ARTHRITIC KNEES - DO YOU NEED SURGERY?

Long time ago, knee pain used to be an old age problem where people who suffered were very few and even lesser population getting knee replacement done. But now there is a dramatic shift in number of people facing the knee arthritis and number of surgeries being performed. Moreover, the age at which these arthritic changes occur has reduced. The changes in the knee seen at around or over 55 years of age are now been observed as low as at 30 years of age. 

I consider early knee arthritis similar to premature graying of your hair. Just imagine why do you get grey hair. The reasoning starts with you might be getting older but if it is early then you might be stressed, too much in the sun, not sleeping enough or not eating healthy and may be some genetics. 

Similarly, Osteo-Arthritis of knee is a term for inflammation of old age knees. But in early knee arthritis, overloading of joints (especially if your muscles are weak), stress, poor diet or disturbed sleep can disturb your metabolism to deplete calcium from the bones and put your knees under abnormal load and may result in early and faster degeneration. Rheumatism or gout can also eat up your knee joint and make it degenerate early. Last but not the least, a previous injury with unresolved inflammation or infection can lead to early arthritis. The only difference is it is not affected by your genes. Even reduced Vitamin D3 levels in blood can cause degeneration of the joints because it is linked to your bone strength. So either it is simply that you are getting older or you are causing it with bad lifestyle as mentioned above.

I feel this early arthritis of the knee is a major concern because with the speed we are replacing the knees, soon we will have a major population with metallic knees.  The world will soon have a workforce of "not so natural" knees.

Are the replaced knees good for your health? I think when your knees are damaged enough to make you stop enjoying life it becomes necessary to undergo knife chopping but only if it is a promising procedure. The question is not whether surgeries are good or bad, it is about whether you need it and if no then what can you do to avoid it.

Now carefully read this paragraph to know your answers. Knee arthritis means the pain and stiffness generated in your knee due to inflammation caused by loss of cartilage (Lubricant inside the knee) and wear-tear of joint surface as well. At early age when you show the signs of arthritis, there is loss of cartilage but doesn't mean its fully gone. The knee can become completely healthy as there is only some loss of lubrication that means your bones are still not touching each other directly. The reason behind your pain is something more than what your doctor told you or the X-Rays are showing there. 

The first thing I usually notice in knee pain is that within 72 hours of pain the muscles stop working efficiently and shows weakness on examination. And if your pain has now become chronic, you can easily judge how much your muscles have become weaker. And when you try walking with knee pain, there is subconcious adjustment in the way you walk to avoid pain, which may lead to abnormal functioning of your Lower Back, Hip or Ankles. So there is a gross weakness and imbalances in the whole body. All these changes may lead to more pressure on your affected knee causing more or unresolved pain. The knees are mainly survived by strong thigh muscles, ligaments and healthy cartilage along with healthy lower back and muscles of HIP and ANKLES. 

If only knee cartilage has got some injury there are many other structures to keep you moving pain free. All you need to do is following a suitable exercise regime supervised or crosschecked by a concerned health expert (in this case your Physiotherapist), working on healthy diet in order to control your weight and regular walks if or when you become painfree. This change will not only help your knee pain but also work on saving your knees from further damage. 

Remember, if you can prevent it you don't need to cure it. please feel free to comment here if there are related questions in your mind.

REMEDY FOR UNRESOLVED PAIN

Any pain lasting for more than 12 weeks is generally considered as Chronic Pain. This means whether the injury is traumatic or non traumatic, it should or must heal within 6-12 weeks at maximum. If you do not help yourself to get better within this time frame, you are basically channeling your nervous system to adapt to the painful sensation given by the local tissue damage.

Poor Diet, Lack of Sleep, Emotional or physical stress, lack of physical activity, your boss and colleagues, family and friends. all of this can affect your pain to become good or bad. Many things are not in our hands but anything from the list above which you can change to help your self should be tried. Hence, your lifestyle modification is a big term where you have to consider anything which influences your pain. Just remember self help is the better help. The change starts from YOU and the rest will follow. A doctor or Physiotherapist can give you the path to recovery but you need to proactively participate and reach to the goal of pain-free life.

Long standing pain generates a threat to your normal body movement and you start avoiding them which in turn makes the joints and muscles unhealthy. There is a sub-conscious fear in moving all the time and the brain and body kind of pre-decide that this particular movement will cause pain. Inability to move freely along with fear of pain increases the neural and chemical response in the brain to make you feel sick all the time. In such conditions, medicines usually don't work or mask your pain very temporarily.

