New research suggests that one in five people views joint pain as a normal part of ageing – that jolt in the knees halfway up the stairs, the ache in the back after hours at a desk. In fact, back and neck pain, as well as pains in the legs and feet, are now a leading cause of sick leave amongst the over 50s.
Yet ageing doesn’t have to be so painful – and the concern amongst health professionals is that this resignation leads us to slow down and do less while reaching for painkillers instead. This is the worst action to take – or not to take – says David Vaux, therapies manager and exercise lead for Arthritis Action, whose book Stronger will be published by Hachette next year.
“Exercise is the most effective medicine we have for prevention and management of joint pain,” he says. “Think of the body as a human machine. Rust sets in and the engine starts to fail if it isn’t used. If you’re not in the habit of consistent training or regular activity by middle age, then that is really the time to start.”
This doesn’t mean, of course, that age-related wear and tear won’t happen. More than 10 million people in the UK have arthritis, and the most common form, osteoarthritis, will affect half of us by the age of 70. Uncommon before middle age, osteoarthritis occurs when the cartilage that cushions the ends of bones gradually thins. (The other type of arthritis, autoimmune arthritis, which includes rheumatoid, occurs when the body’s natural defence system attacks the joints, causing pain and inflammation.)
“But this doesn’t mean that our joints have to be problematic as we get older. Our joints are complex living tissue that can repair and maintain,” says Larry Koyama, physiotherapist and MSK (musculoskeletal) champion at Versus Arthritis. “Regular movement and exercise builds muscle and strength, improves bone density and increases mobility. It really is a case of use it or lose it.”
So what are the best exercises to prevent joint pain?
Ease those creaky knees
The knee joint carries the whole weight of your upper body, so it’s particularly vulnerable to wear and tear. An estimated 5.4 million people in the UK have knee osteoarthritis, compared to 3.2 million with osteoarthritis in the hip.
Contrary to what you might have heard, knee pain is not caused by running – research has shown that recreational runners have less chance of developing knee arthritis than sedentary people. “If running makes your knees hurt, then maybe walk on a treadmill. But if running isn’t causing pain, don’t stop,” says Vaux.
High heels tend to cause pain in the Achilles and the lower back, rather than the knee.
Best exercises for your knees
“The wall sit works through static isometric contractions – that’s where you contract a muscle group and hold it in the same position for the duration of the exercise,” says Vaux.
“Stand with your back flat against the wall, engaging your abs, so your lower back is right against the wall. Slide down until your thighs are parallel to the ground. When it comes to how low you should go, imagine you’re sitting on a chair and stop there. “Do a couple of sets, each time holding for 30 seconds or so,” says Vaux. “Try adding 10 seconds each time you do it so that you get up to two minutes.” Aim for two sets of two-minute wall sits twice or three times a week.
If you are starting to find this easy, progress to bodyweight squats. You can use a chair to get started and use additional cushions to make things easier to begin with – taking the pillows away as squatting becomes easier.
Keep your hips supple
The ball-and-socket gives more movement than any other joint and the hip joint is the body’s largest. It bears nearly all of our weight, allows for a large range of motion in our legs and also stabilises the connection between the upper and lower body.
Arthritis is the most common cause of hip pain – especially osteoarthritis, where the cartilage in the joint is worn away and the bones start to rub together.
“It’s also not uncommon to find that pain you are experiencing elsewhere is actually caused by a hip joint problem,” says Vaux. “The hips can often refer pain to the knee or the groin or down the leg.” Hip pain can make everything difficult – getting dressed, doing up your shoes, rising from a chair.
“Knee lifts are a very simple and effective hip exercise,” says Koyama. “You can do them lying down or standing up while holding on to something for balance, then raise one leg and bring one knee to your chest.” Hold that position for 30 seconds. Try two to three sets on each side.
Best exercises for your hips
“The hip thrust strengthens the gluteus maximus, which is the biggest muscle in your body, and important movers and stabilisers of the hip joint,” says Vaux. “It supports the hips, helps keep them stable.”
Start with your back to a bench or sofa with your knees bent and feet shoulder-width apart. Then drive upwards in a thrusting movement so that the front of your thighs are in line with your abdomen and chest.
Lower under control to the starting position. Try two to three sets of 10 two or three times a week. You can progress from your own body weight version (if this become too easy) by trying a single leg version of the same movement. For the weighted version, place a weight or household object onto your pelvis and hold it in place with both hands.
