Our resident Performance Dietitian, Pip Taylor talks all things joints, answering some of your questions about your joints and how to best look after them.
Understand more about what strategies you can implement to keep through diet, exercise and supplementation to get the most out of your body.

Is joint longevity something we’re really taught enough about? Why do you think that this element of health is not more prominently discussed amongst highly active people?
Joints and joint health are something we are still learning about. It used to be accepted that joint pain as we age was inevitable and simply due to ‘wear and tear’ – a catch phrase to explain any pain, loss of mobility or function. While it’s true that we do have structural changes with age, and signs of osteoarthritis appear – these changes don’t have to mean pain or movement loss.

Instead, what we now know about joints is that frequent use is what keeps them healthy. Proper use keeps joints lubricated and stimulates the repair and rebuilding process. A lack of use on the other hand, allows the cartilage to become dryer, more brittle and more prone to damage over time. This tends to happen in the parts of the joint surface related to ranges of motion that aren’t sufficiently being used, which means the broader range and more movement the better.

However – and this is the kicker for athletes and those involved in sports – movements that require a lot of twisting and turning through joints and under pressure, significantly increase risk of injury. It’s these injuries that can lead to a higher risk of joint pain later in life, and accelerate structural changes and inflammation that accumulates where there has been injury/damage.

Even though this is a risk of sport, for the most part physical activity, training and sports have benefits that far outweigh any risks. Plus for athletes at the elite end, the risk of long term implications is generally not front of mind when setting athletic career goals.

What are the numbers telling us? Are more people being slowed down by joint pain and inflammation than we realise?
Joint pain and inflammation are largely a result of arthritis. However, it’s important to distinguish between rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is an auto-immune problem, where the immune system attacks one’s own joint cartilage. Osteoarthritis is typically referred to as a ‘wear and tear’ condition, where the joint cartilage becomes worn down over time and what’s most commonly associated with ageing and/or following ligament injuries.

Research published in Sports Medicine and led by Durham University’s Department of Sport and Exercise Sciences shows that over 50% of retired rugby players experience osteoarthritis pain, more than twice the frequency of their counterparts from non-contact sports.

Similarly, a systematic review conducted by Dresden University, found that male professional soccer players have a 2.3-fold risk of knee osteoarthritis compared with the male general population. These numbers are significant, but don’t tell the whole story when it comes to joint pain experienced more widely by non-contact sport athletes or less active individuals. In fact, most pain comes from inactivity.

In a paper published from Stanford University, doctors warn that “the greatest threat to the health of the aging athlete is not the aging process itself but rather inactivity. Motion is critical to articular cartilage health, repair, and homeostasis (a healing joint environment).” So inactivity is the real curse. Whether that is frequent high periods of sitting associated with most modern day lives, or our retirement as athletes or a move away from our youth sports. This lack of movement may increase risk of weight gain – itself a major risk for joint issues – and along with diet and other lifestyle choices, only serves to accelerate joint pain. Plus, the still widely held view that impact and running is bad for joints probably discourages many with joint pain from being active again.

How much of a barrier to performance are joint issues in the here-and-now, and what are the long-term implications?
Anything that causes pain is going to be detrimental to performance and research has been pretty clear that you can’t repair damaged cartilage through surgery and management of symptoms such as cortisone and NSAIDS (nonsteroidal anti-inflammatory drugs) is largely ineffective or short term. Appropriate exercise and lifestyle, including diet will help not just joints but the rest of the body stay healthy and functional and reduce levels of systemic inflammation.

What are some of the most effective ways to look after our joints? Are there exercises we can incorporate into our training, food to consume or potentially avoid?
Prevention is key. That means:

  • Maintaining a healthy weight: a higher muscle mass to body fat percentage is crucial. Maintaining muscle strength ensures you move well, while excess body fat, especially around the middle is inflammatory – worsening osteoarthritis symptoms.
  • Staying hydrated: hydration helps maintain joint lubrication and healthy cartilage.
  • Eating a healthy diet: a Mediterranean style diet that focuses on plenty of fruit and vegetables, wholegrains, nuts, seeds and healthy fats such as olive oil and Omega 3 rich fish. Key supplements or specific foods that decrease inflammation can also be incorprated. Those with solid research include fish oil, turmeric, collagen, vitamin C and zinc. Also pay attention to Vitamin D levels – either through adequate sunshine or supplements – as this is crucial for inflammation but also bone development and health.
  • Getting regular exercise: using all your muscle groups and moving through full ranges of motion in multiple planes. Exercises that allow for unlimited variety in angles of resistance and range of motion – like exercise bands or reformers are great to incorporate. Cardio fitness is also key – improving circulation and blood flow as well as a host of other benefits.

How do we balance the need to push our limits for improved performance, while also protecting the longevity of our joints?
Technique is a big factor, we know that technique and appropriate training and strength programs help reduce imbalances and facilitate movement in a structurally sound way. This helps to reduce injury risk, which research shows is a risk factor for joint issues later in life.

Research shows that joint instability through ligament injury comes before bone and cartilage degeneration in osteoarthritis, so trying to avoid or minimise the risk of ligament damage is the primary concern.

Your training program should allow for consistent progression and movement by incorporating recovery to minimise injury risk caused by fatigue or overuse.

Diet is really key for helping to control levels of systemic inflammation. By paying attention to these aspects from the outset, we can help support healthy joints and reduce pain symptoms.

Studies:

  1. Freiberg, A; Bolm-Audorff, U; Seidler, A “The Risk of Knee Osteoarthritis in Professional Soccer Players: A Systematic Review with Meta-Analyses.” Dtsch Arztebl Int 2021; 118: 49-55. DOI: 10.3238/arztebl.m2021.0007
  2. Luria A, Chu CR. “Articular Cartilage Changes in Maturing Athletes: New Targets for Joint Rejuvenation”. Sports Health. 2014;6(1):18-30. doi:10.1177/1941738113514369.
  3. Hind K, Konerth N, Entwistle I, Theadom A, Lewis G, King D, Chazot P, Hume P. “Cumulative Sport-Related Injuries and Longer Term Impact in Retired Male Elite- and Amateur-Level Rugby Code Athletes and Non-contact Athletes: A Retrospective Study”. Sports Med. 2020 Nov;50(11):2051-2061. doi: 10.1007/s40279-020-01310-y.