Arthritis and Joint Health

ARTHRITIS AND JOINT HEALTH

Aging is all about the joints. There are of course many other symptoms of getting older: loss of muscle mass, deterioration of balance and coordination, increased unsteadiness. But when the joints are movable then we can be more active and everything else improves. If the joints are stiff and inflamed, activity is greatly diminished. Our health and the quality of our life in our older years is so strongly affected.

Our job is to improve the health and condition of our joints.
Aging becomes much easier and more enjoyable.

But for many, our joints don't cooperate:

Arthritis, injury and other chronic conditions cause joint deterioration producing stiffness, inflammation and pain.
Increased extended sitting makes our joints stiffen chronically.
Our style of movement becomes doddery, wooden and stiff.
Our joint health deteriorates instead of improving.

A fundamental issue: We become less graceful as we age.

A joint is defined as the place where 2 bones meet. Bones have lots of pain cells. If they rub together it hurts. Cartilage exists to buffer the bones. Many of the disorders we endure as we age have to do with deterioration of that cartilage. With deterioration, friction and therefore pain increases.

That joint friction may be due to arthritis or inactivity or prior injuries but a huge culprit is that we become less graceful as we age. Healthy joint movement means that there is less friction in the joint. The joint moves more smoothly. In other words, a worthy goal is to become more graceful as we age. But, unfortunately, for most the opposite is true. We move woodenly. We walk without rolling through our feet and instead plop them down with heavy steps. We shift our weight heavily from side to side as we walk down hallways. We sit down abruptly. Loss of core strength, especially in the abdominals, means that movement is not supported which puts even more stress and strain on the joints. Movements become jerky, risking real injury to joints or surrounding tissues.

The ultimate solution to joint health is to learn to move our joints smoothly. Strive to become more graceful in all things.

But instead we stiffen. What happens when the joints are inflamed or stiff?

Circulation decreases: Good circulation is critical for overall health. When it is diminished, our cells absorb less oxygen, our most essential nutrient.
The nervous system does not operate as well as it travels through joints that are swollen or stiff. Our reflexes diminish but everything else does as well. When our nervous system is compromised like this, our overall health suffers.
We are much less active if our joints are inflamed: Level of activity is the best predictor of elder health. The less active we are the worse everything is.
Tight, stiff or inflamed joints become a Catch 22: The stiffer the joint, the more pain we experience and the less we move which in turn causes the joint to get even stiffer and more inflamed. We end up in an infinity loop downward.

The solution is to move our joints, especially if moving is painful as is often true with arthrtis.

There is one caveat to the above recommendation. Pain feels differently based on the condition involved. Nerve pain is not good. If you move and your lower back hurts, find a way to move so it doesn't (hint: pull your belly in). Don't continue to move with that kind of pain if possible. However, the pain of arthritis is quite different. If you have arthritis and it hurts to move then you are doing something right. In other words:

Moving through the pain of arthritis will ultimately reduce it.

What causes deterioration of the cartilage?

Injuries caused by sports, martial arts, dance or accidents from early life. Particularly onerous are contact sports like football and soccer. Sometimes the cartilage injury is immediately apparent and may even require surgery. Sometimes it takes years for the cartilage damage to reveal itself.
Improper chronic use of the joints over time. For example, writing in script causes major strain in the thumb and index finger joints and over time may result in deterioration and arthritis in the stressed areas. In this case the joint at the base of the thumb is especially affected.
Arthritis in all its forms causes deterioration of cartilage: There are many types of arthritis. All result in osteochrondral destruction based on inflammation. 75% of those over the age of 65 experience some form of arthritis. Arthritis causes permanent and irreversible damage but symptoms can be greatly reduced through treatment, especially through exercise. The course of the deterioration can therefore be modified.
Inactivity causes the joints to stiffen significantly, increasing inflammation and exacerbating any existing conditions like arthritis.
Genetic factors can make us more vulnerable to misuse, especially autoimmune ailments like rheumatoid arthritis or psoriasis.

Sometimes cartilage deterioration causes other conditions which are more severe. When the cartilage of the spine is compromised for instance, nearby root nerves may become irritated causing painful problems like sciatica or herniated disks.

