and number of ligaments.
Secondly, the non-weight bearing joints of the upper extremities: shoulder complex, elbows, wrists, and hands. While they don’t bear as much weight as the hips, knees, ankles and feet, these joints are involved in anything you do with your arms/ hands. They are smaller and generally have more moving parts, so these joints are vulnerable to degeneration as well, especially the glenohumeral joint of the shoulder.
The first course of action in preventing joint degeneration, which tends to start in most people around age of 40, is through diet and nutrition. Eat a wholesome diet rich in phytonutrients; i.e. plants. Phytonutrients are vitamins and minerals naturally found in plants that are important co-factors in numerous biological functions, such as enzymatic activity, tissue repair and anti-inflammation. Some like turmeric are strong anti-oxidants. Think of oxidation, or oxidative stress, as the body’s version of rust. Oxidation is what causes rust and decay in metals; oxidation in the human body damages cell membranes, proteins and DNA. It is caused by excess free radicals— oxygen-containing molecules that have an unpaired electron, making them highly reactive. They take electrons from tissues in order to return to a stable state, which damages them. In fact, oxidative stress is a leading theory of aging and joint wear and tear. Eating a diet rich in phytonutrients—green, leafy plants and plants with hues of blue, purple, and orange equips your body with the nutrients it needs to counteract oxidative stress. Thus, think of a plant-based diet as being protective of your joints.
On the contrary, eating a diet rich in processed foods and added sugar can place a burden on your body. Not only is there a lack of nutrients, there are ingredients that can raise your triglycerides and bad cholesterol; form plaque in your arteries, and even cause toxicity. They must also put a strain on your liver, lymph system and kidneys, the organs involved in detoxifying your body.
Next, move those joints! You’ve got to find the right balance between helpful movement that exercises and strengthens your joints, and the ones that can cause damage. I’m not saying to avoid things like weight lifting and running, because when done properly, they benefit your joints.
Basically, repetitive jumping activities and wrong running technique that “pounds” your knees, hips, feet and spine joints have the potential to cause tiny cracks in your cartilage, which can expand into pits and eventually tears. An example of the movement you should avoid is playing basketball often, where you run on a hard court and jump and land hard to do layups numerous times; often landing on one leg first.
Running is a great aerobic exercise, and I do it myself, being in my mid-50s. But do it wrong, and you are setting yourself up for hip, knee and foot pain. With running, first of all, I highly advise running no more than 20 miles a week. You don’t need that much cardio from running, and running beyond this point every week turns the tables, as the cardio benefit is at the expense of your hip, knee and feet joints. Long distance running is especially not advisable, as it can generate excessive free radicals, causing oxidative damage to your body. Repetitive pounding especially if you are over the age of 40 when cartilage loses its thickness and pliability can cause micro-tears which can expand as you keep doing it, like a tiny, 2mm crack in a car windshield that gradually grows into a really big crack with every bump in the road.
Also with running, definitely do not use a jumping type movement. Think more in terms of really fast walking. Keep your feet close to the ground as you run, and land on the forward half of your foot (toes, ball and arch) rather than your heel. Your head should not bob up and down as you run; or it should be minimal.
Do closed kinetic chain exercises. This means the levers involved in movement (i.e. for lower extrmities, your lower leg and foot) are secured to the ground during force generation. A perfect example are squats and lunges. With this type of exercise, you have more control, and you isolate the muscle better because your leg is secured to the ground with your weight.
For upper extremities, an example is planks and push ups. Chin ups as well — same concept, the levers are firmly secured as you exercise the muscles and joints in a controlled fashion.
Remember, joints are comprised of two bones connected by ligaments. A tendon (the ends of a skeletal muscle) crosses over the joint and connects somewhere on both bones (origin and insertion points). So when you do squats, you are strengthening the ligaments and tendons of the joint, giving it more support. With more support, the joint is more stable and able to withstand forces better; i.e. it will last longer. How does it happen? Wolf’s Law of physiology states that connective tissue increases in mass in response to repeated loads. It’s one of the body’s many survival and environmental adaptation mechanisms. The mechanical stress signals to the brain to mobilize cells to secrete more matrix and collagen to handle the load. This is why resistance exercises are highly recommended for women who are at risk for osteoporosis—it builds up bone mass and turns down bone loss.
Conversely, being sedentary leads to muscle, bone, and connective tissue atrophy. Weak joint components will increase your risk of injury.
But again, be careful not to overdo it. Do the movements slowly and controlled, and focus your mind on controlling the primary mover muscles rather than your rep goal. This will maximize joint strengthening and minimize injury.
Summary of Main Points
- Proper joint function is necessary for everyday movements, and therefore is critical to quality of life.
- Joints are prone to injury and degradation due to their daily use.
- It is advisable to be proactive to ensure your joints stay healthy throughout your life because joint components are comprised of tissues that do not regenerate well. One major injury can mean lifetime dysfunction.
- The recommended approaches to maintaining joint health are a plant-based diet rich in phytonutrients, and closed kinetic chain exercises to strengthen your joints so that they are more durable and resistant to injury and degeneration.
Next time, I will discuss more ways to keep your joints healthy, and if you already have chronic joint issues, things you can do to reclaim function.
