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5 Things You Need to Know About Joint Health

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Roman returns from a visit to Dr. Kareem and drops some knowledge bombs.

Let’s get the easy part out of the way: I’m currently smart, and I got that by being stupid.

Sure, my current level of fitness knowledge is certainly quite high, but like anyone else, I started out a bit green.

Which is to say: Like most guys, I was paying a bit too much attention to getting bigger,faster and stronger, and not really enough to the less cool aspects of training. The boring stuff like health,soft tissue quality, mobility, and joint care.

When I was 23, I tore my meniscus (a chunk of cartilage in the knee) in probably the lamest way possible: playing paintball.

Not that paintball is uncool, but after years of putting my body through the rigors of varsity sports, intense training and 500 pound squats, it was a little ignominious.  I simply twisted the wrong way at a friend’s paintball gathering and down I went like a heap.

Now, while I’ll say for a 23 year old I was certainly training intelligently, I wasn’t doing all the other stuff I should have. Not much in the way of stretching or foam rolling, no dedicated days for massage or other therapy.

Instead, I just put my body through the abuse and managed to thrive in spite of myself.

Fast-forward 5 years later, and I’ve certainly learned my lessons.

Over the past half decade, I have really geared my training in a much more rounded way, and I have a huge focus on recovery and prevention.

However, even though I now do almost everything “right” sometimes my body is still the victim of itself.

Being as strong as I am, my muscles sometimes are a bit more capable than the body parts to which they’re attached, and despite how careful I am I still wind up with the occasional injury or joint issue.

In point of fact, for the last 14 months, I’ve been dealing with severe elbow pain in the form of medial epicondylitis, or interior tendonitis.

And lemme tell you, shit sucks.

I haven’t been able to get rid of it—and not for lack of trying. I’ve seen a doctor, an active release guy, and even an acupuncturist. After getting poked and prodded and having needles (some of which were hooked up to a battery) jammed in my joints, I’d pretty much resigned myself to the fact that this wasn’t going away anytime soon.

For about 5 months I trained around it, avoided heavy pressing and watched my triceps shrink from the lack of stimulation.

In May of last year, I was fortunate enough to attend a seminar with Joel Marion where he introduced me to Dr. Kareem, physical therapist and trainer who takes a pretty unique approach.

Over the course of the last eight or so months. Kareem has been working on my elbow (and my neck, where it turns out the problem originates) and has really helped reduce the pain to a degree I never thought possible. While I won’t claim to be pain free (the guy’s a doctor, not a level 5 cleric who wields a +2 mace of disruption and turns undead while calling down Helms blessing), but I can actually train hard again, and he’s given me a new outlook on joint care.

Anyway, as often happens during the course of care, Dr. K has also become a really good friend.

Here is an awesome video of him abusing my elbow, and giving a really cool description of what’s been going on in my arm.

It’s less fun than it looks. To be honest, that session was a bit less painful than they used to be, and is certainly less painful than attempting to train on the elbow was a just a few months back.

Small price to pay for regaining the use of my right arm, I should say.

Now, I just want to quickly cover a few points about joint health and healing that you need to consider:

1) It’s not always an acute injury.

The big issue with joint problems is that they can sneak up on you. If you’re not very mindful of what feels right and wrong, and if you don’t know what to look for, you’ll get an injury seemingly out of the blue.

Wrist problems are one example. A slight twinge can become crippling without there ever being an event, a memorable “injury” that you can point to when you eventually need to see a professional.

And sometimes, as in my case, it’s something as simple as a strength imbalance that can create an issue. This is one reason why training for symmetry ain’t all about looks (It’s just partly about looks).

2) If your joints aren’t functioning properly, you can’t train properly.

No, your joints aren’t sexy. They aren’t abs, bis, or calves, they’re hidden under the skin and they crack and pop when you’re trying to quietly walk down stairs.

But consider this a life lesson: Beauty isn’t always on the outside. Or, less succinctly, functionality and longevity aren’t always on the outside. Your joints are a crucial, yet unseen part of not just your strength training and bodybuilding gains, but your overall health. If your joints aren’t functioning properly, you can’t train properly.

If you can’t do that, you simply can’t make progress. Period.

3) Don’t train around the injury.

