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Weights and Arthritis Ė Good & Bad
A number of weight lifters, many of them my friends Ė John Grimek, Tommy Kono, Bill Clark and Pat OíShea are prominent examples Ė have suffered from arthritis later in life and eventually had to have joint replacements. Iíve also experienced some joint problems. One might think, based on these cases and others, that weight training is bad for the joints. Obviously, it can be hard on the joints. In most cases, however, strength training protects the joints, and relieves pain and improves mobility for those who suffer from arthritis.
Strong Women and Men Beat Arthritis (G. P. Putnamís Sons, 2002) is the latest in a series of books on the benefits of strength training and sound nutrition by Miriam E. Nelson, Ph.D., an associate professor and director of the Center for Physical Activity and Nutrition at Tufts University. Nelson and fellow scientists Kristin Baker and Ronenn Roubenoff present cutting-edge information on how you can treat Ė as well as prevent Ė arthritis.
What is arthritis?
Arthritis literally means joint disease (arthro, joint, and itis, inflammation). There are many types, but osteoarthritis accounts for 80% of the cases and affects millions of people around the world. Osteoarthritis is a degenerative disorder in which the cartilage Ė the cushioning between the bones that acts as a shock absorber Ė begins to breakdown.
Cartilage is composed mostly of water; itís like a damp sponge or a balloon filled with water. When pressure is put on the joint, the water is pushed around to equalize the force and protect the bones. The spongy part of the cartilage also contains chondrocytes, cells that regenerate new bits of cartilage.
Osteoarthritis is usually thought of as "wear-and-tear" arthritis, but Dr Nelson says thatís "too simplistic." The immune system is also involved. Nelson explains that the job of the immune system is to repair damage and, in the case of cartilage, it sometimes overdoes it. "The problem," says Miriam Nelson, "is that the white cells of the immune system cause damage even as they clear it up: They carry enzymes that break down cartilage." Moreover, she explains, cartilage has no blood supply and, as a consequences, only limited ability to repair itself.
Eventually, the combination of wear and tear, over-active immune system and slow healing causes enough damage that the body "sounds an alert to the changes with pain," says Nelson. That means youíve got trouble. All is not lost, however. As weíll see, there are ways to prevent or treat arthritis.
The risk factors
Some people are more likely to develop osteoarthritis than others, according to Dr. Nelson. Age, gender (women are slightly more likely to develop arthritis than men), excess weight and family history are all predisposing factors.
Injury to the joints, of course, increases the risk of developing osteoarthritis and appears to have contributed to the problems experienced by the famous lifters mentioned above.
Tommy Kono (see art. # 74) believes a knee injury was the precipitating factor in his hip replacement. "To compensate for my bad left knee I taxed my left hip too much," he told me in an email. "It is amazing how we minimized injuries when we were young, but later on self preservation kicks in and sometimes it is too late for the damage has been done," Tommy wrote. "This is the reason I harp on perfect technique for the Olympic lifts and the correct way to perform the full squat."
In a letter to a friend of mine, John Grimek (art. # 25) traced his double hip replacement in his 80s, shortly before his death, to an injury suffered about 10 years earlier in a spur of the moment squatting session. He let an unexpected visitor to the York Barbell gym talk him into doing some very heavy squats. The visitor wanted to do squats, and Grimek agreed to join in, even though he hadnít done squats for some time. Squats were always easy for John and he thought he could get away with it. Unfortunately, it appears that he eventually paid the price for showing the much younger visitor who was boss.
Pat OíShea suffered a major injury to his left quadriceps Ė you can see his atrophied thigh in the photo on page 205 of Challenge Yourself Ė which may have been a contributing factor leading up to his recent hip replacement. He blames his hip problem on "overuse." Pat says, "Too many years of split snatching, running and backpacking." Happily, he reports that after the implant his hip "has never felt better."
Bill Clarkís hip and knee replacements came after 20 years behind home plate as a baseball umpire and 38 years of pounding up and down hardwood basketball courts as a referee (see the profile in the last chapter of Challenge Yourself). Bill's long involvement in harness lifting, back lifting and other odd lifts probably didn't help. He set national All-Round lifting records in the 70-74 age group in 2002.
