knee osteoarthritis symptoms

Knee Surgery for Torn Meniscus – Best to Leave it Alone?

March 12, 2016 by James Bogash

There are a few things that have managed to make it into “everyday thinking” despite the fact that it is more dogma than reality. Knee injuries are one of these things.

If you injure your knee and tear something, whether one of the supporting ligaments or one of the two meniscus (or is it menisci??), you’re going to have to have surgery.

I was personally one of these back in 1987 when I tore the medial meniscus of my right knee and had a portion of it removed surgically. If only I had known then what I know now…

The problem with evaluating whether or not surgery for a particular condition works is that we just don’t do placebo surgeries—it’s an ethical problem. Kind of like a placebo-controlled trial on whether parachutes are safer while skydiving. We just don’t do placebo surgeries. Or at least we didn’t until 2002 when the Houston VA medical center decided to do a placebo-controlled surgical trial of patients with knee pain who went under the knife for “debridement,” or a clean-out to get rid of damaged tissue hanging around in the knee joint.

Turns out there was no difference between those who had the full surgery and those who had the placebo surgery. Truly ground shaking outcomes considering that this type of procedure is done some 800,000 times per year in the US alone.

But I really don’t think that many surgeons truly changed based on the evidence of this study over a decade ago. From an insurance standpoint, it was pretty easy for the surgeon to just say he was going in to fix a meniscal tear. And this sounded like a good idea because the back part of the medial meniscus (posterior horn) is commonly torn and it does not have a very good blood supply so healing just isn’t going to happen without surgical intervention to go in and remove the torn meniscus.

There are a couple of problems with this thinking.

The first problem is a biggie and has to do with how we determine whether or not there is any damage to the knee using MRI. Many people mistakenly believe that MRI is an exact science and that, if something is “found” on MRI, it’s the thing that is causing the problem.

Study and after has concluded that there is very little correlation to what is found on MRI and a patient’s symptoms. That’s not to say that that torn medial meniscus on your MRI is not causing you pain, it’s just that we can’t know for sure. And I can tell you, from treating hundreds of knees over the years, that a huge chunk of knee pain comes from the soft tissues surrounding the knees (muscles, ligaments, fascia) and not from what is going on inside the knee.

Fix these tissues and the knee pain goes away, regardless of whether or not the meniscus is affected by the treatment. But very few knee pain patients manage to find their way into physician’s offices that are truly competent with addressing these tissues. Part of this may be because they aren’t aware that these types of treatments even exist—It’s the surgeon’s office to MRI to physical therapy and back to the surgeon to schedule the procedure. Kind of circular.

The second problem has to do with this particular study. In it, researchers looked to answer the question about whether surgery to repair a degenerative meniscus tear (as opposed to one that happens from trauma) actually does squat. Specifically, they were interested in whether self-reported locking or catching would be improved by partial meniscectomy (since it is increasingly well-established that doing the surgery for pain alone is not beneficial).

Seventy patients underwent the real surgery to remove a portion of the medial meniscus and 76 had a sham surgery done. Here’s what they found:

Thirty-two patients (46%) in the true surgery group reported catching or locking before surgery; after surgery that number was 49%.
Of the fake surgery group, 37 (49%) reported catching or locking before surgery; after “surgery” the number was 43%.

In other words, some $50,000 later, risk of injection and time off and pain for rehab, there was pretty much no difference between the groups.

Studies like these and the other ones mentioned in this article are blowing open the doors of the dogma that surrounds knees injuries, findings on MRI and the value of arthroscopic surgery. This is not to say that there is not value to the surgical options, but you better damn well be sure you see someone who truly understands how to assess and treat the soft tissues surrounding the knee before you go under the knife.

Common Knee Osteoarthritis Symptom Treatment Fails Again

July 11, 2015 by James Bogash

Knee osteoarthritis symptoms. For some, it seems like the diagnosis is pretty much the same as saying that surgery is inevitable.

There are times when I think that more information is a bad thing. There have been countless times in my practice where someone gets hooked on imaging findings (whether they are MRI, CT scans or X-rays) and focuses on what damage is present rather then what is reality.

Whether it’s a shoulder, low back, neck or knee imaging study, there have been multiple studies pointing out two very important problems. First, there is very little correlation between imaging findings and symptoms. In other words, if someone has “stuff” wrong on a MRI, it does NOT mean this person is going to have pain. You cannot look at a MRI and state that this patient will or will not have pain.