Even if you’re capable of training “around” the injury/issue for a while, you have to consider what that’s going to do to you over the long run. Over time, you’ll develop what we call “compensation patterns” which can be as simple as developing a muscle you’re not targeting to as complicated as totally screwing up your recruitment patterns and not being able to develop at all.

4) Joint inflammation affects blood flow

If you create swelling (tendonitis or even muscular swelling) blood flow to can be compromised, which limits all facets of fitness: cardiovascular fitness, obviously, but strength as well. If blood can’t get to the right places at the right speed, your muscles and bones aren’t getting the optimal amount of nutrients from your blood.

Limited blood flow also greatly reduces your ability to generate force, but will hinder the training effect and the amount of microtrauma you’re able to create.

Building on that, limited blood flow is also going to severely impede your recovery ability, for the reasons listed above. You’ll train like shit, get shit-all from the training, and recover like shit. I had to deal with this for 5 months, please don’t be like me.

5) It hurts.

A lot.

++++++

Got a joint issue? How are you treating and training it? Leave a comment below and we’ll see if we can’t get Kareem to pop in and answer some questions.

About the Author

John Romaniello is a level 70 orc wizard who spends his days lifting heavy shit and his nights fighting crime. When not doing that, he serves as the Chief Bro King of the Roman Empire and Executive Editor here on RFS. You can read his articles here, and rants on Facebook.

  • Josh

    My problem is tennis elbow. You said there’s no way of getting it better, only from it getting worse. Is there anything I can do for it? my doctor honestly just says lay off lifting and prescribes an anti inflammatory and doesn’t take it seriously.
    I also happened to catch what I thought was distal biceps tendonitis. I was doing eccentric hammer curls yesterday for it (lower portion), and it felt like a snapping was going on close to my medial golfers elbow. Ever since I’ve been worrying sick that I have snapping triceps syndrome, but the snapping only happened as I was locking out at the bottom of the hammer curl.
    I’m 19 years old too, so this is very frustrating to me because lifting has always been my favorite thing to do.

  • Gwen

    Hi, about a month ago I was doing sprints. Heard something poped in my knee, didnt think anything about it. Keep sprinting. Next day my knee was stiff. It didn't hurt just stiff. I stretched real good in the sauna, ice when I got home. Wasn't too bad. About a week went by and I was doing box jumps and twisted the same knee again! This time it hurt. Went through the same routine but it took longer to heal. Now, it seem like I'm always doing something to hurt this knee. What can I do to fix it for good. I don't want to miss anymore training time. I workout about 5 days a week twice a day. Thanks

  • Dave

    So I have this itchy, rashy, burning sensation that hurts when I pee…

    Ok, I'm kidding on that one.

    But, on a serious note, I have been battling with some shoulder issues for a couple years, especially when I do heavy pressing exercises. Physical therapy just made it worse so I pretty much gave up on that. I can do high-rep exercises fine, but I can't do that forever because I don;t like being a one trick pony and not adding any strength or dense muscle tissue. Any advice?

  • Kevin

    Dr. K and/or Mr. Romaniello,

    Approximately 3 months ago I injured my right wrist during a floor press; I attempted to lift a weight I had succeeded with just a week before, but on this occasion my muscles failed and the barbell caused my arms to crash into the floor.

    Initially, I couldn't turn my right arm at all and the pain was sharp all along the ulna. I've long since retrieved most of my wrist's mobility, but I cannot fully supinate it without pain in the ulna near the wrist. I'm unsure whether it is the bone itself that is in pain, or a ligament/tendon or possibly nerve.

    The most sensitive area that often becomes very sore at random periods. It seems to be a tendon that runs across the “ball” at the end of the ulna at the wrist joint. It hasn't shown any sign of healing, I saw a doctor who told me to ice it and massage it 3 times a day, but I have yet to obtain any benefit.

    It's irritating as I cannot place any load on it, not even a bare barbell. However, if I ball my hands into fists, I can do push ups, but not with flat hands on the floor.

    Any advice for treatment/rehab?

  • Matt

    Hey John and/or Dr. K,

    I asked this question after another article before I came across this one. I've been experiencing what I describe as burning sensations and some cracking in my knees especially when I kneel. I work for a chiropracter and when I asked her advice she told me that I have to stop doing squats. She said that I'm making my knees arthritic. I'm under the impression that it's impossible to get the desired leg results without squats. So what do you suggest? Do I stop the squats??? Thanks!

