Another Successful Meniscus Repair: Congrats, Jackelin!
18.6 million Americans develop knee pain each year per the CDC. 4 million Americans develop hip pain each year per the CDC. Joint pain is a significant problem for Americans today. Unfortunately until we figure out how to tap the fountain of youth or rejuvenate damaged joints, your born with one pair of hips, knees, etc for life. Therefore, it is important to do whatever we can to preserve the health of our joints, getting as much mileage as we can out of the joints.
There are risk factors that increase the rate of joint damage and pain. Age is perhaps the single most influential factor. Over time, it is inevitable that wear and tear will accumulate and cause pain, stiffness, and inflammation in the knees. The chart below illustrates the incidence of knee osteoarthritis with age.
An estimated 62% of adults with arthritis are <65 years old.
Nothing can be done to stop the march of time. But there are risk factors that we can modify to prevent the wear and tear of the joints.
Work-related factors, such as frequent heavy lifting, kneeling, stair climbing, and standing for long periods of time, can increase the risk. The jack hammer operator or furniture mover will likely have more wear and tear on their joints then the average desk worker. If knee or hip pain is becoming debilitating, and your job is more demanding on your knees than the average, a long term solution that involves an alternative occupation, one that may not put as much stress on your joints, is worth considering.
Activity-related factors, such as the sports or recreational activities you do may also be contributing to your joint problems. Unlike work related factors, activity related factors usually are more flexible and easier to modify. Participation in certain physical activities and sports increases the risk for joint pain, especially if improper techniques (e.g., not warming up or cooling down correctly, poor body mechanics) are used.
For example, if your knees are becoming increasingly sore, certain sports such as marathon running are high impact on the knees and best minimized. This can be a tough pill to swallow for someone who is passionate about running. In these circumstances, I ask my patients to weigh the risks and benefits. For some, the “runner’s high” might be worth the incremental damage the knee may be subjected to. It is an individual lifestyle decision that I invite my patients to think about. A strategy I often suggest for individuals passionate about one particular activity is cross training with other less impactful activities to minimize the stress on their joints. Based on each individuals goals and objectives I try to help craft a plan that spares the aching joint as much as possible.
Weight-related factors are probably the most important modifiable risk factors in the health of joints. In fact, two in three people who are obese will develop symptomatic knee OA in their lifetime according to the CDC. Due to the physics of the way we walk and move, our joints are subject to forces orders of magnitude greater than our body weight. For example, while going down stairs, the knees experience forces as much as 9 times ones body weight across the knee joint as the forces of gravity and the muscles are compounded at the joint.
Maintaining joint mobility and range of motion is key to optimizing joint function. When joint motion is limited, it inevitably places additional stress on the joint. Greater excursion of a joint facilitates greater transmission and dissipation of forces by supporting muscles as opposed to joint interfaces. Muscles around a joint act like dampening mechanisms that help decelerate motion across a joint. If the joint motion is limited to begin with, surrounding muscles cannot serve as dampers/shock absorbers.
During the gait cycle there are several points where our entire body weight is propelled off of one leg. With each step you take, two to four times your body weight is transmitted through the knee joint. Due to the physics of locomotion, a even a weight loss as small as 10 lbs can translate to your knees feeling as much as 40 lbs lighter! Studies show that people with arthritic knees lose about 20 percent of their pain with every 10 pounds of weight loss. For some folks, that can be the difference between surgery and no surgery! To drive the point home, I often tell my patients-
“Imagine walking around all day with a backpack that had a 10-pound weight in it…you would quickly feel how achy your back, hips and knees were towards the end of the day.”
Many people fail to recognize the role their weight plays in their joint function. Even though your weight may double, your joints and bones do not increase proportionately to support your additional weight. In fact, after skeletal maturity, by mid-20’s, everyone’s bone mass has peaked, and a slow and irreversible progressive decline in bone mass begins. Any additional weight only concentrates greater forces at the joints and bones built to support a lower body mass/ideal body weight.
This is perhaps one of the most common questions I field in the clinic. Many people avoid exercise as joint pain progresses. This unfortunately can actually promote even more rapid joint deterioration, stiffening, and pain. Cartilage, the substance that lines joint surfaces and facilitates smooth joint movement, is nourished by joint movement. Furthermore, disuse of any joint leads to progressive weakening of the muscles around the joint.
Not all exercises are created equally, and once joint pain sets in, exercises that preferentially spare the affected joint but still promote movement need to be chosen. Listed below are different exercises and the stresses they place on knees shown as a multiple of your body weight. Use it as a guide to identify exercises that you find tolerable. As your joint pain improves, you can resume higher impact activities on the more stressful side of the spectrum.
Posture involves placing your body in the optimal position for joints to function. The more your body is off-center, the more work your muscles have to do to maintain your body position. These muscles eventually fatigue, causing strain on the joints. Maintaining good posture takes advantage of the way your joints were intended to work. You want your head centered over your shoulders, ears aligned with your shoulders, and your torso centered over your pelvis. Having a strong core in your abdomen and lower back helps promote good posture and, ultimately, lessens the pressure on your hips, knees, and ankles. Examples of exercises such as planks, back extensions, yoga and Pilates can help strengthen the core.
Finally muscle strengthening can help sore joints. Muscles help support a joint. Strong muscles absorb shock and force. Stronger muscles around a joint reduce the force experienced at the joint itself and in turn can alleviate pain and discomfort. For the lower extremities, stretching and strengthening the hamstrings, hip flexors and quadriceps (particularly the oft neglected Vastus Medialis Oblique) muscles at least three times a week can help.
When developing a strengthening program, choose an exercise routine you enjoy that doesn’t hurt. While there are situations where muscle achiness and soreness are acceptable, when you have arthritis, there’s no gain in pain. A good rule of thumb is monitoring how long any pain or achiness last after a work out. If 24 hours later you are still having significant pain and swelling, I would consider re-evaluating the exercises you are doing and the stress the joints are enduring. Consulting with a trainer/physical therapist can certainly be helpful. Information about local arthritis friendly fitness programs can be found a www.arthritis.org. Aquatic exercises are excellent choices if land based ones hurt the knees or other joints.
If you are looking for some great exercises to start with, check out this Livestrong website for examples of great toning work outs you can do at home.
If you have a joint problem that has slowed you down, please call 281-690-4678 or click here to schedule a consultation so we can discuss a strategy to get you back on track!
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