Brisk Walks May Help, Not Harm, Arthritic Knees

Brisk Walks May Help, Not Harm, Arthritic Knees

If you suffer from knee arthritis and worry that walking will only worsen your damaged joint, a new study suggests you put your fears aside, slip on some sneakers, and take a brief but brisk walk.

The researchers estimated that if older adults with the condition added just 5 minutes of brisk walking to their day, their odds of needing knee replacement surgery could dip by 16 percent.

On the other hand, light walking — akin to a “stroll” — may have no impact, said lead researcher Hiral Master, a Ph.D. candidate in biomechanics and movement sciences at the University of Delaware.

Her team reached those conclusions by digging into data from over 1,800 older adults with knee arthritis who wore portable devices that tracked their walking intensities for at least four days.

Over the next five years, 6 percent of the participants had total knee replacement surgery.

The researchers used the data on people’s walking habits to examine the effects of replacing “non-walking” time with time spent walking at different intensities. The findings showed that substituting just 5 minutes of down time with moderate-to-high intensity walking was linked to a 16 percent decline in the odds of needing knee replacement surgery.

The study authors defined “moderate-to-high” intensity as more than 100 steps per minute. In laymen’s terms, Master said, that’s a “brisk” walk that gets your heart rate up — not a stroll around the block.

The findings were presented Saturday at the American College of Rheumatology’s annual meeting, in Chicago. Such research should be considered preliminary until published in a peer-reviewed journal.

Knee osteoarthritis develops when the cartilage cushioning the joint gradually breaks down, which can eventually result in bone scraping on bone.

The condition is common among middle-aged and older Americans. According to the Arthritis Foundation, up to 13.5 percent of men and 19 percent of women aged 45 and older have knee arthritis that’s severe enough to cause pain and other symptoms.

And those patients often wonder whether walking is good or bad for their arthritic joints, said Dr. Paul Sufka, a rheumatologist at the University of Minnesota, in Minneapolis.

“They often ask whether they should minimize their activity, keep doing what they’re doing, or intensify,” said Sufka, who is also with the American College of Rheumatology’s communications committee.

“The general advice we give to patients is to stay active,” Sufka said. But, he added, the truth is there is too little evidence to give patients definitive recommendations.

The new findings do not prove that brisk walking directly lowers the risk of needing knee replacement surgery, Sufka noted.

But, “this gives us some useful information to bring to the discussion,” he added.

Overall, Sufka said, research does suggest it’s better for people with knee arthritis to be active rather than sedentary. And that’s not just for the sake of their knees. Physical activity has a range of health benefits, including lower risks of heart attack and stroke.

Master agreed, and pointed out that exercise can help arthritis patients’ mental well-being, as well as physical.

And it doesn’t take a huge lifestyle change, she explained. The new findings suggest people can benefit from adding a short, brisk walk to their day.

In fact, Sufka said, such incremental shifts may be best.

“The best exercise program is the one you can actually stick with,” he said. “If right now, you’re walking around the block every day, what would be 5 percent or 10 percent more than that? You can gradually build from where you are.”

And what if walking is painful? That’s a tricky question, Sufka acknowledged. Some patients might benefit from physical therapy rather than only exercising on their own, he said.

Beyond aerobic exercise like walking, strengthening exercises for the leg muscles supporting the knees can also be helpful, he suggested.

More information

The Arthritis Foundation has an overview on knee arthritis.

SOURCES: Hiral Master, P.T., M.P.H., Ph.D. candidate, biomechanics and movement sciences, University of Delaware, Newark, Del.; Paul Sufka, M.D., assistant residency director, internal medicine residency program, University of Minnesota, Minneapolis, and member, communications and marketing committee, American College of Rheumatology; Oct. 20, 2018 presentation, American College of Rheumatology annual meeting, Chicago

An In-Depth Guide to Medial Knee Pain: Symptoms, Causes, and Treatment

An In-Depth Guide to Medial Knee Pain: Symptoms, Causes, and Treatment

If you’re experiencing knee pain, you may have a meniscal tear. Our orthopedic experts explain what causes this injury and what you can expect during your recovery.