What can improve the condition of cartilage and therefore our overall joint health?

Consistent moderate exercise will reduce inflammation and in turn create an environment for the joint in which healing may take place. With a reduction in inflammation comes improvement of circulation and nervous systems activity through the joint which improves joint health and reduces pain. This forms a positive Catch 22. With reduced pain, more movement is possible for even more reduction in inflammation, etc. etc.
Strength building exercise for the muscles immediately surrounding affected joints takes stress off the joint itself, reducing inflammation and stiffness.
Increase core strength: When the muscles of the torso are engaged, much less stress is placed on the joints of the lower body in particular. Pulling the belly in helps especially in smoothing our movements.
Stay hydrated: Hydration is essential in flushing out toxins from your body. This in turn reduces inflammation. Well hydrated cartilage reduces the rate of friction between bones which means you can move more easily.
Diet: An anti-inflammatory diet is very helpful.
Foods to avoid: Processed foods, sugars, fatty meat, fried foods, refined carbohydrates, foods high in omega-6 fatty acids, alcohol.
Foods to include: Fatty fish, dark leafy greens, nuts, olive oil, berries, garlic and onions and green tea.
Supplements: Chondroitin sulphate and glucosamine are naturally occurring substances in the body that prevent degradation of cartilage and promote formation of new cartilage. Both, when obtained from animal sources, are available as over the counter products. Calcium with magnesium and Vitamin D as a combination is also recommended. Some recommend omega-3 fatty acids. In general, it is wise to purchase the best supplements available instead of the cheapest. And further research is recommended.

Arthritis:

Arthritis is the inflammation or swelling of one or more joints. There are more than 100 forms. Specific symptoms may vary but usually include joint pain and stiffness. Arthritis causes cartilage deterioration and is a major path for those older. It affects the joints that bear weight the most: knees, hips, feet and spine.
Osteoarthritis: a debilitating, progressive and degenerative condition that leads to the deterioration of cartilage and even potentially bone loss. Osteoarthritis affects the joints most misused throughout our life, especially the fingers, knees, spine.
Rheumatoid arthritis: an autoimmune disease that can be inherited. In this disorder, immune cells attack and inflame the membrane around joints.
Psoriatic arthritis: a form of arthritis that affects some people who have psoriasis. It is an autoimmune condition.
Gout: occurs when urate crystals accumulate in the joint (usually the foot or toes), causing inflammation and pain. Men are affected more. Drug treatment is effective and easily available.

Which joints are especially vulnerable to arthritis?

The fingers: The first joint at the base of the nail has a very limited range of motion and is often the place we see arthritis first. The other finger joints often become inflamed with age as well.
The knees: We abuse our knees all our lives more than almost any other joint in the body, especially if we are very active when young in stressful movement. Soccer in particular causes extreme stress on the knees.
The spine, especially the lower spine: We misuse our spine throughout our lives. Then as we age we weaken the supporting musculature through being inactive, causing more spinal stress. Spine joint deterioration results, particularly in the lower lumbar spine.

Treatments for arthritis:

Consistent exercise is the best treatment by far whenever your arthritis bothers you. Exercise actually reduces arthritic pain.
Loosing weight is strongly suggested if you are overweight. Excess weight puts extra stress on joints, exacerbating deterioration of the cartilage. A lower weight reduces stress particularly in the knee and foot joints.
NSAIDS (non-steroidal anti-inflammatory drugs) like Advil or Aleve can relieve the pain of arthritis by reducing inflammation.
Heat therapy: In general, heat is recommended for arthritic joints. It is helpful to keep vulnerable joints warm in colder weather. Wearing gloves and/or socks at night for instance.
Corticosteroid injections: This type of therapy should be relied on only if other less invasive treatment has been unsuccessful. Cortisone shots are controversial since the substance does not leave the body. Over time this type of treatment may actually make the cartilage deterioration worsen.
Surgery may be required: Joint replacement surgery may be indicated, especially for the knee, hip or spine joints.

