Preventive Healthcare for the Joints

At Stone Clinic we’re often asked, “What can I do to preserve my knees?” The answer: don’t get hurt. Knees can go forever, providing their cartilage and ligaments stay intact. “But how do I not get hurt?”

Avoid Injury

Knees and ankles take one to three million steps per year, supporting up to five times our body weight. The bearing surface, called articular cartilage, has a remarkable ability to absorb force and provide nearly frictionless lubrication up to five times as slick as ice on ice. Unless it is injured or attacked by an inflammatory disease, articular cartilage can last forever—no matter how much running or other reasonable forces are applied. Once injured, however, its repair capacity is hampered by a low storehouse of reparative cells. 

If the meniscus in the knee joint is injured, or a portion removed, the forces are concentrated on a smaller area of the articular cartilage. That’s when wear, down to the bone, occurs. If the ligaments of the knee are damaged, the joint motions are abnormal. As happens with a car out of alignment, the surfaces wear rapidly.

So our first answer—don’t get injured—is correct. And if your knee is injured? Repair, regenerate, and replace the damaged structures immediately, with the goal of restoring normal anatomy.

To avoid getting injured in the first place, the key is to choose wisely.  Most often we make the choices that lead to injury. Here are a few ways to avoid the costly ones.  

First, keep your head in the game. Most errors we see are mental errors. The athlete was out of control, got distracted, or landed poorly from a jump. They lunged when they shouldn’t have, stuck their leg out to block an opponent when a different move would have been smarter…the list goes on. Here, the point: Focus in sports is not just on your opponent. It’s on you. Your ability to maintain body awareness and make great choices determines whether or not you end up in my office.

Second, optimize your health. This means everything from mental health to fitness, including your diet and body weight. If you don’t want to get injured, don’t start out injured. Self-inflicted injury used to be thought of as smoking cigarettes and drinking too much alcohol. It is now clear that every meal, every choice, every decision about whether to train or not, determines how healthy we are. It appears that dietary choices heavily biased toward plant-based diets may make the largest difference in total body inflammation and disease development. And while supplements such as glucosamine appear to help joint lubrication and cartilage health, not many others have been shown to be at all helpful. An addiction to the testosterone, pheromones, adrenaline, and endorphins produced during daily exercise is the best possible addiction to have. It’s also important to enjoy yourself. It can be fun to make a game out of optimizing your health. But it’s a painful chore if you see it as a chore. Healthy people get injured less often.

Third, partner up. Playing and training with a partner dramatically increases the efficacy and efficiency of your fitness program. “The family that plays together, stays together” was a rule we heard growing up. It remains a great guideline today.

Fourth, recognize injuries—minor and major ones—early, and treat them aggressively. We are developing the entire field of anabolic therapies for joint and tissue injuries where we inject bioactive factors that boost stem cell recruitment to the site of injury. We don’t know yet whether or not this will truly accelerate healing or prevent arthritis, but the data is encouraging so far.

Fifth, sleep more. We often cut our sleep short. Then we work and play with fatigue, and wonder why we get hurt. The volume of data suggesting that a minimum of seven to eight hours of sleep per night dramatically affects our testosterone levels, our fitness, our decision making, and our memory storage, is overwhelming. Those last two hours of deep REM sleep—when we imbed the lessons we learned through the day—are the key hours. Without them, we repeat our mistakes and leave ourselves open to avoidable errors of judgment and action.

So, how do you not get hurt? Be smart. Live smart. Your knees, and everything connected to them, will thank you for it.

Medically authored by
Kevin R. Stone, MD
Orthopaedic surgeon, clinician, scientist, inventor, and founder of multiple companies. Dr. Stone was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.