Banish backache
“Back pain is very common and will affect most of us at some point,” says Koyama. “The causes can be complex.”
Pain might be caused by an accident, a muscle strain, a sports injury or poor posture. Spondylosis – the term for spinal degeneration – is an age-related condition that is very similar to the changes caused by osteoarthritis in other joints. The discs in the spine thin, the spaces between the vertebrae narrow and cartilage breaks down between the facet joints.
“If we set ourselves a good strengthening programme in middle age and stick to it, we’re much less likely to get back pain,” says Vaux. “Yoga is good for maintaining the flexibility of the lower back and building a strong core – the ab muscles and lower back which interact to keep posture stable. A stable core is like a strong scaffolding and it massively reduces pain from spinal degeneration.”
Try also to avoid long periods sitting down.
Best exercises for your back
Repeated studies show the plank is highly effective at strengthening the muscles which stabilise the spine. It works on the core at the front and the glutes behind while significantly reducing the risk of back injury and back pain.
Adopt a push-up position, with wrists and elbows stacked under the shoulders. Push through your hands and squeeze your core by pulling your belly button towards your spine. Keep your torso straight, with no sagging or bending. “Hold for 30 seconds, but aim to build this up over time to two minutes. Repeat two or three times a week,” says Vaux. To make this harder, try a side plank.
Shrug off shoulder pain
“Shoulder pain is very common in office workers,” says Vaux. “We sit at our desks and slide into a C-shaped slump.”
If your posture is poor and you haven’t committed to strength training, weakening shoulder muscles can cause smaller muscles to take on the slack and tighten, including those in the neck – shoulder and neck pain often come together.
Best exercises for your shoulders
“With shoulder exercises, you really need to strengthen all the major muscles, the front and back, for the full range of motion,” says Vaux.
Start with the wall or box press-up. For the wall press-up, stand facing a wall or high-backed chair, lean into the wall or chair and place your hands shoulder-width apart – start the exercise from here.
To make things slightly more tricky, progress to press-ups: from a kneeling position, place your hands on the normal press-up position and, keeping the kneeling position, start your exercise from here. Move on to full press-ups – get on the floor on all fours, positioning hands slightly wider than shoulders. Extend the legs back so you are balanced on your hands and toes, feet hip-width apart. Slowly bend your elbows and lower yourself to the floor. Push back up to the start position. Aim for two or three sets of 10 twice a week.
Relieve elbow pain
Osteoarthritis is not common in the elbow. The most common type of elbow pain is known as “tennis elbow” (there’s also “golfer’s elbow”) which occurs when any repeated physical activity or work task puts pressure on the tendons near the elbow joint.
Best exercise for your elbows
“One of the causes of elbow pain is lack of strength in the forearm muscles and weak grip strength,” says Vaux.
Take two shopping bags, fill with something heavy and lift them, one in each hand, as if standing to attention. Hold for 30 seconds. To progress that, walk around a route in the garden or your home, still holding. Aim for moderate difficulty – six out of 10.
Once you can do this easily, try using the same bags but loop tea towels through the bag handles, using the tea towels to grip, and carry as previously.
Strengthen your hands
Hands are complex, delicate structures – 27 small bones make up the hands and wrists, and more than 30 muscles are involved in controlling them. Osteoarthritis can affect hands and wrists, particularly the joints at the ends of the fingers or the base of the thumb, causing pain and stiffness. Keeping them moving as much as possible will help maintain movement, strength and function.
“Very simple things are helpful here,” says Koyama. “Take a small soft ball and squeeze it for 10 seconds; repeat two or three sets about twice or three times a week.”
Best exercise for your hands
“Wringing a towel is good for hands and grip strength, and also wrists, elbows and forearms, as the muscles here are all very connected,” says Vaux.
Stand or sit up straight with your elbows bent at your sides. Grip a rolled-up towel firmly with both hands and slowly twist it one way and then the other as if you are wringing water out of it.
Are there exercises to avoid?
It’s not about avoiding any exercise – finding one you enjoy enough to stick with is key, says Vaux. “But whatever it is, it should be regular and in moderation. Training really hard, pushing yourself to the maximum is the worst thing you can do as that’s when you get injured and that forces you to stop.
“The whole ‘train hard or go home’ thing is such an unhelpful narrative for joints. Just as crash diets don’t work in the long term, crash exercise programmes never win. Think tortoise, not hare. You can’t have longevity without good joint health and that comes with consistency and moderation.”
