Gain with No Pain
Joint-friendly exercise is becoming the hot fitness trend, as Olympic athletes and weekend warriors do their darndest to prevent injury and stay limber, flexible, and strong.
By Valerie Latona PHOTOGRAPH by Getty Images
When you’re a two-time olympic snowboard champion like 24-year-old Elena Hight, taking tough landings is just a part of the game. During one particularly tough “trick,” (as Hight calls her soaring, superhero-like stunts)—she tore the tissue that surrounds her left hip joint. Ever-tough, she kept right on boarding. Progressively the pain and discomfort became unbearable, eventually requiring that she undergo surgery. This was followed by months of intense recovery.
This year—in time for the 2014 Winter Olympics in Sochi, Russia—Hight is back in peak form, a lead contender for the gold. “Snowboarders land low to the ground,” she says. “It stresses the knees and the joints. The more conditioning you do in the off-season, the more your body is protected from injury.” Conditioning exercises—strength training, flexibility work, balance exercises, and cardio—is what Hight focused on to prepare for the season ahead.
“Most people think that strength training is all about building muscle,” saysBrad Jones, Hight’s physical therapist and strength coach, the founder of the b project clinic in Carlsbad, California. “It’s important for that, but strength training is also critical for stabilizing the joints.”
Muscles surround these joints, Jones explains, controlling their movement. The stronger, more flexible, and more balanced the muscles are, the better aligned the joints are. In this state, joints can perform at their peak. Training is a good idea for everyone, not just Olympic athletes.
Since most of us don’t train, joint injuries—particularly in the weight-bearing hips and knees—are rampant, says Nadya Swedan, MD, a physical medicine and rehabilitation specialist in New York. According to the Centers for Disease Control and Prevention, 23 million people in the U.S. have chronic joint problems— and that’s not including people with arthritis, the degenerative disease of the joints that causes chronic pain.
WHY JOINTS ARE VULNERABLE
Without joints and their crisscrossing muscles and tissues, we’d all be stuck in place. Joints, which exist wherever bones intersect, allow us to bend, pivot, and move our bodies in many different directions.
There are different types of joints—from ball and socket joints (in your hips and shoulders) to hinge and pivot joints (in your elbow and knee) to saddle joints (between the fingers). It’s not the joints themselves that are typically the problem.
It’s what is in between, and around, these bony knobs (muscle, tissue, and fluid) or lack thereof, that can cause pain, stiffness, and movement problems. Elizabeth Matzkin, MD, assistant professor of orthopedic surgery and chief of women’s sports medicine at Harvard Medical School, explains that tissue (ligament) holds bones in position and controls movement to prevent dislocations or overextensions.
Meanwhile, the ends of joints are covered with tissue called cartilage, which reduces friction between the bones and cushions the joints. Many moveable parts are subject to tears: cartilage, ligament, and tissue such as the meniscus—the rubberyC-shaped discs that surround and cushion the knee joint. Hight tore her labrum, the ring of soft, elastic tissue that surrounds both the hip and shoulder.
“Anytime your feet leave the ground together, as in a jump, you risk tearing some tissue, particularly in the hip or knee—both of which bear the brunt of your weight,” says Dr. Swedan. This includes snowboarding, skiing moguls, and doing jumps—be it in ballet or basketball. Once you tear any tissue surrounding the joints, even with surgery, you’re more likely to get arthritis (a breakdown of the cartilage surrounding the joints) 10 to 15 years down the road, explains Dr. Matzkin.
“Once it’s damaged, or we start to lose it, as with arthritis, we don’t have a really good way to replace it, yet,” Matzkin says. “Nothing is as good as what we’re born with.”
JOINT-FRIENDLY EXERCISE
Cartilage doesn’t have its own blood supply, and gets its nutrients from the joint fluid that surrounds it. Exercise forces more nutrient-rich fluid into the cartilage, lubricating it and the joints. The right kind of movement can help stabilize the joint and protect this crucial tissue. “It helps to keep your weight down,” adds Matzkin, noting that significant extra pressure is put on joints whenever an individual is overweight.
“This makes the potential for injury greater. For every step you take, your knee feels five times your body weight. The more weight you carry, the more pressure is on your knee. So a five-pound weight loss can actually feel like a twenty-five-pound weight loss to your knees.” Running—particularly on pavement— has gotten a bad rap for its impact on the joints. (“The harder the surface your feet are landing on, the more impact on the joints,” says Swedan.)
And when it comes to winter sports, snowboarding—as Hight or her fellow snowboarder can tell you—and skiing moguls are just as stressful as running. So what’s best to keep those joints juiced? Low-impact aerobic exercise helps to control your weight, without giving joints a pounding, says Swedan, author of The Active Woman’s Health and Fitness Handbook.
WEAK IN THE KNEES
Chronic knee pain is one of the most common injuries for athletes and non-athletes alike. To prevent it: Biking, be it outdoors or indoors via a recumbent or upright stationary bike, allows your legs to move smoothly, sans impact. Be sure your seat height—and handlebar height, if you’re riding outdoors—is right for you.
The wrong height can strain your knees. Cross-country skiing is “a really safe exercise,” says Swedan. “You’re basically moving your feet front and back, without any rotation. And you’re also not lifting your foot up and coming down in an uneven way, as you would if you were skiing moguls.” Elliptical machines mimic the smooth motion of high-impact running—without the impact.
To mix things up: try the ElliptiGO, a bike-elliptical hybrid that you “ride” outdoors. The bike’s pedals move in a forward motion emulating a runner’s stride, without the same pounding impact. (From $1,800, elliptigo.com) A mini trampoline (or rebounder) absorbs the impact of your jumping and minimizes potential for injury while improving strength, endurance, balance, and coordination.