This misconception then leads to the second problem. There is a large chunk of the surgical field that is devoted to doing procedures based on stuff we find on imaging. Got a disc bulge? Cut it out. Have knee osteoarthritis? Replace the knee. Torn rotator cuff? Surgical repair of the shoulder.

This particular study highlights just how wrong this approach is. In yet another study on the relationship between arthroscopic surgery of the knee for arthritis found on imaging and beneficial outcomes of the surgery, researchers looked at the results across 9 different medical trials. Specifically, these middle aged and older patients with knee pain and degenerative knee disease underwent knee arthroscopic surgery. Here’s what they found after an average of 2 years had passed after the surgeries:

There was a very small benefit to surgery in patients’ pain levels (basically, a benefit of 2.4 mm on a 0-100 mm scale).
There was no significant benefit on physical function.
Harms included symptomatic deep venous thrombosis, pulmonary embolism, infection, and death.

The bottom line is that, going in for surgery just to “clean out” the knee has virtually no benefit but a list of risks. This is a procedure that, frankly, should no longer be done except in rare cases (and I don’t know exactly what these cases might look like…).

So what can you do instead of surgery?

Move. Not exercising is one of the worst possible things you can do for knee arthritis. Hiking, swimming, weights, stationary bike, whole body vibration–there are lots of things you can do to strengthen your knees.
Find a chiropractic who can competently treat the soft tissues of the knees–look for those that do Graston, ART, NMR, fascial manipulation.
Consider a TENS unit to control the pain in the short run.
Consider a joint support formula with glucosamine in it.
Add vitamin D to your supplement list.
Get down to your ideal body weight.

By using these tools to help manage your knee osteoarthritis symptoms, you won’t ever need to worry about whether or not the risks of surgery outweigh the miniscule benefits.

The Latest on Glucosamine / Chondroitin for Knee Osteoarthritis Symptoms

March 21, 2015 by James Bogash

The idea of using natural approaches for knee pain has been around for quite some time. Glucosamine began to hit the scenes when I was still in school.

Yes indeed. The first clinical trial, while I was in chiropractic school, was on a brontosaurus. Sure, weight loss would’ve helped and the vegetarian diet was definitely anti-inflammatory, but the real problem was getting them into the MRI scanner for the imaging.

(And, for the paleontology geeks out there, I am aware that the brontosaurus was actually an apotosaurus…)

Ok…so maybe the research hasn’t been around quite THAT long, but there are times when it sure seems like it. And quite frankly, the research over the years has been a blend of “OK” and negative (as in not helping at all). Personally, I think this has happened for several reasons:

Many patients put into trials do not have knee pain caused by arthritis. Just because you have arthritis on imaging does NOT, I repeat–does NOT, mean that arthritis is causing your problems. In many cases, the soft tissues surrounding the knee are the problem. Glucosamine is not going to help a shred if this is the case.
There are definitely issues of the quality of the supplements used. You get what you pay for.
The study length was not sufficient. While there is some anti-inflammatory action of glucosamine, this is not likely its strong point. Following up for 6 months is not likely to show much of a difference versus a study that lasts years.

All of this brings us to this particular study. In it, researchers set up the details in a slightly different manner than previous studies. Specifically, they followed 600 patients with knee osteoarthritis for 6 years and determined whether or not they were taking prescriptions (anti-inflammatory drugs, analgesics) and/or a glucosamine/chondroitin supplement. They then looked at structural changes of the knee (loss of joint space width and cartilage volume). Here’s what they found:

In the group NOT taking analgesic/NSAIDs, those who were taking the glucosamine / chondrotin lost less cartilage volume after 2 years (over the medial central plateau).
This protective effect of Glu/CS occurred in participants with more severe osteoarthritis.
In the group who were taking the analgesic/NSAIDs, those taking Glu/CS also lost less cartilage volume (global plateau at 12 months and the central plateau at 24 months.

Overall, this study did NOT look at how much knee pain the participants had, but rather looked objectively at how the knee joint itself was responding to the glucosamine and chondroitin. And the results are very heartening.

