OSTEOARTHRITIS & YOUR KNEES

More than 27 million Americans have OA and the knee is one of the most commonly affected joints. There are many treatment options available including several non-pharmaceutical and non-surgical choices.

WHAT IS OA OF THE KNEE?

Osteoarthritis is commonly known as “wear-and-tear arthritis,” but did you know that young people get it, too? Osteoarthritis, or OA, is the most common type of arthritis; it happens when the body’s natural cushioning—cartilage—wears away between joints. Think of cartilage as a shock absorber for your knees; less cushion results in bone rubbing against bone, and that can cause stiffness, pain, swelling decreased mobility and bone spurs. OA typically develops slowly and becomes worse over time. There is no cure for OA, but there are many treatments available that can ease the pain and help people to retain or regain their mobility.

WHAT CAUSES OA?

The ability of cartilage to heal decreases as people age, but the causes of knee OA vary. It can be hereditary or can be the result of injury, infection, overuse or excess weight.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As it does the protective spaces between the bones decrease resulting in bone rubbing on bone, producing painful bone spurs.
  • Obesity is the No. 1 driver of knee OA and the No. 1 cause of disability in the U.S.
  • Weak muscles around the knee can cause OA
  • Every extra pound of weight adds 3 to 4 pounds of extra weight to the knees; extra weight increases pressure on knees
  • Genetic mutations can make a person more likely to develop knee OA; abnormalities of bones surrounding the knee joint can also cause OA
  • Women ages 55 and older are more likely to develop knee OA
  • Athletes who play soccer, tennis or run long-distance may be at higher risk
  • Activities that cause a lot of stress on the joint—kneeling, squatting, lifting heavy weights of 55 pounds or more—can cause OA of the knee due to repetitive stress
  • Those with rheumatoid arthritis or metabolic disorders are at higher risk to develop knee OA

WHO GETS KNEE OA?

  • More than 27 million Americans have OA; the knee is one of the most commonly affected joints with more than 11 million people diagonosed in the U.S.
  • Chances of developing OA increase after age 45 and according to the Centers for Disease Control, the average onset of knee OA is 55 years old.
  • More than 40 percent of knee replacements happen over the age of 65, so many people have to find other forms of conservative, non-invasive and non-addicting methods to control pain and maintain an active lifestyle.
  • Women aged 55 and older are more likely than men to develop knee OA.

WHAT ARE MY OPTIONS IF I HAVE KNEE OA?

There are many options available for those with knee OA, including several that are non-pharmaceutical and non-surgical choices. You’ll want to talk with your health care provider about the treatment or combination of treatments that’s best for you; here are some you may want to explore and consider:

MOTION IS MEDICINE

  • Activities; walking, strength training, swimming, biking, yoga, tai chi and other low-impact activities may help with pain and function of the knee
  • Lighten up; a 2007 review found that overweight people who lost a moderate amount of weight had reduced pain and disability from knee OA
  • Braces, sleeves other devices can help reduce pain and stiffness, take weight load off the affected joint and improve confidence and function for those with knee OA
  • Transcutaneous electrical nerve stimulation, or TENS uses electrodes to send a mild current to the affected joint, which can help alleviate pain
  • Acupuncture, balneotherapy (soaking in warm mineral springs) or heat or cold therapy may help ease joint pain for some people with knee OA
  • Medications can include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, prescription medications, corticosteroid or hyaluronic acid injections and more
  • Glucosamine and chondroitin sulfate, some studies have shown, can reduce pain and improve physical function; natural supplements, including avocado, soybean, capsaicin and turmeric, may have anti-inflammatory benefits for some people
  • Joint replacement or joint-preserving surgery may be an effective option for some people

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HOW CAN DONJOY HELP?

If you have mild to severe knee OA and experience intermittent to chronic knee pain, or if you are not a candidate for surgery, ask your doctor about the science of bracing. DonJoy pioneered the concept of functional knee bracing more than 30 years ago and offers the most advanced technologies available.

