In America, getting a joint replacement of the hip carries a hospital “list price” of $13,000, but hospital and surgical charges can run another $65,000 or more (hence the rise in medical tourism like this). I’d be lying if I professed to know the exact additional amount of money spent each year on joint physical therapy, medications, supplements, and other treatments for joint issues, but with as many folks in the general population who I know (including active people, exercise enthusiasts, and weekend warriors) with joint pain, I’d wager it’s a lot!
In this two part series, you’re going to learn why these joint injuries occur in the first place and three simple things you can do about it.
The Poor Problem of Neglected Joints
Often us exercise enthusiasts and active folks tend to prioritize “conditioning” and ignore activities that don’t make us breathe hard or feel the burn. Mobility is possibly the most neglected basic ability in an endurance training program, especially for a high-volume athlete such as an Ironman triathlete or marathoner.
Time and time again I have taught camps, clinics, and seminars during which athletes or exercise enthusiasts who can hammer like animals on the bike all day long or run stone-faced for hours on end or spend ever single morning in the gym simply can’t do something as simple as a full squat with both arms held overhead, or even a proper push-up.
As a result, these seemingly fit folks are predisposed to all of the disadvantages that accompany this lack of basic mobility, including:
-Muscle tightness that creates ugly postural imbalances, such as shoulders rolling forward in a hunchback pattern, hips rocking back (to create that nice skinny-fat beer-belly look), and one side of the body being higher or lower than the other side. This results in leg and arm length discrepancies, not to mention funny looks when you’re wearing a swimsuit, tight clothing, or anything else that reveals your body asymmetries. Aesthetic annoyances aside, these are also huge issues when it comes to injury risk. So you look weird and you get hurt easy. Not fun.
-Soft tissue, muscle, fascia and tendon restrictions such as extremely tight IT bands (on the sides of the thighs), tight and immobile rotator cuffs in the shoulders and restricted neck and upper back muscles. Any of these can make even a young, spry marathoner move like an 80 year old man when doing anything other than jogging. For example, when teaching triathlon clinics, I’ve had groups of triathletes lunge across a room with medicine ball held overhead, and they suddenly looked a lot more like baby deer on ice than like athletes.
-Joint capsule restriction in the knees, hips and shoulders. Each of your joints are surrounded by a fibrous tissue sac called the joint capsule. This capsule surrounds the joint and is filled with a fluid called synovial fluid that lubricates your tissues and the spaces within this capsule. When the joint capsule is immobile, fluid can build up in the joint and the tissue can’t move properly, meaning you’re predisposed to premature cartilage breakdown in that joint, along with nasty meniscal tears, sharp pains and “catches” in your joints, swelling, inflammation and everything else that simply can’t be permanently fixed with an ice pack, an ibuprofen and a trip to your favorite massage therapist.
-Muscular restrictions and faulty movement patterns. It’s not just your joints that get restricted. Since your muscles themselves are comprised of fiber and are surrounded by a spider-webbish sheath called fascia, immobility in this soft tissue can also cause some serious movement deficits. This includes shoulder blade (scapular) and middle back (thoracic) immobility that leads to shoulder pain while swimming, hip extension immobility that leads to lower back pain on the bike and hip flexor immobility that leads to calf pain and inner thigh pain on the run. Yes, that means that you can address propensity for Achilles tendonitis or plantar fascitiis by simply standing up every hour from your desk and stretching tight hip flexors or foam rolling tight quads.
-Overworking of muscles. When a joint is immobile, the joint above or below that immobile joint is forced to take up the slack or significantly assist with a motion it’s really not suited for. Just picture the common scenario of a runner’s or cyclist’s knee doing weird sideways movements instead of hinging forwards and backwards. This happens because an immobile hip is stuck in constant external rotation, and as a result, most of the hinging must be accomplished by either the knee joint or the low back joint. This places undue and unnatural strain on these areas. Of course, an unsuspecting athlete might simply try fixing the knee or fixing the low back, without ever actually rescuing the hip from that external rotation.
