How to Slow Down Joint Degeneration from Aging

How to Slow Down Joint Degeneration from Aging

Do you notice that it takes more effort than before to do simple things like run, squat, or get out of your car?  You can still do them, but not as fast and springy as when you were younger.  If you’re over age 40, it’s likely you can identify with this.

The inevitable reality of being mortal is that our body starts to deteriorate after maturity, which is around age 21.  For those who “age well” the deterioration rate progresses slowly and is hardly perceptible until the later years; for those who do not age well, the changes can occur relatively fast and are obvious.

The main musculoskeletal changes associated with aging are:

  • Muscle atrophy, especially in the upper leg and glutes
  • Decreased muscular strength and endurance
  • Decreased cardiovascular endurance
  • Decreased ligament and tendon elasticity
  • Decreased joint cartilage thickness and suppleness
  • Increased body fat percentage

The focus of this article and following ones will be on slowing down the gradual breakdown of the musculoskeletal system via exercises, stretches, diet, new habits and routines and other lifestyle modifications.  Yes, slowing down the aging process and extending your “full functional” years is very possible if you have a good plan, and diligently stick to it.  In other words, start developing good wellness/ life extension habits if you haven’t done so already.

In this article, the topic is joints.  I previously wrote about the importance of keeping your joints strong by doing  specific joint exercises during your workouts.  This discussion is on doing daily joint stretches to counter the degenerative forces that come with aging.

One of things most people first notice as a sign of getting older is decreased ability to absorb and rebound from external forces and mechanical stress.  You start to notice that it takes a bit longer to jump up from a seated position and get up after falling.  You find it more difficult to bend, squat and maintain other awkward body positions.  If you trip and fall to the ground, it takes more effort to get back up.  And, when running you notice that you can feel the shock in your knees more, and therefore do not run as long, or give it up entirely.   The reasons for this are decreased muscle strength, decreased ligament and tendon elasticity, and most of all, thinning cartilage in the weight-bearing joints.  It takes more energy and effort to do these things because your body “hardware” has lost some of its youthful, structural integrity.  Your mindset /motivation to move may be unchanged but your body isn’t responding as quickly and strongly.

As you get older, the cartilage lining your synovial joints (the joints encapsulated by ligaments) loses fluid content.  To compound matters, when you are past the age of 40, human growth hormone (HGH) secretion by your pituitary gland practically ceases.  HGH is the “fountain of youth” hormone that is largely responsible for the features associated with youth:  energy, high metabolism, supple skin, thicker muscles and thicker, bouncier cartilage.  It’s why younger people can bounce right back up after falling down, making it look effortless.

If you are over the age of 50 and your occupation or recreational interests involved placing pressure on your feet, knees, hips, spine, shoulders, elbows or hands chances are you are experiencing aches and stiffness.  Your age, plus your history are not doing your weight bearing joints any favors.  So what can you do?

If you are over the age of 40 and feel the slightest stiffness in your joints, I highly advise you start a daily routine to keep your cartilage healthy.  Your goal is to effectively counter the natural progression of osteoarthritis—the disease that involves advanced thinning of cartilage, bone-on-bone contact, and resultant chronic inflammation and joint dysfunction (stiffness, pain, reduced range of motion).  It plagues millions of people over the age of 50.  Practically all former football players have osteoarthritis.

By investing just a couple of minutes a day every day, you can literally save yourself years of pain down the road, and perhaps preclude the need to take harmful anti-inflammatory medications and even the need to get knee and/or hip replacement surgery.  Instead of pain, you will be able to squeeze out a decade or more of pain-free movement.  That is a huge, quality of life issue because most of the enjoyable things in life require some degree of physical fitness—walking, bending, lifting etc. and joint pain can severely restrict your ability to engage in these activities.

