Jonathan Price has always been someone who loved staying active and exercising. Growing up in south Wales, rugby was his first passion. Through school, university, and beyond, he also surfed, rowed, played squash, and ran competitively – on the track, in 10k races, and in cross-country events. As his career and family life took over, much of this fell by the wayside, but running stuck with him. He made time for marathons and half marathons – “I’d run a half marathon every weekend just for fun,” he says – and during the workweek, he’d fit in regular 30- or 40-minute runs to relieve stress and clear his mind. “I travel a lot for work,” says Price, now 50 and a company CEO. “With running, all you need is a pair of running shoes, and you can do it anywhere.”
By his mid-40s, though, Price’s body was starting to push back. He wasn’t recovering as well as he used to. “I could run just fine, but I’d be in pain for two or three days afterwards,” he says. On top of that, every six months or so, his lower back would completely lock up. A physiotherapist thought it was “tight hip flexors” and suggested “hip opening” exercises, meant to reduce stiffness and improve flexibility. Someone else prescribed muscle relaxants, but the pain only got worse, and his range of motion kept shrinking. Finally, in the summer of 2023, a chance meeting with a hip surgeon led to a diagnosis of osteoarthritis, and at the end of that year, Price – then 47 – had a double hip replacement.
Was Price just unlucky, or did decades of exercise speed up the damage to his joints? After so many years, so many miles, and so many cycles of use, had he simply, as his surgeon Giles Stafford puts it, “hit his number”?
Orthopaedic surgeons often recommend swimming or cycling to reduce the impact on our joints. Photograph: microgen/Getty Images
As a consultant orthopaedic hip surgeon specializing in sports-related hip disorders, Stafford frequently sees patients dealing with joint problems earlier than most. “They’re usually active people who’ve done a lot of sport and worn out their joints through that,” he says. Stafford compares our joints to bearings in a car. “There’s clearly a genetic aspect, but also a big mechanical one,” he says. “We all have a certain number of cycles in us before damage sets in, and someone who’s going to the gym, running marathons, or doing high-impact, high-intensity, repetitive exercise might hit their number younger and faster.”
Osteoarthritis (OA) is the painful result of cartilage breaking down – that smooth, slippery tissue that cushions the ends of our bones so our joints can move without friction. OA is on the rise. Every year, more than a quarter of a million people in the UK have joint replacement surgery, and by 2060, demand is expected to jump by 40%. While there’s evidence of more cases in younger people, by age 70, one in two UK adults will have OA. For some, that might just mean a bit of stiffness climbing stairs. For others, it could mean needing help with washing and dressing. In old age, OA often determines whether someone can live independently and whether their final years are spent dealing with pain.
When it comes to causes, though, the picture is confusing. Our bodies’ design is key. Our genes help determine our build, our gait, how we load our joints, and where pressure falls when we move. Genetics are also thought to influence the quality of our cartilage and the inflammatory responses that can damage it and drive OA forward. Price now knows he was born with a subtle shape abnormality that isn’t uncommon. The ball of his hip joint’s ball-and-socket wasn’t quite spherical, so it didn’t rotate smoothly without friction, which quietly, over time, sped up damage with each cycle of use. But beyond genetics, is asking too much of our bodies – or too little – raising our OA risk? Should we worry about over-exercising, or not exercising enough?Is it exercise itself, or the wrong kind of exercise? Unfortunately, the answer seems to be all three.
A sedentary lifestyle is a major factor. This is partly because OA is linked to obesity, which adds weight to our joints and increases inflammation, but exercise matters beyond that. Cartilage gets its nutrients from synovial fluid (the fluid in our joints), and we need to move to keep that fluid circulating. “Sitting for long periods during the day also seems to cause metabolic changes that promote inflammation,” says Dr Benjamin Ellis, a consultant rheumatologist at Imperial College Healthcare in London. Building strength and muscle also helps absorb impact and stabilize our joints. “Our joints, bones, and bodies get stronger under challenge, and that happens through tiny micro-injuries,” says Ellis. “The body heals them, and that healing builds bone and muscle.”
