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How To Train Clients with Inflammation and Joint Pain
Recently we have received many questions from our trainers with regards to training clients that experience chronic inflammation, swollen joints and joint pain. As always, it is imperative during the Client Consult phase, to go through a careful Health Screening Process with any client and ensure your client has been through a physical examination with their Physician.
Before we address possible treatments for inflammation, it is important to understand the cause.
Inflammation is not an evil manifestation that randomly transpires in the body. Inflammation plays an important part in your immune system. According to Keenan Walket, Ph.D, a postdoctoral fellow in the department of neurology at the Johns Hopkins School of Medicine in Baltimore, “Inflammation is, very basically, the body’s reaction to something that’s not supposed to be there.” Inflammation occurs in order to repair your body and keep it healthy.
I’m sure you have experienced a cut on your knee, or a bee sting. The red, swollen, painful area that resulted was inflammation flooding the area in order to repair the damaged tissue. This temporary, short lived inflammation is known as Acute inflammation. Inflammation is released, the cycle of destroy and repair happens relatively quickly (a few hours to a few days) and everything goes back to normal.
Chronic inflammation is a different story. While the same process occurs, the inflammation lingers for much longer periods of time (weeks, months, even years) as a result of the threat not being neutralized. In some cases, even after the invader has been nullified, inflammation persist.
Clients that are overweight are experiencing chronic inflammation. The body recognizes the excessive fat cells as a threat. In order to eliminate the threat, the body continues to pump out more white blood cells. Until the fat cells are diminished, the body will stay in a constant state of inflammation.
If a client tells you they are experiencing more joint pain and inflammation than normal, ask them what they have been eating the past few days. You will likely see a direct correlation between a “cheat week” and more pain.
I had a client, who was in great shape by todays standards. She was in her 50s, a little overweight, but ate healthy for the most part. Along with our workouts, she would also go walking every day. She came to me by her Doctor’s recommendation due to her recent weight gain, and persistent joint pain. She made great progress, we got her weight into a much healthier category and her joint pain immensely improved.
During the summer, she went camping for a week and was experiencing extremely painful inflammation by the time she returned. She believed it was from the hiking, but she hikes daily, and I knew immediately that was not the cause.
Yes, she was hiking, however, she was also eating hotdogs, cold cuts, brats, smores, galore, for a week. Eating highly fatty foods for a week can be detrimental to chronic inflammation. She couldn’t believe eating unhealthy for a week would impact her body to such an extreme degree. A few weeks later, she took the same camping trip, but this time we put together a healthy meal plan. She had the opportunity to eat a few fun camping foods, but for the most part, we had a solid strategy. When she returned, she had no joint pain.
What you eat, and drink can either promote or combat inflammation. The foods that are generally deemed unhealthy are the same ones that promote inflammation.
Foods that cause inflammation:
Sugar: desserts, commercial cereals, specialty coffee drinks (watch out for sneaky foods like yogurt, sauces, frozen breakfast foods, canned fruit, canned soups, instant oatmeals)
Saturated Fats: pizza, cheese
Trans Fats/Fried Foods: fast foods, processed snacks
MSG (Mono-sodium glutamate) often found in prepared Asian food, some soy sauces, dressings and meats.
Processed Meats: hotdogs, brats
Refined Carbohydrates: white breads/rolls/crackers, pastas, pastries
Red Meats: burgers, steaks (Grass fed, Drug and Hormone Free are healthier choices)
Margarine: shortening, lard
Oils: hydrogenated oils, vegetable oils, seed oils, watch out for salad dressings
Drinks: soda, other sugar-sweetened beverages such as juices, energy drinks, excessive alcohol
While most of these foods are no brainers, McDonalds happy meal is clearly a no-go, other foods might surprise you with the amount of unhealthy ingredient levels. While apple sauce or a granola bar might seem like a great snack, they are often loaded with sugar.
Pay special attention to the “add-on foods.” After spending the time to make the perfect healthy salad, before adding salad dressing, be sure to check the label, you might just be pounding tablespoons of sugar without even realizing it.
Foods that fight inflammation
Nuts and Seeds: flaxseeds, almonds, walnuts
Fruits: strawberries, blueberries, blackberries, oranges, cherries
Green Leafy Vegetables: spinach, kale, collard greens,
Fish: salmon, tuna, mackerel, sardines, herring, trout,
Beverages: coffee (not a 500 calorie Frappuccino…actual coffee), cocoa, green tea
Oils: Olive oil, flaxseed oil, coconut oil
Does this mean your clients can only eat fruits, nuts, vegetables and fish for the rest of their lives? Of course not. There is a balance. According to Dr. Andrew Luster, of the Center for Immunology and Inflammatory Diseases at Harvard-affiliated Massachusetts General Hospital, “The goal is not to consume a certain amount per day, but to incorporate as many of these foods as possible into your regular meals.”
MSM, Glucosamine and Chondroitin: There are mixed reports on the effectiveness of these supplements. Most studies show modest to no improvement. They can be taken independently or in combination.
While there has not been a great deal of long-term research with MSM, joint pain, inflammation, Arthritis and other related conditions, several small and short-term studies have shown improvements in both Arthritis Symptoms as well as exercise induced inflammation. The dosage for MSM is typically 1,000-3,000mg taken per day with meals. The Arthritis Foundation cites a 2006 pilot study where 50 men and women showed improved symptoms of pain and physical function without any major side effects, while taking 6,000 mg of MSM.
