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Joints Don't Wear Out, They RUST Out


Welcome to the first ever Kinetic Life blog! The mission here is simple. We want to share information, tips, and tools that encourage individuals to live more kinetic and healthy lives. We believe that movement truly is medicine, or perhaps even better (as you’ll see later). So let’s get right to the point. Does exercising wear your joints out? Are you more likely to have joint pain if you’re an athlete or daily exerciser? If you work in healthcare, you’ve likely overheard a patient talking about how they “wore out their knee”. The question arises, is this true? One of my favorite professors once told me, “joints don’t wear out, they rust out”. Let’s see what the research says.


Joint pain and loss of function from osteoarthritis (OA) is one of the leading causes of disability worldwide. Seventeen percent of the worldwide population carries the diagnosis of OA. In the US alone, OA has doubled in prevalence since the 1950’s. It’s speculated that this rise is associated with the rise in obesity and sedentary lifestyle. However, since OA is multifactorial, it is very hard to isolate single causative factors definitively.


Let’s talk about what we know for sure. There have been over 50 randomized controlled trials (for the knee alone) in consensus that exercise is crucial for joint health. Daily exercise significantly decreases disability, pain, and improves function in those with OA across dozens of studies and multiple joints studied. Exercise is such a potent analgesic for OA related pain that it has been found equally effective as daily NSAID use and 2-3 times more effective than daily acetaminophen in some studies. We also know this: those who suffer significant knee trauma or ligamentous injuries are at a much higher risk of OA. Those who sustain an ACL tear in early adulthood are 20% more likely to have OA related knee pain in their lifetime.


But does exercise lead to increased risk of OA? Maybe. Maybe not. The evidence is conflicting on whether or not strenuous exercise leads to a higher chance of developing OA. However, there are some interesting consistencies throughout the research.

1. Moderate training and sport do not increase your risk for OA.

2. Exercise likely provides protection from clinical symptoms of OA.


Let’s break these down.

The verdict is still out on elite level athletes and extreme distance runners and the risk for OA. However, moderate running and moderate sport and fitness engagement is considered safe for joints. A 2017 article in the Journal of Sports Physical Therapy found that recreational runners are much less likely to develop knee or hip OA than their sedentary counterparts. All of this means that if you’re not an elite level athlete/endurance athlete, you did not “wear your joints out”. In runners, moderate running programs are seen to be joint protective. The really interesting finding is this: some studies within the RCT’s found that elite level athletes had higher prevalence of radiographic OA. Despite the elite athlete’s radiographs indicating “more severe” joint disease, they had fewer clinical symptoms than sedentary adults with “less severe” radiographic OA. We find again, that lifelong activity seems to provide protection against joint pain and clinical symptoms.


So can you “wear out” your joints? Unless you’re an elite level athlete, the answer to that question is very likely no. If you are an athlete pushing yourself to the limits, there’s good news for you too! Although the research is inconsistent on whether this increases OA risk, the clinical effects of OA are significantly less for these individuals.


Long term moderate physical exercise is a “no brainer” for joint health, decreasing OA risk, and decreasing OA symptoms if already present. We can go the gym with confidence and without fear that we're slowly breaking down our joints. We can put the myth that routine training wears out joints to rest for good.


Let’s stay kinetic, friends.




References



1.Van Ginckel A, Baelde N, Almqvist KF, Roosen P, McNair P, Witvrouw E. Functional adaptation of knee cartilage in asymptomatic female novice runners compared to sedentary controls. A longitudinal analysis using delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC). Osteoarthritis Cartilage. 2010 Dec;18(12):1564-9. doi: 10.1016/j.joca.2010.10.007. Epub 2010 Oct 13. PMID: 20950697.


2. Skou ST, Pedersen BK, Abbott JH, Patterson B, Barton C. Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J Orthop Sports Phys Ther. 2018 Jun;48(6):439-447. doi: 10.2519/jospt.2018.7877. Epub 2018 Apr 18. PMID: 29669488.



3.Lefèvre-Colau MM, Nguyen C, Haddad R, Delamarche P, Paris G, Palazzo C, Poiraudeau S, Rannou F, Roren A. Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis? Ann Phys Rehabil Med. 2016 Jun;59(3):196-206. doi: 10.1016/j.rehab.2016.02.007. Epub 2016 Apr 18. PMID: 27103057.


4.Suter LG, Smith SR, Katz JN, Englund M, Hunter DJ, Frobell R, Losina E. Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood. Arthritis Care Res (Hoboken). 2017 Feb;69(2):201-208. doi: 10.1002/acr.22940. Epub 2016 Dec 31. PMID: 27214559; PMCID: PMC5121085.



5. Chloe Gay, Candy Guiguet-Auclair, Charline Mourgues, Laurent Gerbaud, Emmanuel Coudeyre,

Physical activity level and association with behavioral factors in knee osteoarthritis,

Annals of Physical and Rehabilitation Medicine,Volume 62, Issue 1,2019,Pages 14-20,ISSN 1877-0657,


 

Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.


If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.






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