Osteoarthritis is a bit of a vicious cycle of we don’t move because we’ve got pain, but then because we don’t move, we don’t release synovial fluid and kind of lubricate the joint. Strength training is very joint friendly, and one of the reasons is that we’re never surprising those joints with heavy loads quickly, like other types of exercise may. Welcome to the Strength Changes Everything podcast, where we introduce you to the information, latest research, and tools that will enable you to live a strong, healthy life. On this podcast, We will also answer your questions about strength, health, and well -being. I’m Amy Hudson. I own and operate three exercise coach studios.

My co -hosts are Brian Sagan, co -founder and CEO of The Exercise Coach, and Dr. James Fisher, leading researcher in evidence -based strength training. And now for today’s episode. Welcome back to the Strength Changes Everything podcast. We are in a series of episodes all about how strength training reverses some of the negative effects of aging. Today’s episode is all about joint pain. Joint pain is a common prevalent thing that people experience and associate with aging.

So in today’s episode, we’re going to talk about how prevalent this is. the most common types of joint pain people experience, why this gets worse with age, how this can impact quality of life if you’re walking around with a lot of joint pain, and then what does research show about how strength training can help with this and exactly how that works. So if this is something of concern to you, you currently are experiencing this or you anticipate experiencing this, you’re going to want to tune into this entire episode. It’s going to be a good one. All right, Dr. Fisher, how are you doing today? I’m doing very well. Thank you, Amy.

How are you? Good. Are you currently experiencing any kind of joint pain today? I have to think about it for a second. But no, I feel pretty good. I feel great today.

Thank you very much. How about you? So far, so good. Knock on wood. Right. Because you’re strength training regularly.

Hopefully that’s why. But OK, so I just kind of want to start off today’s episode and asking asking you, you know, like what are the most common types of joint pain out there? Yeah. So when we think about where people experience pain in their body as a, as a skeletal issue, uh, it’s typically low back pain. Um, although that’s. That’s more musculoskeletal.

So it’s primarily thought of now as being or non -specific low back pain as being a product of weak lumbar muscles. Um, I think we’ve talked about that previously and I’m sure we’ll talk about it again in the future. So it’s not something I’m going to get into too much today. Um, But beyond that, it’s the knees, the hips and the fingers. Actually, the hands can be quite a big one where people experience joint pain. All right.

Sounds good. So very common areas, very high usage areas as well. How prevalent is this, you know, among the aging population? Yeah, so really when we think about this kind of pain, we’re probably talking about something called osteoarthritis, and that is a chronic degenerative joint condition whereby the cartilage, which is the the kind of the smooth tissue that acts as kind of a shock absorber at the end of the bone, um, that gradually wears down over time. So as far as the prevalence, it’s about 7 % of the population globally, but actually it’s an, an age related condition. So if we move to, let’s say the 50 to 69 year old age category, it’s now 23 % of the population.

Uh, and some studies have listed this as the most common cause for musculoskeletal pain in this of age group. Wow, so it’s pretty common. Why do people experience this more with H? The cartilage wears down. There’s a natural kind of wear and tear.

It’s thought of as a wear and tear condition. So the cartilage naturally wears down. And then the body’s ability to repair joint tissue actually declines with age. Specifically, cartilage is called avascular, which means it doesn’t have a direct blood supply. So it can’t heal or recover from injury or from wear and tear as easily as other tissues can. And it’s thought that as we age and as we lose muscle, there’s a cumulative exposure to that kind of mechanical stress at the joint itself rather than through the muscular system because of a loss of muscle.

And of course, any minor injuries that occur. So as we age, we’re more likely to fall or trip or things like that. Okay. Yeah, I know I’ve explained to clients in the past. which has helped them. If you picture your bones and your joint, the stronger the musculature around that joint is, the more protected it is and the less prone to injury it is by everyday activities.

So I think we all understand that. And that loss of muscle around the joints, it makes sense how it can lead to increased vulnerability there or weakness or pain. Yeah, absolutely. And I think it was Doug McGuff a few episodes back who talked about the idea that our skeleton is not this super strong structure that we often think of it as. If we think about the skeleton hung in our anatomy classroom when we were at school, actually it was held together with wires and bands and so forth. The skeleton itself will crumble, will fall.

It’s the connective tissue and specifically the muscular system that holds it together, that gives it support and gives it strength and strength. Absolutely. Okay, so then how would somebody experiencing joint pain impact their quality of life? I mean, what are some of the downsides? Can you paint a picture of what this may look like for a person if they don’t address this? Yeah, so pain is talked about in the literature as a lived experience.

Unless you’re experiencing chronic pain, it’s very hard for somebody to empathize with what that is actually like. Obviously, the pain itself, the physical discomfort itself is you know, is the primary thing. But associated with that, there’s stiffness when there’s movement, there’s impaired joint function that can lead to some functional decline. So our capacity to perform simple functional tasks and decreased mobility. That limits our capacity to perform simple activities of daily living. So, you know, if you’re sat on a chair in pain and your joints ache and you’re suffering, you know, you might not want to get out of the chair to use the restroom, or you might not want to get out of the chair to make a drink or things like that.

