By Martin Ebner - Head PT and sports nutrition specialist at Ebylife
As a Fitness coach, I'm naturally attuned to making sure my clients use proper technique when they work out so they don't pull a muscle, tear a ligament, or injure a joint. Some of the most injury-prone joints are the synovial joints (joints that move) such as the knees or elbows. The human body has approximately 350 joints, most of which are synovial. However, many are not moveable, such as the one that joins the two nasal bones that form the bridge of the nose. In this article, we’ll concentrate on the moveable joints, because, frankly, if your nose is literally out of joint, i.e. broken, you don't need advice on how to stay ahead of joint pain, you need medical attention!
Joint health is essential to pretty much every activity you do, from working out and playing sports to all your regular daily activities like carrying the shopping bags, walking, bending over and standing upright. Being physically fit, having a balanced diet, avoiding injuries, and getting plenty of sleep will help you stay healthy and keep your joints healthy too.
Joints
The word "joint" comes from the Old English for "joined" (like sleep/slept). Where two or more bones come together, they are joined or "joint." Moveable joints have cartilage on the ends of the bones where they come together. Healthy cartilage helps them move by allowing bone ends to glide over one another. It also protects bones by preventing them from rubbing against each other. A joint is usually formed of fibrous connective tissue, cartilage, and synovial fluid. Joints can be grouped according to their type of motion:
Ball-and-socket joint: Hips and shoulders.
Hinge joint: Fingers, toes, elbows, knees, and ankles.
Condyloid joint: Similar to ball-and-socket, but without axial rotation, wrists.
Pivot joint: upper vertebrae that allow the head to turn.
Gliding joint: these allow gliding/expansion. They are present in the ankles, shoulders, and hands.
Saddle joint: Fingers.
Types of Joint Pain
Some words have a sound or meaning that I find ironic and "acute" is one of them because an acute injury is anything but "cute." Usually, an acute condition is generally sudden and severe. Examples of acute joint injuries would include:
Dislocations
Fractures and breaks
Sprains and strains
Chronic conditions, on the other hand, are more long-term. Examples of chronic joint pain include:
Bursitis: Bursitis is inflammation or irritation of a bursa sac. These sacs contain the synovial fluid that helps ease rubbing and friction between tissues like bone, muscle, tendons, and skin. Bursitis is common around major joints like shoulders, elbows, hips, or knees.
Degenerative joint and bone diseases: The most common, osteoarthritis, occurs when the protective cartilage that cushions the ends of the bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in the hands, knees, hips and spine.
Gout: A kind of arthritis, gout is caused by a build-up of uric acid in the blood. If one's kidneys don't filter enough out, it can form tiny sharp crystals in and around joints. These crystals can cause the joints to become inflamed and painful. The big toe is commonly affected.
Osteoporosis: A young person's body makes new bone faster than it breaks down old bone. In older people, the body's ability to grow new bone decreases. Osteoporosis occurs when bone growth rate becomes slower than the rate of bone break-down. This causes bones to become weak so that even mild stresses can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.
Rheumatic disorders: Autoimmune disorders occur when the immune system mistakenly attacks the body's own tissues. Rheumatoid arthritis affects the lining of the joints, causing painful swelling and joint inflammation that can eventually result in bone erosion and joint deformity.
Overuse injuries such as tendonitis: When the thick fibrous cords that attach muscle to bone, the tendons, become inflamed from overuse, the result is Tendinitis. The condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your tendons, it's most common around your shoulders, elbows, wrists, knees and heels. The most famous form of tendonitis is Tennis Elbow.
Risk Factors
Joint injuries can be caused or worsened by a variety of things. They may include:
Existence of arthritis; rheumatic, osteo, gout, other degenerative issues.
Previous joint injury, such as a sprain, hyper-extension, hyper-compression, or a break.
Obesity or being overweight.
Poor muscular conditioning or physical fitness.
Repetitive motion through sports, manual labor, your job, or hobbies.
Age (joint injuries become more likely over time).
Poor form during activities.
Over-training or overextending/overexerting the body during activity.
Not using proper safety equipment during activity.
Prevention
Preventing joint injuries involves reducing risk factors. Some steps you can take to protect your joints include:
Training/education: Working with a personal trainer, especially when beginning an unfamiliar activity, will help ensure that you are using proper form when engaging in activities such as weightlifting. If you are ever in doubt about how to correctly perform an exercise, make sure to ask a trainer at your gym to give you some tips.
Buddy system: Your running partner or lifting spotter should be in the habit of watching your form and keeping you focused on proper technique, adjusting your positioning or form to avoid straining your joints. If you don't have one, get one!