What you need to do at this stage is to come out of threatening painful memory  through controlled pain-free movements (Pain free activities). Resting at this time is not a correct choice but being careful to not create too much pain is. I believe any activity or exercise causing pain more than 20 % is a good sign to step back or stop that activity. Doing ice compression as a therapy can work very well if and when pain increases. At times you need pain modulation procedures like Manual therapy, Massage, Dry Needling / Acupuncture or even taping to facilitate pain free movements. Once you get better with pain, simultaneously start loading your damaged tissues via exercises which mainly includes strengthening against gravity or resistance. 

In the beginning, you may find some discomfort in doing strengthening exercises but that is a normal response to tissue loading rather than any damage which you might think is happening. But tissue loading capacity will increase you will start feeling stronger and active with your earlier painful movements. In my opinion, it will take from 6 weeks to 6 months, where decent muscle strength will build up and you will reach to your pre-injury level of fitness.

Since, chronic pain involves memory of local tissue damage, nerves which conducts painful sensation to spinal chord and the brain at the center, there are social and psychological factors which can variate your pain on daily basis. I always tell my patients that the part of brain which responds to chronic pain is also responsible for your emotions. So, it is very natural for emotions to make you feel pain and vice a versa. You definitely feel emotionally stressed on the days when it is painful or when you are emotionally stressed your pain increases. Anything which disturbs the chemistry of your brain will disturb the pain also.

SHAPE YOUR FOOT - HEAL YOUR PAIN

All the ladies who keep shaping their foot cosmetically by pedicure, stylish footwear, nail-paints and foot accessories kindly pay attention to this write up. When you can take care of how well your feet looks then you should also look after how well your foot works or moves. I am not going to face your anger by saying do not wear high heels etc. etc. but you should definitely cut down the time for which your feet suffocates in those high heel shoes. 

Now to all the men who are living highly sedentary life, we are not made for sitting that long where you do not move your feet or weight bear on them. Our feet are living structures but not plants or trees who can survive just by being fixed to its roots. So moving out and repeatedly taking active breaks from your sitting work is highly recommended.

There are 54 bones in your ankles and feet altogether along with 33 joints, 107 ligaments, 19 muscles and tendons that hold everything in place. As a child you have more bones but some of them gets fused by the time you become an adult. We become brutal to our feet by keeping these numerous bones locked in shoes for at least 8 to 10 hours. 

Also the reduced physical activity doesn't load your feet enough and consequently the muscles to hold these small bones and the arches becomes weak. These small muscles holds the foot in normal stable position but due to weakness the foot and ankle wobbles (unstable). This disturbed stability afffects your other joints like knee, hip or even spine for the reason that nobody moves just from one part of the body. If you do not move correctly with your ankles then you can't move right from your other body parts.

As  consequence, a disturbed mechanics of your foot can lead to number of problems like Heel Pain (Plantar Fascitis), Knee pain or even Low Back Pain. A lot of health professionals like Podiatrists (Ankle and foot specialist), Physiotherapist and Chiropractors believe that even a neck pain or a cervical headache can be the result of poor foot mechanics.

The solution to this problem lies in becoming aware of how your lifestyle is affecting your health. Just knowing the wrong things and making little effort towards correcting it can make a huge difference to prevent what you may suffer and regret from. Here is a check list which you need to keep in mind in order to stay foot friendly :

Avoid prolong standing with your heels. 

Avoid pointed heels and prefer platforms.

Prefer wider shoes with raised arch support.

Instead of prolonged sitting do intermittent sitting. 

Learn some basic workplace foot exercises which are not time consuming.

Increase your effort to do more physical activities not just the weekend struggles.

Allow your feet to breathe out of your shoes and bellies very regularly during office hours.

Remember just a small change in your daily behavior can save you and your money from unnecessary damage to your health. Hence, SHAPE YOUR FOOT for better health not just the better looks. 

Feel free to comment below if you are curious enough to know more on this subject.

THE WRONG MOVE

With all the bones intact (Not broken or removed), our body is comprised of 206 or more bones. The variation usually comes if you have an extra lumbar spine (6th Lumbar vertebra). 32 plus teeth or extra fingers or thumb. But you can't do anything with them if you do not have numerous muscles enclosed with the single Fascia running through the whole body.

For completing a simple task, your body has to undergo a complex series of movements where your brain via spinal cord orders the muscles to move  in a complicated manner. Moreover if you succeed in completing it satisfactorily your brain registers it as a success and retains the memory of sequence to use it when you do anything similar to the previous activity. Have you ever wondered how  dancers coordinate with music and do performances without forgetting the steps? Yes they do practice repeatedly till they improve their moves and the brain learns the sequence of their performance. 