Most importantly, they can help people return or continue to live an active lifestyle. No one person with knee OA is treated the same, so it’s important to look at all of the available solutions to find what is right for you. Some people may need a lot of off-loading capabilities, while others need just a slight push and comfort that surrounds the muscles around the knee.

Preventing ACL Injuries

Dr. Adam Yanke, MOR sports medicine physician, recently sat down to discuss a study that showed athletes with fatigue are at higher risk for anterior cruciate ligament (ACL) injuries. One of the ACL injury prevention programs that Yanke recommends for young athletes is Knees For Life (Kneesforlife.org), which offers a downloadable brochure and an opportunity to obtain complimentary gym bag tags featuring warm up exercises and other prevention strategies.

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ACL Bracing by DonJoy

HELPING WITH PREVENTION, PROTECTION & HEALING

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DonJoy pioneered the concept of functional knee bracing more than 30 years ago. Our first prototypes were simple neoprene sleeves sewn together in the Carlsbad, Calif. garage of our founders, Philadelphia Eagles Offensive Line Captain Mark Nordquist and local lawyer Ken Reed. Those first braces came from a deep understanding of the need for prevention, protection and healing, and DonJoy has led the profession of performance ever since by studying the body, listening to athletes, consulting physicians and pushing the envelope of innovation.

THE PERCEPTION

The overall perception of knee bracing technology available to most patients today is that “everyday” knee braces can be unsightly, bulky, heavy, minimally effective, restrictive and uncomfortable. These misconceptions combine to produce “brace anxiety” among many patients, often preventing mainstream adoption and compliance of braces that can help prevent injuries, allow people to remain active while healing, and protect the knee from future injury.

THE REALITY

Patients are looking for quick, effective and economic options for maintaining or regaining their life activities; most want to delay expensive, invasive surgeries. While some patients are turning to the use of prescription narcotics (which can lead to addiction) and cortisone shots to manage their pain, these treatment options do not provide stability to the knee.

THE FACTS

Young people between the ages of 15-25 account for half of all ACL injuries.

A person who has torn their ACL has a 15 times greater risk of a second ACL injury during the initial 12 months after ACL reconstruction, and risk of ACL injury to the opposite knee is two times that of the restructured knee.

Many athletes don’t return to sport after ACL reconstruction due to fear of re-injury.

BRACING FOR PREVENTION

Given the physicality of football, it’s easy to understand why collegiate and professional linemen wear braces on both knees. The line of scrimmage is an environment prone to knee injuries, so team doctors, athletic trainers and coaches don’t hesitate to equip their players with bilateral (both knees) custom braces.

As with helmets and shoulder pads, knee braces have become standard equipment to assist in preventing season-ending knee injuries. And the same logic holds true with skiing, snowboarding, soccer, basketball, volleyball, professional rodeo, water sports and others. An ounce of prevention is worth a pound of cure.

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BRACING POST INJURY

Why brace after ACL reconstruction? Clinicians will typically prescribe a functional knee brace after the patient has regained full range of motion—that’s usually between three to five months after surgery. Graft strength of the new ACL is considerably weaker than the native (original) ACL during the first 12 months, so a brace during this early period helps protect it from harmful forces that occur in everyday life or in sport.defiance-300x250

Bracing also elevates a patient’s confidence, allowing them to return to their previous or enhanced level of activity. Just look to athletes including Robert Griffin III, Tiger Woods, Adrian Peterson, Tom Brady, Lindsey Vonn, Matt Ryan and Peyton Manning just to name a few. Another important reason? Peace of mind. A functional knee brace provides not only confidence for the patient, but confidence for the surgeon, knowing that their patient’s knee is protected.

KNEE INJURIES: MORE COMMON IN WOMEN?

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Knee injuries are no laughing matter; 55% of all sports related injuries are knee injuries. But who is at greatest risk for knee injuries when it comes to sports? It turns out that women are 4-6 times more likely to suffer a sports related injury than their male counterparts in the same sport. Out of all sports related injuries, the most common injuries among female athletes are anterior cruciate ligament (ACL) injuries.

