Today I am hoping to shed some light on this increasingly common source of joint pain. We may have experienced twinges of knee pain in the past after an aggressive hike or perhaps we are now in the throws of seeking answers to unrelenting knee pain.
Your doctor can quickly provide you with a “diagnosis” and perhaps offer as a solution in the form of an injection, a prescription for pain and anti-inflammatory medication or of course the most invasive of treatment options, surgery.
In some cases surgery is unavoidable and may feel like the only option.
These cases are more the exception than the rule.
Surgeries to repair, for example, an acutely torn ligament or meniscal tear may be both necessary and wise especially if the individual is young, active and would like to return to high level of function and sports.In this case a surgical repair or reconstruction will provide the best shot at maintaining a normal active lifestyle with the fewest limitations.
What is most alarming is the current trend increase in elective total knee joint replacement surgeries in the last 20 years. The average age for total joint replacements is decreasing, even while most joints only have a life span of only 15-20 years.
A study presented at the 2014 American Academy of Orthopaedic Surgeons (AAOS) meeting highlighted the rising numbers of knee replacement surgeries. When researchers reviewed hospital discharge data for more than 2 million people undergoing this procedure, they found the rate of knee replacements jumped 120 percent over a 10-year period!
The overall increase was steep, but it was even more pronounced in younger age groups. While the number of surgeries increased by 89 percent among those ages 65 to 84, they increased by 188 percent in 45- to 64-year-old patients!
Knee joint revision surgeries are also on the rise for this very same reason.
Studies have found that 85 percent of knees last 15- 20 years, and the AAOS estimates 10 percent of patients will need a revision at some point. The younger patients are when they undergo the first surgery and the longer they live afterward, the more likely they will be to need revision surgery.
Studies have shown The number of revision surgeries increased 133 percent during one study period, particularly among younger patients.
So the question I want to attempt to answer is Why is there such an increase in Knee Pain and Medical procedures to Manage it?
WHATS BEHIND THE INCREASE IN KNEE PAIN?
Although there are many potential causes, I will outline and discuss a few of the highlights:
1.MUSCLE IMBALANCES AND ALIGNMENT ISSUES:
This is a very common underlying factor in the etiology of knee pain that is often “overlooked” by orthopedic surgeons and can eventually lead to uneven wearing down of the cartilage or meniscus of the knee joint leading to early degeneration.( arthritis)
Although the knee joint is a rather simple hinge type joint it relies on ligament ( bone to bone connections) and tendons ( muscle to bone connections) for stability, support and mobility.
Proper functioning of the knee joint depends on a dynamic interplay of all muscles connecting above and below, think foot and hip. The knee is often times caught in the crossfires when foot or pelvic/hip alignment are creating dysfunction and a bio-mechanical nightmare at the knee. For example, an overly pronated (flat) foot, a leg length discrepancy or pelvic rotation can result in excessive loads and pressures at the knee joint.
The most common culprit in the onset of knee pain are weak hip stabilizers, a weak core, weak Quadriceps, namely the VMO, tight hamstrings, tight Ilio-tibial band (side of the leg) and tight hip flexors. These muscle imbalances lead to most forms of the knee complaints we see in therapy including the common Patello-femoral pain in younger athletes. Mal-alignments at the pelvis, foot and ankle will change the ground reaction forces and increase compression forces at the knee and the patella or knee cap. Once you have an understanding of how your alignment and muscles are creating an unhealthy movement pattern, you can begin to work on changing the dynamics through specific targeted, exercise, muscle energy techniques to correct alignment issues, and kinesio taping and orthotics, if necessary.
2. SEDENTARY LIFESTYLE, POOR DIET, EXCESS WEIGHT:
There can not be a discussion of tissue breakdown, inflammation, and arthritis without discussing other major players, as there is never only 1 player in a team sport and complex system like the human body.
I will call these 3 ‘The Unhealthy Triad” and this includes excess weight, poor diet and a sedentary lifestyle, all of which are preventable contributing factors.
First and foremost and because it is the easiest to correlate with joint degradation and arthritis, is EXCESS WEIGHT or increased BMI.( Body mass index)
Breakdown of cartilage or cartilage degeneration is often seen in Osteoarthritis. Inevitably it also involves the synovial membrane and thickening of the sub-chondral(underlying) bone. This is also enhanced by active inflammation as the body attempts to ‘repair’ or clean up the affected area by sending in inflammatory proteins and other molecules.
Excessive joint loading is a primary factor when discussing arthritis of the knee. The end goal is to reduce joint loading so to preserve the joint cartilage and stave off arthritis. Weight reduction is obviously one critical component to unloading the knee joint. Under normal walking conditions the load felt at the knee joint is 3-5 times that of body weight for level ground walking and up to 8 times for downhill walking! So even carrying an extra 10 pounds on the body can be felt at the knee joint as an additional 40-80 pounds!
