Prescription for Joint Health
Cartilage doesn’t grow back once it’s lost — which is why protecting your joints matters just as much as treating them once they hurt.
After more than 30 years as a joint replacement surgeon, here’s what I tell my own patients: it comes down to four things. Lose weight, eat well, exercise, and play it safe.
1. Lose Weight
Nothing shortens a joint’s lifespan faster than excess weight — research consistently shows obese patients face several times the risk of knee osteoarthritis compared to those at a healthy weight, and even being 10 pounds overweight adds meaningful stress to your joints. Here’s why: normal walking puts roughly four times your body weight through your knees and hips. Carry 20 extra pounds, and that’s nearly 80 extra pounds of force on your joints with every step. The reverse is also true — even modest weight loss measurably slows joint deterioration and eases pain. For many of my patients, it’s the single most effective first step in treating arthritis without surgery.
2. Eat Well
Diet alone doesn’t cause or cure arthritis (gout is the one exception) — but eating well supports the healthy weight that protects your joints, and adequate calcium and vitamin D support the bone strength that helps prevent fractures later in life. Focus on a varied diet: plenty of vegetables, fruits, and whole grains; modest fat, sugar, and sodium; alcohol in moderation. If dairy isn’t part of your diet, a calcium supplement is a reasonable substitute.
The importance of vitamins and minerals in your diet
Be sure to take the recommended daily requirements of vitamins and minerals. It’s very important to get adequate levels of calcium and vitamin D. The higher your peak bone mass, the less likely you'll be to have fractures later in life. Maximum peak bone mass depends partly on your inherited ability to make bone, the amount of calcium you consumed over your lifetime and your exercise level. In most cases, bones weaken when you have low levels of calcium, phosphorous and other minerals in your bones. The loss of bone mass, known as osteoporosis, is more prevalent in women, but men get osteoporosis too. In fact, by age 65, men lose bone mass as fast as women do, and by age 75, one third of men have the disease.
Premenopausal women and postmenopausal women who use Hormone Replacement Therapy (HRT) should consume at least 1,200 milligrams (mgs) of calcium and 2,000 international units (IU) of vitamin D every day. Postmenopausal women not using HRT and those at risk of steroid-induced osteoporosis should get 1,500 mgs of calcium and 2,000 IU of vitamin D daily. Men should consume 2,000 mgs of calcium every day.
Good food sources of calcium include skim, low-fat and whole milk, low-fat plain yogurt, Swiss, cheddar and ricotta cheese, kale, broccoli, canned salmon with the bones, and orange juice and other products—such as tofu—fortified with calcium. If you find it hard to get the recommended amounts of calcium from your diet because you can’t eat dairy products, for example, try calcium supplements. Supplements—even plain old TUMS--are just as effective as calcium from food, are inexpensive, and generally are well tolerated and well absorbed if taken properly.
3. Exercise
Strong muscles act as shock absorbers for your joints — they reduce stiffness, improve stability, and slow the wear that leads to arthritis. It’s never too late to start: even patients in their 80s and 90s see real gains in strength, balance, and mobility from a sensible exercise program. The most effective approach combines range-of-motion work, strength training, and aerobic activity — not just one or the other. Low-impact options like swimming and cycling are especially good choices, since they build strength and cardiovascular fitness without pounding the joints.
Suggestions for a joint-friendly exercise routine
A well-rounded exercise program combines three things: range-of-motion work, strength training, and aerobic activity. Strength training in particular is often overlooked — but building the muscles around a joint acts like reinforcement, reducing the grinding that leads to further wear, while also improving bone density and stability. It’s never too late to start, and even modest strength gains can meaningfully reduce pain and disability from arthritis.
Best low-impact choices: Swimming and cycling are excellent starting points — both work major muscle groups without pounding your joints, and swimming’s buoyancy makes it especially good for advanced arthritis or post-surgery recovery. For cardio equipment, ellipticals and recumbent bikes are kinder to the knees than a treadmill or stair machine; if you’re already in pain, running is one of the hardest activities on your joints, pound for pound.
One swap worth making: if you’re working on quad strength, skip the seated leg extension machine — it puts undue stress on the knee. Lunges (kept to 90 degrees or less) are a better alternative.
More isn’t always better. Vigorous exercise or heavy lifting can do more harm than good, especially as you get older — aging tendons don’t keep pace with muscle strength gains, which raises injury risk. Past middle age, favor lighter weights with more repetitions over heavy loads, and keep shoulders especially mobile if you want to stay active in overhead sports like golf.
Listen to your body. Unusual fatigue, increased swelling, or pain that lingers more than an hour after exercise are signs your program needs to be dialed back.
4. Play It Safe
Muscle mass naturally declines starting in your 40s, and tendons and ligaments lose elasticity with age — which is part of why high-intensity, high-impact activities carry more injury risk later in life than they did at 25. A single significant injury, even one properly treated at the time, can lead to arthritis in that joint years down the road. The best protection is simple: stay active, but know your limits, and don’t let fatigue push you past them — most injuries happen at the point where a workout or activity has already gone on longer than it should have.
The dangers of overdoing it
In my own practice, I’ve seen a good number of younger patients develop early osteoarthritis after pushing too hard — overestimating how far they could safely run, or getting hurt on the basketball court. That pattern is worth paying attention to in the moment, not just in hindsight: a lot of these injuries happen near the end of an activity, once fatigue sets in and both judgment and balance start to slip. The moment you’re telling yourself “just a little further” is often exactly when you should stop.
High-impact, direct-contact sports like football and soccer carry a higher long-term arthritis risk — but you don’t need a career of contact sports to be affected. Even a single injury in your younger years — a broken bone, a torn ligament, a bad ankle sprain — can lead to arthritis in that joint decades later, even if it healed properly at the time. This is known as secondary osteoarthritis.
Know your limits — and know that fatigue is exactly when your sense of your own limits gets least reliable. Overestimating what you can still safely do is one of the most common ways a healthy joint becomes an arthritic one.