Most Knee Cracking Is Normal, Expert Says

Most Knee Cracking Is Normal, Expert Says

SUNDAY, Aug. 16, 2020 (HealthDay News) — If your knees crack when you walk or run, don’t be too worried, an expert says.

“Knee cracking could mean lots of things,” said Harshvardhan Singh, assistant professor in the department of physical therapy at the University of Alabama at Birmingham. “If it is painful, then you should see a health care provider.”

The cause can be a large kneecap that doesn’t fit well into the groove, producing cracking during activities such as running and jogging.

And if the thigh muscle is too tight, it can pull the kneecap, causing an audible crack. Degeneration of knee cartilage can, too.

“The degenerative changes can also lead to pain and/or locking of the knee joint,” Singh said in a university news release. “Typically, degenerative changes are common in older people.”

Scans have shown that the displacement of joint surfaces forming the knee can cause a chain reaction in which natural gas bubbles collapse. The result: knee cracking.

“You should not be worried if your knees crack often as long as it is not associated with pain,” Singh said.

If you have had a recent trauma to the knee and it starts to crack, you should see a doctor even in there’s no pain, he said.

“Do not allow these sounds to make you feel abnormal or mentally stressed, or limit your functional activities,” Singh said. “A knee crack by itself does not indicate presence of any disease.”

It’s normal for knees to crack when you are active and it does not mean you have arthritis, he explained.

“Interestingly, in knee arthritis, knee joint becomes hypomobile and loses its movement to a certain degree, which may lead to no knee crack,” he said. “A knee crack may mean your joint is mobile and lubricated.”

A professional may be able to help quell the cracking, Singh said.

“A physical therapist may be able to help you determine if there are specific movement patterns or any biomechanical alignment which may be leading to knee crack and prescribe you certain exercises to help improve it,” he said.

More information

For more about cracking knees, visit Johns Hopkins University.

SOURCE: University of Alabama at Birmingham, news release, Aug. 10, 2020

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What Jobs Are Toughest on the Knees?

What Jobs Are Toughest on the Knees?

Joint replacements for knee osteoarthritis are becoming more common, and now researchers have identified jobs that may lead to one.

Based on a review of 71 studies that included nearly one million workers, the riskiest occupations include agriculture, construction, mining, service jobs and housekeeping. And jobs that demand excessive kneeling, squatting, standing, lifting and climbing stairs all increase your odds.

A team of researchers from the University of Sydney in Australia, and the Universities of Oxford and Southampton in the United Kingdom found that:

  • Carpenters, bricklayers and floor installers have roughly three times the risk for knee osteoarthritis, compared with sedentary workers.
  • Farm workers have 64% higher odds for the condition, slightly higher than the 63% for builders and construction workers.
  • Housekeeping also carries a risk — with unpaid houseworkers facing up to 93% increased odds for knee osteoarthritis.
  • Some jobs were kinder to the knees, however. Workers in commerce, forestry, fishing, machinists, plumbers, electricians, technicians and postal workers did not have a statistically significant risk for knee osteoarthritis, the study found.

“Knee osteoarthritis is a leading cause of loss of work and disability worldwide and can necessitate invasive surgery including total knee replacement, so preventing occupational hazards is critical,” senior study author Dr. David Hunter said in a news release from the University of Sydney, where he leads the Institute of Bone and Joint Research.

Osteoarthritis develops as cartilage deteriorates and bone comes into contact with bone, causing pain and swelling, and limiting function, which affects lifestyle. It can follow an injury, but most of the time the cause is unknown, according to a New York orthopedic surgeon.

“There is a genetic component, but there’s also a lifestyle component,” said Dr. Jeffrey Schildhorn of Lenox Hill Hospital in New York City, who reviewed the findings. One of the biggest risk factors is being overweight or obese.

“I’ve seen arthritis in every walk of life,” he said.

Osteoarthritis is a disease of aging, so it’s not surprising that more people are suffering from it and that the number of joint replacements is soaring, because people are living longer, Schildhorn said. But, he added, there is no miracle cure.

“The thing with arthritis that makes it difficult to deal with is that cartilage has no true regenerative ability,” he said, suggesting that the best way to prevent it is to eat well and watch your weight. Stretching and exercises like yoga will also help keep joints limber, Schildhorn added.

Treatment can include pain medications, and physical or behavioral therapy. But when these don’t work, a knee replacement may be in order.

“Osteoarthritis is mechanical wear and tear,” Schildhorn said. “Some people have more resilient cartilage than others.” If it is very soft and flaky, no treatment is going to work and it has nothing to do with a person’s lifestyle — or their job, he said.

But employers can help by providing physical therapy and teaching workers how to do their jobs with less stress on their knees, Schildhorn said.

The report was recently published in the journal Arthritis Care and Research.

More information

Learn more about knee osteoarthritis from the American Academy of Orthopaedic Surgeons.

SOURCES: Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; University of Sydney, news release, July 8, 2020; Arthritis Care and Research, July 8, 2020

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In Many Cases, Hip Replacement Also Eases Back Pain

In Many Cases, Hip Replacement Also Eases Back Pain

THURSDAY, July 9, 2020 (HealthDay News) — If you have a bad hip and lower back pain, a new study suggests that hip replacement surgery may solve both issues at once.

Researchers at the Hospital for Special Surgery in New York City focused on 500 patients who underwent hip replacement surgery and followed up with them one year after the operation.

Over 40% reported pain in their lower back prior to hip surgery. Of that group, 82% saw their back pain vanish after surgery.

