We’ve all heard the crunching sounds echoing across the gym when someone attempts their first squat of the day and thought, “Ooooh, that can’t be good.” If you CrossFit long enough — or really do any physical activity long enough — you will experience a sore shoulder, achy knee, or stiff low back. Or a combination of those areas and symptoms. The stats on joint pain say it’s just a matter of time before something starts to bother you, whether you exercise or not. Unfortunately, it’s the nature of the beast.
What can we do to maintain our joints?
Keep exercising. Our joints are sensitive to the load that is applied to it and need mechanical loading for joint maintenance. Moderate mechanical loading maintains the integrity of the cartilage; however, both disuse and overuse can result in cartilage degradation (1).
[M]ost of us will reach for the medicine cabinet to remove the annoying ache that will make you hesitate on a lift or slow down your workout.
The problem is most of us don’t like working out with stiff achy joints. And most of us will reach for the medicine cabinet to remove the annoying ache that will make you hesitate on a lift or slow down your workout. Some will reach for fish oil instead and have found it to be a good alternative to over-the-counter medications. Despite the confusion and conflicting information floating around the Internet, there is a good amount of evidence that supports the use of fish oil for joint health. Fish oil provides eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both omega-3 polyunsaturated fatty acids which have been studied in petri dishes and placebo-controlled, double-blind studies. What the results have shown is that fish oil can provide benefits to our joints and may even help slow the breakdown and progression of inflammatory joint diseases.
Here are some well established benefits of fish oil for joint health:
- Pain is a way that our body alerts us to something not working correctly and keeps us from further injuring ourselves. Intense exercise will break down muscle and cause delayed-onset muscle soreness (DOMS) along with general aches and pains. Most of us would prefer to workout with less joint pain, especially if we’re performing multi-joint movements. EPA and DHA have both been shown to decrease pain.
- EPA and DHA both help block pain signalling. DHA is more potent than EPA in comparison. The cascade is very complex, but here’s the over simplified version: Compounds in these two omega-3 fatty acids (RvE1 and RvE2) prevent an inflammatory cytokine (TNF-α) from interacting with a nerve receptor and block the release of the stimulatory neurotransmitter, glutamate. Preventing the release of glutamate stops the pain signal from being transmitted (2,3).
[Scientists] found was that there was a high correlation of decreased pain in those who had higher amounts of omega-3’s in their blood and synovial fluid.
In a double-blind, placebo controlled, prospective study, patients with rheumatoid arthritis (autoimmune arthritic disease) found a decrease in tender joints and also found the physician’s pain score to be significantly lower as well. Some patients who continued to take fish oil were able to discontinue NSAIDs (anti-inflammatory drugs) without experiencing a disease flare (4). In another study, 36 patients with rheumatoid arthritis and swelling who were taking fish oil examined the level of DHA and EPA in the blood and in the joint fluid. What they found was that there was a high correlation of decreased pain in those who had higher amounts of omega-3’s in their blood and synovial fluid (5).
- Fish oil supplementation also was shown to provide relief from general musculoskeletal pain,neck and back pain, and pain from the discs in the back.
- Inflammation is a process largely used by our immune system to protect us from foreign invaders and heal damaged tissue. As you’ve heard before, too much of a good thing can be a bad thing, and chronic inflammation is a bad thing. Chronic inflammation occurs when white blood cells overstay their welcome and release chemicals that begin to destroy surrounding tissue instead of saving it.
- There is evidence that EPA and DHA suppress inflammatory cytokines such as IL-2, IL-6, TNF-α, and the inflammatory marker C-reactive protein (CRP) in the blood following fish oil supplementation. The suppression of cytokines tells white blood cells to stop recruiting more of their friends to come help out and also to stop making more WBC’s (4).
- Fish oil is also being studied as an alternative to medications for pain relief and inflammation. DHA and EPA are essential to the body producing resolvins. Experiments have shown that resolvins reduce cellular inflammation by blocking the COX-2 pathway. DHA was also recently found to produce “maresins” which work as a switch for WBC’s that essentially turns off inflammation (6,7)
Decreased Cartilage Breakdown
Fish oil can be helpful in reducing the impact of enzymes and chemicals that destroy cartilage.