The reasons for women having an increased risk of knee injury has nothing to do with strength or ability; it comes down to genetics and anatomical factors, form, and training. Simply put, women are built differently than men and some of those differences put added pressure on their knee joints. Thankfully, the factors contributing to the increase in injuries have been widely researched and while genetics can’t be changed, form corrections and training programs have been proven to prevent knee injuries in women’s sports.

Within the sports community, female athletes who play basketball and soccer are somewhere between 2-10 times more likely to suffer an ACL injury compared with male athletes, according to the American Orthopaedic Society for Sports Medicine. The reason for the high rate of ACL injuries within these particular sports can be attributed to that most ACL injuries—whether in male or female athletes— are caused by non contact mechanisms. These include common movements like landing from a jump or making a lateral pivot while running. But why are women so susceptible to ACL injuries? Let’s take a look at the factors and what can be done to reduce the risk.

Genetic and Anatomical Factors:

ACL

The anterior cruciate ligament, or ACL, is one of the four major ligaments of the knee. It connects the front of the tibia (shinbone) with the back of the femur (thighbone). It helps provide stability to the knee joint.

The strength and use of the surrounding muscle groups, such as quadriceps and hamstrings, have a serious impact on the ACL. When running and jumping, women tend to lead with their quads, whereas male athletes seem to have a better balance between the quads and the hamstring muscles. A balance between quads and hamstrings means the impact is more evenly distributed, thus reducing the pressure on the knee.

Another reason for increased knee pressure is that women have a wider pelvis which creates a larger Q-angle at the knee. This often results in a more “knock-kneed” posture in women, leaving the ACL more vulnerable for injury.

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Additional anatomical factors in ACL tears such as the diameter of the ACL are still being researched.

Some doctors think women are more prone an ACL injury because of the differences in the amount of circulating hormones such as estrogen. Certain hormones give ligaments strength and flexibility. Fluctuations in hormone levels may have some impact on the function of the nerves and muscles and may lead to an increased risk of injury.

Form:

When researchers at the Loyola University Medical Center sought to explain why this increased risk of ACL injuries in women was occurring, they uncovered that poor form when landing a jump contributed to the risk.

“Women tend to land with the knees straighter and feet rotated inwards, compared to men who tend to land with more of a bend in the knee and the feet rotated slightly outward,” says Dr. Patrick McCulloch, an orthopedic surgeon with the Methodist Center for Sports Medicine in Houston who was involved in the research. “This puts the knee in a better position to absorb shock.”

After this discovery, the same researchers spent six weeks correcting these form issues resulted in a reduction in the likelihood of ACL injury by up to 50%.

Prevention Through Training:

As doctors and orthopedic surgeons were seeing an increase in ACL injuries in women, training and conditioning programs were designed to correct problems with form, strengthen knees and surrounding muscles and reduce the risk of injury. FIFA, the governing body of the World Cup and other international soccer tournaments, has designed a warm up program specifically designed to reduce the rate of ACL injuries in soccer players (male and female).

Teams that perform FIFA 11+  program at least twice a week, for 20 minutes at time, experience 30-50% fewer injured players, according to FIFA.

In addition, the Sports Physical Therapy department at Massachusetts General Hospital have put together a detailed sports conditioning program to help increase knee strength and reduce knee injuries specifically in female athletes through active warm-up, stretching, strengthening exercises, plyometric drills, and agility drills.

While ACL injuries for female athletes were reaching epidemic proportions, through understanding the problems causing the increase and creating prevention programs based on research, the rate of these injuries is on the decline.

By BetterBraces.com

A Teen’s Journey and Return to High Level Soccer after ACL Surgery

On behalf of Celiana Torres would like give a huge thanks to Dr. Cole and Staff throughout the entire process. After surgery things were not easy. It was not only the discomfort from surgery, but emotionally Celiana would cry by just thinking that she might not be able to play and perform as she did before the injury. Celiana said after seeing Dr. Cole on each appointment that he would “say something positive and motivate her more” which made her feel confident that she would return to high level soccer once again.

