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Saturday, July 22, 2006

Knee Pain

Mike wrote:
"This product (Nutra-Life Joint Factors 4500 - Ed) has been brilliant. The problem I have is with my left leg, which was twisted in a skiing accident when I was 15. While it always made its presence felt, it only threatened to become incapacitating when I reached about 55. The joint factors has allowed me to keep on exercising as I always have done. I am running up to 50 minutes about twice a week at the moment.

Another thing I have appreciated since your talks at last year at our company is the advice on diet. In particular, the change I made to breakfast (now muesli, fruit and tea only, (except for now and then!)) and stopping taking sugar in coffee and tea, have been very beneficial."

Gary Moller comments:
Knees, knees, knees - I get so many inquiries about painful knees nowadays! Is it because of the tsunami of active Baby-Boomers now hitting that age when injuries of old are starting to fester their way to the surface? Is it because keyhole ops for niggly knees are flavour of the month? Is it because commonly prescribed medicines for knee pain only deal with symptoms and not the cause? Is it because contract health providers are mostly focussed on outputs rather than outcomes? Or is it all of the above?
The answer is "YES" to the lot!

So, your knee(s) hurt for some reason? If you go to a surgeon, you will be operated on. If you go to a rheumatologist, you will be prescribed a powerful medicine. If you go to a physio, you will be given utra-sound and strange exercises. If you go to an osteopath, you will be massaged and manipulated. If you go to a podiatrist, you will be given $500 orthotics, if you go to a personal trainer, you will do lots of funny exercises and go on a diet. Sounds uncomfortably like a lottery to me, I reckon! Currently, in NZ, if you have a knee problem, you will probably be sent to the surgeon. Heaps and heaps of knee ops are happening.

With the focus on surgical outputs (ie: number of ops performed this year as compared to last year) patients are being recorded as successes whether pain-free post-op or not. There is generally no followup at all once the stitches are out and no way the patient can provide useful feedback to the surgeon and funding agenices - like Mike (above) has provided me several months down the track. This is an extremely unsatisfactory state of affairs: My impression is that there are legions of people out there who are not fully recovered from their knee ops and some are, in fact worse off! But, by all accounts, they are recorded as "successes" of a system that is working well. No proper feedback loop = bad service and much waste.

Body heal thyself
During my training years ago, we were told that joint cartilage is incapable of healing itself. The standard procedure with a cartilage injury was to cut the whole thing out. This was a terrible action, in retrospect, condemning many to plastic joints about now.

What we do know nowadays is that cartilage, even in old age, is capable of self repair. Even in the case of tears (so long as they are small) healing can happen - so long as the joint is protected from further injury and given the right nutrition and exercise to help the healing processes.

Cartilage in mature adults does not have a direct blood supply so it heals poorly when damaged, be that from overuse or direct trauma like twisting the joint while under pressure. But it still is living tissue that is constantly being replaced by new tissue. It will heal with time and the right care. This process of repair relies on the supply of oxygen and nutrients to the cartilage cells and the removal of wastes via the fluid inside the joint called "synovial fluid". This exchange and tissue repair is enhanced by:
  • Rhythmic movement of the joint through its full range of movement
  • Oscilating compression and decompression of the cartilage
  • Keeping the joint warm
  • A diet that is rich in the ingredients that build healthy cartilage tissue
  • A diet that is rich in anti-oxidants to soak up free radicals before they can harm the healthy cartilage cells
  • Avoiding medicines, including anti-inflammatories and aspirin, that inhibit cartilage cell activity
So, you will gather that dealing with knee pain is not via a single one off solution like surgery or drugs. It is a multi-factorial and long term project.

