n email from a reader who asked a great question:
"You stated that cartilage can be strengthened as long as the right load is being used. Does that mean that if I currently have no knee pain, doing body weight squats regularly would be a good way to keep knee cartilage healthy? And if so, do you have any opinions on the debate over depth of squat i.e. partial, 90 degree, full squat?
One of the things, I really like about your site is it's emphasis on joint health. I'm 35 yrs old with a long history of contact sports and a number of thankfully minor injuries. I don't have any obvious joint pain, or problems that I know of. I'm currently trying to figure out the best fitness routine to adopt if my main goal is joint health, range of motion, freedom from pain etc. I've been able to gather a bit by reading your own workouts you've posted, but I'd love to hear more about your thoughts on the best way ensure joint health, range of motion, etc. into the later years of life."
Thank you for your email and questions. I think the last sentence of your email, turned into a question, gets to the heart of the matter. "What can I do to ensure joint health, range of motion, etc., into later years of life?"
I completely understand this one. And, came to understand the importance of joint health, in my self, later than I would have liked. I missed or ignored many early warning signs as so many others do. Pain is only one of the symptoms of joints that needs attention. There are two other things to consider when it comes to the language of joint problems: stiffness and / or aching. And of the two, stiffness seems to be the most insidious. I've met with hundreds of clients who recall feeling a sense of stiffness well before they ever had aching or pain symptoms in their knees and most of them ignored it. I know I had that symptom in my left knee and lower back over thirty years ago and now have to work much more diligently to keep relatively healthy joints.
So, assuming you have no symptoms, there are a few basic requirements for healthy joints (to avoid turning this into a thesis, I've omitted a few things but these are the fundamentals). It's more than whether to do squats or some other drill. Joint health is a lifestyle choice. It's a set of values and beliefs that are expressed in your everyday life. So, with that in mind, here they are:
- Regular movement through out the day and maintain an active lifestyle. Walk much more than you sit. If you work at a computer, use a software program to interrupt you and guide you through some general movements and stretches. Buy a pedometer and shoot for 10,000 steps per day. Joints need to be moved frequently under a variety of loads and movement patterns (which is one of the reasons my training sessions vary). Joints deteriorate over time from disuse or misuse. A sedentary lifestyle, exemplified by fewer than 5000 steps per day, allows the joint surfaces to soften but without any warning. Then, if you decide one day to suddenly become active, after being relatively inactive for years, the joints aren't prepared for the increase in force which sets you up for injury.
- Aerobic exercise at least three days per week for at least thirty minutes. Running is not my first choice when it comes to maintaining healthy joints but, if you've been a regular runner, someone who started early in life and have continued to run, running is ok for you according to the research. But, the key here is consistency. If you've not been running regularly for several years, don't start until you have adequate strength and even then, start with a gradual, beginner's program. I prefer to use elliptical machines, cycles, arc trainers, etc. They create lower compression loads and you can move your joints (hip and knee) through a larger arc of motion which your joints really appreciate.
