Health & Fitness..........................................................12

If you want to succeed in fitness or anything really, surround yourself with people that are better than you at that activity. Learn from them, ask questions and don’t be afraid to admit that you don’t have all the answers. Everyone comes to a point where they need to ask someone for help. Even Personal Trainers need Personal Trainers to push them or help in whatever area they are trying to succeed in. Do your research and find a qualified trainer who is knowledgeable and looks the part. It could even be a close friend that is fitter than you. Being fit is a lifestyle that takes a lot of daily commitment. “Getting in shape” is a shortterm non-specific objective that can end in frustration. Set specific goals. Celebrate when you achieve them. Never belittle your accomplishments. As you climb your own personal mountain, I hope you look down and see your transformation, and remember where your journey started. When you look forward to the next mountain top, don’t lose momentum. Everything happens one step at a time.

Keep “priming” and B-Active For Life!

THE DEGENERATIVE KNEE JOINT

Patients are often shocked when I tell them their knee pain is due to osteoarthritis, as if they have contracted some terrible and uncommon affliction. This is because many people confuse Rheumatoid Arthritis – a relatively uncommon and progressive joint disease in which your immune system attacks and destroys your joints – with Osteoarthritis (OA), which is simply a term for agerelated wear and tear of a joint. I fully expect that every 50- or 60-year-old that attends my clinic will have varying degrees of Osteoarthritis in their knees. Our knees take an incredible battering over the years, and for them to wear down is almost as inevitable as death and taxes.

The pattern of symptoms with degenerative knees is quite obvious. They are usually stiff in the mornings and loosen up as the day progresses. Too much weight bearing activity will make them hurt, for example being on your feet all day or going for a walk. They may swell and feel hot. As it gets severe the knee may wear unevenly, resulting in bow-legs or knock-knees – known as Varus and Valgus deformities respectively.

The end-game for Osteoarthritic knees – and it is a very good one – is knee replacement. Patients are often very reluctant to consider knee replacement, but it is life-changing surgery and Orthopaedic knee-specialists are very, very good at it. The likelihood of an excellent outcome is extremely high. The main problem is that, even though your new joint is made of extremely advanced materials, it will still wear down and, unlike your own knees, an artificial joint will not attempt to repair itself. Depending on your weight and how active you are, a knee replacement should function well for 10-15 years or even longer. However, when it is worn out you will need another one and subsequent kneereplacement surgery is significantly less successful than the initial replacement. Ideally, therefore, it is an operation that you want to have just once for each knee, so retaining your own knees as long as possible is the goal. Until you reach that stage there is a lot you can do to prevent or slow the progression of knee arthritis.

The first thing to consider, and almost the last thing that my patients want to hear, is that excess weight is almost always a major contributing factor – one might even call it causative. On a day-to-day basis I find it quite rare to see a normal-weight person with severe osteoarthritis of the knees. The exception to this is usually people who have done a lot more physical activity over their lives, such as footballers or runners. And when you think about it, this makes complete sense. Imagine how long your car would last if you had it permanently loaded with 10 or 15 bags of cement – the suspension would not last long. This is the same with the human body.

Depending on what activity you are doing, up to ten-times your body weight can be transmitted through your legs with each step, which means if you are 50 pounds over your ideal weight, your knees might be absorbing anywhere between 150 and 500lb with every single step. I often say to patients: imagine if I gave you a backpack that weighed 50lb and asked you to wear it for a week; how do you think you would feel at the end of it? Everything would hurt – low back, hips, knees, ankles, shoulders. Well for some people, that is what their joints are enduring on a permanent basis. So, to prevent degeneration of the knees, control your weight. And if you are overweight and getting knee pain, try to lose the excess pounds. Easier said than done, of course, but I have seen weight loss alone almost completely resolve degenerative knee pain. And if you do struggle to lose weight without assistance, there is a breakthrough new medication that can help, so you should speak to your doctor. In conjunction with weight, consider other lifestyle factors. You might not be able to do much about repairing the actual knee joint itself, but if you strengthen the structures all around it, they will help compensate. Your Physiotherapist is the specialist in guiding you in this regard. In general, nonweight bearing exercise is a good way for you to strengthen your legs without further aggravating your knees and one of the best ways to do this is by exercising in the water. Here in Bermuda, we are blessed with so many ideal beaches that it is easy to find a quiet stretch of water where you can exercise. You don’t need to be a good swimmer – simply walking back and forwards in waist-to-chest deep water will give you a workout without loading your joints.

Additionally, stopping smoking may help. A Mayo Clinic study published in 2007 found that active smokers had more knee pain and more cartilage loss than non-smokers. And the other health benefits will be immense. Your body really struggles to heal itself if you smoke cigarettes, because after every cigarette there is a 60–90-minute period in which your blood flow is reduced. If you smoke 10-20 cigarettes a day that means your body is almost permanently in a state of impaired blood supply. It is not easy to do, but it is the single most important thing that most people can do to improve their health.

Good nutrition is clearly essential – your body needs all the essential building blocks to function and repair. Vitamin supplementation has not been shown to help with osteoarthritis, but if you are deficient in any vitamins then supplementation to address this may help. In addition, there are some other supplements that have been shown to help with osteoarthritis, such as Glucosamine, Chondroitin, Fish Oil, SAM-e, Curcumin and New Zealand Green-Lipped Mussel Extract. However, although these are touted as “natural”, all substances that have pharmacologically active ingredients can have side effects and interact with other medication, so you should speak to your doctor or dietitian before starting these.

If these measures aren’t enough, we start to consider other medical and surgical interventions to help. As the main problem with knee degeneration for most people is pain, analgesia can mask the pain or make it more tolerable. Simple analgesia such as Paracetamol – Acetaminophen in the US and known by the brand Tylenol to most people – is a relatively safe and well-tolerated painkiller that can usually be used on a regular basis if necessary. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Ibuprofen and Naproxen (Advil and Aleve) block a specific enzyme called