Is your weight contributing to your joint pain?

BENEFITS OF WEIGHT LOSS

Most of us know how hard it is to lose excess kilos and we are aware of the many benefits of losing weight. However, I wanted to highlight the benefit of weight loss from a Physiotherapy perspective. Weight loss can have a positive effect on symptoms of joint and soft tissue pain as well as urinary incontinence.

 

Decreases the pressure on your musculoskeletal system

Some musculoskeletal conditions are associated with increased weight. For example, osteoarthritis (OA) is when there is decreased cartilage in the joints resulting in less cushioning. OA particularly affects the weight bearing joints such as the hips and knees and OA sufferers commonly report joint stiffness, pain and swelling. Obesity is considered a risk factor for the development of OA and the progression of the condition (Spector et al., 1994). This is particularly the case for knee OA. Studies on twins have demonstrated that the risk of knee OA (on x-ray) increases with each kilogram of increased body weight (Cicuttini et al., 1996)

Now that the bad news is out of the way, let us talk about the good news!

When we lose one pound (0.45kg) of weight there is four times less load on the knee which each step we take (Messier et al., 2005) Let us put this into perspective. If a person lost 5kg (11 pounds) of weight, they would have a 44 fold reduction in the load exerted on the knee joint. For someone with joint pain this is significant. If you think about how many thousand steps an individual does in one day, this decrease in load should improve their symptoms.

If we move away from OA and focus on other musculoskeletal complaints, obesity has been shown to be a risk factor in several conditions. Some of these include plantar fasciitis which is one of the most common forms of heel pain (Riddle et al., 2003). Interestingly, I have treated pregnant women with plantar fasciitis which resolves post birth as they return to their pre-pregnancy weight. Obviously a person’s foot biomechanics plays a role in plantar fasciitis and whether being overweight may contribute to poor biomechanics is unknown. Conditions of the upper limb such as carpal tunnel syndrome (Geoghegan et al., 2004) and rotator cuff tendonitis (Wendelboe et al., 2004) are also associated with increased Body Mass Index (BMI). In the lower limb, obesity is also a risk factor for hip bursitis (Cohen et al., 2005).

 

Improvement in urinary incontinence

An increased waist circumference is associated with an increase in abdominal and bladder pressure (Richter et al., 2008). This pressure acts on the bladder and pelvic floor and can negatively affect urinary leakage such as with stress incontinence (leakage with cough, sneeze, run, jump etc.). Therefore, reducing abdominal fat can improve symptoms of urinary incontinence (Auwad et al., 2008).

 

How to know if you are a healthy weight?

BMI is a widely accepted and simple tool that is used to classify adults as either underweight, a healthy weight, overweight or obese. It can be calculated by taking your weight in kilograms and then dividing it by your height squared in metres (kg/m2) (WHO, 2006).

The following BMI values have been recommended by the World Health Organization (2006):

  • Underweight BMI < 18.5
  • Healthy weight BMI ≥ 18.5 and BMI < 25
  • Overweight BMI ≥ 25 and BMI < 30
  • Obese BMI ≥ 30

You can use the BMI calculation and classification to work out if you are in the healthy weight range.

 

If you experience any of the conditions outlined in this blog, then please understand that there may be a multitude of factors causing or contributing to your symptoms. However, our weight is a lifestyle and modifiable factor. I believe that you can’t change what you can’t control. However, if there are factors you can control, and that may alleviate your symptoms somewhat, then it is worth a shot. Food for thought!

 

 

References

Auwad, W., Steggles, P., Bombieri, L., Waterfield, M., Wilkin, T. and Freeman, R. (2008) ‘Moderate weight loss in obese women with urinary incontinence: A prospective longitudinal study’, International Urogynecology Journal, 19(9), pp. 1251–1259.

 

Cicuttini, F., Baker, J. and Spector, T. (1996) ‘. The association of obesity with osteoarthritis of the hand and knee in women: a twin study.’, Journal of Rheumatology, 23, pp. 1221–1226.

 

Cohen, S., Narvaez, J., Lebovits, A., Popovic, J., Gharibo, C. and Stojanovic, M. (2004) ‘Corticosteroid injections for trochanteric bursitis: Is fluoroscopy necessary? A pilot study’, Regional Anesthesia and Pain Medicine, 29, pp. 41–41.

 

Geoghegan, J., Clark, D., Bainbridge, L., Smith, C. and Hubbard, R. (2004) ‘Risk factors in carpal tunnel syndrome’, The Journal of Hand Surgery: British & European Volume, 29(4), pp. 315–320

 

Messier, S., Gutekunst, D., Davis, C. and DeVita, P. (2005) ‘Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis.’, Arthritis Rheumatology, 52, pp. 2026–2032.

 

Richter, H.E., Creasman, J.M., Myers, D.L., Wheeler, T.L., Burgio, K.L. and Subak, L.L. (2008) ‘Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: The program to reduce Incontinence by diet and exercise (PRIDE) trial’, International Urogynecology Journal, 19(12), pp. 1653–1658.

 

Riddle, D., Pulisic, M., Pidcoe, P. and Johnson, R. (2003) ‘Risk factors for Plantar fasciitis: a matched case–control study’, J Bone Joint Surg Am, 85-A, pp. 872–877.

 

Spector, T.D., Hart, D.J. and Doyle, D.V. (1994) ‘Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: The effect of obesity’, Annals of the Rheumatic Diseases, 53(9), pp. 565–568.

 

Wendelboe, A., Hegmann, K., Gren, L., Alder, S., White Jr, G. and Lyon, J. (2004) ‘Associations between body-mass index and surgery for rotator cuff tendinitis’, J Bone Joint Surg Am, 86-A, pp. 743–747.

 

World Health Organization (2006) WHO: Global database on body mass index. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html (Accessed: 24 August 2016).