healthy body tips

For years, studies have offered conflicting opinions on whether exercise is good for knees. A new report released today by the American College of Sports Medicine (ACSM) provides strong evidence that exercise is, in fact, good for the knees. 

The report, titled "What is the Effect of Physical Activity on the Knee Joint? A Systematic Review," was published this month in Medicine & Science in Sports & Exercise®,ACSM's official scientific journal. A research study led by Donna Urquhart, Ph.D., and Flavia Cicuttini, Ph.D., examined the effects of physical activity on individual parts of the knee. 

"Several studies have already examined the impact of physical activity on the knee as a whole, but none have looked at the effect of physical activity on individual parts of the knee," said Dr. Cicuttini, head of the musculoskeletal unit in the School of Public Health and Preventive Medicine at Monash University in Australia. "As it turns out, exercise affects each part of the knee differently, which helps explain why there have been conflicting reports for so long." 

According to the team's findings, while exercise was linked to osteophytes, or bony spurs, there were no detrimental changes to joint space, the place where cartilage is housed. There were beneficial effects on cartilage integrity, with evidence of greater volumes and fewer defects. 

"These findings are significant, as they suggest that osteophytes, in the absence of cartilage damage, may just be a functional adaptation to mechanical stimuli," said Dr. Urquhart. 

The report comprised data from 28 studies, representing 9,737 participants from all parts of the world. All included studies examined the relationship between physical activity and knee osteoarthritis and also included MRI evidence of osteoarthritic knees when investigating disease progression or healthy knees when investigating disease incidence. 

Osteoarthritis - a degenerative joint disease that attacks cartilage and underlying bone and often preys on knees, hips and hands - affects nearly 27 million Americans and is the leading cause of disability in noninstitutionalized adults.

More than 14 million visits were made to physicians' offices in 2008 by patients with knee problems. Five new studies presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) look at the effect that obesity has on knee arthritis and a patient's ability to recover from knee surgery. 

One new study found that while weight loss via bariatric surgery may improve knee pain in obese patients with knee osteoarthritis, there may be permanent damage to the knee from being morbidly obese. 

The investigation included 10 morbidly obese patients with knee osteoarthritis who were evaluated before and after bariatric surgery. Patients lost an average of 51 pounds in one year. One year after surgery, knee pain and function improved significantly. 

"For a long time people felt there was nothing they could do to mitigate the debilitating effects of knee arthritis, but now we know that surgically-assisted weight loss is a way that folks can help themselves," says Michael S. Sridhar, MD, co-investigator and resident at Emory University. "However, there is probably some element of irreparable damage from being morbidly obese that may constrain the improvement in knee pain despite significant weight loss. Looking at the actual joint surfaces with advanced imaging to assess damage is the exciting next step in studying the evolution of knee arthritis in the obese population." 

Also, two new studies just released examine whether obesity contributes to greater complications after hip and knee replacement surgery. The first study considers patients in the "super obese" category who have a body mass index (BMI) greater than 45. Few studies have examined whether complication rates for total joint replacement (TJR) patients may increase for "super-obese" patients. 

Ran Schwarzkopf, MD, co-investigator and chief resident, New York University Hospital for Joint Diseases, and his research team found that the number of overall complications were significantly higher for the "super-obese" compared to non-obese. Among "super-obese" patients, each 5-unit increase in BMI over 45 was associated with a statistically significant increased risk of having in-hospital and post-operative outpatient complications or readmission. Also, days to discharge were found to increase by almost 14 percent for each 5-unit increase in BMI over 45. 

The second study analyzed complication rates for morbidly obese patients (BMI greater than 40) after TJR. The study reviewed data from 12,355 patients and compared complication rates in morbidly-obese patients versus normal-weight patients. 