In my view, in order for a preventive measure to be feasible, it must meet the following criteria:

  1. It must be practical, with minimal preparation required
  2. It must be realistic – no super-human feats required
  3. It must address the problem and have close to immediate results

Here is the basic routine that I personally do every day to guard against cartilage deterioration.  I will update this post with a video that illustrates these exercises, but for now, here is the description so that you can get started right away:

Arm propellers – slowly and with focused intent, make large circles with your arms, with the left arm moving counter-clockwise and the right arm clockwise, crossing in front.  Keep the angle of your upper arm about 30 degrees relative to the coronal plane of your shoulder to avoid jamming your shoulder joints.  Do about 20 rotations, and then reverse directions of both arms.

This exercise moves the glenohumeral (GH) joint, where your upper arm (humerus) articulates with your scapula.  Many people don’t realize that in a typical day, they rarely raise their arms above shoulder level.  This prevents areas of the GH joint to get proper lubrication, causing the cartilage to “dry out.”  This exercise exposes all parts of the cartilaginous-lined humeral head to synovial fluid, the “motor oil” of joints and even stimulates production of it.  The rigorous movement also stimulates lubricin production, a compound that further reduces friction inside the joint.

Elbow propellers – similar to the arm propellers, rotate your lower arm (forearms) in opposite circles by keeping your upper arm relatively stationary so that most of the movement is at the elbow joint.  There is some movement in the GH joint, but also some in the radio-ulnar and humero-ulnar joint.  Do 20; reverse directions.

Wrist stretches – interlace fingers as if to pray, then alternately pronate and supinate the hands while making a circular motion, stretching the wrist joints in all directions.

Finger flexion and extension – make loose fists with both hands, and then unfold the fists segmentally (extend the fingers) first at the metacarpal-phalangeal joints (knuckles), then proximal interphalangeal joints, and then the distal interphalangeal joints until your hands are flat, fingers fully extended.  Then, reverse the process (flex the fingers segmentally) back into a fist. Repeat about ten times.

Collarbone stretches – this mobilizes the sternoclavicular (SC) joint, where the proximal clavicle articulates with the sternum (breast bone).  The joints are identified by the two, large bony protuberances at the base of the neck.  For this exercise, make a shortened swimming stroke with your arm:  bring it backwards, raise it up for the stroke and with elbow bent about 90 degrees, make a big scooping motion downwards, reaching all the way back (palm of hand should be facing upwards), and then supinate your forearm and repeat the motion.  You will probably hear some grinding noises in your SC joint as it moves.  Do about 10 repetitions; switch sides.

Torso circles – This nicely moves the joints of the lumbar spine in a stirring motion—the facet joints and the intervertebral discs, forcing their hydration.  Place feet about two feet apart and place your hands on the sides of your pelvis.  Hinge at the hip joints (bend torso forward and down, being careful to contract your back muscles for support) and then move your torso in a large, counter-clockwise circle reaching the maximum lumbar active range of motion in all directions of the circle.  Do ten circles; reverse directions.

Lumbar extensions –  I recommend doing these especially if your job involves prolonged hours of sitting, such as a desk worker, airline pilot, or truck driver.  Sitting flexes your lumbar spine, which encourages posterior disc migration, a risk for herniated discs.  Simply place the palms of your hands behind you, just below your waistline.  Then, lean backwards and bend over your hands (try to keep them stationary in space), arching your back and hold for two seconds.  You should feel tightness in your low back.  If not, bend back some more. Return to neutral.  Do 10 repetitions.

Hula hoops – this targets your hip joints by moving your pelvic bowl around the femur heads.  With feet shoulder length apart and hands on your sides, make big circles with your pelvis like a hula hoop motion.  You should feel your hip joints moving even though your legs are stationary.  By doing this, you bathe all areas of the femur heads and stimulate synovial fluid production.

Knee circles – the knees move mainly as a hinge joint (flexion and extension) but there is some ability to rotate and translate (move in a circular motion and side to side motion).  With feet together touching, bend your knees bout 30 degrees and place your hands around them.  Move your knees together in a clockwise direction 20 times; reverse direction.

