Keeping Joints Healthy

When you climb stairs or squat to pat the dog, do you hear a snap, crackle and pop?

Genetics can be to blame for some joint maladies, but how and how much you use your joints are much bigger determinants of joint health throughout a person's lifetime, says Emily M. Jones, MD, a family practice physician and sports medicine specialist at Dartmouth-Hitchcock Orthopaedics, which has offices in Concord, Manchester, Nashua, Keene and Lebanon.

Some of the guidelines for keeping joints operating smoothly – particularly the weight-bearing hips, knees and ankles – are pretty straightforward. For starters, keep an eye on your waistline, says A. David Davis, MD, an orthopaedic surgeon at Access Sports Medicine and Orthopaedics, located in Portsmouth, Exeter, Plaistow and Raymond. Excess weight wears out cartilage, the tissue in joints that enables bones to smoothly work together without rubbing against each other.

Check that your diet includes adequate amounts of calcium and vitamin D, which affect your bone health and in turn influence your joints. And, as always, steer clear of smoking, which inhibits your body's ability to heal and has been associated with decreased bone density, Davis says.

For maximum joint health you should also avoid a sedentary lifestyle, which can lead to a shrinking range of motion within joints through lack of use, creating stiffness and a loss of function. "If we do not actively work on keeping our mobility, over time it will decrease," Davis says. Exercise increases blood flow to joints and strengthens the muscles and ligaments that surround joints. Regular exercise can also help compensate for the muscle loss that naturally occurs with age, helping you to avoid falls and injuries.

But this is where trying to do the right thing can get confusing. Some exercise enthusiasts find themselves caught in a Catch-22: They want to run and play tennis and pursue vigorous activities that they know will benefit their bodies in many ways, but in doing so risk wearing down the cartilage in weight-bearing joints, setting themselves up for problems that can plague them for a lifetime.

So, what is helpful and what is harmful? Take running, for example, a big-time burner of calories, but one that creates a lot of impact on the joints. Are runners asking for joint trouble or not? "There haven't been any decisive studies to show that running on an uninjured knee will cause damage to the knee," Davis says. Problems often arise because people who have an injury or damage to the knee keep running. "But there are people who have run their whole lives and do not have injuries, [who] don't show any increasing risk for arthritis," he says.

The key, with running or any activity, is to listen to your body. "Go for the burn, but don't go for the pain," Davis says. In other words, discomfort or achiness from muscle fatigue during exercise is OK and normal; pain is not. If you feel sharp or repeated pain in the same area, don't ignore it. Have it evaluated, Davis says. "Catching it early is really important. Never exercise through a painful joint. That means you're causing more damage," he says.

Going to the doctor rather than disregarding joint pain gives patients the opportunity to benefit from relatively simple interventions, such as tweaking their activity level or correcting muscular imbalances that affect movement, Jones says. It can allow patients to delay or even avoid invasive treatment, such as joint replacement surgery.

Pain can be tricky, though, because one man's pain is another person's discomfort, and sometimes while you're caught up in an activity "your blood flows and things can start to feel a little bit better," Jones says, only to worsen later. It's important to remember that pain can indicate that damage is occurring, whether the pain shows up during the activity, later that day or the next day.

People who want to exercise but experience joint trouble can often switch completely or partially to low-impact activities that improve the range of motion of joints without creating a high force, Davis says. Swimming, yoga, elliptical machines, stationary and regular bicycles and walking, for instance, are all "very, very helpful for increasing your knee health," he says.

In fact, even if you don't have problematic joints, if you habitually engage in a high-impact sport, you might want to consider mixing up your routine to include exercises that work the joints without overloading them, Jones says. Just be sure to incorporate some weight-bearing exercises to build up bone density and help prevent bone-related disease. Work muscles evenly and don't skip stretching since tight or imbalanced muscles can strain joints and impede proper movement, raising the odds that you'll damage cartilage, Jones says.

Be properly conditioned for whatever it is you like to do. Yes, we're talking to you, weekend warriors. Your muscles should be able to support and alleviate the stress on your joints during activity. If you sit on the couch all week and then try to play multiple games of co-ed softball on the weekend, you're putting yourself at an increased risk for injury that could lead to long-term trouble, Jones says.

As for joint-related supplements, proceed with caution and perhaps a dose of skepticism. Glucosamine and chondroitin, for example, have not been proven to work. "There are many people who find those types of supplements can be very effective," Davis says. "However, there haven't been any decisive, clinical, randomized studies to show that they definitively improve your joint health. I usually tell people, if you feel that it's helpful, it's unlikely to cause harm. So they can be tried on a careful basis."

Just keep in mind that supplements are not held to the same FDA requirements as medications, Davis says. "It's not the same as taking, say, a Tylenol where there's very strict oversight. There's no oversight on supplements, essentially, so … be careful in how much and what you take."

Sound Off

Clicking and popping noises emanating from your knees most likely are not music to your ears, but they needn’t cause panic.

If you’re experiencing the sounds but are pain-free, you’re probably OK, says A. David Davis, MD, an orthopaedic surgeon at Access Sports Medicine and Orthopaedics, which has offices in Portsmouth, Exeter, Plaistow and Raymond.

“Oftentimes, audible noises coming from your knee that are not associated with pain are part of your normal knee anatomy, or can be a function of your normal knee anatomy and your biomechanics,” he says.

If your usual activities begin to be associated with pain, swelling, redness in the joint or stiffness, however, “you should have an evaluation because you may be either doing more damage or may have unrecognized damage in the knee,” Davis says.