Even more so when you consider that the drugs used to treat knee osteoarthritis symptoms are well-known to actually destroy the lining of the joint you are trying to prevent. Despite this underlying damage from the medications, this natural approach to joint health was powerful enough to protect.

Knee Osteoarthritis Symptoms: It’s Not Too Late to Add This Vitamin

December 13, 2014 by James Bogash

Considering that exercise and mobility are key aspects to keeping us young with age, knee osteoarthritis symptoms can be deadly.

Despite the fact that exercise is one of the most powerful tools for managing the pain of osteoarthritis, it is, paradoxically, the first thing most people with knee pain avoid first.

Of course, long before you should worry about developing knee arthritis pain in the first place, an anti-diabetic and anti-cardiovascular diet (which are pretty much the same thing) have been shown to lower your risk of developing arthritis in the first place. That means obvious things like maintaining an ideal body weight, not smoking and eating more fruits and vegetables.

But if the 60’s, 70’s and 80’s have already done you in and you have been diagnosed with knee osteoarthritis, there is a long list of things that you can do to help maintain your mobility.

As I’ve already mentioned, exercise is the top of the list. (Since it’s beyond the scope of this article to discuss all the ways to improve osteoarthritis symptoms, if you’d like to read more, you can download my eBook Knee Pain Answers by clicking here)

If you’d like a simple solution that you can add today to delay any further progression of your knee arthritis, then look no further than this particular study. In it, researchers looked at 418 participants who had at least one knee with both symptomatic and radiographic osteoarthritis. Vitamin D and parathyroid hormone (PTH) blood levels were checked at a baseline and then evaluted 2 and 4 years later in those participants who had progression of his or her knee osteoarthritis (defined as any increase in the radiographic joint space narrowing score).

As a quick refresher, PTH is designed to keep calcium levels stable in the bloodstream. This means that if vitamin D levels are low (vitamin D helps your body absorb more calcium from your diet) the body has to respond by raising PTH to break down bone to keep calcium stable in the blood. So low vitamin D and high PTH indicates something is really off kilter in your body. Now back to the study.

Here’s what they found:

As has been seen in almost every other study on vitamin D, the blood values were at the very low end of normal (26.2 μg/L) and a good chunk of the participants were deficient (16% were below 15 μg/L).
Those with vitamin D levels below 15 had double the risk of knee osteoarthritis progression.
Even worse, those participants who had both low vitamin D and high PTH had a 320% higher risk of arthritis progression.

Now. This does not mean that you can start sipping on liquid vitamin D at 10,000 IU per day and sit on your duff watching football, confident that your knee pain is going away by tomorrow.

But this does add vitamin D to the list of things that you can do to either slow or halt the worsening of your knee osteoarthritis symptoms.

Knee Osteoarthritis Symptoms–Can Laser Lipo Help?

February 13, 2014 by James Bogash

Knee osteoarthritis symptoms can ruin an otherwise well planned out retirement. Just when you have the time to play more golf, your body gives out on you.

There is always knee replacement surgery if you happen to be a huge fan of Bob Vila and have no aversion to Black and Decker or Ryobi power tools being used on your femur and tibia. Thank god for anesthesia.

For the rest of us who would like to die with all the parts we were born with (with the exception maybe of your foreskin due to the fact that, at the time, you were in no position to argue to merits pro and con), I have written extensively about ways to manage knee osteoarthritis pain in previous articles (that can be found by clicking here) or even in my Knee Pain Answers eBook (which can be found by clicking here).

Prevention of knee arthritis, however, is a different story and begins decades before any symptoms are felt. Overall, a lifestyle that is anti-inflammatory is key. Diet, exercise and stress management all play key roles.

Given the never-ceasing rise in obesity rates in developed nations, I figured that I would address this aspect from a unique angle, tying it into this particular article. In this review article, the authors review the links between adipose fat and the inflammation-producing hormones they produce, referred to as adipokines.

Adipokines are hormones that come from your abdominal fat and do all kinds of nasty things to your overall health. Damaging your blood vessels is on top of the list (leading to things like heart attacks, stroke and dementia), but slowly destroying the surfaces of your joints is on the list as well.

This is where the tie in with laser lipo comes in. I have covered the theory behind the use of cold laser applied to the abdominal area to cut down on the inflammation and the adipokines being produced by this wayward organ system (yes—the abdominal fat does become its own organ system just like the heart, lungs and brain).

