The Washington Post ran a wonderful article a couple of weeks ago about alternatives to knee surgery.
I was flattered that the reporter, Sally Squires, saw fit to include a condensed version of my story. We talked a couple of times. As a journalist myself, I know that good reporters conduct a lot of interviews, and not everyone they speak with makes the final cut.
When interviewing me, Squires was quite careful and thorough. As she explained in the article, she has been suffering from her own travails with knee pain, so I imagine that the research she did had a special resonance.
She gives a great overview of the dimensions of the problem our country has with sore knees: one in four adults have chronic knee pain, and the number of sufferers has jumped 65% in four decades. About 680,000 total knee replacements were performed in 2014.
Can you imagine that? That’s about one in 500 Americans – in just a single year. What’s more, when adjusted for population, that rate doubled from 1991 to 2010. As her article notes, the number of knee replacements is outpacing operations for coronary artery bypass surgery.
This country has a crisis of bad knees, it seems.
Squires also quotes someone about the delayed onset of symptoms with knee pain. This is critically important, and I don’t remember reading much if anything about this when I undertook my own journey to save my knees.
It means that the activity you do now may seem pain free, but your knees might protest hours later. And if you don’t connect the dots between pain now and something dumb you did yesterday, your knees may never get better because you’ll never try to modify your behavior! I talk about this at some length in my book; it was a key revelation for me.
Finally, one small thing: she did mention that I still notice some burning in my knees when sitting. Honestly, I did suffer occasional spells of burning in my knees (when sitting) during the “post-recovery” period after I healed enough to go back to work.
But the problem with burning under my kneecaps lessened over time. I haven’t had any issues for (I think) two years now. I have to put “I think” in parentheses simply because it’s been a while, and I no longer track every little sensation from my knee joints.
But she’s correct that I did have this problem, and it took a while to shake. And it’s not like my knees never complain. I really beat them up sometimes (like in a very intense Thanksgiving bicycle ride this week). I still like to play hard.
And I’m glad that I can again!
If you haven’t read the excellent article that Squires wrote, please check it out here.
Friday, November 29, 2019
Saturday, November 16, 2019
Humans, Salamanders, and the Ability of Cartilage to Heal
Get a load of this: a scientific study is confirming that cartilage does have the capacity to regrow. Hooray!
Of course some of us have believed that for a while.
The reporting on this discovery has a kind of breathless tone of disbelief. The researchers who did the study call this ability we possess a “salamander-like” regenerative capacity. Salamanders, of course, can regrow limbs and parts of major organs.
As I’ve said a number of times, at least two studies done a decade or so ago have discovered that deep holes in cartilage can fill in naturally, at least part of the way, over a few years. (For more, see here and here.) That doesn’t surprise me at all.
From an evolutionary biology standpoint, it just makes sense.
The cartilage in our knees takes a banging over the course of decades. It’s hard to believe that it would be designed so that it just wears out, like the tread on an overused car tire. Cartilage should have some natural regenerative capacity. Indeed, evidence has been found that, when damaged, it does try to repair itself.
The problem is, cartilage changes slowly. Defects in the tissue can easily get worse if too much pressure is applied to the knee joint. So getting better isn’t quick, or easy.
Anyway, more details on the study:
Researchers at Duke Health found that molecules called microRNA oversee the regeneration process. These molecules are more active in animals that are known to efficiently mend their own damaged limbs or fins, such as salamanders or zebrafish.
The research team thinks the microRNA could be used in treatments that could possibly reverse arthritis.
By the way, the researchers also looked at the age of cartilage in different locations in the body. It happens to be “young” in the ankle, “middle-aged” in the knee, and “old” in the hip. That, they suggest, could be why arthritis occurs more often in hips and knees.
So there you go. As you focus on gentle, low-load movement to heal your knees, you may be awakening your inner salamander!
Of course some of us have believed that for a while.
The reporting on this discovery has a kind of breathless tone of disbelief. The researchers who did the study call this ability we possess a “salamander-like” regenerative capacity. Salamanders, of course, can regrow limbs and parts of major organs.
As I’ve said a number of times, at least two studies done a decade or so ago have discovered that deep holes in cartilage can fill in naturally, at least part of the way, over a few years. (For more, see here and here.) That doesn’t surprise me at all.
From an evolutionary biology standpoint, it just makes sense.
The cartilage in our knees takes a banging over the course of decades. It’s hard to believe that it would be designed so that it just wears out, like the tread on an overused car tire. Cartilage should have some natural regenerative capacity. Indeed, evidence has been found that, when damaged, it does try to repair itself.
The problem is, cartilage changes slowly. Defects in the tissue can easily get worse if too much pressure is applied to the knee joint. So getting better isn’t quick, or easy.
Anyway, more details on the study:
Researchers at Duke Health found that molecules called microRNA oversee the regeneration process. These molecules are more active in animals that are known to efficiently mend their own damaged limbs or fins, such as salamanders or zebrafish.