Let’s take a quick look at how these type of issues could manifest in a joint “falling apart” or becoming painful with age, or, vice versa, how a bad joint could manifest itself in these issues.
How a Joint Degrades
You have three types of joints: synovial joints, cartilaginous joints, and fibrous joints. Synovial joints are them most common type and are held together by ligaments. They have cartilage covering the articular surface which is at the ends of both bones and where movement occurs in the joint. Synovial joints contain a fluid called synovial fluid, which provides lubrication between these two bone ends. As a result, synovial joints allow a great deal of movement but can also be more susceptible to injury.
Cartilaginous joints are also held together by ligaments and also have cartilage between the two bone ends. However, cartilaginous joints do not have synovial fluid and therefore have more restricted movement potential. Cartilaginous joints are located in areas where stability is more important than flexibility, such as your spine and ribs.
Fibrous joints (also known as fixed joints) are connected only by dense fibrous connective tissue, with almost no movement. For example, each separate section of your skull is held together with a fibrous joints. There are three ways in which any of these joints can become injured: 1) overstretching, 2) compression, and 3) overuse, and often, it is a combination of these three factors that causes a joint injury.
First, overstretching or forcing a joint beyond its normal range will usually cause ligament injury and may also cause injury to the cartilage. For example, falling on an outstretched arm can force the wrist joint beyond its normal range and cause injury to the surrounding ligaments, potentially damaging the cartilage within the wrist joint. Or landing the wrong way on your leg after a jump may cause your knee to twist and bend at the same time and this can cause damage to the ligaments and cartilage within the knee (meniscal injuries and tears tend to occur in this way). Overstretching a joint will usually cause joint swelling as the synovial membrane, (the part of the joint that holds fluid) can become inflamed, and this can cause more synovial fluid to be produced. In some cases, overstretched joints can completely dislocate. Common joint injuries from overstretching include:
-Meniscal Tears/Torn Knee Cartilage
-Glenoid Labrum Tear (shoulder)/Shoulder Joint Injury
-Hip Labral Tear/Hip Joint Injury
-Shoulder Dislocations
-Finger Dislocations
-Knee/Patella Dislocations
Second, compression of a joint will usually cause cartilage damage. If this compression is coupled with movement or twisting, such as occurs in a meniscal tear, ligaments can also become injured. If there is sufficient compression and movement within the spinal joints, then disk bulges or slipped discs can occur (this is where the cartilage or disk between spinal vertebrae is forced out of position). Damage to the synovial membrane usually causes joint swelling and pain following a compression injury.
The types of injury that occur through joint compression are very similar to that of overstretching:
-Meniscal Tears/Torn Knee Cartilage
-Glenoid Labrum Tear/Shoulder Joint Injury
-Hip Labral Tear/Hip Joint Injury
and also include:
-Slipped Disks/Disk Hernia/Herniated Disc/Intervertebral Disk Injury
-Facet Joint Injury
-Neck and Back Joint injuries
Third, overuse of a joint can also cause joint injuries via a gradual breakdown of the articular surface. This again can affect all aspects of the joint, but wearing of the cartilage is usually the most significant. Over time, just like a hinge becoming rusty, cartilage can become worn due to repeated stress. In addition, you lose fluid from your cartilage as you age, which reduces the potential for cartilage to absorb shock and further increases the risk of injury. As the cartilage wears, the two ends of bone can come into contact and cause damage. As this bone tries to repair itself, small spurs of bone form which are called “osteophytes”, and this is known as Osteoarthritis.
Common types of joint overuse injury include:
-Osteoarthritis/Degenerative Joint Disease/Degenerative Arthritis
-Cervical Spondylosis/Neck Arthritis
-Degenerative Disc Disease
So now you know that even if you’re exercising, it’s not going to guarantee that you’ll eliminate joint pain, and in many cases, it can increase risk of joint pain. The good news is, you can stop these joint pain issues in their tracks, and in next week’s episode and Part 2 of this series, you’re going to discover exactly how to do it. In the meantime, do you have questions, comments or feedback about how joint pain occurs? Join the conversation at Facebook.com/getfitguy.