No Pain, No Sprain: I cringe when I hear slogans like, "Impossible is Nothing," "Just do it," and "No Pain, No Gain." Stop if you begin to feel any form of alarming pain such as stabbing and avoid “pushing through” an injury. Many injuries are repetitive in nature and are exacerbated by a “macho” attitude. Surgery and rehab are not at all sexy.
A healthy weight means healthy joints: The joints of your lower extremities especially suffer from excess weight. According to a Healthline article The Link Between Weight Loss and Knee Pain, losing 10 pounds (4.54 kg) results in 40 pounds (18.14 kg) less weight in each step for your knees to support.
Rest Days: Overtraining can wipe out the health benefits of your fitness regimen and have many unintended side effects, joint pain being just one of them.
Engaging in regular exercise to strengthen the muscles around and supporting your joints. More on that later.
Eating a healthy diet low in salt and sugar and high in vegetables, as recommended by your doctor. More on that later.
Avoiding activities that cause pain: I know that sounds rather obvious, however, it needs to be said. Often our favorite activities are what cause joint pain to begin with. You may need to change your activity or sport if you feel it’s no longer comfortable for you.
Making sure you have the proper footwear to support your knees, hips, and other joints during activities like running and weightlifting. See: How to choose the right running shoes
Healthy Cartilage
As mentioned above, joints rely on cartilage for smooth operating. Cartilage is one of the collagen proteins that make up about a third of the proteins in the human body. A healthful diet can help the body produce collagen. Nutrients that may support collagen formation include:
Bone Broth: By eating foods that contain collagen, you get all the building blocks needed for making collagen. The most famous of these is bone broth.
Proline: In egg whites, meat, cheese, soy, and cabbage.
Anthocyanidins: In blackberries, blueberries, cherries, and raspberries.
Vitamin C: In oranges, strawberries, peppers, and broccoli or high-quality supplements. Liposomal vitamin C is a great choice, as it has already been broken down into its most bioavailable form so you get more bang for your buck!
Copper: In shellfish, nuts, red meat, and some drinking water.
Vitamin A: Occurring in animal-derived foods and in plant foods as beta-carotene.
Collagen supplementation: Collagen protein powder (hydrolyzed collagen) is available over the counter or online. Protein powders are generally good sources, but check the label and do a little research. Collagen peptides are dietary supplements that use enzymes and hydrolysis to make collagen more soluble and easier to digest. The US National Institutes of Health (NIH) states in a report about collagen peptides that they "have the potential to optimize health and address physiological needs posed by aging and exercise." Not only can it help you to build lean muscle mass, but it may also help to rebuild healthy cartilage and decrease joint stiffness when used daily. Personally, my favorite collagen supplement is Amandean’s Premium Marine Collagen. It’s one of the most effective, clean, and bioavailable collagen supplements on the market and is sourced from sustainably caught fish. All that, without any GMOs, funny aftertastes, added calories, or gluten!
Jello!: Gelatin, a partially cooked form of collagen, contains glycine, proline, lysine, and valine, all important amino acids in building healthy cartilage. Lysine and valine are essential amino acids, meaning they are not made by the human body. Amandean also makes an incredible, unflavored, clean gelatin supplement that will outshine any gelatin product in the grocery-store. Use it to thicken soups, make healthy gummies, or form your favorite desserts. (Just don't tell the kids it's actually good for them!)
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Omega-3 Fatty Acids
If you've heard of omega-3 fatty acids, there's a good chance you have some type of arthritis pain. They help reduce inflammation throughout the body, and some studies have shown benefits for heart health, brain function, and diabetes.
According to the US National Institutes of Health (NIH), fish oil supplements are the most commonly used dietary supplement in the United States. That's mostly because of the omega-3 fatty acids it contains. The two types of omega-3 fatty acids found in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The third type of omega-3 fatty acid is alpha-linolenic acid (ALA). The body must convert ALA to either EPA or DHA, so foods or joint supplements high in EPA and DHA are preferable.
EPA and DHA can reduce inflammation, which causes swelling and pain. DHA is more effective at reducing inflammation than EPA, but both have a role. EPA and DHA come with other health benefits: they help prevent heart attacks, they help lower blood triglyceride levels and blood pressure. As well, EPA taken with statin medication is more effective in reducing the inflammation of arteriosclerosis than medication alone.
Between 1000 to 3000 mg of fish oil each day can help reduce the intensity of joint symptoms like morning stiffness, tenderness, swelling, and discomfort. The omega-3 fatty acids present in this amount can also increase blood flow throughout the body during exercise, which can help reduce joint pain and swelling.