Led by Richard J. Friedman, MD, FRCSC, co-investigator and Chairman, Department of Orthopaedic Surgery, Roper Hospital, Charleston, SC, the study found that morbid obesity contributed to a significantly higher incidence of complications such as redness around the surgical wound, swelling of the legs, bacterial infections, respiratory disorders, neurologic and gastrointestinal complications and cardiacarrhythmias following total hip and knee replacements. 

Another new study just released analyzed the effects of isolated weight loss via bariatric surgery on knee osteoarthritis. The study involved 24 obese patients with knee osteoarthritis who were scheduled to undergo bariatric surgery. Patient weights and knee symptoms were recorded before the surgery and 6 and 12 months after surgery. Patients were not prescribed exercise or physical therapy, anti-inflammatory medications or knee injections post-operatively. 

"Other studies have looked at the effect that a combination of weight loss, diet and exercise had on knee arthritis, but it was difficult to say which of these factors contributed the most to reducing knee pain," says Christopher Edwards, co-investigator and a fourth year medical student at the Penn State College of Medicine. "Our study should send a message to patients, health care providers, and payers that weight loss is an important consideration in the treatment of knee arthritis." 

Elena Losina, PhD, co-director, Orthopedics and Arthritis Center for Outcomes Research at Brigham and women's Hospital Associate and Professor of Orthopedic Surgery, Harvard Medical School , led a research team to examine trends in total knee replacement (TKR) utilization and found that it doubled during the decade from 1997-2007. The proportion performed in younger groups tripled. The proportion of obese persons increased by about 15 percent between 1997 and 2007. Such an increase in the obesity epidemic could explain about 20 percent of the increased utilization of TKR. Data suggests that expanding the indications for TKR in younger ages (due to sport-related injuries, obesity and as a consequence, early onset of osteoarthritis) is the likely explanation for the dramatic increase in TKR rates in the US.

"The important thing to remember about Osgood-Schlatters is that it is self-limiting," says Dr. Bratt. "Therefore, we do not do anything to make the patient worse, even in the short term. Therefore, no surgery or injections are commonly used for this disease."

Prevention of this problem to progress to a point where the athlete has to completely stop their activities is fairly easy. The pain and inflammation need to be treated and special exercises added to the routine of the athlete to maintain the condition worse.

The first step is to treat pain and inflammation with a prescription anti-inflammatory such as ibuprofen. This ingredient is found in several medications such as Advil and Motrin ® ®. Ice can also help control swelling. If the pain is bad, the child should rest and refrain from activities until it is under control. A good rule of thumb both Robinson and Dr. Bratt agree not to do anything that gets worse or unbearable pain.

Physical Therapy

Although physical therapy is not always advisable or necessary to relieve symptoms canhelp so the athlete can return to sports quickly and safely.

My daughter, Wende, has Osgood-Schlatters three years ago while his classmate, Kyle Edmiston. Our doctor recommended physical therapy, which Wende went for six months. If the Edmistons', it does not cover physical therapy, so I just took the advice of your doctor and treat pain and inflammation with ibuprofen and ice, and Kyle extra stretches before football . Today, Kyle still has occasional problems, while Wendy is relatively painless. If physical therapy can be approved for that or not, Wende certainly helped manage their pain during the softball season.

Terry Robinson said that the most important aspect of physical therapy is the type of patient education, which may include parents and coach. "There's no use putting a child in treatment and change your exercise routine if you go home and sit on the floor with crossed legs to play video games," says Robinson. "In addition to treatment, become aware of what other activities can affect the healing process."

As for the brakes, Dr. Bratt says, although not hurt, it does not really help either. "There are too expensive, so if you want to prove that it's OK, but no real evidence that they do better," he says. "However, if it makes the child feel better, whether physical or psychological, by all means, they wear them."

It is also a good idea for the child to protect your knees during sports by using a soft brace, as the type used in volleyball. This will protect the area from the pain of being beaten by a blow of a ball, another child or a fall, which can make things worse.

In the end, the only real cure for the condition is time. All children get over it, and the pain goes away as your tendons to catch up with bone growth.