  • Sean

    Well, now at 41, I have done some damage to myself as well. I was also an athlete in track, football, tennis, basketball….and wasn't very flexible….still not. I herniated a lower disc in the summer of 2008, gave myself physical therapy and slowly got back my strength, then just recently re-tweaked it. Using an inversion table to help with decompression and stretching every chance I get. I do have very tight hip flexors, so I do light squats then split squats right after to work on imbalances.

    I also had a left rotator cuff injury in my late 20's during a softball game (hit so hard that I lost 3 softballs in the nearby forest) and have been recently dealing with that again, just less than before. I use stretching and ice therapy as well as light lifting.

    Severe Piriformis Syndrome, from heavy wide-leg squats and sprinting. This one took 10 years to get over! Again, ice/heat, stretching, acupuncture, etc., but what actually solved the issue was the disc herniation! So, I realized they were all interconnected with the sciatic nerve being irritated by the disc and piriformis.

    Now I stretch often, inversion everyday, lift moderately heavy with strict form, stretch immediately after working out, then ice down every evening. I also take good supplementation to encourage the healing process. I am careful not to overtrain so I am sure to get adequate rest. I found out that I just don't recover like I used to so I listen to my body very carefully. ;-)

  • Helen Crew

    I have trouble with my shoulders. I had rotator cuff surgery several years ago and at times it really aches. My other shoulder also aches and keeps me awake at night.

    I have tried using ibupropen, heat pads, cold pads, magnets, creams, and really had no luck. Any suggestions?

  • Unfortunately I learned the hard way too! I had hamstring issues and would do everything our trainers told me to do for recovery…..I would get feeling good…..get cleared to practice full speed and POP, jack up my hamstring again. I got really frustrated with the trainers and team doctors and went to my cousin who is a chiropractor (Utah Jazz's Team Chiropractor) and he discovered my hips had an anterior tilt to them which was disengaging my glutes so my hamstring was doing all the work and straining cause of it. He adjusted my hips, told me to really stretch my hip flexors, and to foam roll. He also suggested I start doing more single leg stuff not just heavy squat ( thanks strength coach lol) So I did all of the things he suggested and haven't had a hamstring issue since. it makes me wonder how many other athletes out there have that very same issue? I know I've had several buddies get help cause of the same thing. O well I'm glad I figured it out my last year of eligibility lol!!

  • Muhammad

    This question is for Kareem, but if John could help answer my question or add to anything Dr. Kareem has to offer, that would be greatly appreciated as well.

    It feels tight at times, and when i mimick the motion of an overhead dumbell tricep extension, it clicks. Most of the time, several clicks, when making a full extension. Even when i keep doing it, in order to get the tightness out, it usually still clicks. Is this Tendonitis? Or is it something else.

    I was laid off, and currently dont have healthcare. Id really love to know what it is. I as well, have weaker forearms in comparison to my biceps, and triceps for that matter. Maybe the same imbalances as John? Any help would be greatly appreciated. Thank you.

  • Clement

    @Dr K,

    So nice of you to come out here! Thanks for your comment!

    I think the main problem is that, as ylwa said earlier, the majority of our workouts do not have corrective work ingrained in them. You could do a bench press, a deep full squat or a pullup with perfect form, but it doesn't correct our imbalances! We still have to follow up with foam rolling, corrective mobility exercises…

    But we all have to understand that it's essential.

  • james

    thank you Dr. :) @Dr. K –

  • one more thing…

    good job with the smiley faces – since i discovered this, I think I've :-D put :-( them :-D on :-) every :-) post

    just kinda cool that i can type ')' and '-' and it turns yellow… or maybe i'm too easily entertained??

  • @Ylwa – Hey Ylwa,

    hehe…

    you know – in all honesty, I think we have to get away from 'traditional rehab exercise' – i find it boring too – there's a way to make any rehab get incorporated into a workout and it's more fun… more energetic… and more effective with all the increased blood flow & tissue prep

    I'd rather start seeing the 2 fields merge… it's a great combo!