Most of this is felt at the medial ( inside) knee compartment, which not surprisingly is the first knee compartment to show signs of arthritis. In Physical therapy we often suggest joint “off-loading” support in the form of knee braces that reduce compartment load, using a cane on the contra-lateral side,and heel wedges to alter foot mechanics.
Of course, Nothing will be as effective as weight loss in the management of knee OA.
Now that we addressed that rather difficult topic, lets discuss sedentary lifestyle.
While the aggressive athletic warriors ( you know who you are) have their share of wear and tear, sprains and strains and injuries, which can lead to early onset of arthritis, the opposite scenario is the “desk dweller” or couch potato who sees little if any physical activity. Loss of muscle strength, power,endurance and mitochondria ( muscle fueling powerhouses) diminish with low activity. This will directly affect the health and integrity of the weight bearing joints. So when it comes to health of the joints and activity and exercise, it is advisable to maintain muscle mass, power, flexibility and strength through exercise, walking, cycling or a combination of high and low impact exercise. As is most things in life, it’s all about striking a balance.
Last but not least in this triad, is diet. As the saying goes: “You can’t exercise your way out of a bad diet.” The diet that most of us are consuming looks less and less like real whole food. We are growing ‘attached’ ( addicted might be the better choice of words) to the processed, packaged, preservative laden, highly palatable pseudo foods that line grocery store shelves and fast food markets.
What does this have to do with my joints, you may ask?
The diets most Americans are consuming is highly INFLAMMATORY, calorie dense, nutrient poor, highly oxidative and damaging to the cells of our body.
Many studies have shown that years of eating habits such as this will lead to early degeneration of joints, increased inflammatory processes in the body, which spells double trouble for all body systems = DISEASE!
Regulating oxidation and inflammation can improve health, vitality and longevity. Oxidation to put it plainly is our cells “rusting” from the inside. While some oxidation is a normal part of cellular metabolism, too much, too quick, without a balance of antioxidant rich foods contributes to disease.
Foods that are anti inflammatory and loaded with anti oxidants should be the focal point of every meal. Dark leafy greens, brightly colored vegetables and fruits, seeds, nuts and omega 3 rich fish is a great place to start.( see below)
A recent study looked at the anti-oxidative and anti-inflammatory effects of Vitamin E on knee tissue of patients with late stage osteoarthritis of the knee.
Those in the study taking the Vitamin E had decreased inflammation and decreased oxidative stress,and improved clinical symptoms, identifying Vitamin E as a “disease-modifying agent for Osteoarthritis.”
What are some examples of other potent anti-oxidant foods: Carotenoids: Carrots, squash, broccoli, sweet potatoes, tomatoes, kale, collards, cantaloupe, peaches and apricots (bright-colored fruits and vegetables!),purple grapes,pomegranate, cranberries, green tea, Vitamin C: Citrus fruits like oranges,lemon, and lime etc, green peppers, broccoli, green leafy vegetables, strawberries and tomatoes
Vitamin E: Nuts & seeds, green leafy vegetables, and finally my favorite of all: Red wine 🙂 (in moderation of course!)
There are just a few of the more common issues we encounter. There are many more possibilities for the onset and progression of knee complaints and in Physical Therapy we investigate the many contributing and causative factors providing conservative solutions for those who wish to avoid surgery.
If a patient wishes to be intentional and implement the suggested positive behavioral, dietary and lifestyle changes and therapeutic measures suggested in therapy, improvements can be seen in the form of increasing physical function decreased pain and improved mental health, vitality and quality of life.
Stand up, learn what you can do and take action, Knee pain doesn’t have to sideline you from enjoying life.
Be blessed, be well.
If you have any questions, feel free to contact me and I will try to assist you :
4 STRATEGIES TO MOVE FROM RESOLUTIONS TO REAL SOLUTIONS.
A brand new year with a fresh crop of 365 new opportunities to begin again….Instead of Resolutions, begin the year with Real Solutions.
Like most people you may be starting the New Year with motivations running high and a sense that a new crop of 365 days was just what you needed to propel yourself toward healthier habits. You may have set a few worthy goals such as lose 20 pounds, begin a certain diet, exercise more, eat healthier foods, manage stress.. and so forth. And if you’re similar to most people by mid January you will begin to feel a sense of ‘love lost’ when you think about those ‘resolutions’. If The sparks that ignite your motivation, begin to fizzle out with the holidays fireworks,.you are in good company. When it comes to life changes, most people have the attention span and focus of a squirrel, and when it comes to will power, well, that is not as powerful as we had hoped.