Interestingly, it is reported in the December 2002 issue of Milo that a study performed in England found basketball to be the most injurious sport of all. Olympic weightlifting was number 19 and powerlifting was 12. A later study sponsored by the National Centers for Disease Control also found basketball at the top of the list for reported injuries; weight training and aerobics were near the bottom of the list.
Finally Ė and importantly Ė muscle weakness is a major risk factor. "If your muscles are weak," Miriam Nelson writes, "you are at an elevated risk for developing osteoarthritis." As weíll see, strength training is the key element in her prescription for beating arthritis.
"Muscle is the most important protector of joints," says Dr. Nelson; "cartilage only absorbs shock that gets past the muscle." Thatís why muscle weakness is so harmful. "Without strong muscles, cartilage wears out much sooner."
Miriam Nelson compares muscle and cartilage to the shock absorbers and springs in a car. In your body, the muscles, like shock absorbers, take the brunt of the shock, but once in a while the impact is so severe that the cartilage, like the springs and axles, takes the hit. Just as the passengers feel and hear the bump, you feel a painful shock in your joint. Nelson says thatís called a microklutz; it means the shock got through to the cartilage. "Over many years," says Nelson, "such shocks can slowly degrade the cartilage."
As the damage to the cartilage increases, the pain forces people to become less and less active. It sets off a "vicious cycle," says Nelson. Pain leads to inactivity, muscle weakness, joint damage and more pain, and the cycle starts over again.
The bad news is that you canít grow new cartilage to replace the cartilage that has been worn away. The good news, says Nelson, is that "you can grow new muscle and thereby rebuild a critical part of the jointís shock absorber system."
Miriam Nelson not only says you can beat arthritis with strength training, she proved it. In fact, she says, the study which forms the foundation of her book was more successful than she and her colleagues hypothesized.
Arthritis has been around forever but scientists only began studying it about 125 years ago. For at least 100 years after that, doctors thought the best treatment for painful joints was rest. Actually, thatís still the norm in many, perhaps most, places. A friend of mine has severe arthritis in both knees, and to the best of my knowledge she has never been encouraged to exercise. The doctors prescribed strong pain pills Ė they allow her to walk and work Ė and told her that they will replace her knee(s) when the medication no longer allows her to function.
Dr. Nelson says early studies of the benefits of exercise were not encouraging. That may be one of the reason for the treatment my friend has received; the other is probably a history of non-compliance by patients. According to Nelson, earlier studies fell short because they focused on walking and range of motion exercises. They didnít address the problem of muscle weakness. The exercises "werenít intense enough;" the training wasnít designed to make the muscles "become more powerful," says Nelson. "Thatís the whole point."
With the help of Ronenn Roubenoff, M.D., a board-certified rheumatologist, and her doctoral fellow, Kristin Baker, Dr. Nelson designed a study to determine the effect of aggressive strength training on older adults with osteoarthritis of the knee Ė in their own home. They recruited 46 people, 55 or older, with moderate to severe knee pain. All were "significantly limited" in their ability to do normal things Ė "walking, stair climbing, even just sitting and standing." Kristin visited each person at home several times during the course of the four-month study.
Half did strength training and flexibility exercises three times a week. The other half received emotional support and tips on healthy eating from Kristin, but no exercise guidance; 38 participants completed the study.
The training Ė gentle to start with and progressively more intensity Ė included modified squats, step-ups, knee extensions and other exercises. Kristin instructed them to start with "moderate" intensity and learn perfect form, and then over the course of several workouts increase the intensity to "hard." She encouraged them to increase the weight or reps as they got stronger. She explained that reasonable muscle soreness is normal; that itís "a sign that you are challenging your muscles appropriately to adapt and become stronger." The key is to "begin slowly and progress consistently," she told them.