Cartilage is a connective tissue composed of special cells called chondrocytes that produce materials that give cartilage its elastic, flexible, yet durable and rigid structure. Cartilage has no blood vessels or nerves, so getting nutrients into the tissue requires a mechanical method. Chondrocytes get nutrients by motion, specifically compression and bending. Physical motion creates a pump that diffuses nutrients into the cells. When you squat, make sure to remind yourself that you are helping feed your knee cartilage. It’s also a fun fact to spit out during the cool down if you want to impress your peers. Because of the lack of blood supply to cartilage, the healing and repair process is slowed down significantly compared to other tissues. Pain signals are also decreased due to the lack of nerve supply and may not be felt until a joint is severely degenerated. All the more reason to try and maintain your cartilage as long as possible.
- Fish oil can be helpful in reducing the impact of enzymes and chemicals that destroy cartilage. In one study scientists injected EPA into joints with osteoarthritis (OA) and found that it prevented further progression of OA. EPA was found to preserve the chondrocytes by decreasing oxidative stress-induced damage and preventing the expression of enzymes (MMP’s) that degrade cartilage in the presence of too much inflammation (8). In another study scientists used cow cartilage cells (bovine chondrocytes) and exposed the cells to IL-1. The cells expressed all the hallmark inflammatory markers and destructive enzymes as seen in human OA. They then treated the cells with EPA, DHA, ALA, and AA (different types of omega fats to get a comparison). The results showed that EPA had the greatest effect at stopping the cells from making the destructive enzymes and found the inflammatory markers were decreased as well. The next most potent was DHA. Scientists concluded that supplementing with fish oil for OA “may be especially useful” (9). Other studies have also found similar results and shown fish oil (EPA and DHA) to stop cells from making inflammatory chemicals (cytokines) and cartilage destroying enzymes (MMP’s). Scientists were particularly excited about EPA’s potential to “prevent cartilage degradation associated with chronic inflammatory joint disease”.
Increased Bone Health
While bone is largely made up of minerals, protein, and vitamins, essential fatty acids have also been shown to play an important role in our bones’ overall health.
Believe it or not, our bones are living tissue. Bone has its own blood vessels and living cells and can grow and repair itself. Bone also has nerve supply which allows us to feel pain. Our shins remind of us this when we miss a box jump, and when our cartilage wears out and have bone rubbing on bone. While bone is largely made up of minerals, protein, and vitamins, essential fatty acids have also been shown to play an important role in our bones’ overall health. Omega 3’s have been studied for their effect on osteoporosis and decreasing bone loss in astronauts.
- Omega-3’s have been shown to alter calcium loss, increase bone building cells (osteoblasts) and decrease cells that breakdown bone (osteoclasts). Newer reasearch is even using mice to explore the potential role omega-3’s play in the developing skeleton of infants and children (10). Fish oil is also being studied for its potential benefits for osteoporosis and bone loss prevention. One randomized, double-blind, placebo-controlled study of 126 postmenopausal women found that bone turnover decreased with omega-3’s supplementation. Even on a short-term basis high-dose fish oil was found to inhibit bone resporption. The potential to reduce osteoporotic fractures was also evaluated and results suggest that there may be an association between higher omega-3 concentrations in the body and a decreased risk of osteoporotic fractures. Astronauts have also been studied, as spaceflight and weightlessness leads to bone resporption. NF-kappaB (a chemical that tells our body to increase the production of inflammatory cytokines) was elevated in astronauts following a short spaceflight, and the higher amounts of fish (a rich source of omega-3 fatty acids) they ate was associated with reduced loss of bone mineral density after flight. Scientists also studied cells in a pitri dish that where supporting the cell study findings, a higher intake of omega-3 fatty acids was associated with less N-telopeptide (a marker of bone mineral loss) excretion during bed rest. This study showed potential benefit of fish oil preventing bone loss in the astronauts as well as in the cells that were studied (11).
If fish oil is beneficial for old women with osteoporosis, people with rheumatoid arthritis and osteoarthritis, babies and their bone development (potentially), and astronauts… chances are it may provide some benefits to you as well. The key is to start eating more fish or start supplementing sooner rather than later to reap all the benefits.
Frank Bodnar, DC, MS is a coach at CrossFit Eastern Ridge. Learn more about his practice at Functional Movement Chiropractic.
Performance & Fitness
As Many Rounds/Reps As Possible in 8 Minutes
20 Lateral Hops over Med Ball
150m Row Sprint
20 Forward Hops over Rower
20 Double Unders
-Rest 5 Min-
As Many Rounds/Reps As Possible in 8 Minutes
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