Aging and the myth of wearing out your joints

As I approach 50, as a very active person, I’m noticing aches and pains where I haven’t had aches and pains before: right knee, left shoulder, both hips.

I have an excellent sports medicine clinic I call my second home. I love them. They see me as an athlete, albeit a recreational athlete, and they always ask what I’m doing, what I want to keep doing, and how much it matters to my quality of my life. I think it helps that they are home to a research centre on activity and aging!

This place is quite unlike various family doctors who have tended to give versions of the following sorts of advice: rest, ice, and take six weeks off activity and come and see me again if the pain is still with you. The Fowler Kennedy crew are more thorough, more proactive. I’m assigned physio and I do it. I see a massage therapist. I try to take care of myself. If someone tells me to make sure I warm up my shoulder and make sure it’s fully mobile before it bears any weight, I do as I’m told.

I love watching all the young varsity athletes there and play a game of guessing their sport by their build. I’m getting good at it. The kinds of injuries they have are also a clue. They heal so fast these young people. They’re like starfish. I think they could grow whole new limbs if need be.

I’m not a starfish but I am a good patient and I appreciate the help I get st the Fowler Kennedy. But last fall, as a result of their investigations, I got some bad news. Soccer associated running pain got me in the door and I learned that my knee pain is likely caused by early stage osteoarthritis. (Very early, really it’s no big deal, and no knee surgery required.)

Does this mean I should stop running, I asked. I’ve already mostly given that up due to stress fractures but what about soccer?

“God no,” they said, “keep moving.” Inactivity is far worse for your joints than activity, they insisted.

What about the idea that running (biking, etc) wears out your joints? I’ve heard that from well meaning friends and family.

“Oh, that’s a myth.”

The “wear and tear” theory of aging is a hard myth to kill. Lots of people subscribe to it. Here’s the about.com entry on it.

“Perhaps one of the oldest theories of aging is called the rate of living theory. This theory states that people (and other creatures) have a finite number of breaths, heartbeats or other measures. In ancient times, people believed that just as a machine will begin to deteriorate after a certain number of uses, the human body deteriorates in direct proportion to its use.”

I think some people believe a version of this myth that’s like the ancient Greek idea about heart rates. Aristotle thought a low heart rate was good because each life contained only so many heart beats. Best not to use them up. I sometimes joke about Aristotle and my decision not to drink. You’re only allowed so many drinks in a life time. I started early and so I’m done.  Not the full story but I like it as a line. So like Aristotle and heart beats, some people seem to think that you can only run or walk so much in a lifetime and then you’re done.

I was happy then to read this in the Globe and Mail, reporting on research that shows that activity is good both to prevent osteoarthritis and even to lessen its effects once it has set in.

“All of this suggests that the results of another new study, to be published in Medicine & Science in Sports & Exercise, shouldn’t actually be surprising. Dr. Paul Williams of the Lawrence Berkeley National Laboratory in California has been following a huge cohort of runners and walkers since 1991, and his latest study analyzes osteoarthritis risk in 90,000 of them.

In brief, he found that those running more than 12 kilometres a week were 18.1 per cent less likely to develop osteoarthritis and 35.1 per cent less likely to need a hip replacement during the study’s 7.1-year follow-up, compared to those running less than that amount. Even those who ran considerably more – there were 863 subjects who ran more than 96 kilometres per week – had similarly reduced rates of osteoarthritis.

“The evidence seems to suggest [running] is good for you,” Aspden agrees. “Even when osteoarthritis has started, the suggestion is to keep exercising, albeit preferably low-impact – but gentle jogging isn’t ruled out.”

Williams’s study can’t determine whether it’s the lower weight or the fat-induced inflammation that’s more important; it will take years for scientists to reach any definitive conclusion in that debate. But the epidemiological evidence is already clear: Avoiding physical activity – even high-impact activities like running – in order to “preserve” your joints is a losing strategy.”

Read more here.

So keep moving. I get that. I like moving. Lots. But what about the pain? What about when moving hurts?

The answer turns out to be something like, toughen up buttercup. Yes, stay active as you can tolerate it. It’s good for you. I wondered about the connection between inactivity and aging in an earlier blog post and asked Is aging a lifestyle choice? That’s because research is showing that lots of problems associated with old age actually stem from inactivity. Why do older people move less? One answer is that it hurts to move more.

Tracy has written about intuitive exercise, Intuitive eating? Yes! Intuitive Exercising? Not So Much and this is another case where we’d do well to ignore our intuitions. Yes it hurts, now move anyway.

I’ve written before about pain and pain killers and aging athletes, see Bye bye Vitamin I?.

“After caffeine, iburprofen is the drug of choice of my midlife athlete friends. We go for long bike rides, stop for brunch, and out come the plastic baggies filled with cell phones, mini tubes of sunblock, credit cards, cash, and inevitably a stash of pills. Vitamin I, we call it. Without which us aging athletes wouldn’t function. Or so we think.”

But now there’s some debate about the damage it does to your small intestine and how effective it is anyway at managing workout related pain.

This makes it even harder to tell from the feeling of pain just what you ought to do. Some people are very tentative and stop moving at the slightest discomfort and it turns out that might be as a much of a mistake as muscling on through pain caused by damage or impact. Tracy has written about telling good pain apart from bad pain, see Good Pain, Bad Pain, but this is a third sort. It’s neutral pain, and needs to be ignored.

I love Louis CK on turning 40 and athletic injuries. If you haven’t seen this, and you’re an over 30 athlete, it’s worth watching.

As Bette Davis said, old age is not for sissies. I’m not old, yet, but I’m aware of myself as ‘not young’- as ‘no spring chicken’ as my partner and I joke.

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