From the 47-year-old runner who needs a double hip replacement to the 27-year-old CrossFitter with a ruptured ACL, those who push their bodies too hard often regret it. What are the lessons for the rest of us?<\/p>\n
Jonathan Price has always been active and exercise-focused. Growing up in south Wales, rugby was his first love. Through school, university and beyond, he also surfed, rowed, played squash and ran competitively \u2013 on track, in 10k races and cross-country. Career and family demands meant that much of this fell away in later years, but the running stuck. He found time for marathons, half marathons \u2013 \u201cI\u2019d run a half marathon every weekend just for fun,\u201d he says \u2013 and, through the working week, regular 30- or 40-minute runs to manage stress and clear his head. \u201cI travel a lot for work,\u201d says Price, now 50, a company CEO. \u201cWith running, all you need is a pair of running shoes and you can do it anywhere.\u201d<\/p>\n
By his mid-40s, though, Price\u2019s body was beginning to object. He wasn\u2019t recovering so well. \u201cI could run just fine but I\u2019d be in pain for two or three days afterwards,\u201d he says. On top of this, every six months or so, his lower back seemed to seize up completely. A physiotherapist thought it was \u201ctight hip flexors\u201d and pointed Price towards \u201chip opening\u201d exercises, designed to reduce stiffness and increase range of motion. Someone else prescribed him muscle relaxants, but the pain only deepened, and his range of movement continued to dip. Finally, in the summer of 2023, a chance encounter with a hip surgeon led to the diagnosis of osteoarthritis and, at the end of that year, Price, then 47, had a double hip replacement.<\/p>\n
Was Price unlucky, or did decades of exercise accelerate his joint damage? After so many years, so many miles, and so many cycles of use, had he simply, as his surgeon, Giles Stafford, puts it, \u201chit his number\u201d?<\/p>\n
As a consultant orthopaedic hip surgeon specialising in sports-related hip disorders, Stafford often sees patients who are experiencing joint problems earlier than most. \u201cThey are usually active people who have done a lot of sport and knackered their joints through that,\u201d he says. Stafford likens our joints to bearings in a car. \u201cThere\u2019s clearly a genetic aspect, but also a big mechanical aspect too,\u201d he says. \u201cWe all have a certain number of cycles in us before the damage sets in, and someone who is going to the gym, running marathons, taking on high-impact, high-intensity, repetitive exercise programmes might hit their number younger and faster.\u201d<\/p>\n
Osteoarthritis (OA) is the painful result of the breakdown of cartilage, the smooth, slippery tissue that cushions the ends of our bones so that we can move our joints freely without friction. OA is on the rise. Each year, more than a quarter of a million people in the UK have joint replacement surgery, and by 2060 demand is expected to have risen by 40%. While there is evidence of rising cases in younger people, by the age of 70 one in two UK adults will have OA. For some, that might just mean some stiffness while walking up the stairs. For others, it could mean needing help to wash and dress. In old age, OA will often determine whether someone can live independently and if their final years are spent navigating pain.<\/p>\n
When it comes to causes, though, the picture is confusing. The way we are made is key. Our genes help determine our build, our gait, how we load our joints and where the pressure falls when we move. Genetics are also believed to play a role in the quality of our cartilage and the inflammatory responses that can damage it and drive OA forward. Price now knows that he was born with a subtle shape abnormality that is not uncommon. The ball of his hip joint\u2019s ball-and-socket wasn\u2019t quite spherical, so it didn\u2019t rotate smoothly without friction, which quietly, over time, accelerated damage with each cycle of use. Beyond genetics, though, is asking too much of our bodies, or asking too little raising our OA risk? Should we worry about over-exercise, not enough exercise or the wrong kind of exercise? The answer, unfortunately, seems to be all three.<\/p>\n
A sedentary lifestyle is a major driver. This is partly due to OA\u2019s link with obesity, which increases the weight on our joints, and raises inflammation, but exercise matters beyond this. Cartilage relies on synovial fluid \u2013 joint fluid \u2013 for its nourishment, and we need to move around in order for that fluid to circulate. \u201cSitting for long periods of the day also seems to cause metabolic changes that are pro-inflammatory,\u201d says Dr Benjamin Ellis, consultant rheumatologist at Imperial College Healthcare in London. Building strength and muscle also acts to absorb impact and stabilise our joints. \u201cOur joints, our bones, our bodies strengthen under challenge and that is done by tiny micro-injuries,\u201d says Ellis. \u201cThe body goes in to heal them and that healing builds bone and muscle.\u201d<\/p>\n
