Our bodies are incredible machines, but we can take the mechanics for granted until something goes wrong. How can we maintain healthy joints throughout life and avoid surgery? Here, rheumatologists and orthopaedic surgeons give their tips \u2026<\/p>\n
Move as much as possible <\/p>\n
According to the UK chief medical officers, we should all be getting 150 minutes of moderate-intensity exercise<\/a> (such as brisk walking or cycling) a week, or 75 minutes of vigorous activity (such as running). However, says Prof Scarlett McNally, a consultant orthopedic surgeon at East Sussex Healthcare NHS trust, about 27%<\/a> of adults in England \u201cdo less than 30 minutes a week of exercise that gets them out of breath. If you can increase that just a little, it has massive health gains.\u201d<\/p>\n Arthritis \u2013 joint pain and stiffness \u2013 is likely to reduce as sport and exercise participation increases, says Prof Alister Hart, an orthopaedic surgeon at University College London. \u201cClearly there are caveats,\u201d he says, pointing out that some football and skiing injuries can increase the risk of arthritis, for example. \u201cBut on a population level, the more sport, activity and exercise we do, the less arthritis should happen.\u201d<\/p>\n McNally points out that \u201cchange is really difficult for people,\u201d especially if they are already experiencing problems in their joints. Osteoarthritis \u2013 the most common type of arthritis, which occurs when the protective cartilage around the bones breaks down \u2013 is no longer referred to as \u2018wear and tear\u2019, she adds, \u201cbecause joints are better if you use them. Stay active and build up your muscles.\u201d Through this you can \u201ckeep them strong and it can reduce the pain to keep them moving\u201d.<\/p>\n \u201cWhen patients have a lot of pain in their joints, muscles or tendons, then exercise can be a frightening thing to engage with because it might make the pain worse,\u201d says Dr Elizabeth MacPhie, a consultant rheumatologist in Preston. \u201cWe have to support patients to understand how to look after their joints when they have arthritis, not to be fearful of doing exercise, and find the right type of exercise for them.\u201d<\/p>\n There are resources online, such as the website Moving Medicine<\/a>, which can help you to get started.<\/p>\n Pay attention to aches and pains<\/p>\n Generally, movement is medicine, says Hart. \u201cAs an orthopedic surgeon doing a ward round, you see people recovering from hip fractures. What\u2019s the first thing you do? You say, \u2018We need to get you up and moving. It will help you heal your tissues by releasing chemicals that will improve your healing.\u2019\u201d<\/p>\n Try low-intensity movements first, such as stretching or cycling, he says. \u201cOver a few weeks, you\u2019ll realise whether you can do things. If you really can\u2019t do anything, then clearly you need to get help. The red flags are pain waking you at night for many nights and a need for painkillers for more than a week.\u201d<\/p>\n Practise glute bridgesA glute bridge \u2026 bend your knees to 90 degrees and push your pelvis to the ceiling. Photograph: Posed by model; Nemanja Mohenski\/Getty Images<\/p>\n Hart says that the ultimate exercise is glute bridges: \u201cI tell all of my patients that you can do zero harm with glute bridges, and almost anybody can do them \u2013 people who are recovering from fractures, hip replacements and back surgery. When you are lying on your back, bend your knees to 90 degrees and push your pelvis to the ceiling. If you do it with an exercise band across the lower thighs, then you start working your gluteal muscles, and that will help both your hips and your knees.\u201d<\/p>\n \u2026 and squats<\/p>\n Squatting is equally crucial. \u201cIf you fall over and you can\u2019t get up, you\u2019ll become dependent on others very quickly,\u201d explains McNally, \u201cso the glutes and the thigh muscles are very important.\u201d These can be strengthened through squats. Alternatively, \u201cif you\u2019ve got stairs, going up and down them is really good. I teach people sitting-to-standing exercises, because it builds up the same muscles as a squat.