Maintaining and Building Muscle Despite Arthritic Joints
Maintaining and Building Muscle Despite Severely Worn and Arthritic Joints
Part 1
By William Wong, ND PhD, Member of the world Sports Medicine Hall of Fame.
As with all rules, few are hard and fast. The exception to the rule came, honestly enough, with the Russian Olympic team. Full range off motion bench presses, where the elbows are dropped lower than parallel with the chest were blowing out the shoulders of their olympic athletes, damaging the long head of the bicipital tendon under the anterior deltoid. To compensate, their exercise physiologists and kinesiologists (bio mechanists),developed the simple floor bench press, in other words doing a bench press from laying on a floor in a power rack so the elbows could not go all the way back (horizontal extension). This solved the problem of blowing out the bicipital tendon but would it strengthen throughout the full ROM as well as the full Range Of Motion bench press? They pulled out their strength testing equipment and found that indeed, even though the exercise was not full ROM, the partial ROM done did strengthen the muscles involved as well and as fully as the full ROM work did. (3)
It has to be said that the concept of partial repetitions came from Dr John Ziegler MD at the York Barbell club and US Olympic Weightlifting Team (which were synonymous in the 1930’s - 90’s). The York Power Rack first used the concept of partial ROM movements with isometric hold at the top of the rep to build strength through out the Range Of Motion. Olympic Lifter Bill March was the primary example cited as to the validity of the work. (4) (5)
That takes us to now. Those of us who have had an active life, doing, building, working physical jobs, have a ton of joint wear and arthritis to show for it. We once thought that if we worked out and ate well we’d be covered and go into our old age fit and able. Life and human structure had other ideas. The very things we did to keep ourselves fit and active, were the things that caused the joint wear and become arthritic regardless of what supplements and precautions we took. From simple overuse and wear to injury, what we did to exercise, in sport, in military service, in physical labour all had a hand in wearing out the joints even though the body was supposed to be rebuildable in good part. Turns out not so the joints, they do not rebuild except when promoted to through therapies from the outside: Prolozone therapy, PHP injections, Autologous Stem Cell therapy etc can in part rebuild the joints to an extent but for all of the promise of those therapies, they help some but fall short of completely rebuilding the inside of a joint. And so the arthritis and dysfunction continue.
We trudge though our workouts, running less, doing lighter resistance, fewer movements and the older we get, the more joint wear we incur not just from exercise but from life, we loose muscle mass (sarcopenia). The loss of muscle mass is on average 10% a year from age 50 to 60 so that by 60 most non exercising folks have barely enough muscle to move them selves around.
Here I’ll site my own example and journey back to the basics I learned when I started weight lifting in the late 1960’s. Going to brag here a bit: Having been a, life long strength trainee starting in Olympic and power lifting then later, body building (to make myself attractive to the girls); having been a fencer, gymnast and gymnastics teacher, skydiver, an NRA High Power shooter, a life long martial artist; all of that over the decades gave me a good deal of fitness but from 50 on I began to feel the wear. Most who were active as athletes or combat troops, or just plain fitness folks in their teens and 20’s begin to feel every every injury they walked off, every ache they ignored once they get to and past 35. Things hold steady from there till 50. As the late actress Susanne Summers wrote in one of her fitness books, that 50 is when the bottom falls out. Physiologically she was very, very right.
The hormonal changes, pre menopause in gals from 35 on, where testosterone plummets (its what keeps gals strong, trim and with mental, physical and sexual drive). Progesterone (what built the body in the womb and continued to maintain and preserve it till 35 -40) begins to wane. With the guys, they hit andropause some where between 40 to 45 and have lowered testosterone, no progesterone and more estrogen in them than their wives do so they are estrogen dominant. Estrogen is catabolic (i.e. destructive) to muscle. The higher the estrogen the lower the muscle mass and the higher the ratio of subcutaneous (under the skin), fat that is carried. The less muscle mass one has the more bones loose mineralization and become hollow (osteoporosis).
Remember always that bone density is directly related to the muscle mass around them. That's the true definition of Wolf’s Law, not as the MD’s have been teaching merely weight bearing through walking. How is walking going to increase bone density in the spine, in the thorax, in the arms and shoulders? The old Soviet physiologists definition of Wolf’s Lay is much more physiologically correct: "Mineralization is laid into bone along axial lines of stress”. Another words a bone must be compressed, pushed against, pulled against, stressed with an overload, to get denser and stay that way.
To compound the muscle loss are worn joints. Whether the thinning to elimination of hyaline cartledge or the bony deterioration of a joint happens to the active from use and over use, and in couch potatoes from inactivity and Hypo Kinetic Disease (sickness through lack of movement). Joint wear finds us all and says a painful “hi”!
So how can we counter the muscle loss and continue to exercise even though our joints refuse to go through a full range of motion? We go back in time to the forgotten work the John Ziegler MD developed for Bill March: Partial reps with an isometric hold at the top of the rep. (5)
First let me say that isometric contraction with out a movement part of the exercise and with out an overload (a fairly heavy resistance), is good for folks recovering from debilitating conditions involving nerve or brain damage. But for folks looking to increase their muscle mass for combating sarcopenia in their senior years it isn’t of much use. Why? Because with isometrics alone there is no over load. Moving and holding a resistance is what stimulates muscle growth and strengthening.
So despite what our joints don’t want us to do, how do we combine a movement through the less painful parts of our present Range Of Motion with isometrics to reverse and overcome muscle mass and strength loss?
Let me use the exercises I personally do as examples as to how to do Adaptive Physical Education to exercise.
Lower Extremities:
From running (weather stadium steps, Harvard steps, interval wind sprinting etc) and skydiving I had injuries to both my knees. Unhappy triads, i.e. torn medial meniscus, partially torn Anterior Cruciate and partially torn Medial Collateral ligament in both knees. Rehabbing them myself for range of motion and for strength and stability, I managed to avoid surgery. Those injuries sparked significant arthritis and joint wear and I went from being able to squat in the 400’s as I had from age 17 to 50, (at body weights ranging from 185 to 200), to have to move to Leg Presses which were easier on the knees.
Knee extensions became painful in the start and mid part of the Range Of Motion. I began to loose muscle mass in the thighs. Ditto for the calves as they are worked one the same machinery.
With most any exercise the weakest (and usually most painful) portion of the ROM is the starting point of the exercise: In the barbell curl its the very start of the movement as it is in the knee extension. Usually the first 1/3rd of the movement. If we adapt the partial ROM with overload and isometrics principle to the exercises we do we can have the benefit of the overload of weightlifting with the near maximal contraction of isometrics.
On maximal contractions: There is another principle we need to think about; “Time Under Load” i.e. the actual time spent in very strong muscle contraction during an exercise. For example the time under load for one set of 8 reps of regular isotonic barbell curls may actually be less than for a set of 1 curl done in a partial ROM and holding weights at the top position against a stop for 10 seconds! It’s this time under load that is what causes our muscles to adapt to the stressor and rebuild itself stronger. (*Remember that exercise is a stimulus response mechanism, exercise is the stimulus adaptation to the stimuli is the response).
Have I explained the functional principles involved with this type of exercise well enough? Hope I have with out getting too technical.
I can’t cover every possible adaptation of every possible exercise known but in Part 2 we’ll go over some of the adaptations of exercise I’ve made given my abilities and disabilities. From there you can get some ideas on how to adapt what ever exercises you might be doing or need to be doing given your abilities and disabilities using the Partial Range Of Motion Overload with Isometric Hold principle. (Have got to find a shorter name for that)!
Get past the foul language sometimes used in this article and get to the meat and potatoes of what’s being taught.