While there are few studies that show the effectiveness of the combo, Chondroitin, Glucosamine and MSM are prescribed in combination to support healthy joints and taken to reduce pain in those with osteoarthritis and other inflammatory joint problems. Some people swear by the combinations, others find no relief at all. It appears to greatly depend on that condition, as well as the dosage of the three.
The Arthritis Foundation reported Chondroitin Sulfate provided modest pain relief during a 2011 study for hand Osteoarthrosis. As a result of no side effects, it can be tried as an alternative to NSAIDs, especially for individuals that need long term treatment. However, it was mentioned thus far, there hasn’t been a study that has compared Chondroitin and NSAIDS head-to-head.
Glucosamine has also been shown to provide moderate pain relief with some patients that have osteoarthrosis of the knee, hip and spine.
The Arthritis Foundation has also cited a study that is “the most comprehensive long-term study of any supplement.” The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) presented interesting findings.
- The study found the combo had no effect with the participants that experienced mild knee pain.
- However, the study showed significant relief for participants that had moderate-to-severe knee pain.
- The study determined the combo had no effect on preventing joint and/or knee damage.
- In the final phase of the study, the combo provided no greater benefit to knee pain relief during a four-year period.
Due to the mix results from the study, the American College of Rheumatology does not recommend either supplements for initial treatment of osteoarthrosis, but the Arthritis Foundation states, “Chondroitin and glucosamine supplements alone or in combination may not work for everyone with osteoarthritis. However, patients who take these supplements and who have seen improvements with them should not stop taking them. Both supplements are safe to take long-term.”
Vitamin D: According to the Institute of Medicine (IOM) 600 to 800 units per day of Vitamin D can reduce the risk of Osteoarthrosis and rheumatoid arthritis. Various sources recommend different optimum levels of Vitamin D intake. Remember the Individuality Principle and experiment with the different recommendations until you find what works for you. I am a big fan of spending 10-15 minutes outside each morning without sunscreen, to soak in the Vitamin D sun rays.
As always, remember your Scope of Practice. While it is important to keep up on the latest studies and understand the effectiveness of different supplements and how they could potentially help your clients…you are NOT a Doctor. Always have your client speak with their Doctor before prescribing anything new, whether an exercise program or nutrition prescription, having a Doctors approval is absolutely necessary.
You already know exercise is essential to living a healthy lifestyle. The Center for Disease Control and Prevention (CDC), recommends adults exercises for 2 hours and 30 minutes of moderate intensity, or 1 hour and 15 minutes of vigorous intensity per week.
For clients that come to you with varying degree of inflammation, swollen joints and joint pain, the same exercise principles you use for all clients applies. Gradual Progressive Overload is key.
The CDC, recommends “start low, and go slow,” which is the fundamentals of GPO.
- Start your clients with joint friendly, low impact activities such as walking, biking or swimming.
- Gradually increase to strength training exercises.
- Flexibility exercises are also very important to improving inflammation. These can be done daily.
- Balance exercises are recommended to be performed 3 days a week.
- Even if your client isn’t training with you daily, put together flexibility and exercise prescriptions they can follow on their off days.
Other Lifestyle Recommendations
Quit smoking. This is a no brainer for many reasons. The toxins from smoking have a direct link to inflammation.
Gum Health. Inflammation can occur in your gums. If your gums are inflamed and swollen or they bleed from brushing or flossing, it is time for a checkup. Use a soft bristle brush and gentle brush your teeth twice daily. Don’t forget to floss and rinse regularly. Anti-gingivitis toothpaste can also have more benefits than your typical toothpaste.
Get Your Beauty Sleep. One of the many side effects of sleep deprivation is inflammation. Getting too little or too much sleep can cause inflammation. The National Sleep Foundation recommends 7-9 hours of sleep for adults 26-64 years of age, while 6-10 hours may be appropriate with certain individuals.
From previous articles, you know almost all diseases such as Autoimmune Disorders, Cancer, Heart Disease, Diabetes, Kidney Disease, Osteoporosis, even Alzheimer’s, Dementia and Cognitive Decline are linked to chronic inflammation. Did any of the nutrition, exercise or lifestyle recommendations blow your mind? Probably not. You fight almost every disease, disability and dysfunction with exercise, proper nutrition and good lifestyle choices. Drill into your clients, the kitchen and the gym are all they need to succeed!
Arthritis Foundation. (2018, February 07). Arthritis Physical Activity Overview. Retrieved from https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
Arthritis Foundation. (2018). MSM. Retrieved from https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/guide/msm.php
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Centers For Disease Control and Prevention. CDC (2018, February 07). Physical Activity for Arthritis. Retrieved from https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
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Hess, A. (2018). Chondroitin Sulfate and Glucosamine Supplements in Osteoarthritis. Retrieved from https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/glucosamine-chondroitin-osteoarthritis.php
Kim, L., Axelrod, L., Howard, P., Buratovich, N., & Waters, R. (2006). Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: A pilot clinical trial. Osteoarthritis and Cartilage, 14(3), 286-294. doi:10.1016/j.joca.2005.10.003
Merwe, M. V., & Bloomer, R. J. (2016). The Influence of Methylsulfonylmethane on Inflammation-Associated Cytokine Release before and following Strenuous Exercise. Journal of Sports Medicine, 2016, 1-9. doi:10.1155/2016/7498359
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RD, J. R. (2017, October 03). What Are the Benefits of Chondroitin Glucosamine MSM? Retrieved from https://www.livestrong.com/article/205738-what-are-the-benefits-of-chondroitin-glucosamine-msm/
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