Saturday, June 25, 2011

Comment Corner: I'm Only 20 and Desperate for Help

I got this comment from a reader recently (which I've edited a bit for space):

I have some worn out cartilage, or a meniscus tear from playing too much football ( soccer ) .. Im desperate for help. I went to my doc, and he said dont run or do anything for weeks and take these antiflams. … I also added glucosamine to my supplements. Result? Got fatter from lack of exercise and once I got back into it, pain was still there.

My knee doesn’t hurt when I walk or run, but when I squat it does. Its that type of motion that hurts the most, when i squat, or kneel.. when i want to get into a car, or out of my chair. I only turned 20 about a month ago, so you can imagine my frustration. I cant play football to the best of my abilities due to this injury and I cant practice bodybuilding to the fullest ( I cant work out my quads coz any exercise causes knee pain !! )

I dont want to quit my sports at such a young age, and thats why I push thru the pain sometimes, but also i dont want to risk further injury that might cause me problems in the future.

There are five or six things I could say, but I'll limit myself to three, to keep this relatively short and sweet (which I always fail to do, but at least if I begin with that intention, I have a chance of succeeding).

To the commenter: First, I'm not a doctor or physical therapist. Consider the following "things to think about." Discuss them with a doctor or physical therapist who is actually examining your knee and (hopefully) asking lots of good, sharp questions about your injury history and daily routines.

It's hard to be young, active and saddled with knee pain. But the good news is you stand a good chance of escaping a life sentence of misery if you do the right things now.

Okay then, the three things in your story that jumped out at me:

1. Got fatter from lack of exercise and once I got back into it, pain was still there.

Yup. Sounds familiar. This is a hallmark of chronic, nagging knee pain. Give it a rest for a week … two weeks … then it comes roaring back. Welcome to a club you don't want to belong to.

But sitting around getting fatter isn't a good thing at all. If you gain ten pounds, that's ten more pounds your legs need to push to a standing position when you get up from a chair -- a motion that isn't comfortable for you to begin with.

(In fact, try this: Rise from a chair. Now put ten pounds in a backpack, slip it on, and do the same thing. That feels even worse, I imagine. Herein lies the basic problem with weight gain. Instead of driving a 5,000 lb. load over a bridge with a 4,000 lb. limit, you're driving a 6,000 lb. load -- so you're moving in the wrong direction by putting on weight.)

What I would think about if I were you: changing exercises for a while. Clearly you like to be active and also need to be (or the pounds begin to accumulate). Easy bike pedaling? Swimming using a stroke that's not hard on the knees? In the meantime, it seems to make sense to avoid activities that stress your knee joints too much.

2. thats why I push thru the pain sometimes

Hmm. This is where I'd suggest you hit the reset button. There are some injuries where you can push through the pain and your body will heal anyway. On other injuries, you're just doing more damage to yourself and digging a deeper hole to climb out of.

My experience was that soft tissue injuries in the knee fall into the latter category, unfortunately. Why? Remember two key things about the hyaline articular cartilage in the joint: (1) It has no nerves (2) It has no blood supply. So it heals slowly and provides poor feedback when it's being damaged.

I would do a rethink on pushing through the pain. When I cycle now, I often "push through the pain." But it's "my lungs are burning/my legs are sore/I'm working out hard" pain. It's not knee pain. I never push through knee pain anymore.

3. I also added glucosamine to my supplements.

Hate to break it to you, but:

Surprise. Glucosamine (probably) doesn't work.

I began researching glucosamine (an important building block of knee cartilage) after taking it for months on a doctor's advice. I took the recommended dose daily. And I perceived no benefit at all.

There have been conflicting studies about the efficacy of this supplement. Some say it does work, some say it doesn't. So you could wade into a morass of studies and pick whichever ones you happen to like best, and arrive at an inconclusive conclusion.

But there's a better way to get at the truth.

Taking glucosamine orally can be beneficial only if (it should go without saying) enough of it reaches the joints to have a positive impact. This is where a big problem lies.

When you swallow a glucosamine pill, it doesn't go straight to your knee joints. It goes to your liver, which rips much of it apart. A significant portion is metabolized and broken down into carbon dioxide, water and urea.

A study of 18 subjects ("Low Levels of Human Serum Glucosamine After Ingestion of Glucosamine Sulphate Relative to Capability for Peripheral Efffectiveness," Annals of the Rheumatic Diseases 2006) revealed the large gap between how little glucosamine ends up in your bloodstream and how much is needed to be effective for your joints.

The subjects took the dose recommended for knee pain sufferers (1500 mg). Between 90 to 180 minutes later, the level of glucosamine circulating in their systems peaked, at 11.5 micromoles (a micromole is one-millionth of a mole). The authors noted:

This maximum concentration … is a much lower concentration than the glucosamine concentrations claimed by other investigators to have various significant in vitro [i.e., in the lab] effects. This raises questions about current biological rationales for glucosamine use that were based on in vitro effects of glucosamine at much higher concentrations.

In other words (my analysis): You're taking a daily pill that, for less than 7% of each 24-hour cycle, achieves a maximum concentration in your blood that is well below the level that has been shown to have a positive effect on joint health. This is a big reason I think the glucosamine story is basically a placebo story.

So there you have it: some things to think over and discuss with a qualified medical professional.

In the meantime, keep movin' in a joint-friendly way -- that's never bad advice!

UPDATE: Thought I'd do a quick update to this post. A commenter below suggests having an MRI done, which is a good idea I'd definitely discuss with my doctor. It helps to know as much as you can about the nature of your injury, though doctors are sometimes reluctant to order MRIs for diffuse soft-tissue pain -- just an FYI that you may hit some resistance.

1 comment:

  1. The commentor should get an MRI and find out whether this is cartilage wear or a tear. A good physical therapist might help if thats in the budget. As for glucosamine, yeah, no evidence that it works. It seems to have a placebo effect in many. Studies that check the blood of users for inflammation show no effect. A friend of mine who researches for a major pharma company says studies do show it can end up in the knees, but that doesn't mean it is used by the body to build cartilage. It can just get deposited there and do nothing. Considering all that, it's way overpriced. I think it's a waste of money.
    That said, this guy can exercise. The deadlift can take the place of the squat. I'd try a single leg deadlift and find out if the pain still exists during the movement. Just stay away from quad dominant exercise. Besides, your glutes and hams are larger and will "burn" more fat through exercise than the quads. There are probably a lot of ways to get around it, but above all, if it hurts, don't do it. Find out exactly what the problem is! Don't just go on "it's either this or that." You're not going to get better by guessing what the problem is.