- Move your joints through their normal and available range of motion - a lot - under low load conditions. If you have established an active lifestyle that includes regular aerobic conditioning, movement, flexibility and strength training, you may not need to perform low load, high volume squats - the low load, high volume choice for the hip, knee, and ankle. However, most people become concerned about their joints when they have had symptoms, an injury or perhaps have someone close to them who has struggled with joint pain. Squats then become a staple for joint health. If you're able to squat on both legs with good form and no symptoms, then start with 50% of your body weight (not by adding 50% to your body weight) and perform squats, stopping the motion between a 90 and 120 degree knee angle, for 15 minutes 1-2 times per week (Sometimes people misunderstand what I mean when I say squat with 50% of your body weight. If you weigh 150 lbs., the force you would use would be no more than 75 lbs.). You can increase the load over time, gradually. I've had several clients work their way up to 70% and even 100% of body weight. An important element of this though is that the squatting should be minimally fatiguing (on a scale of 0 to 10, where 10 means you cannot possibly do one more, a 3 or less). So, if you start with 50% of your body weight and at 5 or 6 minutes notice that your legs feel tired, the load is too heavy. Many people are quite surprised to find that, even though they can perform 20 or 30 full body weight squats (or even above body weight squats), they have to use 20 or 30% of their body weight for the joint conditioning component. That's ok. Use what your body says it can handle and no more. My tool of choice is the Total Gym. I know some people who have used something similar called a Body Rail. I've not used it so I can't say if it is worth buying or not. But, using a leg press at the gym, which seems like a reasonable thing to do, is risky. The reason is that most of the leg press machines place your body at angles that increase pressure in the lower back. This isn't as much of a concern when you perform 10 or 20 repetitions but when you perform 200 or 300 or more, the cumulative load can create problems for your spine. Imagine, in your mind, rotating the image (of the seated leg press) 90 degrees to the right. Does that look like something you would want to do 200 or 300 times? A supine leg press is somewhat better, biomechanically speaking, but I've found that the loads in these machines can be highly variable.
- On the issue of the deep squat (more than 120 degrees where the buttocks strike the calf muscle), I think that's very risky for most people and certainly for joint conditioning it could be injurious. I know trainers, some, advocate "deep" squats. But, you must have exceptional mechanics to pull this off and in terms of muscle strengthening, you don't gain much by moving past about 90 degrees of knee flexion.
- The partial squat, usually 45 degrees or less, is often used because the load is too great for the knee - even at body weight. This same person, under less than body weight conditions, can usually squat to 90 degrees without symptoms.
- Optimize your biomechanics. In a nutshell, examine your posture both at rest and moving, you may need to get some help with this from a professional, and determine the things you should change and can change and then go about changing them. For example, for the knee, limitations in flexibility at the hip and ankle often create problems for proper force transmission through the knee. Other joints have similar relationships with neighboring body regions (like th cervical spine and thoracic spine and shoulder).
- Keep your body fat within acceptable ranges. Body weight is not the issue. It's how much of your weight is fat and how much is muscle and other lean tissue. Joint problems seem to follow a rise in body fat.
- Train movements; not muscles. Joint problems seem to crop up when people have either not been exercising the entire body routinely or decide to exercise to improve the way they look by isolating body parts. Your body works best when more body parts work together; at the same time.
- Know your strength levels; check your speed. Muscular strength, in particular fast twitch fiber strength, is very important for joint protection. As you age, you will lose fast twitch fiber strength unless you actively train to keep it (and even then, you'll lose some due to changes in hormone levels). Identify your strength for key functions (such as push, pull, squat, lift, reach) and speed (e.g. how many squats can you perform in one minute, how fast can you cover 100 meters). Most trainers and therapists should know how to test these functions.
- Stay well hydrated. Cartilage loves water and uses it to increase its stiffness. Make sure your body has an adequate supply.
- Vitamin supplementation. Controversy exists here and research is thin but vitamin supplementation ( E, C, A, B6, B2, and Selenium) has been shown to reduce anti-oxidative enzymes and development of mechanical osteoarthritis.
- Protein. Make sure you have enough protein in your diet. It's a major building block for repair and growth. Most experts suggest .8 grams of protein / kg of body weight. If you've sustained an injury or you exercise regularly (which you will if you want to protect your joints), protein intake should be between 1 and 2 kg of protein / kg of bodyweight. There's some research that suggests, although controversial, eating too much protein for too long can deplete the bone of calcium so keep your intake in the suggested ranges.
- Pay attention. Be aware. Listen for the first signs of a joint in trouble - stiffness and swelling. You may not hurt at all. If you wake up in the morning and your knee feels stiff, that often means that whatever you're doing (exercise, not exercising, too much exercise, too much sitting, etc), it needs to change. Watch out for these episodes of stiffness and when they begin to repeat with increasing frequency, take action.
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