  • @Sam – cool, Sam – glad to help :-)

    have a great night,

    -k

  • @Tyler English – awesome stuff Tyler!

    great to hang with you too bud!

  • @Deena – that's really interesting that you brought up shrinking brains – it's amazing the effect that chronic pain (< 6 months) can have on us... it's really important to break this cycle early or your brain will actually tell you to stop growing muscle... just a natural response to try and protect you :-) cool post, -k

  • @james – Hey James,

    sorry to hear this – as for the anti-inflammatory, it's good for just that… but there's a sure bet that at this point there's some degree of capsular restriction in your joint too (meaning that the balloon that surrounds any 2 bones that meet sort of freezes up over time when we don't move as much – over-healing, really)

    I'd recommend mobility exercises & PT – try to find a hand therapist – they're extremely specialized for a reason :-)

    hope this helps you,

    -k

  • @Clement – Hey Clement,

    That's one of the coolest things about Roman – he totally understands balance with exercise, yet he got huge anyway. That's really rare, and it's something to model off of….

    I'm glad you liked the post too – it's always nice to help someone with joint health, even though it's usually not on the forefront of our minds when we feel good…

    have a great day,

    Kareem

  • @Susanne Dunn –

    Sorry – gotta get something off my chest first – who else hates the secret code thing-a-ma-bob – pink on black – are you kidding me Roman? I'm blind…

    Ok, Susanne,

    the catchy feeling without pain can be as simple as a gas release from an increase in laxity in your elbow…

    with pain, can be a loose body and need care – big difference, so does it swell?

    hope this helps!

  • @Jon – Hey Jon,

    sounds to me that you're missing proprioceptive training – things like quick kicks, dyna disc squats, balance board presses, single limb stance bicep curls, step ups… you know, things that cause a controlled balance reaction – (all in exercise video database of DEFL)

  • @Meshel – 3 Cheers for Meshel!

    i look forward to seeing you again soon :-)

    how's the new job?

  • @Matty – sure… Matty – I actually get into this in full detail in the “Postural Strengthening To Reduce Arthritis, Burn Fat & Fix Joints' webinar, but here's the quick and dirty version:

    Plum line first – posture will tell you a lot

    Flamingo test – do you prefer to stand on only one leg rather than the other?

    Pull Ups to bench press – should be a lot easier to do pull ups

    Resting positions – are you the kind to slouch forward or sit back?

    ok… that's a really easy version, but these simple test prove useful – hope they help you!

  • @Jessica (in Aussietraylia) – hey jessica,

    i don't know whether to laugh or cry… sadist, eh?

    after the showing above with the crackling smile on my face, not sure I can argue :-)

    massage IS awesome… so is self-rebounding – worth taking a peek at sometime – you can learn more here: http://myofascialrelease.com

    hope this helps!

  • @Murds – hey Murds,

    Posture is everything when it comes to getting rid of tendonitis in your shoulders… exercises like middle trap on the ball, lower trap on the ball, posterior deltoid-rhomboid pulls, and rhomboid pull ups tend to really help….

    all in all, strengthen back for a solid 3 months while lifting with good shoulder posture and big things tend to happen…

    hope this helps!

  • Jessica (in Aussietraylia)

    Hi @Ylwa – Ha, I KNEW it!! However if your fiancée also thinks so perhaps you shouldn't take your work home with you…. ?

  • Ylwa

    Haha, oh Roman. You've just opened Pandora's box of pain and illnesses with this post. This should be fun.

    I haven't had a chance to look closely into Kareem's stuff yet, but I have alot of his email lying in my inbox. Thought I'd check them out on my 3 h trainride on Thursday morning. But the topic on the importance of joint health never get's old. One of the oldest – and easiest ways to take action on this is – DO YOUR WARM UPS (I should really start live like I preach on this one). This is, or should be, class 101 in any PT education. But having said this, I believe that not only is it neglected, it's also not studied enough. A good warm up is about so much more than getting you heart rate up and blood flow going, WHAT you do matters just as much as that you do it.

    As much else, joint health is primarily preventive, which I guess can be one of the reasons why it gets neglected. It's kind of boring (but I'm sure Dr. K's stuff changes all that, right ;)) and it doesn't give you the same sweat or burn that your other exercises do (most of them). Neither does it show. But it's such an easy and small trade-off to make there really is no excuse around it. So thanks for bringing it up again, as always, great post.