Throughout the whole process she mentioned that with the support from Dr. Cole, hisBCMD white staff and the therapists, a negative was turned into a positive!. At her soccer club, a similar situation happened to a team mate. The coach asked me if it was ok for the parent to call me to ask me a couple of questions in regards to Celiana’s surgery. They were amazed of the recovery and performance on Celiana’s surgery and immediately called and set up an appointment.

In the end, we were excited to hear that Celiana was selected to participate the World Cup in Jordan last Sept. 30th representing Mexico’s U17.

ON-FIELD INJURY RECOGNITION: IF NOT NOW, THEN WHEN?

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recently published study provides a 25 year data analysis of emergency department visits for injuries from youth soccer and shows a year to year significant increase in injuries of all types, especially concussion
  • In spite of excellent efforts at rules changes, better equipment, and training methods injuries in youth soccer will still happen
  • A coach as first responder on the field of play is best equipped to provide basic injury recognition that will positively effect an athlete’s health

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A comprehensive and well-conducted study on injury rates in youth soccer was published
online yesterday in the journal Pediatrics. I encourage all who are interested in youth soccer’s growth as a sport and even those involved in other youth sports to have a close look at this study.

This study provided data gathered from 1990 through 2014 and showed that over this quarter century period the number of soccer related injuries treated in hospital emergency departments in the U.S. increased by 78% and the yearly rate of injuries increased by 111% among players age 7 to 17.

The article discusses some of the reasons for the increase, amongst which are larger number of kids (especially girls) playing the sport, better awareness and broader definitions of some injuries (such as concussion), and also speculates that more aggressive play could play a role in higher injury rates.

My main takeaway: injuries in youth soccer are going to happen. My main question for youth clubs and leagues: what are you doing about it?

Steps You Can Take To Reduce Injuries: Rules, Equipment, Training

There’s been a lot of very positive steps taken on the injury reduction side. Amongst these are US Soccer Federation’s new rules regarding heading for the U13 and younger age groups. I view this as very positive, although concussion tends to be more common in the older age groups not affected by the rules changes. Still, rules changes are important and commendable. Goals should be properly secured. Training regimens such as the FIFA 11+ should be used.

Injuries Will Still Happen- A Coach Needs To Be Prepared

The study published yesterday provided injury statistics for those injuries that were cared for by physicians in an Emergency Department. That’s an important and large number but it drastically underestimates the more common day-to-day injuries that a coach and parent will deal with that never make it to an ER. Even relatively serious injuries such as an ACL tear that goes straight to the orthopedic surgeon’s office, or a moderate ankle sprain treated with a bag of ice, a brace, and possible physical therapy will not be captured by the data.

What this means is that for a coach as first responder on the field of play you’re going to see quite a few injuries common to the sport and to the age group that may never be seen by a doctor. If an injury happens are you adequately trained to make that basic decision of play/sit out/go to doctor now?

Basic Injury Recognition Training Is Critical

ssd.bannerSo our view is this: as long as sports are played and in spite of everyone’s best preventive efforts injuries will still happen. And if injuries happen the first responder coach should have a basic set of skills that helps that young athlete. No one expects you to be trained like an athletic trainer, nurse, or physician. But a basic knowledge of how to evaluate common injuries using a consistent method will go a very long way to making the sport better for all kids.

The methods we teach at Sideline Sports Doc and currently used in the passcard process for all coaches and staff at US Club Soccer are thoroughly vetted and proven through decades of experience. Our content is produced by me and my partners at Stanford and in association with Midwest Orthopaedics at Rush in Chicago. It’s simple, it’s fast, and it works.

Whether you choose to work with us or someone else, I urge you to take action now. What are you waiting for? If not now, then when?