\u201d<\/p>\n Do parkrun<\/p>\n \u201cImpact sports such as running often get a bit of a bad name, with the assumption that they are damaging,\u201d says Hart. \u201cIn fact, your skeletal muscles and tendons need impact to keep them healthy. If you go into space as an astronaut, you come back wobbling all over the place, because muscles can\u2019t work: you\u2019ve got osteoporosis just from being in space for a month<\/a>.\u201d<\/p>\n Hart describes running 5k as a \u201cGoldilocks dose\u201d, meaning not too much or too little. You can even take part by walking<\/a>, says McNally. A healthy living regime, she says, \u201chas to be a habit; it has to be something people just do, otherwise people don\u2019t do it. That\u2019s why parkrun works.\u201d<\/p>\n \u201cSome people like to do long distances or lots of running,\u201d she says. This is fine so long as your body allows you to do it without injury. It\u2019s worth remembering that \u201cthe benefits from exercise stop at an hour a day<\/a>. Beyond that there aren\u2019t so many benefits. Smaller doses really are a miracle cure<\/a>.\u201d<\/p>\n If you can\u2019t run, swim\u2018Low-impact aerobic activities such as swimming appear to reduce pain.\u2019 Photograph: A Bello\/Getty Images<\/p>\n \u201cSome activities which are high impact have historically been seen as bad for joints,\u201d says Dr Matthew Hutchinson, a consultant rheumatologist in London and author of Are You Really the Doctor?<\/a> \u201cYou\u2019ll probably have runners who say the contrary, and they may actually be correct \u2013 there isn\u2019t good evidence running will lead to long-term joint problems, unless you get injured. Low-impact aerobic activities such as swimming, however, definitely appear to improve function and reduce pain.\u201d<\/p>\n \u201cIf people are experiencing pain in their joints, then getting into the water and doing exercise is always easier,\u201d says MacPhie. \u201cNot just swimming, but walking up and down in the pool or doing gentle stretches in the water is a good way to get going.\u201d<\/p>\n Don\u2019t forget to stretch afterwards<\/p>\n Many of us don\u2019t bother to stretch after a workout. \u201cDon\u2019t make it a big deal,\u201d says Hart. \u201cEven if you do two minutes of stretching, that is better than nothing.\u201d He cautions against pushing yourself too far: \u201cTake your joints through their normal range of motion.\u201d<\/p>\n Make time for strength training<\/p>\n Strength training \u2013 weights and resistance work \u2013 is \u201cthe number one way in which you can prevent arthritis. It is never too early or too late,\u201d says Hart.<\/p>\n Even if you are heading for a knee or hip replacement, strengthening is still a good plan. \u201cI\u2019ve had two hip replacements and for the last one I was a day case because my muscles were super-strong,\u201d says McNally. \u201cI couldn\u2019t rotate my hip \u2013 it was horribly painful because of the arthritis \u2013 but I could go on my electric bike and cycle for an hour, which kept my muscles going, and that meant I could get out of hospital sooner.\u201d<\/p>\n Cycling can help keep your muscles strong. Photograph: Posed by models; Halfpoint Images\/Getty Images<\/p>\n Preparing for surgery is crucial, says McNally: \u201cThe big thing is exercise. Just because it hurts when you stand up from a chair the first time doesn\u2019t mean it is going to keep on hurting. Find something you can do \u2013 it is likely to be cycling, static cycling or swimming. Keep your muscles strong and practise balancing on the good leg. If you can balance, then you can get to the toilet and back, and you won\u2019t end up stuck in hospital.\u201d<\/p>\n Conditioning is key<\/p>\n Strength training combined with conditioning \u2013 cardiovascular or aerobic activity \u2013 is essential for avoiding injury, says Hart. \u201cAll professional sports people know that, but it\u2019s about feeding it down to us lot who are having a go and trying to live a slightly healthier life.\u201d<\/p>\n He holds the view that \u201cyou\u2019ve got all the bendy people in the yoga studios \u2013 they don\u2019t need more bending and stretching, they need more strength. And you\u2019ve got all the Muscle Marys in the gym \u2013 they need a bit more stretching, conditioning and mobility work. Everyone should swap.