#008 - Legs for life
Legs for Life: How Lower Limb Health Shapes Ageing, Movement and Resilience
If you’ve ever admired someone in their 80s still walking the hills, dancing at weddings, or bending easily to pick up their grandchild, you’re not alone. There’s a quiet awe we reserve for people who move well late into life.
As an osteopath of over 16 years, I’ve become increasingly convinced that the biggest predictor of this kind of vibrant ageing isn’t hidden in your genetics, your diet, or even your gym routine. It’s found in your hips, knees, ankles, and feet — the powerhouse structures of the lower limb.
When these joints are strong, stable and well-coordinated, they allow us to move confidently, absorb shocks, and adapt to whatever life throws at us — be it a rogue paving stone, a steep woodland trail, or when the DJ puts on an absolute tune.
The good news? You don’t need elite genetics or a punishing fitness regime to build a robust foundation. With the right approach, we can all invest in stronger legs for a longer, freer life.
The Hip: Where Power and Posture Begin
The hip is a deep, stable joint — a ball and socket nestled into a strong muscular sling. It’s capable of handling huge loads, provided the system supporting it is working well.
But many people develop hip problems years before symptoms appear. Some of this dates back to infancy — a condition called developmental dysplasia of the hip (DDH) can create shallow sockets that wear prematurely. For others, it’s the cumulative effect of movement habits, flexibility issues, or strength imbalances.
One of the most important protective factors is strength in the gluteus medius and minimus — the muscles that help stabilise the pelvis and align the leg during walking, running, and climbing stairs. Weakness here is common, especially in people who sit a lot or train in straight lines (think cyclists or treadmill runners). It’s also implicated in hip bursitis and the kind of tendon pain we often see in women over 50.
The fix? Side planks, single-leg work, and targeted gluteal strengthening. These not only reduce hip pain but improve whole-leg coordination and balance.
The Knee: Resilience in Motion
The knee is the most commonly worried-about joint in my clinic — and understandably so. It’s asked to manage rotation, absorb impact, and bridge the demands of the powerful hip and the intricate foot. But it’s also often misunderstood.
Is Running Bad for Your Knees?
One of the most frequent questions I hear is whether running causes arthritis. The short answer? Not necessarily.
A recent study by Hartwell et al. (2024), which surveyed over 3,800 marathon runners, found no link between the amount of running and rates of hip or knee arthritis. Instead, the biggest risk factors were:
Age
High BMI
Previous injury or joint surgery
Family history of arthritis
This is encouraging. It suggests that the act of running, in itself, may not be harmful to joint health, and could in fact be beneficial for metabolic wellbeing (more on that below).
But we must interpret this with care. The study was based on self-reported diagnoses, and there’s a risk of survivorship bias — those who stopped running due to pain or injury weren’t part of the data. Similar caveats apply to the oft-cited study of runners who completed 1,000 marathons without developing osteoarthritis — impressive, but not necessarily representative.
Even so, the overall body of evidence points to a clear conclusion: movement isn’t the problem — poor load management is. Mild aches after a long run? Often fine. Persistent swelling, reduced range of motion, or pain lasting more than 24 hours? Worth investigating.
Why Mechanics Matter More Than Mileage
The key to knee longevity lies in mechanical alignment and muscle control.
For example, a weak gluteus medius allows the leg to collapse inwards during impact (a movement called dynamic valgus), increasing strain on the knee. This isn’t just theoretical — we see it clearly in injury patterns like ACL ruptures, patellofemoral pain, and IT band irritation.
Muscular strength — particularly around the hips, quads, and hamstrings — is a crucial buffer against injury. It’s also a factor in post-injury outcomes: patients who rehab thoroughly after ACL surgery tend to experience less long-term damage than those who return to sport without rebuilding stability.
If you’re running, walking, or working to return to those activities, a good rule of thumb is this: load should match capacity. Increase your training volume gradually. Listen to symptoms. And when in doubt, strengthen the system.
The Ankle and Foot: Small Joints, Big Impact
These joints absorb impact, stabilise the body on uneven ground, and provide vital feedback to the brain about our position in space. Problems here often fly under the radar until they start interfering with balance or movement.
Take the ankle sprain — common in runners, footballers, and weekend hikers alike. Left untreated or under-rehabilitated, it can cause long-term instability, making the whole lower limb work harder to compensate.
Equally, the posterior tibialis tendon, which helps support the arch, can weaken over time and contribute to flat foot deformity or pain on the inside of the ankle. Ensuring this muscle is strong and active is key, especially for walkers and runners with flatter feet.
Rehab here means more than just rest. It means strengthening the peroneals, restoring range, and retraining proprioception (your ability to sense movement and position). Exercises like balance drills, single-leg stands, and controlled hopping build resilience from the ground up.
Strength: The Best Investment You’ll Ever Make
There’s an unavoidable truth in musculoskeletal health: muscle protects joint.
This is particularly clear when we look at the hip flexors. The psoas muscle — key for lifting the leg and preventing falls — is often weak in older adults. A South Korean study showed that patients who sustained hip fractures had significantly smaller psoas muscle volume than healthy peers.
It’s not just about strength for performance — it’s about strength for survival. Strong legs reduce falls, protect joints, and allow us to respond better when life gets unpredictable (as it often does).
And it’s not all about lifting heavy weights. Bodyweight exercises, resistance bands, dynamic balance drills — all can help maintain and restore strength through midlife and beyond.
Bodyweight, Metabolic Health and Arthritis Risk
Perhaps the most modifiable risk factor for joint degeneration is metabolic health.
The research is increasingly clear: obesity, insulin resistance, and inflammation all play a role in accelerating joint wear. A 2024 study by Qiu et al. found that BMI and metabolic syndrome factors (like high blood pressure and cholesterol) were more strongly linked to arthritis than activity levels alone.
This is where regular movement — including running — shows its protective power.
As Thyfault and Bergouignan (2020) put it:
“Exercise induces multi-tissue adaptations with powerful disease-modifying effects.”
By improving metabolic health, exercise supports not just your joints, but your heart, brain, and lifespan. And running is one of the most accessible, scalable tools we have.
Practical Tips: Future-Proofing Your Legs
Here’s how you can put this into action:
Strengthen Your Glutes
2–3 times a week, include side planks, band walks, or single-leg squats.
Balance is Trainable
Practice standing on one leg, add instability (e.g. wobble cushion), and vary visual input (eyes closed).
Run Smarter
Gradually build mileage. Cross-train. Monitor symptoms. Don’t chase progress at the expense of recovery.
Respect Pain
Mild soreness = fine. Persistent swelling, instability, or catching = stop and assess.
Mind Your Metabolism
Exercise for your joints — and for everything else. Manage weight, blood sugar, and blood pressure through consistent activity.
Final Word: Movement Is Your Medicine
Strong legs aren’t a luxury — they’re a lifeline. They carry us through work, family, hobbies, and holidays. And they are far more trainable than we often believe.
Whether you’re hoping to complete your first 5k or simply want to stay mobile into your 90s, the path is the same: build strength, move regularly, and listen to your body’s cues.
Longevity isn’t just about years — it’s about freedom. And nothing grants freedom like confident, pain-free movement.
So take care of your legs. They’ve got a lot of life to carry you through.
Rich Baggot La Velle - Osteopath