It’s Time to Rethink “Wear and Tear”

Medical mysteries have always intrigued me. And it turns out that there is still lots of mystery swirling around osteoarthritis, a disease that is so common that it’s often considered a normal consequence of aging. Rates of osteoarthritis (OA) in the knee have more than doubled in the last 60 years, which is a mind-bending increase. The usual suspects — you guessed it — include age, obesity, athletic injuries and the most commonly cited cause…wear and tear.

New research, just published in the prestigious Proceedings of the National Academy of Sciences, suggests that the perennial culprit — wear and tear — is probably grossly overstated and most likely not the cause of arthritis that it is so widely believed to be.

In addition to busting myths about wear and tear, this study also wisely pointed out that OA in the knee is much more preventable than is generally assumed. We’ll dig a little deeper into this topic, and I’ll share some of my top tips that can help you prevent and treat this painful condition, but first a few startling stats:

50 percent of adults will develop OA in the knees.
25 percent of adults will develop OA in the hips.
More than 27 million Americans suffer from osteoarthritis.

That’s a whole lot of suffering.

What is Osteoarthritis?

Osteoarthritis is considered a degenerative joint disease, which involves cartilage destruction, bone erosion, and inflammation of the surrounding tissues. It can be severely painful and quite disabling. It usually affects older people, but it can strike at any age. My practice is full of patients with OA…and their symptoms run the gamut from nearly imperceptible to totally disabling.

New Evidence Overturns Conventional Explanations About Arthritis

The conventional medical wisdom is that OA is the result of joint stress and overuse. The idea is that with years of activity, cumulative injuries, and overuse — especially in overweight or obese people — that the joints simply wear out over time. The “wear and tear” hypothesis is certainly a plausible assumption, but the evidence just doesn’t bear it out.

Dr. Daniel Lieberman, an evolutionary biologist at Harvard University, is a research scientist who has long been interested in chronic illnesses that are the result of our bodies being poorly adapted to the environments in which we now live. These “mismatch diseases” include a wide range of illnesses and conditions including minor problems like nearsightedness, plantar fasciitis, or back pain to life threatening illnesses like heart disease, diabetes, and cancer. Almost all of our modern chronic diseases can, in some way, be attributed to a mismatch between the environment that evolution equipped us to live in, and the modern surroundings in which we currently live.

Dr. Lieberman had an intuition that arthritis fell into this category as well, but he didn’t have any data to back up his theory. So, to test his hypothesis he enlisted the help of his colleague Dr. Ian Wallace, a post doctoral evolutionary biologist, to dig up (quite literally) evidence in the form of bones of early hunter gatherers who roamed the Americas as many as 6,000 years ago.

The theory Lieberman and Wallace wanted to test ran like this. Hunter gatherers most certainly engaged in lots of running, squatting, and twisting type activities. Presumably, then, we would expect their joints to demonstrate evidence of wear and tear and associated osteoarthritis. But that’s just not at all what Wallace found when he examined ancient skeletal remains. As he explained, “I was actually extremely surprised to find that [osteoarthritis] is much more common today” than it was in hunter gatherer type societies.

After seeing the evidence, Dr. Richard Loeser, a rheumatologist who directs the Thurston Arthritis Research Center at the University of North Carolina, took aim at the conventional wisdom by saying, “Your joints aren’t just like your automobile tires that wear out as you use them.”

Naturopathic physicians like myself have long maintained that exercise and physical activity are not the problem but rather a part of the solution in osteoarthritis. I have said over and over that “movement is medicine” and this new research proves that point. Dr.Lieberman, sums up this view well when he says “If I were a betting man, I would guess physical activity is especially important. One of the things that’s really shifted in our world today is that we sit all the time, and kids sit all the time. And that may be affecting how our joints are forming and how our joints are aging.”

It’s very unfortunate, but in the past arthritis sufferers have been told to used to limit movement, on the assumption that less wear and tear was good for them. It now appears that lack of physical activity may actually contribute (or even cause) OA.

Movement is Medicine

Prescriptions do not only come in bottles from the pharmacy. Movement is medicine in the true sense of the word, and it is especially good medicine for osteoarthritis. That’s because cartilage does not have a robust blood supply and must get nutrients from the synovial fluids that bathe and lubricate the joints. It’s exercise and activity that helps nutrients diffuse into cartilage in the knee, which is what keeps it both strong and healthy.

So, if you want to prevent and even alleviate OA your knees, then here are a couple of foundational lifestyle changes and activities you may want to consider:

Walking, swimming, bicycling…every day!
Tai Chi: The benefits of this ancient practice have been verified by volumes of modern research.
Dietary choices (curtailing processed foods in favor of real whole foods)
Weight loss (to put less stress on the joints).
Foods, herbs, and nutritional supplements that counteract inflammation.
- Turmeric is an essential oil that is rich in curcumin, which helps protect joints against inflammation.
- Quercetin is a bioflavonoid found in many fruits and vegetables. A recent study found that 500 mg a day helped alleviate arthritis symptoms in women.
- Boswellia (also known as Frankincense) is an herbal extract with analgesic, antioxidant, and anti-inflammatory properties.
- Bromelain is an enzyme extracted from pineapple which has been shown to reduce joint swelling and relieve pain in arthritis patients.

Takeaway

Despite its prevalence, there are still lots that we do not know about osteoarthritis. To date, it remains unclear why rates have doubled in recent decades…but my hunch is that obesity, poor diet, and our modern sedentary lifestyles are important factors.

One thing we now know, though, is that the notion that “wear and tear” causes arthritis is largely a medical myth. We should replace the tired old wear and tear rhyme with the much more important (and more poetic) phrase, “movement is medicine.” When you use movement to strengthen your muscles and stimulate your cartilage, you can absolutely improve the health of your arthritic joints.

The evidence is clear… more movement — not less — will help prevent and treat OA.