Madonna recently released her 15th studio album, complete with big-budget music videos filled with energetic dance sequences.
However, in a recent interview, the star also revealed she has a bad knee with no cartilage in it “thanks to dancing for so long in high heels and running on pavement and doing Ashtanga yoga.
As a result, last year she swapped “jumping on trampolines and doing dance cardio and doing a lot of what a doctor would call loading on my joints” for low-impact alternatives like Peloton bike rides, Versa Climber sessions and certain types of high-intensity circuit training.
But if exercise is good for our health, how can years of dancing – and high heels – contribute to poor knee health? Here is what the experts had to say.
What can be done to combat knee pain and osteoarthritis?
Joint pain and arthritis are indiscriminate, says Professor Lucy Donaldson, director of research at Arthritis UK. They can affect anyone, from you and I to pop icons.
Madonna cites a lack of cartilage as the source of her discomfort. Osteoarthritis occurs when cartilage in a joint, which acts as a shock absorber and reduces friction between bones, is diminished. But Professor Donaldson says there are many misconceptions surrounding this process.
“Our joints are not worn down over time and arthritis isn’t just ‘wear and tear’,” she explains. “Our joints are made up of complex living tissues that our bodies constantly repair and maintain. Osteoarthritis occurs when the body can no longer properly maintain and repair tissues in one or more joints, which is what causes the cartilage to become thin and uneven, leading to pain, stiffness, swelling and changes in the shape of the joint.”
The advice for avoiding this is fairly consistent with the advice for living a healthy life generally: move regularly; eat a balanced and nutritious diet; maintain a healthy weight; strengthen the supporting muscles through strength training to reduce stress on the joint and protect against injury; use good exercise technique.
Exercise is not the enemy, as it is sometimes painted. Recent research from Arthritis UK found that “recreational running does not appear to harm healthy knees and may even help protect against future need for osteoarthritis-related surgery”.
"Exercise is one of the most effective ways people with arthritis can improve their health and manage their symptoms,” says Dr Thomas Naylor, an orthopaedic surgeon, sports scientist and TV doctor. “But we know that staying active can be challenging and frustrating when your joints are painful, and many people are discouraged by misinformation suggesting that exercise causes detrimental lifelong impact to the joints affected.
“Small, incremental changes can make a big difference, and it’s important to meet people where they’re at with personalised, accessible plans and support.
“Our bodies are designed to move, and too much rest can actually negatively impact joints as well as the muscles and tissues that support them. Staying as active as possible helps maintain strong and well-supported joints, reduces symptoms and supports overall health and wellbeing."
Professor Donaldson says there are many different types of exercise and activity that will improve your general health and fitness – beyond the age-old recommendations of running, swimming and gym-going, which might not be to your taste.
“Most activities can be adapted to suit your needs,” she continues. “A healthcare professional such as a physiotherapist could advise you on suitable forms of exercise to try.
“...Exercise can help with osteoarthritis pain as strengthening the muscles around joints will help make the joint more stable. But if you find you have significantly more or severe pain while exercising or afterwards, you should stop and talk to a healthcare professional about it.”
Read more: Five stretches you should be doing every day, according to a flexibility expert
High heels and knee pain
Madonna also laid the blame for her bad knee at the door of dancing in high heels. And there is weight to this claim
“The wrong shoes can not only hurt the joints in your feet, but they can also throw off your posture and affect joints all the way up your body,” the Arthritis Foundation reports. “High heels, for example, put extra stress on your knees and may increase your risk of developing osteoarthritis.”
I recently interviewed Dr Milica McDowell, a physiotherapist and co-author of Walk: Your Life Depends On It, and she revealed the exact ways in which a high heel can impact your joint health – albeit in reference to cowboy boots.
“I work in Montana and there are a lot of cowboys and ranchers,” she told me. “They all wear cowboy boots with a stacked up heel.
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“When those guys retire, they tend to have back pain, knee pain, hip pain, Achilles tendon problems and arch pain. It’s just like flight attendants who typically have to wear a shoe with a stacked up heel.”
When the tissues in and around the foot become accustomed to being held in a certain position, they adjust to it. Sitting your heel on a high stack for long periods, day-in, day-out, can cause the Achilles tendon and calf muscles to adapt to a shortened, tightened position.
Because the body is a matrix of interconnected tissues and systems, the knock-on effects of this aren’t isolated to your feet.
“We see this a tonne in my clinic,” says Dr McDowell. “Often, dysfunction in the anatomy of the foot travels up the biomechanical chain, leading to knee pain, a lack of hip range of motion, back pain or people changing their gait and walking mechanics to take a shorter stride.
“So we know that as the foot goes, the body follows. It’s not a matter of if, it’s a matter of when that dysfunction travels up the chain.”
So what does Dr McDowell recommend as a remedy to this? She prescribes footwear that looks like a foot – limited cushioning, a wide toe box and a flexible sole.
It might not look quite so glamorous as a high heel. But it can spare you from knee pain and more later down the line.
Read more: Scientists share six easy ways to increase the health benefits of your daily walk