So our whole quality of life really can start to drop off. We can start to avoid social participation. and any events like that, and these to social isolation, potentially from their depression and a real kind of downward spiral of effect. That all makes total sense. And I don’t think anybody wants any of that, because that’s hard to make peace with. If you’re used to one type of lifestyle, including a lot of social interaction, movement, doing things, feeling good about yourself,

And then you, all of that gets flipped on its head just because of this joint pain. It’s very sad. But there is hope. Yeah. Yeah. Let’s, I mean, so you’re going to share with us now, I mean, what the research shows about and this whole episode is about the fact that strength training has been shown to help with this.

So let’s dive into, you know, what does the research show about this? How strength training can help with joint pain? Yeah, absolutely. It’s very hard to kind of sell this because anybody who’s experiencing joint pain, who struggles with any kind of movement, the last thing they want to do is movement. Well, when we think about exercise and when doctors prescribe exercise, they are very non -specific over the type. And of course, if you’re in joint pain, going for a walk doesn’t necessarily help you because it’s a repetitive movement.

It’s the same kind of wear and tear that you’ve maybe experienced. But in fact, resistance training can unload the muscle or unload the skeletal system, I should say, with certain movements. But more so, it can perform in multiple ways, improve our functionality, our strength, and reduce joint pain. So the primary study that I wanted to talk through today, the title is the effects of resistance training on pain, strength and function in osteoarthritis, a systematic review and meta -analysis. And as we’ve talked about previously, a systematic review and meta -analysis is a collection of literature. So they actually include 27 different studies and around 1700 participants across those studies who were suffering with osteoarthritis.

And within each of those individual studies, they had reported pain based on some scale. So that’s typically something like a visual analog scale or a WOMAC pain some scale, or there are specific osteoarthritis pain scales. So there’s different kind of metrics there. That also measured strength in some metric and they applied a resistance training intervention. Now we’re not going to get heavily into what that resistance training intervention was. Some of them varied in length.

And in fact, the researchers, uh, kind of specifically looked at studies of four weeks or less, five to eight weeks or nine weeks or more. So these are all relatively short studies in the grand scheme of things. If you think about. If somebody has pain from osteoarthritis and we say to them, well, if you go and do resistance training for nine weeks, you’ll reduce pain. That’s quite a considerable thing. Nine weeks is, you know, a couple of months really.

So it was really nice systematic review and meta -analysis and they kind of get into, into some great details. You know, they highlight early in the introduction, the kind of the social impact of the pain associated with osteoarthritis as we’ve talked about. But really what they get into is that. Engaging in resistance training reduces pain. So by any of those subscales, resistance training reduces pain. It increases strength, which is fantastic and as expected, but more so it also improves function.

So the physical function of these participants within the study is improved. And of course that then can enhance their quality of life and their social interaction and all the things we talked about earlier on. Well, that’s exciting. Yeah. So the patients or the people, the participants reported less pain and they were demonstrably stronger and more functional, able to move around more in nine, eight to nine weeks, you said? Yeah, some studies were short as four weeks in duration, and they also showed reductions in pain, improvements in strength, but they didn’t have the same improvements in functional performance.

So I guess we can think of this as kind of a top -down effect. If you’re experiencing less pain, then you can exert more force through a muscle and through a joint. And if you can exert more force through a muscle and a joint, then you can start to do more things and you can improve your functional performance. So yeah, so four weeks, there was reduction in pain, improvements in strength, but it was the studies that beyond four weeks also showed improvements in functionality. And I imagine once you start to feel that reduction in pain, you’re a little bit more not emboldened, but energized to continue feeling better and better and better. I’m sure I’m sure because I don’t live with chronic pain.

And as I said, there’s a very much a lived experience associated with this. You know, we can never say that any two people experience pain the same way or experience the same conditions. But yeah, I can well imagine that once that pain starts to subside, your vitality improves, your kind of lust for life increases, and your desire to get back out and do things and engage in things is enhanced. Absolutely. Okay, so now I just want to know, let’s break down exactly how this works. What is the mechanism by which the active strength training is reducing that joint pain?

Okay, so first of all, when we move a joint, we release synovial fluid. So, fluid is basically the lubricant within the joint. So, of course, osteoarthritis is a bit of a vicious cycle of we don’t move because we’ve got pain, but then because we don’t move, we don’t release synovial fluid and kind of lubricate the joint. Well, Again, we talked about typical cardiovascular exercise or repetitive movement of walking, running, swimming, cycling. Where that would release synovial fluid, it of course can aggravate the osteoarthritis itself. Whereas resistance training doesn’t do that.

