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.