   

In pain, your movement pattern gets disturbed and you abnormally use your body so that work can be done in a least painful manner. This pain avoidance behaviour is normal during acute phase of injury but after sometime you still move in an altered way as you have registered the memory of moving in particular manner. As the time passes and healing completes, these wrong movement pattern sometimes doesn't allow the pain to settle down or it transfer pain to some other site.

   

Imagine an elbow injury where you can't use your elbow effectively due to pain, so you will overload your shoulder or wrist to do your daily activities. In this case you might hike the shoulder up or modify the wrist position to finish your activities. Gradually you develop the memory of using your arm in this way and even after recovering from elbow injury overuse of shoulder or wrist may continue. This might lead to unresolved elbow pain or development of new painful site at the shoulder or wrist later on. There is a possibility that you may not remember the real reason for your pain as there was no trauma or injury to your shoulder or wrist.

With many patients complaining of pain, I always found some level of altered movement pattern which biomechanically is causing an overstress to the area under pain. With careful and detailed examination, we can find out if the person is lacking a good quality of movement around painful area. Memory building of the correct movements with focusing on building strength can greatly improve the quality of movement and will help the pain as well.

Proper education and rehabilitation of your previous injury can play a major role in preventing the future consequences of wrong movement patterns. Exercise to correct or restore normal movement pattern is beneficial if you think you have an unresolved pain at the injured area or a relative pain at different region.

Please drop your comments  if you have also noticed that you don't move right or have unresolved pain which doesn't let you survive happily.

Your Movement Expert

Dr. Kunal Vashist, PT

Senior Physiotherapist

Musculoskeletal and Orthopaedic disorders

(kvashist.physio@gmail.com)

9968302757

POSTURE - Position of the body in which you do Nothing to Everything

The position acquired by the body to do daily activities like walking, running, sitting, or even sleeping etc. is called POSTURE. 

The posture is perfect when you work with maximum efficiency but minimal stress on the body. Similarly with bad posture the same work becomes stressful and can have a bad impact on your health.

Muscular pains and stiffness are common complaints associated with bad posture. At times poor posture can give you serious health conditions like spondylosis and nerve compression. It can also increase joint stress in back, neck, hip or knee leading to faster degeneration which might then become arthritic and painful. Almost always the shoulder and neck pain is linked to your body posture. 

At early age, body can still fight with bad postural habits and you can get away with least or no symptoms. Although, now a days the modern inactive lifestyle is taking toll on children at early ages. it is important to note here that my youngest patient for neck or back pain is now around 10 yrs of age. The good part is that even with worse painful condition they heal quickly and get back to normal.

Solution: 

• Reduce screen time. (Television / Mobile / Laptops)
• Promote Physical Activities (Prefer Outdoor games not Media Games)
• Exercise Daily 
• Correct Ergonomic Education (Sitting Surface & Posture / School Bags)

But when you reach your 30's it is difficult to restore the good postural habits because you have lost the memory of being in good posture for so long. Your joints and muscles cry for some mobility and strength. Now how do you get that when you are so habitual of sitting on that sofa or chair for many hours. Please don't tell me that you are fairly active. When you getup in the morning, from toilet seat to car seat and then from office seat to Sofa seat in the evening, YOU sit all day. 

As you age, you recover very slowly and it takes more effort to see very subtle changes. So the first step is to prevent the loss of joint mobility and muscular strength. Even if you have lost it you can still see positive changes at any age for e.g. muscles do become stronger even if you strength train them at 90 years of age (proven in studies).

Solution:

• Correct Ergonomic Education (Sitting posture / Friendly Furniture)
• Reduce Sitting Hours
• Strength Trainin Daily at home or GYM Weight Training Every other day)
• Physical Activities (Walking / Running / Swimming / Any Sport)
• Active Social Life- Beat your stress (Posture is also linked to Emotional well being)

Our whole life is divided into Days and Nights or Activities and Rest. You need to sleep well in order to recover all the energy you lost during work or exercise. Good sleep and recovery comes from good sleeping posture. Our spine is designed to be 'S' shaped and all curves in the spine should be well supported in order to keep your muscles relaxed during sleep. 

Solution:

• A good Semi-Firm Mattress. (Say no to Spring / Rubber Mattress)
• Pillow support under or between knees. (Depends on face upwards or side lying).
• Pillow Support under your neck (Not just the head).
• Dark Room.
• Avoid sleeping on your tummy.

If you keep yourself moderately active, reduce your long sitting/standing hours and work on your better sleep, then you are pretty sorted with issues linked to bad posture. Remember your body will be thankful to you if you listen to it and make it stronger.

Feel free to comment below in case you need some more information on how to move correctly and efficiently.