Physical Activity

The Key to Rehab That You’re Missing

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Athletes looking to optimize performance and recovery, should consider maintaining proper hydration as an integral component of their nutrition and training regime. This is even more crucial if you are in rehab from an acute injury or recovering from chronic muscle and joint pain. As a Corrective Exercise Specialist, I believe that the majority of chronic muscle and joint pain problems people experience today are mechanical or non-organic in origin. This means that pain is not caused by a genetic condition or acute trauma, but simply due to postural imbalances causing stress on muscles and joints.

Do not ignore the signs of mild dehydration. Dehydration is a factor that can exacerbate chronic muscle and joint pain, slow the rate of healing down, and increase chances of injury on an body that is already stressed due to imbalances.

“How much water do you drink everyday?” is a question I always ask my clients during their assessment appointments. It’s important to get a real understanding of their current and past history of daily water intake. This information helps start a beneficial hydration discussion, since most have no idea they are under hydrated — they truly do not understand the important role hydration plays in their ability to heal.

Dangers of Long-Term Chronic Dehydration

Water is a basic necessity of life and is vital to all biological tissues, systems and functions (1). Depending on factors such as gender, living location, body composition and age, the human body is on average 55-60% water (2). Muscle and connective tissue is made up of a large percentage of water and even our bones are about 31% water (2). Water is integral in supporting the brain and spine, along with lubricating and cushioning our joints (3).

When we hear the term dehydration, we often think of only the acute form (4). Images of excessive sweat, muscle cramping and heat related exhaustion immediately come to mind. Obviously, acute dehydration is a very serious and dangerous problem to an athlete. However, chronic, long-term dehydration is also a common problem many can fail to recognize in themselves because we misread the symptoms.

It is estimated that humans lose 2-3 L of water through breathing, sweat, urine and bowel movements a day (5). If you’re not fully replacing that water loss, your brain sends hormone signals out to divert water away from non-life sustaining areas in order to regulate function of more important organs like your brain, heart and liver. Because the sensation of thirst is not always an early warning indicator of dehydration, it is very easy to get into a semi-deprived hydration state without realizing it.

Over time, all sorts of physical symptoms can arise that may erroneously make you think you have a disease or other medical condition such as [6-11]:

  • Bad breath, digestive problems, constipation, heartburn
  • Regular headaches or migraines
  • Brain fog, mood swings or irritability
  • Overall fatigue
  • Dry mouth, chapped lips, dry eyes
  • Dry, tight or itchy skin
  • Muscle weakness
  • Muscle or joint pain

Note: If you are experiencing any of these symptoms, always seek medical advice! No matter what your diagnosis is, make sure to keep drinking water. Some of these symptoms could be treated with prescriptions, NSAIDS, or over the counter pain relievers, which ironically can further dehydrate you!

The Effect of Dehydration on Muscle and Joint Pain

Since water makes up the majority of cushioning and lubrication between the joints, the effects of long-term dehydration makes less fluid available to protect your muscles, connective tissue and joints. Add athletic training in a dehydrated state to an already compromised posture and function and you increase the risk of further depleted cushioning, weakening and slowing repair.

For example, the discs in between the vertebrae of the spine are filled with fluid and skeletal joints are cushioned by synovial fluid and cartilage. Both can be depleted without adequate water intake. Symptoms such as ongoing stiffness, soreness, pain and in some cases, deformity may develop over time because the protection has worn away due to insufficient cushioning and lubrication (3).

Another problem is muscle and tendon/ligament pain. Dehydration draws fluid out of your tissues and can cause overall body aches, stiff or tender joints, increased tension in ligaments and “knots” in the myofascia that are painful to the touch.

Now extrapolate the effects of dehydration along with training on a body whose muscles and joints are not positioned or functioning in optimal alignment. Stretch that out over the course of months to years, and all of a sudden the cumulative effects on your health, athletic performance and ability to heal and recover leave you severely compromised.

Two Things to Consider

If you are an athlete who has dealt with muscle pain and excessive wear and tear on the joints and you’ve been medically cleared, there are two major things to consider when you are rehabbing.

  1. It’s not the exercise or movement that causes the problem. Always evaluate the body and function. It’s your posture and function in the exercise that needs to be addressed. It’s been my professional experience that athletes with chronic pain have static and functional postural imbalances, which cause joints to move out of place and also muscle-length tension issues that cause compensations throughout the kinetic chain. It is these alignment and function problems that are the origin of a great deal of chronic pain and can cause potential harm to our spine, muscles and joints.  Form follows function and getting the body balanced will enhance healing and reduce the rate of injury and pain due to poor movement patterns.
  2. The body’s ability to heal and optimize performance of joints, cartilage and discs requires adequate hydration. Drinking water and maintaining proper hydration levels can help reduce pain and protect against wear and tear by keeping the cartilage soft and hydrated (12). I’m not in anyway suggesting that simply drinking more water replaces physical therapy or medical treatment. However, training in a chronically dehydrated state will almost certainly make an underlying chronic pain condition worse. A first pass solution for that is simple: Increase your water intake gradually and monitor the changes in your pain levels, performance and recovery.


1. “Healthy Hydration.” ACEFitness. FITFACTS. 2016.

2. “The Water In You.” The United States Geological Survey. 2016.

3. “The Basic Science of Articular Cartilage Structure, Composition, and Function.”  Alice J. Sophia Fox, et al. 2009. 

4.  “Dehydration Symptoms.” Mayo Clinic. 2016. 

5. “What would happen if you didn’t drink water?” Mia Nacamulli. TED-Ed. 2016.

6. “Dehydration“. MedLinePlus. 2016.

7. “Triggers of migraine and tension-type headache.”Christian Wöber. 2016.

8. “What is brain fog? An evaluation of the symptom in postural tachycardia syndrome.” Ross AJ, Medow MS, et al.. PubMed. 2013.

9. “Mild dehydration impairs cognitive performance and mood of men.” Matthew S. Ganio, et al. British Journal of Nutrition. 2011.

10. “Mild Dehydration Affects Mood in Healthy Young Women.” Lawrence E. Armstrong, et al. The Journal of Nutrition. 2012.  Retrieved from 

11. “Mild dehydration: a risk factor of constipation?” Arnaud MJ. European Journal Clinical Nutrition. 2003. Retrieved from 

12.  “Water & Nutrition“. Centers for Disease Control and Prevention. June 3, 2014.