By James Ballard, M.D., orthopedic surgeon, Oregon Orthopedic & Sports Medicine Clinic
When Dorothy first encounters the Tin Man, he stands as stiff as a statue, his joints rusted tight. It’s all he can do to squeak out the word that will get him moving again: "oilcan."
Many of us can sympathize. Over time, our sedentary lives pull a Tin Man on us. We spend weeks, months, years barely moving our bodies, hunched over desks, workstations and computers, slouched in the car, and then, finally, flopped in the comfy chair at home, where we collapse to relax from it all. When we finally do need to get up and move, we find that we no longer can without painful protest from our stiff, rusty knees and hips. Oilcan, please.
Unfortunately, there is no oilcan that can undo the arthritic damage accumulated over a lifetime of immobility. To keep our knees and hips loose, limber and healthy, we need to oil them every day of our lives. The only way to do that is to keep our moving parts moving.
That’s right: If you want to keep moving, you need to keep moving.
Movement is our oilcan. It circulates joint fluid – our oil – around our joints to keep them lubricated. This same oil also feeds the cartilage – the smooth, flexible tissue that coats the ends of our bones where they meet the joints. Unlike most parts of the body, which are fed by the blood, cartilage has no blood supply of its own. To stay healthy and alive, it must get its nutrition from joint fluid. The more you move, the better your joint fluid circulates, helping your body function like the well-oiled machine it is meant to be. Without movement, the cartilage grows thin and malnourished and eventually breaks down, leaving bone to wear against bone. The breakdown of cartilage is the beginning of osteoarthritis.
Living an active life is the No. 1 thing you can do to keep your knees and hips – not to mention the rest of your body – happy, healthy and pain free. But it’s not the only thing. What’s good for the rest of your body is also good for your joints. Committing to a weekly program of stretching and strength training keeps the muscles and tendons that support your joints flexible and strong. Eating healthy, wholesome, natural foods provides the nourishment that your entire body needs to function well. And maintaining a healthy weight protects your joints from the excessive stress of carrying too heavy a load.
Just as there are exceptions to every rule, there are people who do all of these things and still develop joint pain and arthritis. Some people are just born with a genetic code that makes their joints less durable. If you have that code, piling on a sedentary lifestyle, bad diet and obesity will make everything far worse. Maximizing your activity, strength, diet and weight management, on the other hand, will help you squeeze every last drop out of the oilcan.
If you are already starting to feel the early stages of arthritis in your hips or knees, don’t let that stop you in your tracks. Your joints still need activity – they just need you to go a little easier on the impact. Swimming, walking and using an elliptical trainer are all low-impact activities that are gentle on the joints. If pain threatens to sideline you, short-term use of anti-inflammatories can help (limit usage to three to four weeks unless your doctor is monitoring your kidneys). Applying ice to the painful joint after activity also will reduce pain and swelling. Glucosamine and chondroitin are widely promoted as joint pain remedies, and while large studies have found no scientific evidence that they work, they are certainly safe to try. Some of my patients swear by them, and others swear at them.
The question of when to see a doctor for joint pain is subjective. It’s really dictated by your perception of the quality of your life. If knee or hip pain is eroding your ability to enjoy life to a point that is no longer acceptable to you, then see your doctor. Primary care providers are very good at evaluating early joint-pain problems, so that’s a good place to start. Orthopedists are the next line of defense.
Job one is to confirm what is causing your pain, because several things – such as nerve problems in the back – can be mistaken for hip and knee problems. Once we know what the problem is, how bad it is and how badly it is affecting your life, we can start to offer appropriate treatment options.
Aside from joint-replacement surgery, there is no proven way to arrest or reverse arthritis – it is always progressive. However, it progresses at different speeds, and there are many things we can do to help slow it down and to make life more comfortable. The lifestyle tips mentioned earlier are a great start. Physical therapy can play a very important role in helping you strengthen your muscles and loosen up your tendons and ligaments to support your joints better and minimize pain. Steroid and lubricant injections are also very effective at relieving pain.
While all of these therapies can effectively forestall surgery for months or years, arthritis eventually catches up with people. If the quality of your life is becoming unacceptable, it may be time to consider a joint replacement. Again, the timing is subjective. I don’t recommend waiting until life is completely unbearable – studies show that people who wait this long tend to have a harder time with recovery. But if you are thinking about surgery, you should be talking to your doctor about it fairly regularly and getting some guidance on how to determine when the timing feels right.
National studies show that 95 percent of people who have hip replacements are very glad they did. Knee replacements also have good success, but they are a little different. About 80 percent of people who have them are thrilled, 10 percent are happy but not thrilled, and 10 percent are not happy. Much of the disparity has to do with expectations. A knee replacement is an artificial attempt to replicate what you came with. And as good as knee prosthetics have become, they’re just not the same as the real thing. It’s going to feel a little bit mechanical, and it’s not going to bend exactly the same. People who go into surgery thinking their new knee is going to be just like the one they had when they were 20 are bound to be disappointed. However, a new mechanical knee is a vast improvement over a worn-out knee, and most people come to appreciate that.
The recovery time for knee surgery varies, but averages about three months. Hip replacement recovery is quite a bit faster – patients are usually back to their normal activities within four to six weeks. Once you’re back to normal, taking care of a new joint is exactly the same as taking care of your original parts: Hit the road – yellow brick, or otherwise – and keep on moving.