Once joint pain sets in, many everyday tasks become more difficult. So, what can you do to prevent it from happening in the first place? We spoke with preventive medicine specialist Prof. (DHfPG) Dr. Thomas Wessinghage – who, as a former competitive athlete, focuses on one thing above all else: movement, as often as you can literally "manage it."
About the Person
Prof. (DHfPG) Dr. med. Thomas Wessinghage (born Feb. 22, 1952) is a medical specialist in orthopedics, physical and rehabilitative medicine, and prorector at the German University for Prevention and Health Management in Saarbrücken. As a former track-and-field athlete, he won the gold medal in the 5,000 meters at the 1982 European Championships in Athens. Sports and exercise are an integral part of his daily life. He works out five days a week.
Medicom: Prof. Wessinghage, the saying goes "Nothing works without movement!" – is there any truth to that?
Dr. Thomas Wessinghage: A great deal! We live in an age where movement seems to have become superfluous. If we look back, it used to be very different: Around the turn of the century, the average German still traveled about 20 kilometers a day. Today, it's just a few hundred meters. Instead, we spend a lot of time sitting. As a result, certain functions grow stagnant. Organs no longer function properly, the musculoskeletal system suffers, and muscles atrophy. This leads to all sorts of problems that we group together today under the umbrella term of civilization diseases.
To what extent has the situation further deteriorated due to the coronavirus pandemic?
As significant as the coronavirus pandemic may seem to us, it is only a footnote in nature. We have now had to deal with a conglomerate of pathogens – but that is truly nothing new. We have had much worse epidemics throughout history. But one thing cannot be denied: our lifestyle has changed. A study by the Technical University of Munich was able to demonstrate that the average German gained about five and a half kilos during the lockdown – and those who were already overweight gained seven and a half kilos.
What does this mean for the relationship we actually ought to be cultivating with the topic of exercise – especially in light of the pandemic experience?
That is a question you should ask a sociologist. For me as a physician in the field of prevention, it is more a matter of what we can do to get rid of the excess weight and make the joints mobile again.
However, we don't really know yet how people have actually reacted to this. It seems as if there are clear improvements and increased interest in certain areas. Personally, however, I cannot confirm that. And I always have an issue with survey studies in particular: some people might tick a box saying they cycle more because they rode their bike to the bakery once two and a half weeks ago. From that, it is concluded that people are exercising more.
Nutritional studies are also barely useful these days, because it is well known that one should eat more fruit and vegetables – and people answer accordingly. Even if reality looks different. In short: I am skeptical as to whether the pandemic really had or has a major influence on our exercise habits.
You are a former professional athlete, track-and-field star, European champion, and have an impressive running career to your credit. What does being "in motion" mean to you personally?
Movement has been part of my life since I started doing it more or less by accident 56 years ago. My competitive sports career lasted about 20 years and gave me a lot of joy. When I stopped competitive sports at 35, I didn't give up running. I have never really moved less than three times a week – for the last 22 years, it has been closer to five times a week. This means that the coronavirus pandemic certainly had no influence on me and my exercise habits.
A joint is healthy when we don't feel it.
Medically speaking, when is a joint still considered fit?
A joint is healthy when we don't feel it. During my studies, I learned that everyone in their fourth decade of life has at least one arthrotic joint in their body. However, this does not mean that this joint necessarily causes problems. Osteoarthritis is primarily a completely normal process in which the joint gradually shows recognizable signs of aging. This does not have to be accompanied by pain. But it can mean that the joint’s resilience is limited. What we observe today is: many joints give up the ghost very early on. Every year in Germany, we have over 400,000 surgeries in which joints are replaced with artificial ones. That is much more than it needs to be.
Let's turn to the topic of prevention: How can we prevent the development of joint problems?
Movement is an indispensable component of preventive behavior. Much in the body follows the principle of "Use it or lose it!" If we do not use our joints according to their intended purpose—that is, if we do not walk and move sufficiently—we must expect impairments. However, it is also crucial to make this movement possible in the first place. For this, it is necessary to strengthen our muscles. Joints are passive structures that are only moved into flexion, extension, or rotation by the muscles. Good musculature also protects the joints. It surrounds the limb joints like a cuff. In other words: when the muscles are in shape, so are the joints. But if I don't use the muscles, they first become weaker, and secondly, the joint will suffer from a lack of movement. Then, problems will inevitably arise in the joints – perhaps even earlier than in other functional areas.
“Use it – or lose it!”. If we do not use our joints according to their intended purpose—that is, if we do not walk and move sufficiently—we must expect impairments.
What role does body weight play?
For "fit joints," it is just as important to keep your body weight in check. Increased body weight places an extra load on the joint. If we imagine that we multiply our body weight by three to five times when walking briskly, it is easy to guess that even a few extra kilos can have an impact on the joints in the foot, knee, and hip.
In summary: if we keep our bodies in a good functional state, our joints are also in good condition. The exception: we do something that very often involves small, medium, or large injuries – such as in sports. Joints do not like injuries. Here we are talking about micro-traumas, which become problematic as soon as they add up.
