From Arthritis Today:


Lifestyle Factors Influence Osteoarthritis Outcomes

Researchers provide real data to answer questions about OA’s links to lifestyle factors like cracking knuckles and texting.

By Mary Anne Dunkin

Can cracking your knuckles cause cartilage breakdown?  Can texting trigger hand OA?  Will wearing high heels lead to degeneration of your knee joints?

If you’re wondering if your habits are cause for concern when it comes to the health of your joints, take a look at what the research has to say about six common lifestyle factors.

Cracking Knuckles

Although knuckle cracking may irritate those around you, a study published last year in the Journal of the American Board of Family Medicine fails to substantiate a connection between the habit and OA. In the study of 215 people between ages 50 and 89 who had had one x-ray of the right hand during the five past years,  doctors found a similar incidence of knuckle OA in any one joint among people who cracked their knuckles (18.1 percent) and those who didn’t (21.5 percent). The duration in years or frequency of cracking also did not correlate with OA in the respective joint.


Texting is a quick and convenient way to get messages to friends and colleagues, but if you have a child – particularly a daughter – who is constantly texting, she could be headed for OA down the road, says Yusuf Yazici, MD, of NYU Hospital for Joint Diseases in New York City. In a study of 257 children ages 9 to 15, girls who used cell phones reported twice as much pain as boys. Pain was associated with the number of text messages the girls sent, the use of text abbreviations and the type of keyboard on their phone.

The problem, says Dr. Yazici, is that the devices were not designed for children, whose bones and tendons are still developing. Injuries to those structures now, like other joint injuries, could precipitate the development of OA in those joints, says Dr. Yazici, who presented the study at the 2011 annual congress of the European League Against Rheumatism in London.

Dr. Yazici and his colleagues are now comparing groups of students from two high schools – one who use laptops for classroom notes and homework assignments, the other who takes notes and completes assignments with pencil and paper — to see if keyboard use might also play a role in joint pain and damage. “We can follow all of these kids by survey,” says Dr. Yazici. “We plan to follow the students to see if there is any long-term impact.”

Playing Videogames

The same study led by Dr. Yazici suggests that excessive playing of videogames may potentially lead to osteoarthritis, particularly in boys. The researchers found that the amount of time children spent playing videogames was independently associated with pain. For each hour they played each day, the odds of wrist and/or finger pain doubled.

As with texting, Dr. Yazici says videogame devices, whose weight and button placement were designed for adult use, may cause damage to developing joint structures in children. “In adults, overuse injuries have been associated with osteoarthritis,” says Dr.  Yazici. “This is another way of overusing the joints.”


While no specific diet has been shown to cause osteoarthritis, some research has suggested that a diet rich in some nutrients might reduce the risk of OA or its progression. But research is far from conclusive.

One of the most studied nutrients is vitamin E. As far back as 1996, data from the Framingham study showed that men with the highest intake of vitamin E were 30 percent less likely to have progression of knee OA.  Subsequent research out of Australia, however, found no effect of vitamin E on the radiographic progression or symptoms of OA over two years.

In the Johnson County Osteoarthritis Project, the first racially balanced, population-based study of OA in whites and blacks, Joanne Jordan, MD, of the University of North Carolina at Chapel Hill’s Thurston Arthritis Research Center looked at serum levels of a form of vitamin E called alpha tocopherol and found no association with knee OA; however, a higher ratio of alpha to gamma tocopherol, another form of vitamin E, was associated with a 50 percent less likelihood of having knee OA.

So far no studies show that changing your diet will prevent OA or its progression – except as it relates to weight loss, says Dr. Jordan. Being overweight is a known risk factor for OA. “The most important advice is to maintain a healthy weight,” she says.

High-heel Shoes

If you want to protect your knees from damage, a recent study suggests you limit wearing high heels to special occasions.

In a study published in the March 2012 issue of Gait and Posture, researchers in the University of Iowa’s kinesiology department had 15 women walk in selected three heel heights –  flat, two inches, and 3.5 inches – and had at both a preferred (self-selected) speed and at a fixed speed.  The researchers then used motion analysis and the use of a force platform to estimate the forces on the knee. “In other words, we use cameras and reflective markers to measure certain body locations (joints, etc.) and that provide us with movement data during walking,” says Danielle Barkema, who led the study.  “We also are collecting the forces of the body by having subjects step onto a force platform. We combine motion and force data to calculate the forces of the knee joint.”

The researchers found that height of the heels changed the women’s walking characteristics such as speed and stride length. As the heel height increased, they also saw an increase in compression on the medial, or inside, of the knee. “Higher medial loads at the knee are thought to be associated with joint degeneration and medial compartment knee osteoarthritis,” says Barkema, who is now a Senior Research Coordinator in the Medical School at Northwestern University. “We did see a systematic increase in the internal knee abduction with an increase in heel height.  This occurred in both preferred and fixed walking speeds.

“Therefore,” she says, “continually creating this loading by wearing high heels consistently over a period of time may put individuals at risk to develop knee OA.  Our results suggest that the higher the heel – at least up until 3.5 inches – the worse the medial compartment loading becomes.”

While the study does not show that wearing high heels will cause knee OA, its results suggest that wearing high heels, especially higher heels, may put individuals at greater risk for knee OA, says Barkema.

High-impact Exercise

While exercise is a good thing for people with OA, research shows that middle-aged people who participate in high-impact, weight bearing exercise may cause damage to their knees that leads to osteoarthritis. In a study of 136 women and 100 men aged 45 to 55, researchers at the University of California San Francisco found that MRIs were more likely to show lesions of the cartilage, menisca and ligaments in those who reported high levels of physical activity compared to those with lower levels of activity.

Other research has shown that bursts of unaccustomed exercise or exercising without proper warm up can lead to injuries that predispose people to osteoarthritis years down the road.

The message, researchers say, is to stick with lower impact exercises when possible, to warm up before exercise and try to maintain level of activity all week, rather than being a weekend warrior.