It worked! The strength of their quadriceps increased an average of 71%, compared with 3% for the control group. Pain in the exercise group decreased 43%, as opposed to 12% in other group. Physical function improved by 44%, in activities they were having trouble with before, such as walking and climbing; the placebo group stayed about the same. Importantly, the exercisers showed less depression and gained in self-confidence and self-esteem. They even slept more restfully. "Their lives turned around," wrote Nelson.
The changes were "astonishing," says Dr. Nelson. Thatís especially true when you consider that people like my friend are being told the only hope is pain medication and, eventually, joint replacement.
My own case
Iíve been training with weights hard and progressively for more than 50 years. With the exception of my lower back, Arnie Jensen, my doctor at the Cooper Clinic, a radiologist, tells me that X-rays show my joints to be in remarkable condition. The joint spaces in my hips and knees show only minor arthritic changes.
My lower back has been something of a problem for years. I have a congenital curvature in my lumbar spine and the disk spaces are significantly narrowed. I believe the cartilage damage in my lower back was caused by doing thousands of lay-back presses in my years of Olympic lifting; the Olympic lifts now consist of the snatch and the clean & jerk, but the standing press was included when I was competing. I can remember my lower back hurting when I was in high school. In recent years my lower back has been stiff and sometimes sore when I get out of bed in the morning, but it loosens up after I move around for a while. It has bothered me some for years, but rarely hurts when I lift. As long as I warmup well and keep my back flat and tight, it has generally been fine.
I believe my years of lifting and abdominal work has helped my back. My strong back and ab muscles have probably protected my abnormal and arthritic lumbar spine.
In the last few years, however, Iíve begun to feel an occasional microklutz. (What a great word. Never saw it before reading Miriam Nelsonís book, but itís a perfect fit for the painful shocks Iíve experienced recently.) Iíve started to have some sharp pains in my knees when catching the bar at the shoulders in the power clean and overhead in the power snatch. My lower back has also started to complain on these quick lifts; the whipping action of the fast pulls seems to be the main culprit. Miriam Nelson would probably say that the cartilage in my knees and lower back is sending a pain signal through my bones and nerves to my brain Ė and I think sheíd be correct. The pain is definitely a warning signal.
Iíve always told people, if it hurts donít do it. After period of denial, I took my own advice. I made some changes in my workouts to avoid jamming my knees or hurting my lower back. I modified my pulling technique and stopped doing the power clean and snatch.
It feels really good to be lifting pain free again. Squats are a lot more fun when my knees donít hurt from doing power cleans and snatches.
The modification is that Iíve started doing all snatch and clean pulls with straight elbows (demonstrated in our new video). I no longer catch the weight at the shoulders or overhead. Straight-arm pulls are popular with Olympic lifters, who are so fast that they donít have to pull the bar very high to get under the weight.
In this version of the pull, the weight is lifted to about the level of the belly button; thatís it, no higher. The barbell is lifted off the floor slowly by extending the knees and hips, the lower back stays flat and locked. The shoulders stay over the bar, they cover the bar, until it passes the knees, and then the weight is pulled into the body and lifted explosively upward by extending the body, coming up on the toes and shrugging the shoulders. If itís done correctly, you can balance momentarily while up on your toes.
As I say on the video, it doesnít look like much, but itís a wonderful athletic movement. It works the most powerful muscles in the body: the thighs, hips, lower back, calves and the traps. These are the important muscles used in just about every sport, football, basketball, baseball, volleyball, soccer, you name it. Itís basically jumping with a heavy barbell in your hands. It provides almost all of the benefits of the standard quick lifts Ė without the risks.
If I continue to maintain good form Ė like Tommy Kono recommends Ė and heed warning signals, Dr Jensen says Iíll be lifting strong in my 80s and beyond. Thatís my plan. Thatís what I intend to do. Adjustments like Iíve just described should help me get there.
I plan to keep lifting Ė and adjusting Ė to keep my joints strong and healthy.
How about you?
(For more information on strength training, diet and medication Ė even exercising in preparation for joint replacement Ė to beat arthritis, I urge you to read Miriam Nelsonís wonderful book: Strong Women and Men Beat Arthritis. I also recommend her other books on the benefits of strength training to stay young, stay slim and build strong bones.)
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