\u201d<\/p>\n \u201cThe more strength you have in the muscles that surround and support a joint, the less strain is often put on that joint to maintain stability,\u201d adds Hutchinson.<\/p>\n It is not just your joints you need to think about, says McNally. \u201cIt\u2019s also your bones. Resistance exercises and weights are proven to keep your bones strong and prevent fractures.\u201d<\/p>\n Eat with your joints in mindFocus on the basics: fresh fruit, fresh vegetables, food cooked from scratch. Photograph: vgajic\/Getty Images<\/p>\n \u201cTry to eat a healthy, non-processed diet, with lots of whole foods, fresh fruit and vegetables,\u201d says Hutchinson. \u201cIt is very likely that dysregulation of your gut microbiome has a knock-on effect on the development and the severity of inflammatory arthritis [such as rheumatoid arthritis, where the immune system attacks the tissue around joints] and probably other types of arthritis.\u201d He adds that the evidence is quite poor on what specific kind of diet is best for joints, advising instead to focus on the basics: \u201cFresh fruit, fresh vegetables, food you cook from scratch \u2026 doing those things will help your health across pretty much every domain.\u201d<\/p>\n Vitamin D and K are supplements worth taking, says Hart, \u201cparticularly in the UK, in winter; it probably helps every single one of your musculoskeletal tissues.\u201d MacPhie says standard supplements are OK, but the best option is D3 (cholecalciferol) at a dose of 4,000 IU in the winter.<\/p>\n Cod liver oil is also helpful for joints. \u201cIt is rich in omega-3 essential fatty acids, which have some anti-inflammatory properties, although we wouldn\u2019t advise this as a treatment for inflammatory arthritis,\u201d says MacPhie.<\/p>\n As for other supplements that are said to help joints, such as creatine for muscle building and glucosamine and chondroitin supplements for osteoarthritis<\/a>, the experts were cautious about their use.<\/p>\n Slim down if you need to<\/p>\n If you are overweight, losing weight can reduce the strain on joints, says Hutchinson. \u201cThere is also some evidence that excess body fat contributes to driving inflammation, and so there is a lot of interest in the dual role<\/a> of GLP-1 drugs. I\u2019m not saying everyone should take GLP-1 for their joints, but there is probably the benefit that the reduction in weight reduces strain on the joint and inflammation related to metabolic dysfunction.\u201d<\/p>\n Work on describing your pain<\/p>\n Rheumatologists see a lot of patients with unexplained pain. \u201cDescribing pain is very difficult,\u201d says Hutchinson. How can you convey it accurately to your doctor? \u201cTry to keep a diary of when it comes on, what time of day, how long it lasts for. Is the pain located in the joint specifically? Is there anything that makes it better or worse? This can ensure that you have the same level of understanding.\u201d<\/p>\n Quit smoking<\/p>\n \u201cFor pretty much any disease I can think of, but certainly for rheumatoid arthritis, don\u2019t smoke,\u201d says Hutchinson, as it worsens the condition<\/a>. \u201cRheumatoid arthritis is very strongly associated with smoking and the disease\u2019s severity.\u201d<\/p>\n Be careful what you wear on your feet<\/p>\n Carbon-plated shoes<\/a> have broken all running world records: \u201cWhat they are doing is changing biomechanics to get an advantage,\u201d says Hart. The downside to this is: \u201cIt changes the forces in your body, and if you haven\u2019t strengthened for it, you may have some other knock-on effects you didn\u2019t expect.\u201d There is concern around the potential for stress fractures<\/a>. \u201cThe amount of data is really small but there\u2019s a change, and that change is good for speed, but it does risk an injury. Barefoot shoes have the same risk<\/a>. There is no shoe that is ideal to wear all of the time.\u201d<\/p>\n \u201cPeople shouldn\u2019t need expensive kit to start being active,\u201d says McNally. \u201cAny footwear that is comfortable and affordable is fine.\u201d<\/p>\n Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters<\/a> section, please click here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"Our bodies are incredible machines, but we can take the mechanics for granted until something goes wrong. 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