The Big Issue – Weight and Pain

At Physiotas, we deal with clients’ joint and muscle pain on a daily basis.  It is a common occurrence that these same clients have been told (by GP’s, specialists etc) to ‘lose weight’ to help their pain and function.  And this is generally true.  The problem is that people often haven’t received an explanation of how and why this is the case. Which in turn can make it difficult to start the process of weight management.The Problem

According to the latest statistics from the Australian Institute of Health and Welfare (for 2017-2018):

  • 2 in 3 (67%) Australian adults were overweight or obese.
  • 1 in 3 (31%) adults were obese.
  • 1 in 4 (25%) children and teens were overweight or obese.
  • These rates have increased significantly in the last 20 years.

So, with the general trend of increasing rates of being overweight/obese, people sometimes feel their weight is ‘normal’ and therefore not an issue.  Unfortunately, based on the above statistics, an ‘average’ weight is not necessarily a healthy weight.

Rather than comparing to others (which is never particularly helpful as we are all different), Body Mass Index (BMI) is the internationally recognised standard for classifying overweight and obesity in adults. BMI is calculated by dividing the weight in kilograms by the square of the height in metres. As many of us don’t like doing math, there are many online calculators available – such as the one from the Australian Heart Foundation here.

People who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health conditions, including the following 1,2,3:

  • All-causes of death (mortality)
  • High blood pressure (Hypertension)
  • High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Sleep apnoea and breathing problems
  • Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
  • Low quality of life
  • Mental illness such as clinical depression, anxiety, and other mental disorders 4,5
  • Joint/body pain and difficulty with physical functioning6

Today, we are focusing on that last health issue – joint/body pain.  There are a huge amount of research studies that link being overweight or obese to joint pain and arthritis.  One study 7 found for every 5kg of weight gain (above a healthy weight); there is a 36% increase in developing osteoarthritis.  In overweight or obese individuals, when compared to those with a ‘healthy’ weight, pain is more commonly in the load-bearing joints (including the lower limb and the low back 8) – but it is also more common in the upper limbs, hand and digits9, thoracic spine and neck. Studies have shown that being overweight or obese is related to greater severity and faster progression of arthritis than normal weight individuals.

The Question – How does this affect my joint pain?

There are two main mechanisms (ways) that being overweight or obese (specifically an increase in adipose (fat) tissue) affects joint/body pain.

1 – Joint Loading:

Joint (and other) pain has a logical link to obesity: The more weight that’s on a joint, the more stressed the joint becomes, and the more likely it will wear down and be damaged.  For instance, every kilogram of body weight exerts about four kilograms of pressure on the knees during normal walking and daily activities.  So a person who is 10 kilograms overweight has 40 kilograms of extra pressure on their knees during these activities.  That adds up.

These loads increase with higher impact activities – such as walking down stairs or jumping.  As another example, jumping places approximately 7-9 times extra pressure on the knees, 6-8 times at the hips and 9-10 times at the ankles 10.

So if you think about all the steps you take in a day, all the little jobs and normal daily activities, and look at the load going through the joints and muscles – it is quite clear how being overweight can increase the pain and irritation of these structures.

2 – Inflammatory Changes:

But it’s not just the extra weight on joints that’s causing damage. The fat itself is an active tissue that creates and releases chemicals, many of which promote inflammation. The inflammation caused by these chemicals can influence the development and progression of a wide range of conditions – such as osteoarthritis (OA), rheumatoid arthritis (RA), gout, fibromyalgia and lupus.

This effect can be seen in the numerous studies that have linked obesity to hand OA. Obviously, you don’t walk on your hands, so there may be something that is produced by fat cells in the body that causes the joint to break down more rapidly than it might otherwise.

The Other Issue – The Vicious Cycle

This is where things often get tricky – weight and pain is a two way street.  We have looked at some of the science and research into why being overweight or obese can affect joint and muscle pain, but there is just as much research to show that being in pain increases the likelihood of being overweight or obese 11.

It comes down to this – obesity and muscle/joint pain collectively reduce mobility. This can initiate a vicious cycle of events: reduced activity, further weight gain and decreased muscle strength, leading to increased joint problems and disease progression 11. Both issues have also been shown to increase the risk of depression and reduce health related quality of life 12, 13.

This vicious cycle is one of the many reasons why weight management is not an easy process.  It’s hard to lose weight when exercise is limited due to pain, and it can be hard to manage pain when weight is limiting exercise.

The Bad News

Let’s get the bad news out of the way first – losing weight is not easy, especially when dealing with pain.  But just because something is hard, doesn’t mean it isn’t worth doing.  Losing 10% of your body weight (for individuals who are overweight or obese and have joint pain) has been shown to significantly reduce pain and improve function and quality of life 14.

The other bad news about weight management is the old saying ‘if it sounds too good to be true – it probably is’.  Another way we could say this is ‘if someone is trying to sell you a weight loss cure – it’s probably for their benefit, not yours’.  There is no fad diet, magical supplement or single exercise that is going to be the magical cure. It is going to be hard work.

The Good News

The good news is fairly simple – you can do it!  But, you have to start somewhere ….

“A journey of a thousand miles begins with a single step” – Laozi

There is no one-size-fits-all solution to weight management (or pain management for that matter) – because we are all different.  There is, however, some simple advice that can help get you headed in the right direction.

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health” – Hippocrates

Get Moving:

“The only bad workout is the one that didn’t happen” – Anonymous

As a physio, I can’t stress this advice enough – get moving.  Increasing your daily physical activity is a proven way to help manage both weight and pain.  Now, this can be difficult – especially if you are in pain – but getting started is the hardest part.  It might be starting with a 5 kilometre walk, a 5 minute walk or a 5 metre walk.  It might be walking the dog, getting in the garden more or joining an exercise group.  To be honest, what the exercise is doesn’t really matter – it’s the increase that is going to help.  Do a little bit often – it all adds up.  Find something you enjoy, or try something new.

