Man Overboard! by Craig Bowron M.D

Author:Craig Bowron, M.D. [Bowron, M.D., Craig]
Language: eng
Format: epub
Publisher: Mayo Clinic Press
Published: 2022-07-28T00:00:00+00:00

Isn’t Exercise a Young Man’s Sport? Isn’t It Hard on Joints?

When I was growing up, gyms were only found in schools and bigger churches, not in every strip mall or people’s homes. Exercise training was what one did to participate in a sport, and sports (save men’s softball, oddly enough) were for kids. The line on strenuous exercise and athletic training (anything more than a brisk walk) for adult men and women was that it was either unnecessary (“I’m not playing a sport, so why should I be training for one,” “I already work for a living”) or that, with advancing age, they were simply too frail for it. They’d just end up hurting themselves.

This relationship between perceived frailty and risk of injury is a kind of self-fulfilling prophecy. To avoid injury or a heart attack, you might talk yourself into avoiding anything but low-intensity exercise, which then leaves you more prone to the very things you were looking to avoid: injury and heart disease. The truth is that when anyone of any age is out of shape and tries to exert themselves, the risk of injury is higher. It’s certainly true that older folks take longer to recover from injury—muscle fibers torn with strengthening exercises can heal in two weeks for the youthful, and a month for the not-so-youthful.

One frequently voiced concern is that more aggressive exercise could end up wearing out one’s joints and lead to arthritis. That idea holds up to some commonsense scrutiny: the screen door hinge has only so many turns in it before the repetitive movements abrade the metal and the hinge loosens up, which only accelerates the wear.

Like the door, our joints are mechanical in nature, but unlike the door, our joints are alive. The living “connective tissue” of our bones, ligaments, tendons, and cartilage are in a perpetual state of remodeling, and they respond to stresses (rather miraculously) by increasing that remodeling, bulking up in areas where extra heft is needed.

So regular exercise—even intense exercise—is good for our joints. The increased risk for osteoarthritis that comes with participating in sports is thought to be due to either a single-impact kind of disaster (the fall onto the shoulder, the weirdly twisted knee), or to a series of smaller-impact disasters (so-called “dings,” as in “I dinged up my shoulder playing sand volleyball”), and not due to regular use.

There is one way in which the door-hinge analogy does hold up: our joints are indeed mechanical, and they work the best when alignments are optimal. Injury comes most easily at the extremes of position, when the joint is misaligned and not in a good position to handle a load. This is why body mechanics and ergonomics are so important, particularly for a patient with low-back pain who needs to lift a weight. Muscle strength is also critical, because muscles are important in maintaining proper joint mechanics. For example, quadriceps strength is critical to knee stability. Flexibility helps to maintain posture and joint mechanics too.

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