On the other hand, if we push the body beyond its ability to heal, or suffer too severe an injury, we’re back in the danger zone for OA—though it might take decades for the effects to show. An anterior cruciate ligament (ACL) injury—a tear or sprain in the center of the knee—is one example. Professional footballers, who are prone to ACL injuries, have two to three times the average risk of OA later in life. Research also points to a higher OA risk among competitive runners, while recreational running seems to protect against it. (Unfortunately, the definition of “recreational” versus “competitive” varies between studies.) Many orthopedic surgeons—including Stafford—recommend cycling, swimming, or using an elliptical trainer over running, or running on grass or a treadmill instead of tarmac to reduce the impact on joints.
According to David Vaux, an osteopath, consultant for Arthritis Action, and author of Stronger, exercise in midlife should be seen a bit like a dose of medicine. “If you do too much or too little, you’re going to be in trouble,” he says. “The main things I see in clinic are people who are injured and people who are burnt out—and those two things are kryptonite in midlife.” Both can lead someone to stop exercising altogether, or to keep pushing too hard before they’ve recovered. Either can result in OA.
For most midlifers, says Vaux, a healthy exercise routine is steady and consistent, with plenty of built-in recovery time. He says: “It can look quite boring, but boring is good.”
Saket Tibrewal, a consultant orthopedic surgeon at Cromwell Hospital in London who specializes in the knee, makes a similar point. “As we get older, our ability to heal takes longer,” he says. “I do see a lot of runners who have taken it up in the last few years and are starting to get knee pain and knock-on effects. They might go for a run, then do it again the next day, or maybe just have one day off. A lot of people don’t understand how important recovery is.”
Several orthopedic surgeons have expressed concerns about high-intensity, high-impact exercise programs. “Anything that involves a lot of deep-weighted squats, or repeatedly taking your body to its full range of motion under load, can damage your joints,” says Stafford. Gareth Jones, a specialist knee surgeon at Imperial College, has seen patients in their mid-20s and early 30s who have already lost a lot of cartilage under their kneecaps from following such programs. One of Tibrewal’s patients is Naomi Pannell, 27, who recently tore her ACL competing in a CrossFit event.
“The runner’s mindset is that it’ll be all right—it’ll repair itself.”Chris Dunn competing in an Ironman event in July. Photograph: Courtesy of Chris Dunn
“I was in the semi-finals in Madrid, my biggest competition yet,” says Pannell. “It happened on day three, the last day, in 36°C heat.” Pannell and her partner had finished the chest-to-bar pull-ups and the double-unders (like skipping, but the rope passes under your feet twice in one jump). Next came four rounds of “sandbags” (lifting a heavy sandbag from the floor and resting it on your shoulder). “When I went to lift the sandbag for my second round, my knee popped out and popped back in,” says Pannell. “I didn’t fall to the floor. I tried to lift it again, and it did the same thing.” She completed part of the remaining circuit, including a handstand walk, but by the end her knee was badly swollen. “When I found out it was a full ACL rupture, I spent a week crying,” says Pannell. “I’ve never had an injury in my life.”
Tibrewal, who will be operating on Pannell, blames fatigue. “These programmes are very good for cardiovascular fitness and strength, but they involve high repetition and high loading, and fatigue is a badge of honour,” he says. “After multiple rounds, if you’re pushed to the point where your muscles are really tired, you can lose neuromuscular control of the joint. You lose proprioception – your body’s internal awareness of where it is in time and space – and that’s when something simple that you’ve done many times before can go wrong.”
According to Vaux, a healthy midlife exercise regime that protects against OA involves “steps and reps”. “A walk, a jog, or a bike ride a couple of times a week, and you need strength training too. I usually prescribe an isometric-only strength programme – such as wall sits and planks, which you can do anywhere – for at least two months before you do anything more dynamic in terms of strength training. If someone is doing that, I’d take that person’s chances on healthy joints in 20 years’ time over anyone doing something extreme and get-fit-quick.”