    @Jessica (in Aussietraylia) – It's true, we physiotherapist's are a bunch of undercover, professional sadists, ask my fiancée :)

  • Sam

    Hey John-

    I probably enjoy reading your blog the most out of the few that I read and I really like what you have to say about things. The video was great and I have to admit that I laughed at your face when Dr. K started working on your elbow. I could tell that it wasn't feeling so great.

    The best thing that I took away from this article though is that I really need to work on the balance of my development a lot more. I'm starting to notice the imbalance more and more and the fact that it can lead to so many problems almost scared me into focusing on it more. So thank you very much for that. You and Kareem have probably saved me from some pretty painful stuff down the road with just this one post.

    ~~Sam

  • John!

    Joint health is HUGELY important. Especially when we want to keep increasing those lifts and maximizing our metabolism. I know as a pro bodybuilder I don't go into a workout with doing a good portion of stability and mobility work for my joints. Something so many entirely avoid.

    I have to add that one of the highlights of my weekend in Stamford was standing there watching the off camera treatment of the elbow.

    Good thing Kareem knows his stuff! Hope it's on the mend!

    Tyler

  • Deena

    Thanks for sharing!! I have had ACL reconstruction and a couple of meniscus surgeries on my R knee (and no, I am not a football player) :)

    I have continual irritation in the knee as well as hip flexor and back on the same (R) side which gets worse after walking lunges.

    I am still very active between working out, volleyball and softball. I would LOVE to be able to enjoy these activities and life PAIN FREE (i'm worried about the studies that show brain shrinkage due to pain – yikes)

    Thanks for listening (reading)!

    Deena

  • james

    Hi there,

    My right wrist has been sore for about 10 months. I hurt myself at the assisted chin up and at the begining I can't even do bicep curl with dumbells of 2kgs. Now I can do hammer curl of up to 12.5kg but not bicep curl. I just seen a doctor lately and he recommanded me to take an anti inflamatory tablets once a day for 3 months. I have been seeing a chiropractor for a few months now.

  • Clement

    Hi roman, this is an extremely informative article. A lot of pros like Eric cressey and mike robertson also preach foam rolling and other corrective methods, but I, like you in the past, tend to skip these articles on Tnation and glaze over these warnings. I guess I just don't feel I'll ever have the need for these techniques as I don't have issues with going ass-to-grass in squats or letting the bar kiss my nipples in the bench press. This is by no means a request to show that I don't care for these posts; on the contrary, i just want to emphasise the cronic lack of attention being given to these methods. I myself know that they're important and should be done by everyone. I personally feel that foam-rolling is not my thing. But make no mistake, if there were some mobility-type exercises, I'd do them. I do static stretching and try to improve my ankle mobility using some of mike boyle's exercises first thing in the morn.

    But anyway, I digress. I feel it's absolutely essential to include these corrective work as part of recovery, if not for the sake of joint health then to improve your lifts!

  • Per

    I had an elbow problem that probably was caused by the movement when just bringing up the dumbbells and laying down on the bench when doing chest presses. It was treated with massage and acupuncture at my naprapat as well as hot/cold showers and ibuprofen gel by myself. It got better but then re-appeared after a go-kart race (no power servo stearing and a lot of vibrations I guess). Almost gone again now though.

    Second problem is my left rotator cuff that acts up from time to time, last time this weekend after my leg (the squat maybe from the wide grip on the bar) and shoulder workout. (Shoulder exercises: Seated db shoulder press, lateral raises, 1 arm db rows, light weight circuit w front raise/lat raise/rev flyes/vert row/vert press)

    Any suggestions on rehab/prevention would be much appreciated. As well as whether or not I should avoid rowing/pulling exercises while I'm recovering? (Am currently doing Dr K's “Marty workout” in the morning which have some rows/diagonal pulls etc)

  • Susanne Dunn

    When I do pull downs on a machine and extend my arms up, I sometimes feel a pull in my right elbow like it needs to snap into place and it often does. After the snap, it feels normal. This has happened a few times and since I didn't feel any repercussions after, I thought it was a natural adjustment, like chiropractic. SHould I be concerned or have mu chriopractor look at it?