On the other hand, if we overload the body\u2019s capacity to heal, or sustain too great an injury, we\u2019re back in the OA danger zone, though it may take decades for the effects to be felt. An anterior cruciate ligament (ACL) injury \u2013 a tear or sprain in the centre of the knee \u2013 is one example. Professional footballers, who are prone to ACL injuries, have two or three times the average risk of OA in later life. Research also points to a raised OA risk among competitive runners \u2013 while recreational running seems to be protective. (Unhelpfully, the definition of \u201crecreational\u201d and \u201ccompetitive\u201d varies between studies.) Many orthopaedic surgeons \u2013 Stafford included \u2013 recommend cycling, swimming or an elliptical trainer over running, or running on grass or a treadmill rather than tarmac to soften the impact on our joints.<\/p>\n
According to David Vaux, an osteopath, consultant for Arthritis Action and author of Stronger, exercise in midlife should be viewed a bit like a dosage of medicine. \u201cIf you do too much or too little, you\u2019re going to be in trouble,\u201d he says. \u201cThe main thing I see in clinic are people who are injured, and people who are burnt out \u2013 and those two things are kryptonite in midlife.\u201d Both can lead someone to stop exercising altogether, or to keep going too hard before they have recovered. Either can result in OA.<\/p>\n
For most midlifers, says Vaux, a healthy exercise programme is steady and consistent, with plenty of built-in recovery time. He says: \u201cIt can look quite boring, but boring is good.\u201d<\/p>\n
Saket Tibrewal, a consultant orthopaedic surgeon at Cromwell hospital in London who specialises in the knee, makes a similar point. \u201cAs we get older, our capacity to heal takes longer,\u201d he says. \u201cI do see a lot of runners who have taken it up in the last few years, and are starting to get knee pain and knock-on effects. They might be going for a run, then doing it again the next day, or maybe just having one day off. A lot of people don\u2019t understand how important recovery is.\u201d<\/p>\n
Several orthopaedic surgeons have expressed reservations about high-intensity, high-impact exercise programmes. \u201cAnything that involves a lot of deep-weighted squats, and repeatedly taking your body to end range under load, can damage your joints,\u201d says Stafford. Gareth Jones, a specialist knee surgeon at Imperial College, has seen patients in their mid-20s and early 30s who have already lost a lot of cartilage from under their kneecaps through following such programmes. One of Tibrewal\u2019s patients is Naomi Pannell, 27, who recently tore her ACL competing in a CrossFit event.<\/p>\n
\u201cI was in the semi-finals in Madrid, my biggest competition yet,\u201d says Pannell. \u201cIt happened on day three, the last day, in 36C heat.\u201d Pannell and her partner had completed the chest-to-bar pull-ups and the double-unders (like skipping except the rope passes under your feet twice in one jump) and next came four rounds of \u201csandbags\u201d (lifting a heavy sandbag from the floor and resting it on the shoulder). \u201cWhen I went to lift the sandbag for my second round, my knee popped out and popped in again,\u201d says Pannell. \u201cI didn\u2019t fall to the floor. I went to lift it again and it did the same thing.\u201d She completed some of the remaining circuit \u2013 including a handstand walk \u2013 and by the end her knee was badly swollen. \u201cWhen I found out it was a full ACL rupture, I spent a week crying,\u201d says Pannell. \u201cI\u2019ve never had an injury in my life.\u201d Tibrewal, who will be operating on Pannell, blames fatigue. \u201cThese programmes are very good for cardiovascular fitness and strength, but they involve high repetition and high loading, and fatigue is a badge of honour,\u201d he says. \u201cAfter multiple rounds, if you\u2019re pushed to the point where your muscles are really tired, then you can lose neuromuscular control of the joint. You lose proprioception \u2013 your body\u2019s internal awareness of where it is in time and space \u2013 and that\u2019s when something simple that you\u2019ve done many times before can go wrong.\u201d<\/p>\n
According to Vaux, a healthy midlife exercise regime that\u2019s protective against OA involves \u201csteps and reps\u201d. \u201cA walk, a jog, a bike ride a couple of times a week and you need strength training, too. I usually prescribe following an isometric-only strength programme \u2013 such as wall sits and planks, which you can do anywhere \u2013 for at least two months before you do anything more dynamic [in terms of strength training]. If someone is doing that, I\u2019ll take that person\u2019s chances on healthy joints in 20 years\u2019 time over anyone doing anything extreme and get-fit-quick.\u201d<\/p>\n