The meniscus is a key cartilaginous structure in the knee joint. Pain and swelling in the medial, or inside, part of the knee can unfortunately be a sign of tearing, but your treatment options will look different depending on the type of tear, the cause, and the severity. Our guide explains meniscal injuries, and what you can expect when you visit your doctor.

WHAT IS THE MENISCUS?

The meniscus is the C-shaped, rubbery cartilage in the knee that acts as a shock absorber and stabilizer for the joint, distributing the body’s weight and providing a cushion between the femur and tibia bones. The medial meniscus is located on the inner knee, while the lateral meniscus is on the outside. Medial tears are more common, but the symptoms are the same for both injuries.

Meniscal injuries can be classified according to the “zone” of the meniscus that is affected. This allows the physician to determine the amount of blood flow available to aid in the healing process. The red zone is the outer third, which has blood vessels and is more easily repaired by the body. The red-white zone has fewer blood vessels and is less quick to heal. The inner third, the white zone, has poor blood flow and is therefore more difficult to repair.

Meniscal tears also come in a variety of shapes, which may influence the course of treatment. Common shapes include bucket-handle, flap, and radial tears, or complex combinations of the three. A tears is considered “complete” if a piece of tissue has become separated from the meniscus. Degenerative tears, which are generally caused by arthritis, are more typical of older patients. Traumatic tears are common among athletes, who often twist and turn the meniscus.

SYMPTOMS AND CAUSES OF MENISCAL TEARS

The first sign of a meniscal tear may be a “pop” in the joint, and you may continue to feel a popping or clicking sensation with movement. Although you may be able to walk on the knee at first, subsequent pain and swelling can worsen in the days that follow, especially if you continue to use the leg. For a severe tear, the knee may click, lose its full range of motion, or even give way. If a part of the meniscus comes loose, the knee can slip or even lock.

Athletes and young people are especially prone to this injury due to sports trauma or hyper-flexing the joint. A forced twist, especially when the foot is planted, may cause the meniscus to tear. Older people may experience meniscal pain due to arthritis or ordinary degenerative wear to the cartilage. In these cases the pain occurs due to gradual tearing over time, and may present with no trauma to the knee.

KNEE PAIN TREATMENT AND RECOVERY

The first course of action is to follow the rules of “RICE”: rest the knee, ice the area in 20-minute sessions, compress the area, and elevate the leg to reduce swelling. In some cases, the knee may heal with this conservative treatment, but we recommend consulting an orthopedic specialist to examine the joint and monitor your recovery. Your doctor may perform a McMurray test, which includes bending, straightening, and rotating the knee in order to determine if an MRI is necessary. Orthopedic specialists usually will not recommend surgery for older patients, but physical therapy may help you find relief within five weeks.

For younger patients, arthroscopic surgery may actually be a preferred option, as this will help preserve the cartilage and prevent early onset arthritis in the joint. This type of surgery requires only two pinhole incisions. In most cases, when the tear is in the white zone, the fragment is trimmed and the remainder smoothed. Tears in the red zone are usually repaired to retain the full benefits of a complete meniscus. Surgery is often completed in 30 minutes, followed by several days of walking with the assistance of a crutch, or possibly a brace. After a few days you can expect to return to most normal activities. Full recovery, and a return to strenuous activity, can be expected after a few weeks of physical therapy.

Ditch the Golf Cart. Your Aging Knees Won’t Mind

Ditch the Golf Cart. Your Aging Knees Won’t Mind

Golfers with knee arthritis should park the golf cart and walk the links instead, researchers say.

While using a golf cart may seem the obvious choice for golfers with knee problems, a new small study finds that walking provides much greater health benefits. Moreover, it’s not associated with increased pain, inflammation or cartilage breakdown, the researchers said.