  • Jon

    My ankles are destroyed, sprained each one of them at least 3 times if not 4 or 5. I still train reguraly and am active in sports. But when I am training hard or after a long day on my feet when I take my shoes off I can hardly walk for the first few steps. I also have Plantar Faciaitis in my left foot and have torn my Plantar Facia in my right foot completely in half a few years back. I do what I can for it, rolling my foot on a lacrosse ball in the morning, foam rolling and mobility work before my workouts, and static stretches after my workouts but the stiffness and lack of mobility in both ankles persists. Any Suggestions?

  • Meshel

    Post-trauma (car accident) migraines, partial thickness tear of supra spinatus tendon in right shoulder and rehabbed but still painful at times right subluxed patella and hip problems since birth going on here. Treatment has included Chiropractic adjustments, deep tissue massage, acupuncture and recently, treatment with Kareem. Training…Double Edged Fat Loss and hula on off weeks.

    I have had success with both my training and treatment and am anxious to get back with Kareem because he has such great ideas but serious car problems and the new job have prevented regular visits…but soon.

    As always…great stuff, Roman.

  • Matty

    Hey,

    Whats the best way to figure out if we have muscle inbalances? Is there specific exercises to do to test the waters, so to speak? I know im probably training and muscles are compensating for others but is there a sure fire way?

    Matty

  • Jessica (in Aussietraylia)

    At the risk of leaving a long, tedious story…

    A few years ago I ruptured my ACL (anterior cruciate ligament) and tore medial meniscal cartilage in my right knee in a skiing accident. And as much as I&#x92;d love to say it occurred during a near flawless run down a black diamond mogul field until I hit an ice patch alas it naturally occurred through a spectacularly inelegant, inept and very public dismount off the chairlift. (Could pose a serious challenge your paintball incident in the lameness stakes Roman. Let alone the time I almost crippled my back spending hours bent over at a table completing a particularly challenging jigsaw puzzle. Try living down having &#x93;jigsaw back&#x94; some time&#x85;)

    Surgery, followed by 3 plus months of intense, exhausting and at times very painful rehab has left me with a life long respect for my joint health accompanied by deep hatred of my leg brace that will burn inside me until my last breath. However while it was undoubtedly worth every aching moment to get &#x93;my knee back&#x94; and the ability to lead a physically active life, a flare up late last year of sharp pain in my right knee while walking (never a good sign) reminded me that it will also never be the same.

    So back to my physio-terrorist I went (as an aside I have also realised that physiotherapy is simply a thinly veiled façade for giving highly skilled sadists professional legitimacy) to discover that my right ITB was so tight you could bounce coins of it, my kneecap had tracked significantly and my VMO was non-existent having gone out in &#x93;protective&#x94; sympathy. After much discussion and trouble shooting with my professional torturer (and another 6 weeks of daily, mind numbing, repetitive exercises that made me want to lose the will to live but which I am begrudgingly forced to admit worked a treat damn it!!) it turned out that the cause of the problem was a case of what I had NOT been doing rather than a new injury.

    Up until 6 months prior to the recent knee problems, I had been getting a regular (once every 2-3 weeks) remedial massage but had stopped due to my massage therapist going on maternity leave and I had simply never gotten around to finding a new therapist. To be honest I had considered the massage something of a personal and financial indulgence and so thought I&#x92;d be fine without it. Turned out my knee thought differently. I&#x92;m now back at my massage therapist regularly (discovered she works from home) and quite frankly I&#x92;ve learned that if the massage keeps me out of the evil hands of my physio and better yet the scalpel wielding mitts of my orthopaedic surgeon then it is in fact an extremely important preventative strategy. Not to mention a far more pleasant way releasing a tight ITB than “lying on golf balls”.

    Just to finish, there&#x92;s a little saying I love which goes as follows: &#x93;Learn to love your knees, you&#x92;ll miss them when they&#x92;re gone&#x94;.

    Could easily apply to any joint.

  • Murds

    Great article, very informative. I have tendonitis in my shoulder and I've been to several doctors/physical therapists, but nothing really helped the problem except proper rest and some prehab. However, the problem still arises sometimes…how do I go about finding a Dr. K of my own? haha, anyways you should invest in some Fat Gripz to improve those forearms!