Saturday, May 20, 2017

Those Noisy Knees: Crepitus Revisited

The medical community may be realizing that crepitus is significant after all.
A study of 3,500 subjects, led by a group of researchers from the Baylor College of Medicine in Houston, found that those with crepitus were more likely to develop knee pain.
The findings don’t surprise me at all. Back in December 2011 I wrote about crepitus (the medical term for creaky knees). The first paragraph of this excerpt from the post, below, references an arthritis website that describes the condition:
The site also declares, incorrectly I think, "If it occurs without any pain, it is unlikely to be caused by arthritis or any medical condition, and is usually meaningless." A popular "save your knees" book on the market also asserts that that noise from your knees, unaccompanied by pain, isn't significant. I think that's wrong thinking, and dangerous. 
What if you were a ship's captain and spotted a strong beam of light through the fog? If you continued on your way without incident, you might conclude that the light was meaningless. However, if you strayed too close to the light's source -- and wrecked your ship on the rocky shores that this lighthouse was trying to warn you of -- I think you'd argue the opposite: that the light was quite meaningful indeed.
My thinking about crepitus remains pretty much the same, more than five years later.

First, when you’ve got bad knees, don’t obsess about it. For a while, I kind of did (along with eighteen other variables related to my knees as I tried to figure out how to heal them). But it’s very tricky mapping the amount of crepitus you hear in your bad knees to how well they’re healing, or not healing.

In short: Once you’ve got bad knees, monitoring crepitus probably isn’t all that worthwhile.

But as an early-warning harbinger of trouble ahead, I believe the presence of crepitus is very useful. It doesn’t mean you’ll develop knee pain. For instance, when I was thinking of doing the grueling Mount Washington “Hill Climb” on my bike, I remember a forum full of riders who had done the race, and one guy who said his knees were very crunchy, but he was asymptomatic.

However: anytime the crepitus gets worse and worse, I think you are at much greater risk of eventual knee pain. I often wonder about that rider. It’s been about a decade since I read those comments he left. Is he still asymptomatic, or is he now among the legions of people with knee pain?

Saturday, May 6, 2017

Don't Pin Your Hopes on Vitamin D Supplements

When it comes to knee pain, certain beliefs are vampire-like in their resistance to debunking. You find yourself trying to drive a stake into the heart of these beliefs, but in vain.

Basically, even when evidence-based medicine shows certain treatments and supplements don’t work, some people will continue to cling to them.

Glucosamine is one of these. It’s been extensively, thoroughly debunked as a cartilage regrower, as a pain reliever, as a function improver, but you throw a rock at a Bad Knees Convention, and you’ll hit about twenty people who swear by it. Some will say they can’t leave the house before taking their glucosamine tablet. (My standard disclaimer applies here: if glucosamine helps you, and you’re fine coughing up the money for it, go right ahead. But of course, I also believe if taping a piece of pink construction paper to your nose helps with your knee pain, that’s fine too.)

Another belief that is less widespread regards vitamin D supplements, and their beneficial effect on knee pain. When I wrote this post, I was taking vitamin D myself (not related to knee pain, which I no longer have, but rather for general health reasons). Nowadays the vitamin D fad is kind of burning out, and taking high doses has been shown to cause problems.

Yet I’m willing to bet there are still holdouts when it comes to using vitamin D to treat knee pain. So in their honor, I bring you this study, which is about a year old. The lead of this summary about it:
Vitamin D, which can reduce bone turnover and cartilage degradation, did not slow progression of knee osteoarthritis (OA) or reduce knee OA pain when tested in a randomized placebo-controlled trial.
The study included 413 patients who were considered vitamin D deficient. So, if anyone would see an improvement from taking the vitamin, presumably they would. For two years they took vitamin D (or didn’t if they were in the placebo group). Then MRIs were done and pain scores taken.

The authors concluded:
Results showed that even among study participants with low 25-hydroxyvitamin D, supplementation did not slow cartilage loss or improve WOMAC-assessed pain. These data suggest a lack of evidence to support vitamin D supplementation for slowing disease progression or structural change in knee osteoarthritis.
Fun bit of trivia: The lead researcher on this study was Changhai Ding, who also did the very first study I came across that really buoyed my hopes when I had knee problems. I mention that study in the book: it showed cartilage defects were found to improve about as often as they got worse over a two-year period. Fascinating, amazing, uplifting!