It’s that wonderful time of the year for pumpkin-flavored everything, ghosts, ghouls, and skeletons decorating our living spaces! With Halloween right around the corner, I thought it might be fitting to dedicate a blog to “Building a Better Skeleton” and what we can do to ward off the “scary trends in our bone health.”
Let’s get the scary news over with first.
To start with, we have a serious problem with bone thinning in the United States. The National Osteoporosis Foundation reports that at least half of the U.S population over the age of 50 has osteopenia (pre-osteoporosis) or osteoporosis.
The National Osteoporosis Foundation estimates 54 million Americans are affected by osteoporosis and low bone density conditions, and if this trend remains unchanged it is predicted to increase to over 64 million by 2030. Those who sustain a hip fracture due to osteoporosis have a 15-20% mortality rate due to complications, while those who survive, less than half of them will regain full independent function.
OK, now for the good news.
What if I told you that your bony skeleton was designed to remain strong for your lifetime? Could it be that what you believe about aging and bone health is oversimplified and no longer scientifically accurate? Yes, both statements are true!
I have spent the last few years, learning what the science is saying about maintaining strong, fracture resistant bones as we get older.
I am excited to say that I have dedicated an entire chapter to the condition, Osteoporosis in my soon to be released book, Staying Healthy, Living Longer, 7 Powerful Principles to a Healthier You! due to be released this January 2021.
This blog will give you a quick peek into the primary factors affecting whether you will have strong, healthy bones as you age or be part of a growing population of those diagnosed with bone thinning, osteoporosis, or frailty.
Bone density is measured most commonly with a special kind of x-ray called a DEXA scan. This stands for Dual X-Ray Absorptiometry. The DEXA can will give you a number called a T-Score.
For those not familiar with the terms, Osteoporosis, literally means ‘porous bones’ and is diagnosed when a bone density scan T-score measures a -2.5 or less. ( more negative). Osteopenia is when a T score is -1.0 to -2.5. This is considered early-stage or ‘pre-osteoporosis”. Anything over -1.0 ( less negative) is considered normal bone density. A T score is calculated by comparing your bone density to that of a 25-30-year-old or those who should be at “peak bone mass”.
I want to mention here that the time to start thinking about your bone health is when it is the last thing on your mind. Early childhood. Building healthy bone early in life is an insurance policy against loss of bone in adulthood.
A bone density or DEXA scan is recommended for all those in menopause especially when risk factors are present. An important point to remember is that a T score is a snapshot of what has already happened to the structure of your bone and is not a current picture. In other words, It tells a story of what has already occurred and not what is occurring.
Bone mass as represented by a bone density ( DEXA) scan, does not directly translate to bone strength or the bone’s ability to resist fracture under normal daily stress. Many other variables must be considered.
Also, it is important to note that these scans ( T scores), look only at the quantity of bone and not the quality of bone. That is an important distinction that must be understood. You can have a lower bone density, yet have strong and resilient, fracture-resistant bones, or a higher bone density and have older bone that has not undergone reabsorption, that is prone to microfractures and failure.
Normal bone is a living, dynamic tissue. It responds to the stress placed upon it ( weight-bearing loads and resistance training) by strengthening and increasing its density and resiliency. It also responds to nutritional factors, body-wide inflammation, hormonal factors, gut health and even mental-emotional stress.
Normal bone undergoes remodeling as do all tissues. Old bone is reabsorbed by the body by specialized cells called Osteoclasts and new bone is laid down in its’ place by cells called Osteoblasts. Many factors affect these cells and the rates of remodeling, reabsorbing, and rebuilding.
Let me begin by stressing that Osteoporosis, like many chronic and progressive conditions, is not an isolated disorder. Bones exist within bodies and therefore, Bone health is highly reflective of general health.
What are the risk factors for Osteoporosis? Risk factors can be divided into “Fixed” and “Modifiable.”
There are some “fixed risk factors” that we have little or no control over. Such things as having a smaller body frame, being female, early or surgical menopause, and prolonged steroid use for an auto-immune disorder, and history of a family member with an early bone fracture.
However, many of the factors that increase our risk of osteoporosis and bone fracture are modifiable, lifestyle factors. These same modifiable, lifestyle factors are in play for many of the chronic diseases of our time. They share common pathways, therefore, bone thinning can indicate the presence of other health conditions.
Does Osteoporosis have symptoms or early warning signs? Rarely, but there are some subtle clues. One of the hallmark signs are changes in posture. In therapy I look for a rounding of the upper back. There may also be loss of height, periodontal disease, and loss of grip strength.
Here is a short list of the many factors that we can control.
- An Inflammatory diet,- what most of us are eating
- Poor nutritional status or nutrient deficiencies ( Mineral deficiencies, Vitamin D….)
- A Sedentary lifestyle and inadequate weight-bearing exercise; loss of lean muscle, also called Sarcopenia
- Excessive soda or alcohol consumption
- High-stress levels ( increased cortisol)
- Leaky gut, food sensitivities, and Celiac disease.
- Certain Medications
- Hormonal Imbalances
In part 2 of this short blog, I will focus on just two of the many factors that are controllable or modifiable; nutrition, and exercise. I will briefly discuss ways of preventing bone loss, building healthy bone with diet and exercise, as well as preventing falls and fractures.
“Having Healthy strong bones for life, is possible and starts with what you are doing right now.'”Tweet
We are in chaotic and uncertain times. There is a wave of expanding collective anger and pain that is palpable.