I would never look a patient in the eye and tell him or her that he or she needs to do laser lipo to prevent knee osteoarthritis symptoms decades in the future, but it is clear that laser lipo can play a role in curbing the inflammation tearing away at your body. Combine this with dietary changes, exercise and stress management and you can go a long way towards avoiding a long list of chronic diseases driven by inflammation.

Muscloskeletal Pain? Primary Care Docs Not Giving Good Advice

November 12, 2013 by James Bogash

Sciatica. Knee osteoarthritis symptoms. While these two conditions seem a world apart, there is something they have in common: Bad advice.

Both of these conditions have solid research on things that you should and should not be doing to help you recover. The “should” category involves exercise and moving around. Almost always with musculoskeletal pain, moving around is better and staying sedentary is a very bad idea. While my opinion is clearly biased on this one, the acceptable medication approach to most musculoskeletal complaints involves the use of NSAIDs like ibuprofen. Strong pain medication like opioids (Vicodin, Percocet) should not be used, especially initially, and fall into the “should not” category.

In the “should not” category is also imaging. While plain X-rays may be appropriate to evaluate for osteoarthritis symptoms, advanced imaging like MRI and CT scan should not be ordered unless certain red flags are present.

All of this is well supported by the medical research over the past 10 years or so. But one of my continued frustrations with all branches of medicine is just how rare it is for doctors to actually crack open medical journals. The research itself suggests that doctors are, in general, about 19 years behind the medical literature. That means that this particular article, looking at just how well primary care doctors understand the current recommendations for sciatica and osteoarthritis symptoms, won’t grace the typical doctor’s eyes for two more decades.

Basically, they won’t know that they don’t know until around 2033.

Just in case you think I’m being a little too facetious, let’s look at what researchers found in the study:

Despite the clear benefit, less than 1/3 of physicians would give exercise advice (30.2% for osteoarthritis, 32.8% for sciatica).
Overall, though, at least newer docs were more likely to give advice on exercise (39.6% of newer physicians versus 26.0% of older docs for sciatica / 20.8% for osteoarthritis).
Newer physicians were less likely to order tests like CBC or CMP (9.4% vs 21.9%) or a urinalysis (4.2% vs 16.7%).
For osteoarthritis, X-rays were more often ordered by newer physicians (85.4% vs 69.8%).

Overall, these numbers reflect poorly on the typical primary care doctors’ ability to handle common musculoskeletal complaints. For my entire chiropractic practice life I have been confronted with patients and people in the community that ask whether they should see his or her primary care doctor or a chiropractor first. The evidence is very clear–seeing a chiropractic physician first is the best option that will be more likely to lead you down a path with the best and most efficient outcomes.

But clearly I’m biased.

Knee Replacement Surgery? You Need This to Heal Quickly

November 11, 2013 by James Bogash

Knee osteoarthritis symptoms seem to be on the increase, which means that surgery for knee replacements is also on the rise.

In our office, we do everything we can to help patients avoid surgery for knee pain, and we do it well. I can’t tell you how many times I’ve had patients come in thinking that they were going to need knee surgery only to find out that the majority of their symptoms were soft-tissue related and resolved in a short period of time. I’ve written before about how the number of knee replacement surgeries are increasing (expected to increase 700% by 2030), but there is not a corresponding increase in knee osteoarthritis symptoms found on X-rays. This article can be read by clicking here.

All of that being said, not every knee pain patient that walks through our door is going to respond well enough to avoid knee replacement surgery. Luckily, even if a patient still ends up having surgery, most of the evidence suggests that the stronger and healthier the knee is going into surgery, the better the outcomes are going to be. So basically, there is no downside to seeing a physician who is well-versed in soft tissue techniques first.

But what can you do after the surgery to improve your outcome? Besides, of course, sticking with your rehab. Turns out, there is something simple to do.

This particular article looked at what happened with 28 patients undergoing knee replacement surgery and were given either an amino acid supplement (20 grams, twice per day in between meals) or a placebo starting a week before the surgery up until 2 weeks after the surgery. The supplements were taken 1 hour after the rehab sessions. Here’s the details:

Quadriceps strength dropped 14.3% by 2 weeks after surgery but only 3.4% for the amino acid group.
The benefits were even greater by 6 weeks (placebo lost 18.4% versus only 6.2% for the amino acid group).
Even better, the amino acid supplement also protected quadriceps strength in the NON-replaced knee.
Hamstring and adductor muscles of both extremities legs were also stronger in the amino acid group.
Functional mobility tests were performed better at 2 and 6 weeks after surgery with the amino acid group, although most of this was due to the stronger quadriceps.