Ankle circles – point your toes to the ground, and flex them against the ground by placing light, downward pressure.  Then, move your ankle in a clockwise direction keeping your toes in place.  This moves the many articulation points of the ankle, as well as the joints of the forefoot:  metatarsal-phalangeal joints and interphalangeal joints.

BOTTOM LINE:  As you age, your joint cartilage loses its fluid content and starts to get stiffer.  If the joint doesn’t get much movement, it compounds the problem. You can arrest this process by diligently doing these exercises to ensure all your joints are tasked to move, which signals the body to produce more joint fluids.

What Can Be Done About Meniscal Tear?

Capsule of right knee-joint (distended). Poste...

Image via Wikipedia

The meniscus is a shallow bowl shaped piece of cartilage that is attached to the lower leg bone, or tibia.  There is a medial meniscus (inner half of knee) and a lateral meniscus (outer half of knee).

The end of the femur (upper leg) bone has two protuberances called the femoral condyles, which rest on top of the meniscii (plural).  In the standing position, the meniscii bear the full weight of the body above the knee.  They serve as a cushion and shock absorber and protect both of  the ends of the tibia and the femur.  The meniscus also guide the action of the femoral condyles as you bend and extend your knee.

The knee is obviously a highly utilized, weight bearing joint.  It has the largest suface contact area of any joint in the body as it has to bear most of the body’s weight and on top of that, absorb shock from walking, running and jumping.  It is held together by several strong ligaments, the primary being the anterior and posterior cruciate ligaments (ACL, PCL), the medial and lateral collateral ligaments (MCL, LCL), and the patellar tendons.  It is a synovial joint, which means it is totally encapsulated and lined with synovium, a specialized tissue that secretes synovial fluid to lubricate the joint.

The slightest alteration in the inner workings of the knee will lead to problems.  A common one is a meniscal tear.  The two basic types are a radial meniscal tear and a vertical meniscal tear.  A radial tear that expands forms what is called a “bucket handle” tear (3rd set in the below image- top and bottom).

types of meniscal tears

Meniscal tears are caused by excessive pounding forces to the knee, which weaken the meniscii over time.  Eventually a tiny tear forms, which grows in length as the individual continues to engage in the offensive activity (running on hard pavement, weight lifting, playing basketball, etc.), much like how a tiny crack in a car windshield grows into a long crack over time .  If a small piece breaks free, it floats inside the knee space, suspended in the synovial fluid.  Like a grain of sand in a watch, it interferes with the moving parts and can cause the knee to swell and become stiff..  Pain is felt deep inside the knee and is worse with prolonged standing and transitioning from sitting to standing.

Meniscal tears increase the chances of accelerated knee osteoarthritis, as “bone on bone” contact occurs between the ends of the femur and tibia.

TREATMENT:  Diagnosis is made with a knee MRI and arthroscopy.  Meniscal tears will most likely require arthroscopic surgery involving repair to the tear.  If you have a gradual onset of deep, focal knee pain accompanied by knee stiffness that doesn’t go away, see your doctor.

Prevention, as always, is the key.  I advise against sports that involve consistent and prolonged pounding forces to the knee.  This includes long distance running and frequent hard court basketball that involves jumping.  Consider doing functional exercises that combine cardio and strength instead.

Most leg exercises will strengthen the knee.  Do mostly closed kinetic chain exercises where the foot is immobilized.  This includes squats and lunges.

Intermittent jumping exercises are ok as long as they are controlled and are not the focus of an exercise session.  Power jumps and related plyometric exercises fall into this category.

Most meniscal tears grow too large to heal on their own by the time the patient seeks medical help.  This is why surgery is the only option.  The surgeon stitches together the tear, but thanks to the forces the knee has to endure, the tear often returns.

Some patients do not get surgery, and let the tear become chronic.  When it’s chronic, there is less acute pain, and more of a broad, dull pain in the knee.  In this scenario, the knee joint will experience accelerated degeneration, leading to knee osteoarthritis.  Eventually in the later years, knee replacement surgery is needed.

I made a general Knee Pain Rehab instruction video that includes things one can do to help deal with early stage knee pain.

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