Types of joint movement:

Hinge motion: straightening and bending the joint. Hinging is the most common way a joint moves.
Lateral motion: linear movement side to side is less common.
Circular motion: released rounded joint motion. Not all joints are capable of circular motion. We will identify the most important of these below.
Twisting or rotation of the joint takes place especially in the spine. It is a sophisticated motion that should be performed only after warming the joints.
Small adjusting motion is the only motion possible in many joints, like the joints of the sacrum for example. Joint fixation here is very common and can be quite destabilizing particularly for the major nerves that run through this type of joint.

In general, hinge motion is a stressful way to move a joint while circling is the safest and most effective.

Joints which have a circling capability:

Shoulders: have the largest range of motion of any joint. When the joint and the rotator cuff muscles are healthy, 360 degree motion is possible. Improving shoulder joint function is surprising easy and safe. See below.
Hips: also have a very large range of motion, especially if you are Eleanor Powell. Hip circling is extremely effective and simple and should be included in any seated exercise program.
Knees: The knee joints get very stiff with arthritis and inactivity. Knee circling as explained below is the most important movement possible for any knee compromised by injury or arthritis. But the knee is already so stiff that it is important to take the time to allow the joint to relax and move. The smaller the movement the better.
Elbows: The elbows also get quite stiff with inactivity and become difficult, though not impossible, to circle.
Ankles and wrists: can be circled easily and should be included in daily exercise. Circling the ankles should be done before rising in the morning if possible.
Base of fingers, thumbs and toes: a great technique to relieve some of the pain and stiffness of arthritis. Circling the base of each toe is a great way to increase circulation and improve balance. Grasp the end of each of the smaller toes and move the toe in circles. Be gentler with the big toe.
Top of the spine, where the skull meets the first vertebrae: This is one of the most transformative of all movements. Gently circling where the head meets the spine can produce an incremental release of the entire spine.
The joints of the spine: Spine joints have the capability to circle but the range of motion is so specific and detailed that usually only dancers trained in movement isolation can comfortably circle the spine joints. Rounded joint movement is an important element in Middle Eastern inspired dance especially.

The very best exercises to do if you have arthritis:

Circle the knees: Demonstration

Seated version: Sitting in a sturdy chair, toward the front of the chair with both feet flat on the floor, clasp your hands together under one knee and lift that leg up off the floor. Let the lower leg be totally slack, like a rag doll leg. Let the lower leg swing in and out gently and easily. Let the lower leg circle in a very released manner several times in both directions. Keep the circles small and as relaxed as possible. Don't let the foot circle. Keep it slack.
Standing: Standing next to something you can hold onto, keep your feet somewhat together, bend your knees, hold on with one hand and place the other on one of your knees. Circle both knees several times in each direction. The closer your feet are, the more unstable.

Circle the hips: Demonstration

Seated version: Sit toward the front of your chair with your feet apart, knees over your ankles. Keep your torso straight like a board as you circle it several times in each direction. Circles can be smaller or larger.
Standing version: Stand with both feet somewhat apart. Put your hands on both hips and circle your hips several times in each direction. Keep your knees relaxed and soft.

The spine: Circling the joints of the legs (ankles, knees, hips) releases the joints of the spine itself. Moving the spine in all the ways it can move is helpful to improve spine health overall. But spine joint circling specifically is not included. See Lower Back Insight for much more information.

Circle the shoulder: This exercise can be done seated or standing. The standing version is the most effective because it is easier to let the arm really swing without bumping into anything. Stand near a sturdy uncluttered table. Lean over the table. Place one hand on the table to support yourself as you let the other arm hang straight down away from the table. Let the hanging arm completely relax. Use gravity and the weight of your arm to let it gently circle several times in each direction.

Always include circling your ankles and flexing and
pointing your feet every day, regardless.

Two great exercises if you have arthritis in your hands:

Twist and pull the fingers: Grasp the end of each finger, over the nail and gently pull and twist. Wonderful for arthritic finger joints.

Twiddle your thumbs: This is surprisingly effective at releasing pain and inflammation in the joints at the base of the thumbs.

Helpful Links:

Joint Heaven
Reduce the Symptoms of Arthritis
Arthritis and Exercise
Inflammation
Stiff Body and Mind
Chronic Tightness
Guidelines for a Healthy Spine
Anatomy of the Spine
Lower Back Insight
Hip Circles
Aging Hands
Knees That Hurt

Published October 23, 2023.