It doesn’t seem to do that. aggravate osteoarthritis in the same way, but it does release synovial fluid. So that’s one of our primary mechanisms. The acute feeling within the joint means that stiffness is reduced, the joint can move easier. Okay, we then of course strengthen the muscles and the muscles stabilize the joint. That’s great.

We reduce load impact. So now that we have more muscle mass and more strength and more stability, we don’t apply the same forces through a joint. Our muscles are now taking that force, which is exactly what they should be doing. So we’re kind of reducing the stress on the joint itself. Our movement is also increasing nutrient circulation. So we talked about the cartilage being avascular before.

As we’re producing movement, we are able to clear metabolites and improve nutrient circulation into the joint itself to promote healing and to promote recovery and to slow any further degradation. So even if we’re not necessarily seeing improvements in the joint itself when we’re certainly not seeing the same degradation over time. And then we can start to get into some of the really quirky ones like suppressing of inflammatory molecules. We’ve talked previously about systemic inflammation. We have this kind of inflammatory molecules acting that are effectively a part of the aging process. They’re part of the catabolic process.

You know, historically, I’ve talked about up to our sort of 30s, 40s, we’re in an anabolic phase. And beyond that, we’re into a catabolic phase where we’re breaking down. Well, resistance training is associated with youth, so it reduces those inflammatory molecules and kind of almost reverts us back to an anabolic and a building phase. And we can think of that in terms of increasing muscle protein synthesis and increasing proteins which suppress the cartilage degrading enzymes. So there’s a lot happening at kind of multiple different mechanisms and they all work in synchrony to ultimately slow degradation of osteoarthritis in the joint itself, but also improve joint health and functionality.

Fabulous. Well, that, I mean, that, that there’s so many ways then it’s helping. And, um, I think, you know, hearing this there, it just feels like it feels like magic again, right. To me, hearing like how a loading and safely strength training, a joint can really change that joint on so many levels. and reverse that joint pain that normally would be happening. Yeah, absolutely, absolutely.

And there’s one final thing that I’m just going to touch on, and I hadn’t talked to you about this before the podcast, but there’s a concept called exercise -induced hypoalgesia. And there’s a body of research that looks at how acutely resistance training can reduce pain, reduce discomfort across the whole body, not just at a joint level. So, and I think we’ve talked about this previously on the podcast in an episode where we talked about the acute benefits of strength training. But one of the key things that we should think about this in context of osteoarthritis is if somebody has knee pain or hip pain from osteoarthritis, then even if they go and do upper body resistance exercise, they’re still stimulating this exercise -induced hypoalgesia, which is to some extent nulling or dumbing down the pain that they might experience at other joints, then allowing them to go and train those joints. less painful sensation. Wow.

So interesting. So interesting. Um, no, yeah. Thank you for adding that in. So yeah, for, I think my takeaway from this episode is, um, you know, if, if you’re experiencing joint pain, one of the best things you can do, even if it feels counterintuitive is safely strength train. You know, and so what would you encourage somebody listening today, Dr. Fisher, you know, who is hesitant to begin a strength training program because they already have some degree of joint pain?

Yeah, of course. So somebody should speak to a trainer or speak to a coach at the exercise coach and start to have those discussions and explain how they feel. You know, I think personal trainers and the coaches are obviously sympathetic and understanding to that, but they’re aware of the potential benefits of resistance training, the multifaceted benefits of resistance training as a whole. Um, so. I think that just taking that initial step to start to engage in it, giving it a try, understanding that it’s certainly not going to aggravate the condition once people can get past that initial kind of fear element, then engaging in regular resistance training is evidence. There’s a clinical body of evidence similar to any other medical evidence that shows that resistance training reduces pain, improves strength, improves joint health, and reduces degradation.

Absolutely. Yeah, I hope if you’re listening to this, you’re encouraged. You know, I we’ve talked in the past about how the strength training is, is very joint friendly. And the reason it’s joint friendly, one of the reasons is that we’re never surprising those joints with heavy loads quickly, like other types of exercise may, it’s very self guided, you’re working only at your own ability level every second of the movement, and it’s slow and controlled, which is adding muscular load, but very, very safe. And so that is what we’re after, right?

Is that progression and no regression. And so that’s what it’s all about. Excellent. Thank you so much, Dr. Fisher, for breaking this down for us today and for teaching us about this topic. I hope you’re encouraged. I do hope that you’ll share this episode.

If you have somebody in your life who’s experiencing any kind of joint pain, let them know, you know, share them, share them this episode, because it doesn’t necessarily need to continue and persist. There is some agency we may have in the way we age, and this is one of those areas. Thank you for tuning in today and we will see you next week on the podcast. Until then, we hope you remember strength changes everything. Thanks for listening. If you enjoyed today’s episode, please share it with a friend.

You can submit a question or connect with the show at strengthchangeseverything . com. Join us next week for another episode and be sure to follow the show on Apple Podcasts, YouTube, or wherever you get your podcasts so that you never miss another episode. Here’s to you and your best health.