Specifically, the amino acid supplement consisted of leucine, phenylalanine, lysine, threonine, valine, histidine, isoleucine and methionine, listed here in the highest to lowest amounts in the supplement. This should be pretty easy to mimic (the whey protein we sell in our office would match this and much more with two servings), but ALWAYS look at the label of an amino acid supplement, especially when used as a powdered drink mix, to avoid any and all artificial sweeteners. Most of them have it.

Overall, this is a very simple and inexpensive approach to drastically improving the outcomes when you have your knee replacement surgery. But, as I mentioned, please make sure you seek a physician well versed in soft tissue techniques (like Graston Technique, ART, NMR or Fascial Manipulation) before you even consider going under the knife.

Natural Knee Arthritis Cures: It May Not Be What You Think

October 15, 2013 by James Bogash

Knee arthritis pain can be debilitating and destroy your quality of life. At a time when we should be enjoying life, simple activities become a challenge.

Prevention over a lifetime is, of course, the easiest answer, but by this time it’s water under the bridge. So we have to rely on doing what we can do going forward. The easy answer is to turn to mainstream medicine for drugs to help arthritis pain. This is a very, very bad road to go down, despite the fact that this is the path most choose.

Why? Well, for the full story, you can purchase my NSAIDs Dangers eBook, which can be purchased by clicking here. For the Cliff’s note version, not only do they increase the risk of suffering a heart attack (remember the Vioxx debacle where tens of thousands died?) but they will likely will make your arthritis pain worse.

Worse? Yes—anti-inflammatories can make arthritis worse by stopping the ability of the cells of your joints to heal from everyday wear and tear. Worse, they stop the course of inflammation, not allowing it to complete the cycle. You essentially get stuck in inflammation without resolving it.

Then, of course, there is surgery. Outcomes are generally pretty good following a knee replacement surgery, but I personally feel that the bulk of these can be avoided. After all, research suggests that more knee surgeries are being performed, but not because there is more arthritis present. Tells me that there are other things going on besides the arthritis we are finding on MRI and X-ray.

That pretty much leaves natural approaches as your best options.

First on the list, given my bias, are soft tissue approaches like Graston technique, Active Release Technique, Neuromuscular Re-education or Fascial Manipulation. In our office, we have had very strong success using these techniques along with therapies like whole body vibration.

Next are natural anti-inflammatories like turmeric / curcumin, ginger or glucosamine / chondroitin.

Essential to the success of any natural knee osteoarthritis treatment is exercise. The research has been very strong on this aspect of natural treatment approaches. Exercise clearly improves symptoms of knee osteoarthritis, both strength training and aerobic.

But this particular article brings to light something even more powerful than exercise. Dietary changes leading to weight loss. Researchers looked at 454 overweight or obese participants who were at least 55 years of age to see what effects exercise, diet or the combination of the two had on knee joint compressive force, plasma IL-6 levels (as a marker of inflammation), self-reported pain, self-reported function, mobility and health-related quality of life. Here’s what they found:

399 participants (88%) finished the study.
Weight loss for diet + exercise group averaged 11.4%, 9.5% for the diet group and 2.0% for the exercise group.
After 18 months, knee compressive forces were lower in diet group than the exercise group, despite less weight loss.
IL-6 were lower in diet + exercise and diet participants than the exercise alone group.
The diet + exercise group had less pain, better function and better physical health-related quality of life scores than the other two groups.

Overall, it appears that dietary changes leading to at least a 10% weight loss over the course of 1 ½ years is a very powerful tool in the management of symptoms of knee osteoarthritis. Now, this may require a tad bit more work on your part than just popping a pill, but it’s certainly easier than having the bones of your knee sliced off with Black and Decker power tools and titanium hardware implants replacing the original equipment and screwed in using carpentry techniques like countersinking, followed by weeks and weeks or painful rehab providing the outcome is successful and no infection sets in.

Yup. Making some simple dietary changes sounds rough.