Does being active (including practicing yoga) wear out our joints?
Wear and repair vs wear and tear!
I imagine that you’ve heard the phrase “wear and tear” used to describe the process involved in osteoarthritis. But did you know that this crude “bone-on-bone” model is being completely challenged and redefined by research that has been emerging over the past couple of decades?
Today we’ll explore why “wear and repair” might be a more appropriate phrase for describing the way our bodies respond to physical stress.
[Premium members - click the play button above the introduction to listen to the audio version of the newsletter and make sure you scroll all the way to the end to download your exclusive printable Quick Reference teaching guide on osteoarthritis.]
Before we dig into this topic, I’m excited to share something I’ve been working on behind the scenes for the last few months.
Premium subscribers to this Yoga Anatomy Insights newsletter will be able to join a live monthly masterclass, designed to help yoga teachers explore one topic in greater depth than is possible in a newsletter.
Each 1-hour session will focus on a single evidence-based topic, combining anatomy, physiology and practical teaching application, followed by time for questions.
If you can’t join live, every masterclass will be recorded and added to a growing replay library, so you can watch whenever it suits you.
The first masterclass took place on Thursday August 13 - Demystifying Hypermobility, Part 1: Beyond Flexibility. (The replay is now available to watch)
We explored the latest evidence, common misconceptions and practical strategies you can use immediately in your teaching.
For just $15/month or $145/year, you can join Premium and access the live monthly masterclass plus the growing masterclass replay library!
My goal is for Premium to be an affordable source of ongoing, evidence-based continuing education for yoga teachers, with a new masterclass every month covering topics such as posture, pain, fascia, the psoas, aging, breathing and much more.
👉A modern understanding of osteoarthritis
Osteoarthritis is no longer viewed as a quintessential degenerative disease resulting from exposure to average bodily wear and tear, but rather as a multifactorial disorder in which low-grade, chronic inflammation has a central role (Tramś et al 2022). Inflammation weakens the cartilage and its ability to withstand stress, which can in turn lead to joint pain and reduced function.
Currently, x-rays are often used to confirm the diagnosis of osteoarthritis. Three signs that clinicians look for on x-ray are joint space narrowing, formation of osteophytes (bony lumps, or bone spurs, that grow on the bones of the spine or around the joints), and joint destruction.
Clinicians are now beginning to think of these x-ray findings as normal age-related structural changes. Having these structural changes only increase the chance of experiencing pain: It does not guarantee pain. Between 19% and 40% of people with structural changes on an x-ray don’t have pain (Culvenor et al 2019).
If someone with osteoarthritis does experience pain, these structural changes are only one factor in the bigger picture. Someone can have structural changes on an x-ray and their pain can decrease over time while their x-ray looks the same.
It’s important to note that people with osteoarthritis still have synovial fluid in the affected joints even though they might have these structural changes.
And things don’t have to get worse. Knee osteoarthritis is characterised by persistent rather than inexorably worsening symptoms even when the x-rays show more joint changes.
👉The evidence supports movement
Body weight and some structural joint changes are associated with knee osteoarthritis and sometimes pain. Similar to joint changes, weight doesn’t necessarily have to change to decrease pain. Losing weight is often helpful but not entirely necessary: Exercise alone can reduce pain (Messier et al 2015). Aerobic, strengthening, aquatic and Tai Chi exercises are beneficial for improving pain and function in people with osteoarthritis with benefits seen across a range of disease severities.
And here’s the big one! Being active doesn’t wear out your joints! Moderate exercise may be a good treatment not only to improve joint symptoms and function, but also to improve the knee cartilage glycosaminoglycans content in patients at high risk of developing osteoarthritis (Roos and Dahlberg 2005).
Running does not increase symptoms or structural progression in people with knee osteoarthritis (Lo et al 2018).
The same goes for yoga. There is a lot of chatter online that yoga can cause osteoarthritis but there is no evidence of this and the concept makes very little sense biomechanically or physiologically. A systematic review of 15 randomized controlled trials found that yoga practice may downregulate proinflammatory markers, suggesting it can be a supportive intervention for people with inflammatory conditions including osteoarthritis (Falkenberg, Eising & Peters, 2018).
👉Wear and repair, not wear and tear
A study by Ackerman et al in 2020 reported that a 12-week non-surgical knee osteoarthritis management program (including exercise therapy, education, insoles, dietary advice and analgesia) can prevent total knee replacement surgery in people deemed candidates for this in 68%-74% of people with knee osteoarthritis!
We must remember that the human body is strong and adaptable and is capable of wear and repair rather than wear and tear.
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Four ways to continue learning with me, when you’re ready:
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