Pilates, both on a mat and with a Pilates machine, helps strengthen your muscles andimprove your balance, stability, flexibility, and posture. Swimming and aqua aerobics, according to Bradenton, Florida-based Lora Brown MD, a board-certified pain and rehabilitation expert, is a good place to start for people with joint problems.
“The water provides a buoyancy that uplifts the joints and makes it easier to work on range of motion,” says Brown. “And, of course, conditioning and strength training.” Tai chi is good for your joints, as it increases strength, flexibility, and balance through its slow, controlled movements. “If you have good balance, you’ll be able to right yourself quickly if you fall or trip, avoiding tearing the tissue surrounding the joints,” says Swedan.
Walking is the most popular low-impact exercise, because anyone, any age, can do it pretty much anywhere. Swedan recommends walking on stable surfaces (not snow or sand), as uneven surfaces can cause injury if your foot lands unevenly. Yoga postures help increase strength, balance, and flexibility, which are why it’s a favorite of Hight. (“I try to do 30 minutes in the morning and 30 minutes at night,” she says.) But never push yourself into a pose.
If you feel pain, stop and ask your instructor to modify the pose for you. Strength training helps build stronger muscles that help support, and thereby protect, your joints. When the muscles surrounding a joint aren’t strong, they’re unable to prevent the body from moving into an awkward position, which can potentially injure it. “If there’s any kind of imbalance in your muscles, the muscle loses control over that joint, causing the joint to wear funny,” explains Jones,.
“This can create a situation that triggers potential injury and even arthritis over time.” Research will back this concept up: One study that focuses on cross-country runners found that those with weak muscles around the hip had a greater chance of injury. “As women, we’re not optimizing our strength well enough,” adds Dr. Matzkin, “Hormones may play a role in the laxity of the tissue surrounding the joints, but it’s more likely that it’s about proper strength training—or lack thereof— that’s making us more prone to injury.”
Some strength training that involves excessive flexing, especially with weights (such as squats or leg-press machines) can stress the joints—which is why, if you’re starting a strength-training program, it’s best to get the help of a qualified personal trainer or strength coach.
“This goes beyond weight loss and aesthetics,” says Jones. “You have to look 10, 15, 20 years down the road and really think about creating that balance in your body and in your muscles so you’re protecting yourself and your joints.”
Before this winter season began, you’d find Hight with Jones several days a week, doing a mix of jumps and squats as well as single-leg balance moves. Now that the season is in full gear and the 2014 Olympics are right around the corner, you’ll find Hight with her beloved snowboard—and her yoga mat, which she carries with her on every trip.
“I’m really excited for these Olympics,” says Hight. “I had a slow start to the season last year because of my surgery. While my hip is still a weak point for me, I started this season stronger than ever before.” Hight, hip and all, will offer us inspiration—and perhaps gold.
Get a sneaker fitting.
If you pronate (favor one side of the foot over another), a fit specialist can help you figure out the right sneaker for you. Special in-soles can also help. Try Dr. Scholl’s Custom Fit Orthotic Inserts ($50, footmapping.com).
Stretch when muscles are warm.
“Tight hamstring, calf, or knee muscles can trigger knee pain,” explains Cranford, New Jersey-based personal trainer Lockey Maisonneuve.
Roll out your muscles—on the top, sides, and bottom of the knees—to get the knots out of the muscles before injury can set in. “Imagine a pair of wrinkled jeans that are stiff,” says Maisonneuve. “Put those jeans on an ironing board and iron them out and they get soft. That’s what happens to tight muscles when you roll them.” Try the MELT Method Soft Body Roller ($60, meltmethod.com).
Ice it.
“If you’re prone to knee pain after you run, ice that joint for a minute or so to prevent it from becoming too inflamed,” says Maisonneuve. Try FrozenPeaz Ice Packs (from $30, frozenpeaz.com). But keep in mind: if you’re experiencing pain, you might also need to adjust your form to avoid it in the future.
Try glucosamine and chondroitin.
Both compounds are naturally found in healthy cartilage—which is why some experts like Nadya Swedan, MD, recommend these supplements to their patients for joint stiffness and pain. “They can’t hurt,” she says. “And they might just help.”
THREE SIMPLE JOINT EXERCISES
“All joints have synovial fluid in them, which helps to lubricate them—keeping them from getting stiff and inflexible,” says Lockey Maisonneuve, a certified personal trainer and yoga instructor in Cranford, New Jersey. Try these exercises* at home, 8 to 10 times daily, to loosen joints and relieve stiffness. F
Knee flex: Lie on your stomach. Bend your knee and bring the heel as close to your butt as possible. Switch legs and repeat.
Leg swing: Place hands on a wall at chest height, and step back about one foot from the wall. Move the right leg in front of you from left to right. Switch legs and repeat.
Shoulder roll: Roll both your shoulders forward and then backward, 10 to 15 times each way. *Always check with your doctor before starting any exercise program.
GLOSSARY INSIDE THE JOINT CARTILAGE:
Tissue that cushions joints
IT BAND: Fibrous tissue that runs down outer thigh and knee
LIGAMENT: Tough tissue that connects bones (this includes anterior cruciate ligament or ACL)
MENISCUS: Curved cartilage in knees SYNOVIAL FLUID: Clear fluid helps lubricate joints
TENDONS: Tissue on either side of joint that attaches to muscles noting that tears of the ACL (the ligament surrounding the knees) are eight times more common in women.