The research team thinks the microRNA could be used in treatments that could possibly reverse arthritis.
By the way, the researchers also looked at the age of cartilage in different locations in the body. It happens to be “young” in the ankle, “middle-aged” in the knee, and “old” in the hip. That, they suggest, could be why arthritis occurs more often in hips and knees.
So there you go. As you focus on gentle, low-load movement to heal your knees, you may be awakening your inner salamander!
Saturday, November 2, 2019
The Dangerous Shift by Orthopedists to 'Symptom Control'
I’m feeling a bit sour. This kind of irked me:
The lead author on the study, which was published last month in Arthritis Care & Research, rightly says we need to shift our thinking away from taking care of the immediate pain and toward preventing a further decline in physical health.
Well, yeah. Short-term fixes for hard-to-solve, long-term problems aren’t a good idea. It’s like using zip ties to hold your car’s battery cables together (I’d link to the YouTube video where I saw this “fix,” if I could only remember where – I discovered the video when I had to replace my own battery cables.) Short-term fixes are sometimes necessary of course because you need some way to get your car home, or in the case of your knees, to manage pain that's reached unbearable levels.
But, once the pain abates, you should start thinking of a long-term plan to take care of the problem.
Below are more details from the study, which I found mildly horrifying. The researchers discovered that:
* In the 2007-2009 period, orthopedic doctors referred patients to physical therapy 15.8% of the time. Less than a decade later, in 2013-2015, that figure dropped almost by half, to 8.6%.
* Many of these doctors also abandoned “lifestyle counseling” (e.g., exercise recommendations, advice about managing weight). Specifically, lifestyle counseling fell from 18.4% of all visits to less than half of that, or 8.8%.
So what were these poor patients leaving with, if not referrals to physical therapy or good advice about the importance of controlling their weight? You guessed it: little pieces of paper for their local pharmacy.
The number of prescriptions written by orthopedic specialists for nonsteroidal anti-inflammatory drugs (NSAIDs) more than doubled, from 132 per 1,000 visits to 278 per 1,000, and tripled for narcotics, going from 77 per 1,000 to 236 per 1,000.
Personally, I think what many of these orthopedic doctors are doing is shameful. I’m not sure how much of it is because of the long-legged twentysomething drug reps showing up every few weeks with new pills and free goodies to shower on power prescribers, but I think there’s a better way.
True, it’s a harder way, a longer way. Still, if you minimize the pills, and stick to a careful regimen, you can actually improve the health of your bad knees. This isn’t just my story anymore, but the story of a fair number of other people who are regular visitors to this blog!
A new review of how specialists and primary care doctors treat knee osteoarthritis (OA) finds that the use of pain-relieving prescriptions has risen dramatically, while lifestyle recommendations and physical therapy (PT) referrals have dropped.The next sentence provided needed context: doctors appear to be increasingly concerned with “symptom control” rather than treating the underlying issue. The analysis was based on data collected from national surveys conducted by the Centers for Disease Control and Prevention.
The lead author on the study, which was published last month in Arthritis Care & Research, rightly says we need to shift our thinking away from taking care of the immediate pain and toward preventing a further decline in physical health.
Well, yeah. Short-term fixes for hard-to-solve, long-term problems aren’t a good idea. It’s like using zip ties to hold your car’s battery cables together (I’d link to the YouTube video where I saw this “fix,” if I could only remember where – I discovered the video when I had to replace my own battery cables.) Short-term fixes are sometimes necessary of course because you need some way to get your car home, or in the case of your knees, to manage pain that's reached unbearable levels.
But, once the pain abates, you should start thinking of a long-term plan to take care of the problem.
Below are more details from the study, which I found mildly horrifying. The researchers discovered that:
* In the 2007-2009 period, orthopedic doctors referred patients to physical therapy 15.8% of the time. Less than a decade later, in 2013-2015, that figure dropped almost by half, to 8.6%.
* Many of these doctors also abandoned “lifestyle counseling” (e.g., exercise recommendations, advice about managing weight). Specifically, lifestyle counseling fell from 18.4% of all visits to less than half of that, or 8.8%.
So what were these poor patients leaving with, if not referrals to physical therapy or good advice about the importance of controlling their weight? You guessed it: little pieces of paper for their local pharmacy.
The number of prescriptions written by orthopedic specialists for nonsteroidal anti-inflammatory drugs (NSAIDs) more than doubled, from 132 per 1,000 visits to 278 per 1,000, and tripled for narcotics, going from 77 per 1,000 to 236 per 1,000.
Personally, I think what many of these orthopedic doctors are doing is shameful. I’m not sure how much of it is because of the long-legged twentysomething drug reps showing up every few weeks with new pills and free goodies to shower on power prescribers, but I think there’s a better way.
True, it’s a harder way, a longer way. Still, if you minimize the pills, and stick to a careful regimen, you can actually improve the health of your bad knees. This isn’t just my story anymore, but the story of a fair number of other people who are regular visitors to this blog!
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