Published research into what happens when a joint comes to a standstill · Read this before you take it easy for another week
No new supplement. No six months of waiting. A free five minute check that shows which signals in your own answers speak loudest.
"I'll just take it easy for a while, then it will settle down on its own."
Say that sentence out loud.
It sits close to what you think when your knee is stiff on the stairs. When getting up out of a low chair costs you a hand on the banister. When the first hundred metres of a walk hurt and the rest does not. When your knees crack as you climb the stairs and you notice that now. When there is a nagging pain on the sofa in the evening that was not there in the morning.
I am Jesse van der Velde. Not a guru and not a doctor. I study and share what published research says about how a body ages. I have been testing that on myself and with the people I guide for more than fourteen years.
That sentence is the one I want to take away from you today. Resting is what almost everyone does first, and there are numbers on what it costs.
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"Sparing it" rests on one idea: the joint is a part that gets used up. Fewer stairs, fewer kilometres, fewer times loading it, and it lasts longer.
That is how a hinge works. That is not how the tissue in your knee works.
Cartilage is living tissue. So are the muscles around the joint. Living tissue adapts to how much is asked of it, and that goes both ways.
If loading it more changes the tissue, then loading it less changes the tissue too.
That second half has been measured.
In 2005 Ewa Roos and Leif Dahlberg published a randomised study on knee cartilage.¹
What was studied: whether moderate exercise changes the amount of glycosaminoglycan in knee cartilage. Glycosaminoglycan is one of the substances that give cartilage its mechanical properties.
How: 45 people, 16 of them women, average age 46, who had part of the meniscus in the knee removed 3 to 5 years earlier and who are followed for that reason as a group at raised risk. Half were assigned by drawing lots to supervised exercise, three times a week, for four months. The other half did nothing extra. The cartilage was measured at the start and again at the end with an MRI technique that uses a contrast fluid, dGEMRIC. Of the 45 people, 30 completed both scans.
The findings: the exercising group improved on that measure and the control group went backwards, 15 milliseconds against minus 15 milliseconds, p is 0.036. And the more people reported that their activity level had gone up, the bigger the change in their cartilage, a correlation of 0.70 within the exercising group.
The authors write what this shows themselves, in plain words: adult human joint cartilage can adapt to a change in load.
Read that again. The tissue adapts to what you ask of it.
Now the same mechanism, the other way round.
In 2008 Patrick Kortebein and colleagues published in the Journals of Gerontology.²
What was studied: what ten days of bed rest does to how healthy older people function.
How: 11 healthy men and women, average age 67, stayed in bed for 10 days in a row. They were given food that covered their energy needs and the recommended amount of protein, so this is not a study about eating too little. Strength, power, fitness and physical performance were measured at the start and again at the end.
The findings: strength in the knee extensors dropped by 13.2 per cent. Stair climbing power dropped by 14 per cent. Maximum oxygen uptake was 12 per cent lower. There were no medical complications, and on the two standard performance tests there was no significant difference.
That last detail is the most important one for you. On the tests a practitioner would run, these people looked unchanged. The strength had come off all the same.
Ten days. Healthy people. Enough food.
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13.2 per cent, in ten days. That is how much knee extensor strength came off in that bed rest study, in healthy people of 67 who ate as usual.² Eleven people, so a small study, and bed rest is a harder version of taking it easy than most people ever go through.
3.9 per cent, in fourteen days, without a bed. In 2013 Leigh Breen and colleagues published in the Journal of Clinical Endocrinology and Metabolism. 10 healthy older people of 72 cut their daily steps by about 76 per cent, down to 1,413 steps a day, for fourteen days. The fat-free mass in their legs dropped by 3.9 per cent (p less than 0.001). The rate at which their muscle built protein after a meal dropped by about 26 per cent (p is 0.028), and their insulin sensitivity after a meal by about 43 per cent.³
1,413 steps is not bed rest. That is a quiet week or two around the house.
113 per cent, at an average age of 87. In 1994 Maria Fiatarone and colleagues published a randomised study in the New England Journal of Medicine, in 100 frail nursing home residents, 63 women and 37 men, on average 87.1 years old, the oldest 98. Ten weeks of progressive strength training raised muscle strength by 113 per cent, against 3 per cent in the people who did not train (p less than 0.001).⁴
Not 13 per cent. 113 per cent, at the age of 87.
You know your own version of this. Mine is a knee that nagged after a long descent, so I skipped the next walk. And the one after that too, because it still felt fragile.
Two weeks later the stairs got harder, and I told myself the joint had gone backwards.