In fact, most people who begin a “diet” or attempt a lifestyle change will be unsuccessful without the right tools. When it comes to having the right tools, and understanding what leads to success, there is some good news and some bad news.
I will give you the bad news first.
There may be reasons why you have fallen short when trying to change a habit, but they are not excuses.
Now here’s the good news:
There may be reasons why you have fallen short when trying to change a habit, but they are not excuses. Thankfully, you are still responsible, and what you acknowledge you can change. It does require personal accountability.
It sounds simple, and it is, but simple does not mean easy.
I have outlined 4 simple strategies that will put you on solid ground and move you forward. That is where we want to go, right? Therefore, looking back or dwelling on past failures is no longer an option. That would be like trying to drive your car, looking in the rear view mirror. We recognize that nothing good will come from that!
1. YOU WILL CREATE WHAT YOU BELIEVE-
There is no other force as powerful, creative or destructive as your thoughts and own belief system. Therefore, if you have struggled with maintaining weight loss, or a healthy eating lifestyle, the question you need to ask is: Do I believe that I deserve to lose weight and feel good? This is not a question you pose to your head, but to your heart. Your intellect will always tell you what you want to hear, but the heart knows only the truth.
“You cannot solve your problem with the same mind that created it.”
If you are not getting the right answers to chronic, recurrent, problems, this may simply mean you are asking the wrong questions.
|“You cannot solve your problems with the same mind that created them.”-Albert Einstein|
In order to achieve any lasting changes in your diet, exercise or lifestyle factors, you have to dig deeper and ask some difficult questions to uncover the limiting beliefs or lies that are keeping you from rising higher. Some, or most of our limiting or destructive beliefs are subconscious, but specific tools and an honest inventory will help in Identifying, Acknowledging, Challenging, and Releasing these automatic negative thoughts and allow you to create a greater vision for yourself. Your belief system is directly related to your thoughts. Guard your mind like Fort Knox.
The battle is won or lost in your mind, so that is where it must begin
2. GET CLEAR, GET COMFORTABLE:
I would encourage you to get a clear vision of what you want for yourself. This will be your mental map or GPS. You can be assured that you will have times when you will fall of the track, not if, but when. Here’s the point, Just because you get derailed, you don’t have to crash. Immediately, divorce yourself from the tendency to nurse the bad feelings, feel guilty, blame or engage in self- recrimination. Having a vivid vision of what you desire for your self will keep you from losing momentum during the challenging times. There are many ways to do this. Some people do well with meditation, picture boards, positive affirmations, visualization, journaling and writing out their goals. Daily. You must be vigilant, bad habits die hard.
The second part of this exercise is to assign a numerical value to how comfortable you are that you will follow through with the goal. For example, if your goal is to ” exercise 5 times per week for 1 hour” and you assign a 2 to your comfort level ( 0 to 10, with 0 representing not comfortable at all) this is NOT a worthy goal for you at this moment. Modify it until you are at an 8 or better on the comfort scale. Your previous goal may change to, “I will walk for 20 min a day, 4 days a week.” Then give it life by putting it on your calendar. And finally, Don’t break a date with yourself, you are important.
3. WILL POWER IS NOT VERY POWERFUL.
The nature of will power is that it is not a powerful motivator or catalyst for change in the long run. Psychologists and life coaches know this. It may get you started initially, but it is rarely a faithful friend to the end. Instead, you have to cooperate with some natural laws at work here. I will outline a few.
Our brains are wired to seek pleasure and avoid pain. Pretty basic for survival, back in the day. The main motivator for any behavior is based on this principle and so self- gratification and self- protection are the two most powerful activists. Unfortunately, portions of our brains, ( namely, the Amygdala and Nucleus Accumbens) are easily hooked on various forms of pleasure, some good, some not so good.
In the ‘not so good ‘category are sugary, salty and fatty foods which trigger the same centers in the brain as some drugs. The food industry knows the sneaky secrets to turn on the reward centers in your brain and activate the release of the neurotransmitter, Dopamine. In fact, Dopamine is often referred to as the “Master Molecule of Addiction.” Studies have shown that while animals will work hard for a sugar or fat reward, they will work the hardest for a combination of sugar and fat. An example in the ‘good’ category are people that obsessively engage in rigorous exercise to achieve an endorphin release. The so called “runners high.”.
So what does this all mean for us common mortals? Why are bad habits, like not exercising, eating poorly or smoking, so hard to change despite the knowledge of their deleterious effects and contribution to disease? No, it does not mean you are “weak” lacking in willpower and doomed to failure!
Many health coaches and scientists have studied this question and countless methods to facilitate lasting behavioral change. A fairly daunting task, for sure. Lately, many theories converge on the principle of Love versus Fear. What does love have to do with it, you ask? Everything we do comes through motivation from either love or from fear. If you are not enjoying your life, or if fear is an emotion you feel more often than love, joy or peace, then you are probably operating from a primitive, lower brain function which seeks to avoid pain and seek gratification through external means.