It was “completely gone,” said study author Dr. Jonathan Vigdorchik, a hip and knee surgeon at the hospital.

He said that experts in his field have studied the connection between the hip and back for years.

A hip replacement is a surgical procedure to replace a worn-out or damaged hip joint with an artificial one. On average, it is a highly successful operation, with 95% of patients experiencing pain relief, according to the Hospital for Special Surgery.

“It’s an outstanding procedure,” said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. “There are very few things in medicine that are close to hip replacement in terms of how good of a medical procedure it is.” He wasn’t part of the study.

But Vigdorchik added that patients who have undergone some types of spinal surgery before a hip replacement face five times the rate of complications compared to the general population — for which the complication rate is less than 1%.

This knowledge prompted him to dive deeper into the hip-back interplay.

“We noticed that there are certain conditions where a hip condition can actually put undue stress on the back,” Vigdorchik explained.

He and his fellow researchers wanted to find out how effective a hip replacement can be in eliminating low back pain, and determine which patients are more likely to benefit.

The patients whose low back pain resolved after the surgery were those with “flexible spines,” according to Vigdorchik. When a person’s spine is flexible, a stiff or poorly functioning hip can drive the spine to move more than usual, causing pain.

Those with normal flexibility in their spine were also highly likely to have their pain resolved.

“Those are the patients whose back pain went away completely after their hip replacement, because their back pain was probably caused by their hip not functioning properly to begin with,” said Vigdorchik.

But the back pain in patients with stiff spines did not go away. Patients with stiff spines already have serious arthritis of the spine, and replacing the hip is unlikely to relieve their pain.

But how can you know if your back pain could be resolved with a hip replacement?

It’s not easy to figure that out on your own, according to Vigdorchik. “It really relies on a good physical exam, and then good X-rays,” he said.

Before a patient undergoes a hip replacement, surgeons will typically take an X-ray of the patient lying down.

In this study, researchers took X-rays of their patients standing up and sitting down, both before and after the surgery.

These X-rays allowed them to see how the hip and spine moved in relation to each other, and assessed the flexibility of their spine, as the patient switched from a standing position to a seated position.

Vigdorchik encouraged other surgeons to utilize these X-rays to identify patients whose ailing backs may be relieved by a hip replacement.

He also advised surgeons in the field to “look beyond just the hip.”

“Anytime they’re looking at the hip, they should also look at the back, and anytime they’re looking at the knee, they should also look at the hip,” Vigdorchik said.

The existence of an interplay between the hip and back is well known to experts, but Della Valle said that this study showed how consistent it is.

He said the study gives surgeons in the field “some tools to try to predict which patients you can tell, ‘Yeah, your back pain will get better,’ and others, well, maybe it won’t.”

The study was published online recently during a virtual meeting of the American Academy of Orthopaedic Surgeons.

More information

There’s more about low back pain at the U.S. National Institutes of Health.

SOURCES: Jonathan Vigdorchik, M.D., orthopedic surgeon, hip and knee replacement, Hospital for Special Surgery, New York City; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; AAOS 2020 Virtual Education Experience, March 26, 2020, online

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Working From Home? Posture, Ergonomics Can Make It Safe

Working From Home? Posture, Ergonomics Can Make It Safe

FRIDAY, June 19, 2020 (HealthDay News) — If you’re working from home because of the coronavirus pandemic and expect to keep doing so, you need to be sure your work station is set up properly, an orthopedic specialist says.

You also need to take regular breaks to move around, according to Terrence McGee, a physical therapist at Johns Hopkins University School of Medicine in Baltimore.

In an office, many people have ergonomic support and opportunities for physical breaks. You might have walked to the water cooler or coffee machine, attended meetings or walked to co-workers’ desks, he noted in a university news release.

To help you adapt to working at home, McGee has some suggestions to improve the safety and comfort of your workspace.

When sitting at your desk, rest your feet flat on the floor. Use a foot rest if the desk height can’t be adjusted.

Your thighs should be parallel to the ground, with a two-finger space between the back of the knees and the chair, and 3 to 6 inches of space between your thighs and the desk/keyboard.

Place a small pillow or towel roll behind you for lower back support, he suggested. Your head should be level, facing forward, and in line with your torso.

The top of your computer screen should be at or slightly below eye level. The screen itself should be 18 to 28 inches from your eyes, or at arm’s length. If you feel you need to bring your eyes closer to your screen, consider seeing an eye doctor for an eyeglass prescription, or make your screen’s text larger, McGee said.

If you use a dual monitor, swivel your body in your chair rather than constantly turn your head to view the monitors. If you can’t adjust your chair, consider changing the orientation of the monitor from landscape to portrait.

When using the keyboard and mouse, relax your shoulders and place your forearms parallel to floor. Your wrists should rest in a neutral position (hand in line with wrist and forearm). Use soft pads or a wrist rest as needed, and keep the mouse within easy reach and next to the keyboard. Adjust mouse sensitivity for light touch. A cordless mouse is the best option, McGee noted.

Also, use a hands-free headset if you’re on the phone for more than two hours a day, and use a document holder to secure papers when typing.

It’s not good for your physical or mental health to stay seated all day. Stand and move from your chair at least once an hour, McGee advised.

Also, perform desk stretches or chair yoga in between work tasks, he added.

More information

Boston University offers more ergonomic tips for working at home.

SOURCE: Johns Hopkins University, news release, June 16, 2020

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