Have a look at what was really at stake in those two weeks. 1,413 steps a day costs 3.9 per cent of the fat free mass in your legs in fourteen days, in healthy people of 72.³
So the stiffness in week three was not proof that the joint had got worse. Part of it was those fourteen days.
That really makes a difference, because one of those two is something you can act on this week.
1. Resting until it settles.
Whether you give a painful joint rest is of course up to you, and there are days when it is the only sensible thing to do.
But be clear about what rest does and does not do. At that moment it takes the load off, and that is real. It does not tell you why the complaint is there. And the bed rest study puts a price on it as soon as it lasts longer: 13.2 per cent of knee extensor strength and 14 per cent of stair climbing power in ten days, in healthy people of 67.²
The muscles around your knee are what takes load off the joint. Rest takes the load away, and the muscle goes with it.
2. Walking less, avoiding the stairs, taking the lift.
The same reasoning, a friendlier version, and this is the one almost everyone does without ever making a decision about it.
What it does: fewer painful moments today. What it does not do: anything about the reason. And the step study measured what 1,413 steps a day costs, roughly what a careful two weeks at home comes down to: 3.9 per cent of the fat-free mass in your legs, and 26 per cent of the protein build-up in the muscle after a meal, in 14 days.³
3. "It is my age. Nothing can be done about it."
There is a number attached to that, and it is the most useful number on this page.
In that nursing home study the average participant was 87 years old and frail enough to be living in care. After ten weeks of progressive strength training, strength was 113 per cent higher against 3 per cent in the group that did not train, walking speed went up by 11.8 per cent against minus 1.0 per cent, and stair climbing power went up by 28.4 per cent against 3.6 per cent.⁴
Note what that study can and cannot say. It ran for ten weeks, in 100 people, in nursing homes. It says nothing about ten years, and not that everyone changes by the same amount. It does say that 87 was not an end point for these people.
4. The all-or-nothing week.
The pain settles, the good week arrives, and then everything that was cancelled happens after all, in three days.
In 2015 Marlene Fransen and colleagues published a Cochrane review in the British Journal of Sports Medicine. They searched five databases up to May 2013 and found 54 randomised studies on land based exercise in people with long standing knee complaints, against a group that did not exercise. Pooled across 44 studies, pain dropped by 12 points out of 100 (95 per cent confidence interval 10 to 15) and physical functioning went up by 10 points out of 100 (8 to 13), directly after the programme. In the 12 studies that followed people 2 to 6 months after it ended, pain was still 6 points out of 100 lower.⁵
Two things in that record deserve your attention. The authors write themselves that only 19 of the 54 studies (35 per cent) reported the randomisation, the concealed allocation and the handling of dropouts properly, so the pooled figure may come out more favourable than it really is. And what was tested was a programme of regular moderate work, not three heavy days.
Four moves, one shared problem: none of them starts with what is actually going on with you.
The advice failed here, and it was the sensible sounding kind of advice. You did nothing wrong. It can go differently.
This is the heart of it. If tissue adapts to load in both directions, then "rest or move" is the wrong question, because both answers are right for someone.
The question becomes: which of those two is at play for me right now?
A joint that hurts because more is being asked of it than it can carry needs something different from a joint that hurts around a leg that has quietly been losing strength for a year. From the inside, both of those feel like a stiff morning.
That is what the research made available. Roos and Dahlberg showed that cartilage in adults answers a change in load.¹ Fiatarone and colleagues showed that muscle still adapts when you are 87.⁴
What was not there: a way to hold your own situation up next to it.
On one condition. That analysis has to be about you: your complaints, your week, your own answers, question by question alongside what published research describes. A general list of joint tips does not tell you which of those two directions you are in.
BioProfile has built that first step. A scientifically validated questionnaire, five minutes, free and with no account.
You answer questions about your body and your daily life. After that you see which signals in your profile speak loudest, and what the research says about them.
Not a medical examination. An analysis of your own answers. You use the outcome yourself, or you put it on the table with your doctor or your coach.
None of the four moves above started from your own situation. This one does, and it takes you five minutes.
You do the free check. Five minutes, no account, and there is nothing to buy.
Even if you do nothing with it, you have traded "I will take it easy for a bit" for an analysis of your own answers. That trade is worth five minutes.
And the next time you stop at the top of the stairs, you will know which signals in your profile speak loudest.
Do it while this page is still open. Those two weeks of taking it easy run on, whether you read about them or not.
Our scientifically validated questionnaire gives you answers
The scan is not a medical examination. It is an analysis of your own answers. If complaints persist, consult your doctor.