I like to give the following example: Let’s take a soccer game among senior players. Twice the player misses the ball and hits the opponent’s leg instead, twice he steps too hard, twice he trips, twice he slips, twice he is fouled, twice he fouls someone himself – and that’s how quite a few micro-traumas accumulate, which get burned into the "memory" of the joints. They will eventually make themselves felt.
Against this background, is strength training particularly recommended beyond the age of 40, 50, 60, or even 70?
Yes! We know from studies that people primarily build strength in the first two to three decades of life. The maximum strength is reached around the age of 25 to 30, followed by a plateau – and by the fourth decade of life at the latest, our strength diminishes. If we now assume the joint-stabilizing cuff function of the musculature, this means that stability in line with the axis is guaranteed less and less.
And this is where strength training comes into play: it can be used sensibly at any age. First for building strength in young years, for treating back problems in adulthood, and at the end of life, the availability of strength is basically more important than ever before. Strength enables us to participate in life. And it puts our joints in the functional state we desire. Over time, I have liked to phrase it to my patients like this: If you are sitting in an armchair right now, maybe everything is fine. But if you lack the strength to get up from the chair and enjoy life, then you would have to wait until life comes to you – and it probably won't come that quickly.
Is there a difference in strength training between women and men?
Yes, there is the fundamental difference: for the same body weight, men have 15 percent more muscle strength than women. Consequently, strength training may be all the more necessary for women. Example: A particularly delicate joint from a biomechanical perspective is the knee, because they are equipped with very long levers. When walking, our body weight must be stabilized on one side at a time.
In women, for anatomical reasons, one tends to see more knock-knees, while in men one tends to see more bow-legs. Imagine that the person in question gets older; then it becomes more difficult to maintain the leg axis, and so we see a clear deviation. This goes hand in hand with the tendency toward muscle loss. In this respect: if women notice a tendency toward knock-knees, then it would be the right time—as long as there is no pain—to start strength training and ensure that it does not progress. The greater the deviation from the straight axis, the more difficult it becomes to bring the whole thing to a halt.
Are there also joint-friendly endurance sports?
Endurance training is primarily an organ workout. We need good cardiovascular function as well as a good metabolism – and this is where endurance training has the greatest impact. With about 500,000 heart attacks and strokes in Germany per year, more than 8 million diabetics in Germany, and about two-thirds of the population being overweight, endurance training is a top-tier health-maintaining factor.
However: endurance training also requires a basic level of strength. Whether hiking, walking, running, speed walking, jogging... we need strength to stabilize the joints and to be able to do anything that one would call endurance training. The positive aspect of endurance training is evident when looking at the nourishment of the joints: endurance training ensures better nourishment of the entire organism – including the joints.
The loading and unloading of the joints while walking is thus also a health-preserving measure for the cartilage. Because it has no independent blood supply and is only nourished through compression and relief. Only in this way can I count on a good lifespan. Conclusion: Endurance training and strength training complement each other quite well, but strength training is a prerequisite for sensible endurance training.
The loading and unloading of the joints while walking is thus also a health-preserving measure for the cartilage.
Your wish: How should the topic of movement be handled in social perception in the next five years?
I have to tell another story: In Bristol, UK, it was discovered that non-alcoholic fatty liver disease is a medical problem, as about 20 percent of young adults suffer from it. The German Medical Journal reported on this with the side note that there was no medication to treat this condition yet, but that they were working on it. That made me incredibly angry. Because: the best measure against non-alcoholic fatty liver disease caused by a lack of exercise is movement.
You don't need scientific research for that. To treat such things, you need calls to action and an awareness that these young adults should please move. In lectures, I like to put it this way: I would have sent those affected from Bristol to Glasgow on foot; then half of them would have been healthy – and I would have sent the other half back on foot.
There are very simple possibilities; we don't always have to make everything so complicated and see it that way. I would therefore wish that in the health-preserving areas, the awareness of the relevance of movement would be much more pronounced, and that health insurance companies would promote more opportunities to keep oneself healthy through movement.
In fact, we must assume that only 15 percent of the German population exercises enough – the rest are continuously heading toward major medical problems.
In fact, we must assume that only 15 percent of the German population exercises enough – the rest are continuously heading toward major medical problems. Finally, perhaps a connection to the pandemic: I cannot recall any politician publicly calling out, "People, move yourselves—otherwise the risk of a severe progression is much higher!" American studies have also proven this, namely that 77 percent of those affected with severe progressions are overweight. But people in Germany have also become more overweight—due to representation errors, motivational deficits, and a lack of awareness of this. I would like to see that change.
Do you want to read more about the topics of osteoarthritis, rheumatism, etc., as well as treatment options? Then read: For Joint Pain: Most Common Causes and Therapies.
Sports after joint surgery? Listen to the podcast Sports with a Knee or Hip Prosthesis to hear what the expert Prof. Dr. med. Karl-Dieter Heller, President of the German Society for Endoprosthetics (AE), has to say about it.