The take home message is that all lasting change starts with self – love. The love of self, knowing and accepting your true nature and spirit of greatness, gives rise to love of others and thrusts you to a higher level of function. If love, the most powerful force there is, becomes your primary moving and motivating force, you will naturally seek and gravitate toward healthy foods, habits and the positive reinforcement they create, which is feeling good, healthy, vibrant and strong. That is our birthright. Furthermore, “Nothing succeeds like success.” As you create positive habits, they reinforce themselves. It is true freedom to make choices that are life enhancing and that affirm self- love.
Think back to the last time you felt pure contentment, a lightness of being, joy or peace, what were you doing? DO more of that! It’s time to give yourself permission to re- discover or find ways of creating more joy. If you are feeling stuck, don’t forget to check in with your belief system, strategy #1.
“Everything we do comes from either Love or from Fear.” – Arlosky
4. START SMALL, END STRONG
The most common mistake when embarking on a life change for health or personal reasons is to set goals that are unreasonably difficult to stick with and therefore will have a limited degree of success.
An example is beginning a ‘diet’ that is based on the principle of deprivation and elimination. I am certain you can relate to this. You can also most certainly guess why this sort of plan is doomed to fail. If food is a source of pleasure for you and you decide to eliminate every food you are currently considering ‘bad’, you will be miserable. Remember what happens when your brain is miserable? It is pleasure seeking and pain avoiding by nature. Is it any wonder why most diets fail? A simple rule that I will share, is to consider that there are NO foods that are off limits. ( exception of course, are foods that you may have an allergy or intolerance to, and these often times are the very ones you are craving).
Does that mean you can have your fill of donuts and French fries? Of course, the answer is a resounding NO!
As a general rule eating ‘clean’ 80-90% of the time allows time for your body to chemically adjust and down regulate the dopamine and hormonal systems ( insulin, leptin) of reward, cravings etc. Have you ever noticed how when you eat sweet or fatty food, you crave more sweet and fatty food? The formula your body uses is as follows: eat junk, want junk. It’s not in your imagination. It’s a downward spiral due to changes in the chemical and hormonal systems of the body. Your body is very much like a chemistry lab and is inherently good at maintaining status quo and enhancing survival mechanisms.
Do not despair, eating clean is a way of life that will eventually be as automatic as brushing your teeth.
Concentrating on building your meals around Seasonal, Organic, Unprocessed, Local (SOUL) food is the foundation of healthy eating.
Concentrate on building your meals around Seasonal, Organic, Unprocessed, Local ( S.O.U.L) food .This is the foundation of life- long, healthy eating habits. Increase your consumption of vegetables, fruits, healthy fats and oils. Consume foods in their most natural and unaltered states. For example, a baked sweet potato, not French fries. Use the method of ‘crowding out’, that is, filling up on the most “nutrient dense” and healthy foods first and thereby reducing the consumption of the calorie dense, processed, and unhealthy fare. Remember you will always allow yourself the 10-20% ‘free choice’ for a night out or a special occasion. No guilt allowed! EVER!
Make it a practice to increase consumption of water, drinking at least ½ ounce per pound of body weight. A simple practice that has enormous, far reaching health benefits.
Beginning an exercise program gradually, and ramping up intensity slowly, is the kinder more sustainable approach. This will allow you to feel the positive changes without experiencing the negatives of forcing your usually sedentary body to complete a full session of P 90X.
If you are new to exercise, use your smart phone’s app to track the number of steps you take in a day. Set a goal to increase the number of steps weekly until you reach 6,000 steps per day, which is the average for most people, or strive for the 7,000 to 8,000, recommended by the CDC. (Centers for Disease Control). Eventually you may get to 10,000 steps or beyond which is associated with the most health benefits.
Following these simple, real solutions will provide the spring board that moves you forward and allows you to experience success. Success experienced early in the process of life change, is indicative of future and continued success.
If you desire to see yourself in a better place this time next year, you must begin to make different choices. Quite simply, if you desire a different outcome, you have to make a different choice. One small, next right choice at a time, one day at a time.
If you keep your vision in front of you, state your intentions,stay focused on the feelings of accomplishment and the health benefits that will inevitably follow, you are sure to end 2017 a happier, healthier you!
Who needs resolutions anyway?
I would love to help you make this transformation a reality. If you have particular health, fitness or rehab issues that you need assistance with, contact me: email: firstname.lastname@example.org
Visit my website or contact me for New Years “Commitment to Wellness“, 2 for 1 packages!
BE WELL, BE BLESSED.