The physiotherapist

‘A simple yoga flow routine will save a world of pain’

Liam Goode, physiotherapist, White Hart Clinic, London
Our brains are interested in the easy route and will learn pathways of movement that expend the least amount of energy. This can create imbalances in a joint by overworking muscles in a specific range of rotation. If we want to have healthy joints, we need to combat these repeated movements by keeping our exercise very general.

Since nothing in the body is done in isolation, we must build strength across the body. Strength and conditioning programmes are very helpful in engaging all of our muscles and joints, from pilates to yoga, or completing weights exercises in the gym.

Find your starting point with the aim of building up to regularly move your joints in as full a range of motion as possible, such as squatting to get your bottom as close to the ground as you can. Ultimately, if the cartilage surrounding our joints doesn’t move enough, it won’t get enough blood flow and it will dry out and crack.

The earlier you can build a range of movement into your daily life, the better. If you are in your 20s and reading this, a simple regular yoga flow routine will save you a world of hurt later on.

The foot and ankle surgeon

‘Wear trainers for everything’

Nick Cullen, consultant orthopaedic foot and ankle surgeon, Royal National Orthopaedic Hospital, Stanmore

When it comes to our feet and ankles, what we wear is really important. Part of my mission is to try to persuade everyone to wear solid, broad-soled trainers for everything.

If you have to wear a heel, try to offload your weight better with a lower heel or wedges, since the higher the heel the more pressure you put on the balls of the feet which are very prone to problems.

The optimal shoe is structured and lace-up; if you have flat feet, you need arch support for stability and with high-arch feet you need a more neutral running shoe. Asics, Brooks and Saucony are all good brands and I would recommend going to a sports shop with a treadmill to decide which shoes fit your foot shape, even if you never run.

It is also important that we get the small muscles in our feet working regularly. You can look up toe yoga exercises on YouTube or while you are sitting, press your toes into the ground and hold for 10 seconds. Lots of people also have tight calf muscles, which puts more pressure on the balls of your feet when you are walking, so make sure to stretch your calf with a towel or scarf looped under the ball of the foot and held tight, keeping your knee straight and pointing your toes towards your nose.

The orthopaedic surgeon

‘Run or cycle to avoid replacements’

Prof Alister Hart, chair of orthopaedics, University College London

People often think that running will damage their knees, but over the past decade I have conducted studies with the research group Exercise for Science that have shown how distance running can actually be good for rebuilding the health of middle-aged knees, provided injury-prevention exercises are done beforehand.

Non-runners shouldn’t be scared of taking up running, since we haven’t seen evidence of the sport damaging joints further than what might be normally expected by middle age. In fact, exercise as a whole has been shown to improve bone quality in the knee by increasing blood supply and providing muscle strength and definition, allowing the surfaces around the joint to move better.

Equally, cycling can be very good for working the knees and hips with its simple, inline motion. Building up to 30 minutes of movement on an exercise bike every other day can really help to reduce the destruction of our knee and hip joints. Even though we have metal joints that we can surgically substitute, nothing quite compares to our own bone and cartilage, so we must look after these joints to begin with.

The osteopath

‘Move every 20 to 30 minutes’

John Mallinder, osteopath, Osteopathy London

Movement is central to our health. It is essential to keep us strong and flexible. Even great posture won’t prevent potential stiffness or future joint pain without regular movement. Ideally during working hours, especially if you are seated for most of the day, try to move away from your workstation every 20-30 minutes. Walk for a few minutes, make tea, or have a chat with a colleague.

By breaking our routine we can become aware of our posture when we sit again and avoid the negative impact of prolonged periods in one position. If your capacity for movement is limited, during these short breaks you can try some gentle shoulder rolls backwards and forwards, or simple seated spinal twists and side bends, all to a level you find comfortable.

If your job is active but involves repetitive movements or extended periods in one posture, explore movements in different directions during these breaks to give yourself balance. Discomfort can often prompt the avoidance of movement for fear of causing harm, but waiting to be pain-free before gently exercising is a mistake, as it leads to slower healing, weakness and vulnerability.

Regular, gentle movement should always be seen as part of the solution. Seek advice if you are unsure of what is safe for you.

The clinical director

‘Lean on your arms to help your shoulders’

Anju Jaggi, clinical director of therapies, Royal National Orthopaedic Hospital, Stanmore

The shoulder is inherently the most unstable joint in the body and relies heavily on muscular structure to offer support and stability. We need to strengthen the muscles that move and rotate the shoulder by exercising our arms regularly and doing things that might seem a bit unnatural, such as weight-bearing with our upper arms.

By leaning on your desk while you’re seated or leaning your bodyweight through your arms against a wall for 20 minutes per week, we can build our bone density in the shoulder and allow the joint to better align itself. There is also a strong correlation between grip strength and shoulder strength. If you work on your grip, it will have a knock-on effect for helping your shoulder. Squeezing your hand into a tight fist and then releasing to fan your fingers 10 to 15 times per day is a simple and effective exercise.

As we age we naturally stiffen, which is why it is so important to change your behaviour if you aren’t exercising and become more aware of your body so you can identify the areas that might need more attention.

The musculoskeletal physiotherapist
‘Don’t be afraid to slouch’

Aoife O’Meara, musculoskeletal physiotherapist, Royal National Orthopaedic Hospital, Stanmore

A lot of research has been conducted to show that there is no such thing as perfect posture. In fact, if you spend all day sitting with an upright, straight spine, it causes your back and core muscles to work hard and that can eventually cause pain – it’s like walking around with fists clenched all the time. Since every body is different, there is no true neutral when it comes to posture. Instead, we should prioritise changing posture every 30-40 minutes when seated and encourage mobility in the spine. It is safe to slouch, since there is no evidence that it will cause harm when you move regularly.

Equally, when you sleep there is no perfect position to protect your spine: find what feels comfortable, since it is more important to get a good quality of sleep for your overall health. I often find a pillow between the knees works well for patients. If you are experiencing pain, it is important to listen to your body but also to incorporate movement as soon as you can, because long periods of bed rest are ultimately what becomes most damaging for the spine.