Or perhaps you're old-school and prefer the old-fashioned way of getting your fish oil, from eating fish! For each fish below, a serving of 3 ounces (84 grams) contains:
Sources of omega-3 fatty acids other than fish oil or fish-oil supplements exist. They are generally highest in ALA, which, as mentioned above, needs conversion before being useful to reducing joint inflammation and joint pain. They're still good, they just need to be eaten in high enough quantities to meet the current daily recommended intake of ALA which is 1,600 mg for men and 1,100 mg for women.
Chia Seeds: One ounce (28 grams) of chia seeds delivers over 4,900 mg of omega-3 fatty acids and more than meets the recommended daily allowance.
Brussels Sprouts: In addition to their high content of vitamin K, vitamin C, and fiber, Brussels sprouts are an excellent source of omega-3 fatty acids. Cooked Brussels sprouts provide 270 mg of omega-3 fatty acids in each cup (150 gram) serving.
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Algal Oil: Derived from algae, algal oil is one of the few effective vegan sources of both EPA and DHA. Algal oil supplements typically provide 400–500 mg of combined DHA and EPA. I prefer Amandean’s vegan omega-3 supplement (link above) to avoid any risk of unsustainable over-fishing or heavy metal contamination. It’s sustainably sourced & eco-friendly from pure, non-GMO marine algae grown safely in a cGMP facility in the USA.
Hemp Seed: Hemp seeds are comprised of about 30% oil and are high in omega-3 fatty acids. Each ounce (28 grams) of hemp seeds contains approximately 6,000 mg of ALA. Hemp seed oil, available as a supplement and easier to add to foods, provides a concentrated dose of omega-3 fatty acids.
Walnuts: Walnuts are about 65% fat by weight and are loaded with healthy fats and ALA omega-3 fatty acids. Fourteen walnut halves, about an ounce (28 grams), provides 2,542 mg; more than fulfilling an entire day’s requirements of omega-3 fatty acids.
Flaxseed: One ounce (28 grams) of flaxseeds, about three tablespoons, contains 6,388 mg of ALA omega-3 fatty acids, well over the daily recommended amount. This means that one-quarter of a cup (7 grams) of seeds, between two and three teaspoons, has 1,600 mg of ALA.
Perilla Oil: This oil, often found in Korean cuisine, is fast becoming popular as a supplement. In comparison to other plant oils, perilla seed oil consistently contains one of the highest proportions of omega-3 (ALA) fatty acids, at 54–64%.
Just a tablespoon (14 grams) contains nearly 9,000 mg of ALA omega-3 fatty acids. Since perilla oil is high in polyunsaturated fats, it can oxidize with heat and so should not be used as a cooking oil. Rather, use as a flavor enhancer, dressing, or condiment. Perilla oil is also available in capsule form for an easy and convenient way to increase your omega-3 intake.
Additional Supplements
Besides collagen and collagen peptides; fish oil and omega-3 fatty acids; and hemp, algal, flaxseed, and perilla oils, there are many nutrients that can help maintain healthy joints. Most of these can be purchased as stand-alone supplements or together in joint-related health supplements.
Vitamin D: Promotes bone health
Estrogen: Post-menopausal women may find this study done by the NIH on estrogen and joint symptoms interesting.
Glucosamine (glucosamine sulfate): A natural compound found in cartilage.
Chondroitin (chondroitin sulfate): A natural compound found in cartilage.
Turmeric/Curcumin: Curcumin is the active ingredient in Turmeric. It is an antioxidant and anti-inflammatory known to reduce joint pain, especially knee pain caused by knee osteoarthritis.
Boswellia: Boswellia extract has been used for centuries in Ayurvedic medicine to treat chronic inflammatory illnesses. Many people use it to this day to reduce pain and inflammation in the joints while avoiding the troublesome side effects of NSAIDs. Amandean sustainably sources boswellia extract and encapsulates it into powerful 500mg capsules for safe and effective daily use.
MSM: Methylsulfonylmethane is effective in reducing joint pain, stiffness and swelling. It is an anti-inflammatory that inhibits the breakdown of cartilage.
Ginger: Ginger contains anti-inflammatory compounds that function in the same way as COX-2 inhibitors used to treat pain and inflammation. For people with arthritis, ginger's anti-inflammatory properties are particularly helpful.
Calcium: Too little calcium can lead to osteoporosis, which causes the bones to thin and become vulnerable to fractures.
SAMe: S-adenosylmethionine has been found to be as effective as NSAID painkillers, such as ibuprofen. It takes longer to act, but it also has fewer side effects than NSAIDs.
Magnesium: According to PubMed, magnesium mediates bone and muscle metabolism, inflammation, and pain signaling. Low magnesium intake is especially associated with knee pain and knee osteoarthritis.