“Individuals with knee osteoarthritis are often concerned about pain and may be more likely to use a golf cart,” said lead study author Dr. Prakash Jayabalan. He’s an assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago.

However, “this study has shown that golfers with knee osteoarthritis do not need to be concerned about worsening their disease through walking the course. In fact, walking provides the best health benefit,” Jayabalan said in a university news release.

More than 17 million Americans older than 50 golf regularly. Knee osteoarthritis is a leading cause of disability in this age group. The condition causes swelling, pain and difficulty moving the joint.

The study included 10 older golfers with knee osteoarthritis and five without the disease, which is usually caused by wear and tear of the joint.

On one day, the study participants played one round of golf (18 holes) walking the course. On another day, they used a golf cart to play 18 holes. On each occasion, the researchers monitored the participants’ heart rates to determine their level of exercise intensity, and took blood samples to measure markers of knee inflammation and cartilage stress.

On both occasions, the golfers had an increase in these markers, but there was no difference between use of the golf cart and walking, the findings showed.

When walking the course, the heart rates of the golfers with knee problems were in the moderate-intensity zone for more than 60 percent of the time, compared with 30 percent when using a cart.

But even using the cart, golfers met daily exercise recommendations, according to the study authors.

“Bottom line: walking the course is significantly better than using a golf cart, but using a golf cart is still better than not exercising at all,” Jayabalan concluded.

The study was presented recently at the Osteoarthritis Research Society International annual meeting in Liverpool, England. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.

More information

The Arthritis Foundation has more about osteoarthritis.

SOURCE: Northwestern University, news release, April 28, 2018

ACL Surgery Preparation and Recovery

ACL Surgery Preparation and Recovery

Professional athletes’ speedy recoveries from injuries have nothing to do with superhuman abilities. Instead, it’s all about proper preparation and planning.

It’s no surprise that professional athletes tend to be in much better shape than those of us who don’t play sports for a living — but what might seem more puzzling is that they also seem to recover more rapidly from injuries. Think of D’Angelo Russell, the Brooklyn Nets’ star point guard. After suffering a knee injury in November, he underwent arthroscopic knee surgery and fully recovered in just over two months, returning to the court by the middle of January.

Such a speedy recovery isn’t evidence of superior physical fitness, however, so much as a clear strategy in the wake of an injury. Professional athletes have access to some of the best orthopedic specialist available — and these doctors, trainers, and therapists help them follow strict guidelines throughout the process of rehabilitation, ensuring that they can return to action as soon as possible.

While you might not have a dedicated team of doctors at your disposal, there are many steps you can take to enjoy a similarly quick recovery. ACL tears — a rupture of the anterior cruciate ligament, one of several ligaments that stabilize the knee — are a common injury affecting star basketball players and casual gym-goers alike. Here’s what you can learn from the professional athletes’ approach to ACL rehabilitation.

1. KEEP YOUR BODY HEALTHY

In order to help your body best respond to arthroscopic surgery, you need to stay healthy and hydrated. For at least a week before your surgery, be sure to drink plenty of water and eat a nutritious, wholesome diet rich in antioxidants, both of which can boost your body’s ability to heal.

2. STRETCH AND EXERCISE BEFORE SURGERY

Staying healthy requires more than just eating right, of course. Your preparation for surgery should include regular stretches and massages, which can strength the tissues surrounding the ACL and increase their flexibility. These measures ensure that the knee joint remains relaxed and enjoys proper circulation, both of which foster optimal surgical conditions.

3. DON’T BE AFRAID TO ASK QUESTIONS

Nobody expects an injury, so when these unfortunate events happen, you might not know what to expect. Athletes have a whole team on hand — ranging from surgeons to physical therapists — to guide them through the process, and while you might not have the same resources readily available, you should do your best to stay informed. Your doctor and surgeon are there to help you, so be sure to voice your concerns and ask any questions you may have.

