Saturday, January 31, 2015

Knee Pain and the Influence of Genetics

Is knee pain a family affair?

A recent study shows there’s apparently a gene-related link to the development of knee pain associated with osteoarthritis.

The study included 219 subjects, average age 48. Roughly half were the children of parents who had knee replacements; the rest belonged to the control group. The knee pain of all subjects was assessed three times: at baseline, two years later, then eight years later.

Even after the proper adjustments were made to control for such factors as age, sex and BMI, “individuals with a parental history of knee replacement had a more than twofold greater likelihood of worsening total knee pain.”

Interestingly, the adjustments were even made for radiograpic and MRI abnormalities. So that meant researchers were comparing people of similar age, sex and BMI who also had similar-looking MRIs and X-rays. Even then, the offspring of the knee replacement group had a twofold greater likelihood of worsening pain.

The study’s authors speculated that “implies that the genetic contribution to knee pain may be mediated through factors outside the joint, possibly involving pain processing.” I interpret that to mean that, if you’re a child of a patient who had a knee replacement, you may be more likely to experience a worsening of pain simply because you may be more sensitive to it -- an interesting and curious finding.

In any event, I’d argue that the takeaway is that, if you’re in this high-risk group, being proactive about not developing knee pain in the first place makes a lot of sense. Build up the leg muscles around your knees. Find good joint-friendly activities (cycling, walking). Take good care of your knees before they start to hurt.

Saturday, January 17, 2015

Did My Knees Really Get Better Or Do They Just Feel Better (And Does It Matter)?

A long title but I couldn’t think of a good shorter one.

After reading my story, some people say something like this:

Why don’t you get another MRI (or some other test) that shows whether your knees really healed? That would prove whether your program really worked.

To be sure, this kind of comment has never been phrased in a hostile way. There’s no implication I’m a liar or fraud. Rather, people have a deep curiosity -- the same as I do actually -- about what changes physically occurred in my knee joints between the worst days of my condition (when I was suffering each day in Hong Kong) and now.

If I could do such a test (for cheap), and it could measure such a thing, I’d do it in a heartbeat. Hell, I’d love to know. Armed with the test results, I could probably sell five times more books. ;)

But it’s not possible. Here’s why.

(1) Simply having an MRI done would cost a lot; I’m guessing at least $1,000. And my health insurance company isn’t going to pay for a “there’s nothing wrong but I’m curious about what my knees look like” MRI.

(2) I don’t have an ideal MRI to compare it against anyway. True, I had images taken in Hong Kong in early September 2007, but that was before my disastrous experiment with weightlifting to strengthen my quads (which really trashed my knees). An MRI done in November or December of 2007 might have shown more damage.

But here’s the big reason:

(3) My original MRI exam was only somewhat useful in identifying my problem and determining the extent of it. Actually, “somewhat useful” may be a too-kind phrasing. My MRI basically said I had changes consistent with mild chondromalacia. So it found no giant potholes in my cartilage that a subsequent exam might show had healed.

My suspicion is that if a surgeon had cut open my knee, he would have spotted some kind of more obvious cartilage damage not detected by the MRI. But I never went that route (thank God). So, like many knee pain sufferers, I don’t have a good baseline test that says, “Wow, your cartilage is really messed up!” I suspect I was on the verge of going downhill fast, but I was fortunate to fix my knee pain in the relatively early stages.

So how do I know there was damage in the first place and I didn’t just suffer from some weird neurological ailment?

Well, as I relate in the book, there was a lot of noise from my knees when I dropped into a squat (as if I were about to sit in an invisible chair). My knees were so loud that my doctor felt compelled to be blunt and opine that the joints would never get better. Also, when I went into a deep crouch -- which was hard to do and uncomfortable -- and then straightened up, there was a loud, ugly “ripping” noise.

But now those disconcerting sounds, whatever they indicated, are either gone or much quieter (I can still hear a little crunchiness in my knees, but it’s not painful at all). I’m back on the bicyle, riding as hard as ever. I can sit at my desk again through a long 10-hour-plus day without issues.

Do I have a before/after set of tests that shows the improvement? No. But even if I did, would it matter? I’m not so sure it would. Just from the way I feel, I know something in my bad knees sure as hell healed/improved significantly. And I’m pretty confident of that, whether or not those changes could be detected by an MRI or some other test.

Friday, January 2, 2015

Running Not Only Doesn’t Ruin Your Knees, But May Help Them

One of the most persistent knee pain myths is that, if you're a runner, the sport will eventually exact its due and lead to sore, aching joints. If you run long enough, the pessimists warn, you’ll pay the price.

A recent study (the results of which were presented at the American College of Rhematology’s annual meeting) came to a much different conclusion.

Namely, 29.8 percent of non-runners in the study had symptomatic osteoarthritis compared with 22.8 percent of the runners (I have to assume they controlled for weight in their calculations, as that’s a Statistics 101 sort of thing to remember to do.)

The study was huge (2,683 people, who had an average age of 64.5), which is good, but it did have a kind of squishy longitudinal component. Anyone who was a regular runner at some stage in their life, even if it was only between the ages of 12 and 18, was tagged as a “runner.” That can be problematic, as anyone knows who remembers my analysis in the book of one longitudinal study in particular. Still, this would not be the first study to suggest running is beneficial for knee joints, so I think the conclusion makes sense.

One of the study’s authors does raise a caveat: “This does not address the question of whether or not running is harmful to people who have pre-existing knee OA,” according to Grace Hsiao-Wei Lo.

But that’s okay. That’s a lesser issue. Running generally isn’t a good idea if you already have osteoarthritis in your knees, especially if it’s painful (there are better activities that are lower impact on the joints). The good news is that evidence increasingly shows that running doesn’t cause that osteoarthritis.