Exercises
It may sound counter-intuitive, but a program that includes weight-bearing exercise reduces pain and improves joint function. It's tempting to think that doing exercises that do not put any strain on a joint will be helpful. However, the opposite is actually true. The American Academy of Orthopaedic Surgeons recommends exercise to the millions of adults who suffer from "wear and tear" arthritis, which often affects the weight-bearing joints in the knees, hips, neck, and lower back.
How can exercise help to relieve pain? First of all, exercise increases blood flow, bringing nutrients to the cartilage that it needs to stay healthy. Also, specific exercises will strengthen the muscles surrounding the joints. Stronger muscles can handle more weight. As a result, the bones in your joints carry less weight which helps to protect damaged cartilage. Some examples of activities to help strengthen joints include:
Walking
Jogging
Hiking
Dancing
Step aerobics
Soccer ("non-American" football)
Baseball
Basketball
Tennis
Racquetball
Bowling
Golf
Stair climbing
The benefits of exercise must be balanced against stress to your joints over time, however, If you are suffering from joint pain, consult a personal trainer and/or your healthcare provider for advice. Your health and wellness are unique to you, so less high-impact activities like swimming, cycling, or using an elliptical machine might be better suited to you.
Here are some joint strengthening exercises that may be helpful:
Lateral band walk: Improves hip stability, strengthens the hip abductors, especially the gluteus medius, and increases the stability of the knee joint and pelvis. As a pre-exercise warm-up, it can improve hip, foot, and ankle stability as well as knee joint stabilization.
Keeping the resistance band flat, not bunched, place the band just above each knee and wrapped around both legs. With this exercise, it helps to maintain a low, forward-facing posture. Your back should be straight, not rounded.
Position your feet shoulder-width apart. The band should be taut, but not stretched.
Bend your knees slightly and move into a half-squat position to activate the gluteus medius.
Keep your feet in line with your shoulders and face forward with your body weight evenly distributed over both feet.
Maintaining the half-squat position, shift your weight over one leg and take a step sideways with the other leg. Move this leg in and out, sideways, for eight to 10 repetitions. Keep your hips level during the movement.
Slowly shift your weight and switch legs. Do another 8 to 10 side steps.
Single-leg or bilateral glute bridge: Great for improving hip mobility, strengthening the lower back, and stretching the hamstrings.
Lie on your back and bend your knees so your feet rest flat on the floor.
Then raise one leg until it is stretched out straight.
Brace yourself, then drive the heel of the foot still grounded into the floor and push your hips up until your body is in a straight line from your shoulders to the toes of your outstretched foot. Slowly lower yourself again, then repeat 8 - 10 times on the same side.
Switch to the other leg.
Forearm plank: Strengthens the abs, legs and core. Also good for stretching the arches of the feet as well as the calves, shoulders and hamstrings.
Lie facedown on the floor with elbows directly under shoulders and forearms in front of you, palms facing each other.
Tighten your abs as you raise up onto elbows and toes with the weight of your body spread evenly among toes and elbows.
Maintain a straight line from shoulders to hips.
Hold this position for as long as you can maintain the correct form.
Single-leg deadlift: Hip-hinge movement that strengthens the back, core, and legs. The complex movement works the core muscles as well as the standing leg, which help to improve balance.
Stand with both feet under hips.
Shift your weight to the right leg, which should be nice and straight with a soft bend in the knee.
Begin to drive your left foot back like you're stamping the bottom of your foot on the wall behind you, keeping your leg straight.
Simultaneously, slowly start hinging at the waist, tipping your torso forward until it’s almost parallel to the floor.
Keep your arms straight, at shoulder height, and perpendicular to the floor at all times.
At the bottom of the position, your body should be in a straight line from the top of your head to the bottom of your left foot.
Then, begin pulling your left leg forward while keeping it straight, and lift your torso up until you’re standing again. Repeat 8 - 10 times on each side.
Yoga poses: There are many wonderful yoga sequences that improve your posture, increase blood flow in general, and improve your joints. However, as I'm not a Yogi, I'll leave it to my friends and colleagues to guide you through them. It's best to find a well-trained yoga instructor in your area. Or, if that's not possible for you, there are many hundreds of YouTube videos to get you started.
Bridge pose
Warrior sequences
Forward fold
Bow pose
A Quick Word About Osteoporosis
Exercise helps build strong bones and slow bone loss. Combining strength training exercises with weight-bearing and balance exercises can slow the processes that leads to osteoporosis. Strength training helps strengthen muscles and bones in the arms and upper spine. Weight-bearing exercises, such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports, affect mainly the bones in the legs, hips, and lower spine. Balance exercises such as tai chi and yoga can reduce your risk of falling, especially as you get older.