4. FORMULATE AND WRITE DOWN THE RULES

When it comes to recovery, you can’t break the rules. A rehabilitation plan isn’t something you can come up with on the fly, so be sure to consult with your doctor, therapist, and surgeon to formulate a concrete plan centered around defined protocols and regular benchmarks to help you stay motivated and focused.

5. STAY STOCKED UP ON SUPPLIES

Proper recovery requires keeping plenty of tools on hand, such as ice packs and non-steroidal anti-inflammatories. You may struggle to get out of the house while you recover from the procedure, so ensure that you have an ample supply of everything you might need before you undergo surgery.

6. MAINTAIN A POSITIVE MOOD

As a minimally invasive procedure, arthroscopic surgery is designed to shorten recovery timelines, but you’ll still need to spend some time resting immediately after surgery. Since you won’t be able to participate in many of your daily activities, try to have some projects at the ready to keep you happy and occupied. Maintaining a positive mood will help boost your morale, and ultimately assist in recovery.

If you’re considering arthroscopic surgery for an ACL tear, CompOrtho is ready to help. Our team of specialists has decades of combined experience in treating knee injuries, providing every patient with the care and attention they need from the initial diagnosis to the final follow-up. Call us today to schedule a consultation!

Tendinitis

Tendinitis

Tendonitis can affect anybody, from office workers to athletes. Here’s how to keep your symptoms under control.

Tendonitis is a common problem, affecting athletes, office workers, and musicians alike. Indeed, it can affect almost any part of the body, though it’s most common in the tendons of the shoulders, elbows, wrists, and knees. Some of the most frequent types include patellar tendinitis (or “jumper’s knee”), lateral epicondylitis in the elbow (or “tennis elbow”), and Achilles tendinitis.

As common as it is, however, tendonitis can be a debilitating condition, creating chronic pain and greatly restricting the patient’s range of motion. Fortunately, some basic knowledge of its common causes and symptoms can help you seek relief from this condition.

CAUSES AND SYMPTOMS OF TENDONITIS

Tendons are strands of elastic fibrous tissue that connect muscles to bones, providing stability to the joints and enabling a free range of motion. Any tendon in the body can become inflamed or irritated, causing pain, tenderness, and swelling in the affected tissue.

The most common cause of tendonitis is prolonged stress or gradual wear caused by repetitive movements, though it can also be caused by sudden trauma. As a result, most people develop tendonitis while performing their jobs, enjoying hobbies that rely on a specific joint, or playing sports A typist, for example, is most likely to have tendonitis in the wrist, while weightlifters may suffer from biceps tendinitis. Aging also increases the likelihood of developing tendonitis, since tendons become less flexible with age.

TREATMENT FOR TENDONITIS

The severity of tendonitis can vary greatly depending on the specific cause of the inflammation and the particular tendon affected. Most cases of tendonitis, however, can be successfully treated without surgery. Some of the most common courses of treatment include:

  • Resting the affected area
  • Avoiding activities that cause flare-ups or increased pain
  • Taking over the counter anti-inflammatories like Advil or Aleve
  • Physical Therapy
  • Cortisone Injections

If your tendonitis does not respond to these conservative treatments, the inflamed tendon may need to be repaired with a minimally invasive surgery. During the procedure, your surgeon will mend any tears in the tendon and remove any permanently damaged tissue.

Since tendonitis is an injury that often results from overuse, the best treatment in many cases is simply to refrain from using the joint in question. Some effective preventative measures include stretching before exercise, wearing protective braces, using proper technique when lifting, and always maintaining correct posture.

Whether you suffer from tennis elbow or jumper’s knee, our team at New York Bone and Joint can help. With decades of combined experience in treating injured tendons, our specialists are able to provide comprehensive assistance at every stage of the process, from identifying the source of the problem to crafting a personalized treatment plan. If you worry that you may have tendonitis, contact us today to schedule a consultation.