It is an understatement to say we are all being challenged to salvage some sense of peace when confronted with social and political unrest entangled with financial, personal, and health worries. I have seen a great deal more emotional stress, headaches, neck pain, back pain, and overall bodily discomfort in my patients. It is never too long that emotional pain becomes physical pain.
We seem to have hit a pivotal point in society where hatred, destructive dialogue, division, anger, and blame are at an all-time high. Civility, kindness, acceptance, and love are strangely absent. Today and every day, we have a choice to make.
The news and social media are the platforms for expressing this discontent and anger. It has morphed into a means of spreading fear and mistrust or canceling anyone who thinks differently from us. Name-calling, ridiculing, and brandishing opinions as though they are Truth and fact has become a common thread perpetuating this growing anger and unrest.
We seem to have lost the ability to have intelligent conversations with those of differing opinions and beliefs, insisting that others who believe differently than us are “wrong”. There is vehement push back, resistance, self-righteous attitudes, and defiance when our beliefs or opinions are challenged or not accepted as universal Truth. Our ego tells us that if perhaps we shout loud enough we will change the minds of those who think differently. We instinctively know and have seen historically that this is false.
It becomes easy to bully, belittle, dehumanize, and lump groups of people into ‘categories’, as if to ‘shield’ ourselves, simply because they think differently than we do. This is a form of bullying. In doing this, we are perpetuating the negativity, anger, hate, and division that is already escalating. We have now become part of the problem.
The news and news media have always portrayed the lowest common denominator of human existence and is designed with one objective in mind: to activate the portion of the brain ( Amygdala) that creates fear.
More than ever, news media and social media bombard the fear brain, inciting anger, divisiveness, and “me against them” thinking and mistrust of others. This promotes a stress response in the body by upregulating our “fight, flight, freeze, and fear”, Sympathetic nervous system. This is our built-in survival mechanism however, it is not meant to be responding every day, all day to perceived ‘threats’. The consistent hyperarousal of this nervous system is responsible for many chronic health conditions, including heart disease, high blood pressure, diabetes, compromised immunity, depression, anxiety, muscle tension, chronic pain, and insomnia.
I sat quietly this morning in solitude considering the choices we have and the lessons we can learn during times of testing.
We have a choice to reduce the amount of time we spend watching the news or engaging in the various forms of social media. Setting time controls and boundaries can go a long way toward restoring our inner peace. Those who watch the most news, experience the greatest levels of anxiety.
We have a choice to disengage when someone is choosing to express vitriol, name-calling, personal attacks, and other bully tactics. There is no place for this in any relationship or even when expressing our views on a social platform.
We can make a choice to refuse to be offended, as carrying an offense and being easily offended brings the heavy burden of resentment and bitterness, stealing our health, peace, and joy. When we are easily offended our rational brain is hijacked, and our emotional and fear brain is in the driver’s seat. We are essentially giving our control over to someone else, allowing them to influence our reactions and remarks. We may strike out in defense as I have seen countless examples of those who have said they “Can’t be friends with someone who votes for so and so, or who believes such and such.”
We can choose to have an open mind and hold space for duality; simply understanding that two very different ideas can co-exist at the same time while understanding that there is rarely one truth that summarizes a complicated issue. As Steve Jobs has said, “Have strong opinions loosely held.”
We can choose to allow a larger perspective, as pettiness and insisting we are right, cancels our joy, and contracts our world. We need people with other viewpoints to expand our thinking. We don’t have to change our minds but new knowledge can expand our minds if we are secure enough to receive it.
We can choose to have healthy boundaries especially with those who for whatever reason, are angry or abusive. We may have to take inventory of the types of interactions we engage in, protecting ourselves as needed. Distancing from toxic relationships may be necessary if boundaries for decent behavior are not respected. Those who attack or hurt others are often experiencing pain themselves, we can have empathy. Empathy builds resilience.
We can choose to focus on the good that we can do; how we can contribute our energy positively to the greater good or a cause that is important to us. Other questions we can consider: What can I do to lift up myself and others? What is within my control and what is not? How are my underlying beliefs and prevailing thoughts contributing to my unrest, worry, anxiety, and stress? Ultimately, it will be our health that is negatively impacted.
We can choose to make peace our primary goal. If we can cultivate ways of choosing peace, safeguarding peace, and residing in a place of peace, despite external circumstances, we become a very powerful agent for change. Developing healthy habits that protect our peace of mind, may mean limiting the time we spend watching or engaging with news and social media. Instead, we can use our time to listen to soothing music, take a walk in nature, express ourselves in a journal, play with a pet, pray or meditate, or simply breathe.
We can choose to nurture our faith rather than our fears. This is not an easy task at times such as this, but this is precisely when it becomes most valuable.
” When you judge another person, you do not define them. You define yourself…When you respond with hatred to hate, you’ve become part of the problem which is hatred, rather than part of the solution, which is love. Be a person who refuses to be offended by anyone, anything, or any set of circumstances.” – Wayne Dyer.
This above quote by Dr.Wayne Dyer holds tremendous wisdom. Indeed, It is a very difficult call for us to uplevel our responses in a time of chaos and uncertainty. If we can achieve it now, it will be a skill that we can turn to, again and again during other trials.
“I have told you these things so that in Me you may have perfect peace. In this world, you will have tribulation and distress, but be courageous and filled with joy, for I have overcome the world.”- John 16:33
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 :