Repair has to exceed wear
This is the name of the game - the game of life, in fact: even several hours after you die, tiny cartilage cells are still beavering away building new tissue to replace the stuff that you have damaged through sport and normal activities of life. While you still breathe, you must do everything to assist these busy little fellas with their job of keeping you mobile and upright. This consists of:
  • Minimising harm by avoiding excess wear and injury
  • Giving sufficient time for repair and healing before the next assault
  • Ensuring optimum nutrition and circulation for joint health
  • Doing full range joint movement to spread the synovial fluid, thus aiding nutrient exchange
So, here is a list of what you can do for joint health:
  • If you statically stand or sit for long periods at work, break these up at every opportunity by striding about, lying down, sitting, pulling knees to chest, jogging and squatting. Wear shock absorbing shoes, fit quality inner soles. If surfaces are hard, get soft non-slip matting fitted
  • Take the joints frequently through their full range of motion. For the knees; try repeatedly pulling the knee to the chest, then extending fully, tensing the thigh hard. This can be done sitting, standing or lying on one's back
  • Keep the knees warm in cold weather by heating the room and wearing warm leggings when exercising. A long hot bath does wonders for aching joints
  • If you do a really punishing thing like running a marathon, rest 5-10 days after and do not repeat this kind of abuse for at least another 3-6 months. Read our Guide to Running a Marathon
  • Do aqua-jogging once or twice a week the way recommended here
  • Add a machine-based Pilates session once or twice a week to your exercise programme. This will strengthen the muscles that support your joints as well as taking them through their full range of motion
  • If you are over the age of 35 or have ever had surgery on a knee, consider taking a quality formulation of glucosamine and chondroitin (joint food). This supplies the nutritional substrate for healthy joint tissue. Take the maximum recommended dose for at least 3 months before easing off regardless of whether or not any benefit is noticed
  • Take a multi vitamin, anti-oxidant and multi-mineral with the joint food, including vitamin C (A quality joint food formulation will also contain some of these essential vitamins and minerals)
  • Take fish oil, flax seed oil and cook using a quality olive oil. These improve circulation, are essential for healthy joint collagen and have a mild anti-inflammatory effect. They might even help lubricate the joints
  • If you are carrying excess body weight, gradually lose it over several months through exercise and healthy eating
  • If you get knee pain from activities like cycling and running, your style or setup might be faulty. Get it checked by an expert.
  • Feet are a common cause of knee pain. Read this e-Pub about the subject
  • If you are diabetic, ensure the condition is absolutely optimally managed
  • Only take anti-inflammatories, including aspirin if absolutely necessary (I'll write about this matter including non-drugs pain management measures in a future article)
  • Do not have cortisone injections into joints. Read this article about this subject

On the question of joint surgery: If you are earmarked for an op or have been advised to have one, you are welcome to give me a call to discuss this and possible options. While I do recommend the surgical option now and then, there are many cases where this option has been prematurely exercised. Surgery does not always work out over the long run and may compromise the benefits of more conservative measures like nutrition and exercise.


Wayne said...

teh brand "Soft Sol" have started putting out silicon gel insoles, I"ve found that these wear far better than foam insoles which i find can degrade rapidly, I couldnt say whether the silicon insoles are superior at cushioning but Asis must think so gien that they are putting silicon rubber into most of their shoes now including their top of the line model which is entirely silicon rubber in the midsole. I run in one of their other model with silicon, and I"m very impressed by the reduced wear and tear on my legs compared to shoes that are entirely foam rubber. definitely pick your shoes, too hard or too soft can cause different problems, the midsole should compact a bit with pressure applied to it by your fingers from above and below but it shouldnt collapse siginificantly and it shouldnt take a massive effort to get some give out of it, if you run in it and you feel jarring its probably too hard. I had a apir of shoes like this that destroyed my legs in a short period of time.

Wayne said...

by the way I"ve had three knee ops on one knee, having a ligament replaced and part of my cartilage removed nearly twenty five years ago, believe me there is life after knee problems , I still run trouble free over big steep hills in the weekend following the sort of guidelines gary advises. i had arthritis as a teen but have no problems now. at 75 kilos I"m no lightweeight on my feet but my knees are still bearing up well, after damage originally caused by poor diet, over training and poinding the mountains in boots that has no shock absorbing in them.

Wayne said...

often running shoes are "board or combination lasted" which means for extra support they hae a hard sheet of material just under the insole. given that the insole that comes with most shoes is of very cheap plastic foam tht collapses after a little use, then there is the potential for extra jarring punding against the hardened sheet beneath your feet, which will partially reduce the shock absorbing benefit of the foam midsoles, so I always buy better quality insoles to put into my running shoes, you can take advantage of them buy using them in all your shoes to get more for your money, as I've said my preference is for the soft sol gel inserts I've found last way longer. I wont plug too much here but one of the athletics shops advertises shoes that look like normal working shoes but offer similar cushioning to sports shoes, and no i dont work for or have any mates that work for or own sport shoe shops, but it certainly strikes me as a good idea to further safeguard your limbs and joints from pounding, again beware of shoes that are too shoft or unsupporting they allow the angkles to roll too much and that causes too much lateral movement in the knees