By the time people have got desperate enough to see me in clinic their activity, has, almost without fail, reduced:

‘I used to walk 5miles on the coast path, but now struggle to walk the dog around the block’ 

or

I’ve stopped playing golf. I was just about making 18 holes with a buggy until the start of the year.’

 
People limp into clinic and tell me they can’t do as much as before because their hip or knee hurts. But, as a simple statement of fact:


Most people are doing less.

Early on, I started wondering if we  get cause and effect the wrong way 'round. Hips hurt because people are doing less.

No one gets any better by doing less.

At least not anyone who limps into my clinic. 

Generally speaking, their pain gets worse as people do less, often in a downward spiral of pain. 


People do less, get more pain, so move less and hurt even more. 

When you unpick the last year or so for most patients it’s often a gradual decline:
 
‘I used to walk 5miles on the coast path…
…then I started to struggle with the hills...
...but could still walk the dog on the flat… for miles...
...then my walks got shorter and I had to give up yoga...
...but I kept some cycling going. Then I tweaked my knee before Christmas...
...and now struggle to walk the dog around the block.’ 

or
 
‘I’ve stopped playing golf…
...last year my hip really ached at the end of a round...
...but with a buggy I could still play 18 holes…
...I could walk 9 holes but would be really sore the next day...
…I could cycle for an hour or so with friends on a Sunday 
...but now everything’s stopped.
I can’t even get to the gym, and I’ve put on a stone and a half in weight.’
 
Pain and activity are interlinked, and the relationship is complicated. However, I believe...


We get pain and activity the wrong way around.

Not so much =>     Pain leads to less Activity.
More like =>           Less Activity leads to Pain.
 

Let’s take a stab at what is going on...

We decrease our activity and move less.
We lose muscle tone and strength.

• Strength in our back and core muscles.
• Strength in big muscles that cross our hip,
• Strength around our knee: quads and hamstrings, and
• Strength in the muscles of our lower leg and feet. 

Everything becomes deconditioned.

 
And joint pain isn’t always a constant ache. The pain catches us on uneven ground, up or down hill, up or down stairs.

Pain catches- often with an ‘OOOOoooooffff!’ and a sharp intake of breath.


Strong leg muscles need to take the strain.

Strong quadriceps, or quads, at the front of the thigh control force around the knee. The quads pull to absorb shock as the leg strikes the ground.

If those muscles are weak, more of that extra force jolts through the joint. That’s what people describe to me when they say that their knee (or hip) gives out on them. That principle applies to any joint.
 
Picture that 'jolt' repeating several times a day and to a lesser extent with every step:

Peak forces shoot through the joint.

More inflammation: or deep-seated heat, swelling and pain.

The pain part of that inflammation naturally makes people want to do less. 

And a downward spiral begins.


Inflammation is what it's all about.

Minimising or soothing  inflammation is what our treatment strategy needs to be about.

This approach bets on stronger muscles to take the strain and sooth inflammation.
 
The specifics of this are difficult to test. It is difficult to study what is going on in a living, moving arthritic joint. However, the evidence from newsletter #009 and #010 is firmly behind stronger muscles taking the strain and soothing joint inflammation.

Valerie in newsletter #012 was that person. Valerie's weak deconditioned muscles ‘used to walk 5miles on the coast path’ but then spiralled downward. 

And now..

She's flipped that spiral...
She cycles a daily lap of her island,
She enjoys a daily dip in the Atlantic Ocean with friends.
She's no longer on my waiting list for joint replacement. That's music to my ears :)

On its own her story is only weak evidence that moving more can turn things around.

However, combining her story with 1000s of others produces compelling evidence for moving more.

Valerie, and more than 8000 people like her show how a downward spiral can be flipped upwards.

I hope you and your family have a lovely New Year.

It's a good time to move more and eat better. I hope that these newsletters add weight to our collective motivation!

That motivation is amplified if close family and friends join us. As a first step, forward this newsletter onto them and nudge them to hit the Subscribe button below

And anyone can catch up on my first 12 newsletters at www.danhwilliams.com/#subscribe