If you are having trouble getting going – get some help.  Speak to your physio or exercise physiologist.  Physiotas have a variety of options that can help – such as supervised group, or 1-on-1 exercise sessions and hydrotherapy sessions.  Hydrotherapy (supervised pool based exercise) can be particularly helpful as a starting point since the buoyancy of the water will help decrease joint loading.

Eat for Health:

“You are what you eat” – Victor Lindlahr

If getting moving and increasing your physical activity is one side of the weight management solution, the other side would be eating for health.  This does not mean jumping on the bandwagon of the latest fad diet, but instead making wise choices about the food and drinks we consume.  A few simple suggestions:

  • Optimise the portions at your main meal. Most people eat too much meat and carbohydrates (potato, bread, pasta, rice etc) and not enough non starchy vegetables. Eating off a smaller plate can help, as can trying to eat half a plate of non-starchy vegetables or salads.  This can help reduce the calories of the main meal, while making it more satisfying.  For more info – a link to the Baker Heart and Diabetes Portion Guide can be found here.
  • Stick to water, tea and coffee without sugar. The human body is 70% water. Calories from drinks (including alcohol) can add up significantly throughout the day and prevent weight loss. A 250ml glass of juice contains 4-6 tsp of sugar, nearly equivalent to a can of Coke.
  • Avoid fast foods and have a healthier convenience option on standby for the days when time is limited – such as freeze home made meals, chop up a quick salad or make an omelette.

For more information about making healthier food choices, the Australian government has published a lot of good advice on the Eat For Health website.  Alternatively, speak to a dietitian (Milly Clark is a dietitian who works for Physiotas in Launceston. To book an appointment with Milly phone us on 6424 7511 today).

Set SMART Goals:

“If you aim for nothing, you’ll reach it every time” – Unknown

It is important with anything you are working towards to set goals that are Specific, Measurable, Achievable, Relevant and Timely (SMART). For a great explanation of SMART goals, quickly head over to Megan Clarke’s (physio at Physiotas) blog post from February here.  Reality TV and social media has done a great job in selling unrealistic expectations with weight management.  Don’t expect huge changes overnight, or to lose 15kg per week.  Choose realistic goals – maybe aiming to lose 2kg per fortnight might be a goal to work towards.

Get some help:

“A problem shared is a problem halved” – Proverb

Making lifestyle changes can certainly be daunting.  One simple step to make these changes achievable is to get professional help.  There is a lot of advice about weight management and pain out there – unfortunately this means there is a lot of bad advice available.  Social media and friends (however well meaning) are not always the best sources for advice.  Speak to your GP, your Physio, Exercise Physiologist or a dietitian.  Get the best information to set you on the right track.

The Bottom Line

Managing your weight can make significant changes in both preventing and managing joint and muscle pain.  This is not necessarily an easy thing to do, but it is certainly worthwhile.  There are simple steps you can take to get started – exercising more, eating well and getting the right help.

Like always, this is general advice and should be taken as such.  To discuss your particular circumstances, speak to your health care professional.

References:

  1. NHLBI (2013). Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel.From https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults
  2. NHLBI (1998) Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. From https://www.nhlbi.nih.gov/files/docs/guidelines/ob_gdlns.pdf
  3. Bhaskaran K, et al. (2014) Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lance;384(9945):755-65.
  4. Kasen, S et al.(2008) “Obesity and psychopathology in women: a three decade prospective study.” International Journal of Obesity 32.3: 558-566.
  5. Luppino, FS et al. (2010) “Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies.”Archives of general psychiatry 67.3: 220-229.
  6. Roberts, E., et al. (2003) “Prospective association between obesity and depression: evidence from the Alameda County Study.” International journal of obesity 27.4: 514-521.
  7. Lementowski PW, Zelicof SB. (2008) Obesity and osteoarthritis. American Journal of Orthopedics. 37(3):148–151
  8. Mathus-Vliegen EM. (2012) Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts. 5:460–483.
  9. Centers for Disease Control and Prevention. (2011) Osteoarthritis. 2011. [WWW document]. URLhttp://www.cdc.gov/arthritis/basics/osteoarthritis.htm
  10. Cleather, DJ., Goodwin, JE., Bull, AM. (2013)  Hip and knee joint loading during vertical jumping and push jerking.  Clinical Biomechanics. 28(1):98-103
  11. Bliddal H, Christensen R. (2006) The management of osteoarthritis in the obese patient: practical considerations and guidelines for therapy. Obes Rev. 7:323–331
  12. Badley EM, Tennant A (1992). Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire. Ann Rheum Dis. 51:366–371.
  13. Peat G, McCarney R, Croft P. (2001) Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 60:91–97.
  14. Riddle DL, Stratford PW. (2013) Body weight changes and corresponding changes in pain and function in persons with symptomatic knee osteoarthritis: a cohort study. Arthritis Care Res; 65:15–22

About the Author:

Daniel Yeo is a Physiotherapist at Physiotas on the North West Coast.

Dan has been working at Physiotas since graduating from Monash University with Honours in 2011. He has undertaken further professional development in the acute management and rehabilitation of sporting and spinal injuries, as well as dry needling and Clinical Pilates.

Dan is involved in the Clinical Pilates/Clinical Exercise Groups and Workplace Health programs at Physiotas. Dan has worked with a variety of local and interstate sporting clubs including Devonport FC, Tassie Mariners and Soccer TAS. His professional interests include Clinical Pilates, sports and spinal injuries, post-operative rehabilitation and dry needling.

In his spare time, Dan enjoys working out, hiking and all things coffee.