The most important thing is listening to your body. “Pain alone isn’t always a reliable guide because some discomfort can be a normal part of adaptation,” says Vaux, “but persistent joint pain, night pain, or pain on certain movements, swelling, and stiffness should not be ignored. It’s your body telling you there is an issue.” It’s also important to understand your level of fatigue. “Is your performance stable, improving, or decreasing? Decreasing performance indicates you are not recovering properly. How are you sleeping? Is your heart rate significantly elevated first thing the day after exercise? The solution to any of these might be to get something checked out, or to modify your exercise and rest.”
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‘I’d be in pain for two or three days after running’ … Jonathan Price (left) takes part in the world’s deepest marathon in Sweden. Photograph: Samuel McElwee Studios/BecomingX/World’s Deepest Marathon
Chris Dunn, 49, a dedicated runner, waited until he had grade-four bone-on-bone OA in his knee before he stopped running and had it looked at. “I can probably track it back to 2015, when a bad tackle in football twisted my ACL,” he says. Despite the injury, that same year he completed an Ironman triathlon and a marathon. In the years since, he continued to compete in many more marathons, as well as regular triathlons. “My leg was probably weakened, and I weakened it more. My alignment shifted to compensate, and that overloaded different parts of the knee joint,” he says. “Silly really – I left it too long – but once you’re in the runner’s mindset, you think: ‘It’ll be all right. It’ll repair itself.’ When you push yourself to the limits, it’s uncomfortable anyway! You tell yourself…”It’s just a slight ache. By 2023, it had gotten so bad that I could only run 5 or 6 kilometers, and afterwards the pain was so intense I could barely walk.
In May 2024, Dunn had a five-hour surgery to straighten his leg and take pressure off the damaged area. It went really well. “I was back home the next day with a knee brace,” he says. “I used crutches until August. The following April, I ran the London Marathon, and in July I completed an Ironman. Right now, running feels good. There’s a chance I might need a knee replacement years from now, but we’ll see how it goes. I want to enjoy it while I can.”
Price also returned to running after his double hip replacement. Last year, he finished the world’s deepest marathon, held in a zinc mine in Sweden. “It took a while to get used to that strange feeling where everything seems different, but once I started running, it got easier and easier,” he says. Pannell, meanwhile, is aiming to compete in the CrossFit Open in February.
“There’s no universal limit beyond which exercise becomes harmful,” says Vaux. “It depends on many things—like age, genetics, and past injuries—and it’s not permanent: it can change as your tissues adapt. That’s one of the amazing things about the human body. But we need to give it time to adjust and pay attention to what it’s telling us along the way.”
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Frequently Asked Questions
Here is a list of FAQs based on that exact scenario broken down by the type of person asking
The Im New to This Questions
1 I just started working out and Im sore for days Is this normal or am I about to need surgery
Answer What youre feeling is called Delayed Onset Muscle Soreness Its microscopic tears in the muscle fibers and its completely normal Surgerylevel injuries are usually sharp pains swelling or a feeling of giving way If you cant walk or lift your arm without sharp pain see a doctor If youre just stiff and achy thats a good workout
2 How can I get injured if Im just lifting weights Isnt that supposed to make me stronger
Answer Lifting weights does make you stronger but only if your form is correct and you progress gradually The injury usually isnt from the weight itself its from lifting too heavy too fast or using momentum instead of muscle control This puts sudden stress on tendons and ligaments which dont heal as quickly as muscles
3 Ive never been hurt in my life Why would my body suddenly betray me in the gym
Answer Your body isnt betraying youits just that everyday life doesnt usually push your joints to their absolute limit The gym does If you have a slight muscle imbalance the weaker side can get overloaded Its less about being fragile and more about exposing a weak link you never knew you had
4 Whats the difference between a strain and a sprain Which one needs surgery
Answer
Strain A pulled or torn muscle or tendon
Sprain A torn ligament
Most strains heal with rest Surgery is usually only needed for
