[Original newsletter post date: 10/22/20. Key principles in prehabbing if older than 40 – pbk]
A patient of mine raised a question about joint health, and thus this post was born 🙂
Joint health is a topic of special interest to the athletically inclined — if you’re athletic for long enough, your joints will protest — so if you don’t consider yourself an athlete, you might be tempted to skip this article.
But many of us think about our joints only after they get hurt. That’s like focusing on boxing strategy in the last seconds of a 2 minute round — after you’ve taken some dings to the head.
A theme I’ll be revisiting is Getting Ahead Of The Game: “prehabbing” instead of “rehabbing.” That’s true for maintaining joint function, but it’s also as true for preventing chronic diseases, upping your odds of meaningful longevity, and maintaining mental and emotional well being. It’s much easier to maintain smooth functioning than it is to fix what may be irreversible damage. Prevention, rather than a dicey late repair.
1. Use it or lose it
This is key, and I don’t know any trainer who believes otherwise. If you can do your chosen activity, you should absolutely keep doing it, whether it’s walking or kung fu. You may have less gusto than you did in college, or before you got injured and developed scar tissue. But if you completely stop, you are guaranteed to lose not only your strength and stamina, but also your flexibility and joint mobility.
Joints want to stiffen. If you’ve ever worn a cast and been stunned with how stiff you were when the cast came off, you’ve experienced this firsthand. Each joint is surrounded by a tough sack that prevents it from bending the wrong way, and the sack acts like it’s constantly trying to play shrink wrap. If your could touch your palms to the floor in high school thanks to years of gymnastics, then spent the next 20 years working at a computer, you’d very likely have trouble touching your ankles.
2. Go slow and stay smooth
I learned this from my Brazilian jiu-jitsu trainer, Jerry Wetzel. A number of injuries happen when you find yourself in unusual positions, and your body panic pulls your limbs back with 110% muscle force, when the connective tissues may only be up to 75% strength. I learn a new activity by taking the involved joints through the full range that the target activity demands, under control with minimal resistance to start, slowly and playfully. I get familiar with odd positions and not hyper-clenching in them. By going there slowly enough to stop and reset at any moment, the central nervous system learns that nothing bad happens at the extremes of motion and that there’s less need to spasm. And it’s no accident that slow and smooth training also develops the stiffer connective tissues and muscles that haven’t had to move in those ranges for a while.
3. Give your structures time to adapt
Take as long as the slowest adapting structure in the chain, or the weakest link. For most of us, this will be the ligaments and capsules, that tough unyielding sack. By the time this part has adapted, the connected tendons, muscles, and nerves will have long since adjusted themselves.
Right this minute, I’m taking on a new form of archery: shooting arrows Asiatic style by holding the string and arrow at full draw using my thumb instead of 3 fingers in the more common Mediterranean way. It’s like starting over for many reasons, but the biggest hurdle is, you know, one digit instead of three. My “starter” Mongolian bow is half the draw weight of my usual bow, because the pressure on the slowly adapting joint capsule in my poor solitary right thumb is THREE TIMES THE PRESSURE of what I’m used to.
But, I’ve been at this a few days, and created a systematic program to build up the thumb ligaments, modify the circulation in the thumb pad, and toughen the skin like a guitar player’s callouses, and it already feels more tolerable. Trying from Day One to pull a 50 pound hunting bow with my thumb would have been debilitating, even though I’ve already successfully pulled a 65 and 75 pound English warbow with a 3-fingered grip. It’ll be a month or two before I can pull a 25 pound Asiatic bow with my bare thumb, because that’s how long it takes for the soft tissues to adapt to a demand that’s challenging but not ridiculous.
4. Consider the 10% rule
A trainer I respect and follow, Steve Maxwell, advocates increasing a training load no more than 10% per week, maximum, and for some exercises, no more than 5% per uptick. Strength trainers like Mark Rippetoe have even advocated advancing by 0.5-1 pound increments for advanced trainees. It’s the famous overload principle: in a controlled training setting, challenge the muscle by a little bit more than what it can currently do, and the body will adapt to meet and slightly exceed that workload for next time. Try to do too much, and watch out for something going sproing! in short order.
Why go up so slowly? Again, because the ligaments take longer to adapt than muscle tissue. Advance at ligament speed and the muscles will already have adapted. Everything is being challenged by the exercise after all, since the force is transmitted to the muscles, tendons, ligaments, joint surfaces, and skin.
5. Consider not stretching
I had a Kali stickfighting injury as well as a jiu-jitsu training injury where a finger and a knee joint got hyperextended. They healed fine, but both joints are a little too eager to open up backwards if I’m not careful. If anything, I’d prefer those joints to be a little stiffer; they certainly don’t need more extension.
Be mindful of what range of motion your activity of choice needs. If it doesn’t require Cirque du Soleil levels of Gumby-hood, I’d be hesitant to go to extremes. Your muscles have certain range that they can pull you back from — beyond that and the mechanical disadvantage becomes too great to protect the joint.
Include active strengthening. Passive stretching has its place, but keep in mind that rehabilitating a stiff joint by taking it just past the point of comfort and then relaxing into the hold for a minute or more…isn’t how you’re actually going to use the joint. You’re going to be moving and probably contacting a number of muscles in a dynamic activity. So taking a joint somewhere unpleasant and then going completely slack may not be the best habit to develop.
6. If it hurts, find another way
There is a difference between 1) the pain of long disuse, 2) the discomfort of stimulating an adaptation, and 3) the pain of going too far. Here is where a medical professional’s input can be invaluable, particularly if you don’t have experience listening to your body: some discomfort should be worked through, but certain pains are a signal to stop immediately. If you aren’t entirely sure of the difference, get a professional opinion.
But as a general, Captain Obvious rule of thumb, if it really hurts, don’t do it and get it checked out. And if it’s “just” uncomfortable but persistently so, you should get it looked at or modify your technique so it ceases being uncomfortable.