‘We should be catching rabbits and climbing trees’

An active and healthy lifestyle can help prevent bone and joint complaints, writes Christian Duffin. But, if problems develop, there are still measures which can contain, and even limit, the impact of musculoskeletal conditions

In terms of preventing musculoskeletal conditions or keeping them at bay, there is a certain amount of bad news – but also a fair bit of good.

The likelihood of some conditions developing is linked to genetics or wear and tear of the bones and joints, but there are factors within our control, such as our lifestyles or frequency of exercising, that can either reduce the risks or limit the impact.

Predisposition to osteoarthritis is often linked to genetics, says Dr Amit Saha, a consultant rheumatologist at Maidstone and Tunbridge Wells NHS Trust. “If your mum has thin bones, then you may well have thin bones as well,” he says.

Skeletal structure also determines the risk of pain in your joints and bones. “If you are knock-kneed or bow-legged, you will affect how forces are transmitted through your joints,” says Cliff Eaton, a chartered physiotherapist and clinical specialist for DJO UK, a supplier of orthopaedic equipment.

Obesity is a risk factor for musculoskeletal conditions including osteoarthritis. As Mr Eaton says: “If it was suggested you strap a bag of potatoes around your waist and carry it around all day, you would consider it to be crazy. But being overweight means that your joints have to cope with unnecessary load.”

People just don’t move about enough – we haven’t evolved to be just sitting down

Smokers are much more likely to develop rheumatoid arthritis than non-smokers, it is widely believed. An influential study published in the journal Arthritis and Rheumatism in 1996 made the link after studying the cigarette smoking history among twins and linking it to rheumatoid arthritis.

Some conditions have associated higher risks of additional illnesses. Rheumatoid arthritis has been linked with increased likelihood of occurrences, such as heart attacks and stroke, as documented in studies published in 1994 also in the Arthritis and Rheumatism journal.

Diet throughout life, but especially during infancy and puberty, are risk factors, says Mr Eaton. “Ensuring we have a balanced intake of vitamins is critical for the development of normal bone structure. Lack of calcium can result in poor bone mineral density. Lack of exposure to sunlight can result in vitamin D deficiencies, which can alter bone alignments and joint congruity.”

Stephen Moore, a London-based osteopath at Walthamstow Osteopaths, believes that much of our back, neck and shoulder pain results from sedentary lifestyles. “People just don’t move about enough – we haven’t evolved to be just sitting down,” he says. “We’re hunters and gatherers, and we’re supposed to be catching rabbits and climbing up trees.”

Mr Moore comes across plenty of people whose injuries are a result of repetitive movements in their jobs. “Manual labourers like plasterers get shoulder and arm problems because a lot of their work is high above their heads. People on supermarket checkouts keep twisting their body on the same side so they can get bad backs. For bricklayers it can be even worse because they work out in the cold.”

Exercise can be a good way of limiting the effects of musculoskeletal complaints. Researchers from the University of Melbourne in Australia, reporting in the Journal of Science and Medicine in Sport, found that exercise is beneficial for people with osteoarthritis “of all severities”.

Guidelines by the National Institute for Health and Clinical Excellence (NICE) state that exercises, such as local muscle strengthening and general aerobic fitness, should be a “core treatment” for people with osteoarthritis irrespective of age, comorbidity, pain severity or disability.

Exercise regimes have to be tailored for different conditions. Mr Eaton says: “If the knees or hips are affected and weight bearing activities cause pain, then we need to consider non-weight bearing activities, such as swimming or cycling.”

Dr Saha recommends 30 minutes a day of walking for osteoporosis. Running is also worth considering, although many patients with osteoporosis are in their 60s or 70s and so this may not be feasible, he says.

Mr Moore says: “Men often think that going to the gym is a good way of keeping their  bodies flexible and strong, but some men actually increase their likelihood of musculoskeletal pain by concentrating on building up their biceps and their pecs because they think it’s sexy.” Building up core strength in the lower part of the trunk can help, he adds.

According to Dr Saha there is no strong evidence that diet has a significant treatment effect on musculoskeletal conditions. But he says: “I do sometimes get people saying to me that they have cut out something, such as potatoes, from their diet and their joints feel amazingly better. Some patients think that certain things work and, if that’s the case, I tell them to carry on doing what they are doing.”

An obvious way of trying to tackle or prevent musculoskeletal conditions is to seek advice from health professionals, such as GPs and physios, but many people do not bother, says Mr Eaton. “I saw one study where 1,000 people were interviewed and nearly half reported signs and symptoms of arthritis. Yet only 155 had gone to their GP and only 47 had gone to a physiotherapist,” he says.

There are options to reduce the likelihood of musculoskeletal conditions and to moderate the effects. “Popular misconception is that nothing can be done for people with conditions like arthritis because it is simply about wear and tear that worsens with age. I think the main message is to keep active, and do exercise to strengthen the bones and joints. If you don’t use it, you lose it,” Mr Eaton concludes.