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VOL. 5 • NO. 7
© May 2011
ARTHRITIS: Exercise key to slowing common painful condition Say this about Valerie Bertrand — she is determined to get in shape and lose weight. She can be found five days a week working out at Body By Brandy Fitness Studio. Her goals are clear and her reasons are even clearer. If she doesn’t, she knows the pain in her knees will only get worse. And that is something she is trying to prevent. Seven years ago, Bertrand, now 54, was diagnosed with osteoarthritis (OA), one of the leading causes of disability in America. Afflicting an estimated 27 million in the United States alone, OA is the most common form of more than 100 different types of arthritis. Others include gout, lupus, fibromyalgia and rheumatoid arthritis. OA is often called degenerative arthritis because the joint literally deteriorates. Cartilage — a hard but slippery tissue that covers the ends of bones — begins to wear away and eventually bone rubs against bone causing not only a grating sound but pain, swelling and loss of motion of the joint. About 25 percent of people with knee OA have pain when walking and are limited in normal activities of daily living, such as climbing stairs or kneeling and stooping. Many can walk only with the assistance of a crutch or cane. Dr. Elinor A. Mody, director of the Women’s Orthopedic and Joint Disease Program at Brigham and Women’s Hospital, is a rheumatologist, a doctor that specializes in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. She readily admits that though the cause of OA remains a
mystery, one thing is clear — OA is extremely prevalent. “I could take X-rays of most people over the age of 40 and find some level of osteoarthritis of the spine,” said Mody. As it is now, the economic impact of OA is staggering. The disease results in 662,000 hospitalizations, 11 million doctor visits and 632,000 total joint replacements each year. It costs the U.S. economy nearly $128 billion per year in medical care and indirect expenses, including lost wages and productivity. The disease is on the rise — largely in part to increased longevity, the surge in baby boomers and ever burgeoning waistlines. The National Institute of Arthritis and Musculoskeletal and Skin Diseases, a component of the National Institutes of Health, estimates that the prevalence of OA will increase to an estimated 67 million people by 2030. Contrary to a widely held myth, OA is not necessarily a disease of the elderly. Actually, its incidence rises sharply around the age of 45, according to the Centers for Disease Control and Prevention (CDC), and largely affects the working population. It begins even earlier in people who have sustained a joint injury or were born with a congenital abnormality of the joint. A teen who injures his knee playing football in high school could suffer from OA before the age of 30. For Bertrand, the worst times of day are mornings. “I feel like a baby taking its first steps,” she said. “Both knees ache.” It takes about 15 minutes for her to limber up and walk normally. The pain is not all surprising: OA runs
Valerie Bertrand knows that exercise is the best remedy for osteoarthritis that afflicts both knees. Here she walks along a trail in Franklin Park. (Ernesto Arroyo photo)
in her family. “My mother and sister have had surgery on both knees,” she said. Like countless others, Bertrand ignored the aches and pains in her knees for years. Eventually, she sought care from a specialist. He referred her to a surgeon who explained that “her knees were not good, but they weren’t crying for help,” she recalled. The exact cause of OA is not known, but
likely culprits are age, obesity, joint damage, inactivity and genetics. The Arthritis Foundation (AF) states that obesity alone increases the chance of developing OA by two thirds in a person’s lifetime. What is troubling, according to Mody, is that childhood obesity has been found to have a lasting effect and can result more commonly in OA of the hip in Bertrand, continued to page 4
With more options today, surgery not the only recourse
Joint replacement surgery four years ago for osteoarthritis in her left knee has not slowed down Alveta Haynes, 56. Haynes plays tennis regularly at the Sportsmen’s Tennis Club in Dorchester. (Ernesto Arroyo photo)
Alveta Haynes is living proof that osteoarthritis doesn’t trouble only the old. Back in the early seventies, Haynes was in her teens, ripping and running on the courts until she seriously injured her left knee playing basketball. She needed an operation, but arthroscopic surgery,
then in its infancy, was a far cry from what it is now. Instead of repairing the cartilage between her thigh and lower leg bones, surgeons removed the entire meniscus, reducing the cushioning in the knee — a perfect scenario for osteoarthritis (OA).
Haynes needed time to recover but eventually regained use of her knee without limitations. Haynes said the surgery did not slow her down. “I lived with it,” she said. “You figure out how to manage.” For her managing meant icing, overthe-counter pain killers and leg elevation. Though Haynes could ease the pain, she could not prevent the structural damage that worsened over time. By the time she turned 35, she said, “my X-ray looked like an X-ray of an 80-year-old.” The medical term is valgus but most know it as being knock-kneed, a condition in which the leg bones are not aligned straight. She needed reconstructive knee surgery, but she reasoned that she would wait until it became a day surgery. Nearly 20 years later, after chronic pain and constant swelling took its toll, she finally relented. And not a moment too soon. Dr. John Wright, an assistant professor at Harvard Medical School and an orthopedic surgeon at Brigham and Women’s Hospital, has helped patients overcome misperceptions about knee replacement surgery. He also understands the human proclivity of delaying the inevitable. But
he also knows the consequences. “Waiting because you’re afraid is not a good idea,” he explained. “If you wait too long the results will not be as good.” Timing is everything and Wright has heard most of the excuses. Some might say they will have surgery once they retire. Others will say they’ll have the procedure when the pain disturbs their sleep. “Ten years later they are no longer active because of pain and disability,” he said. “They are not going out of the house, to church, and engaging in normal activities because of the pain.” Women have even more excuses for procrastination. “Women wait because they’re caregivers. They tend to put others before them,” he said. But that’s not a good idea, Wright stresses. Women tend to get OA earlier than men; they get it in middle age. They have had too many years of wear and tear by the time they seek care. He understands the misperceptions. Years ago the results for knee surgery were not as good as desired, but, according to Wright, surgical techniques have markedly improved since then. Wright readily admits that obesity is a Haynes, continued to page 4
BEST REMEDY FOR OSTEOARTHRITIS? GET UP AND GO pain. Gentle forms of exercise like walking, dancing, stretching, water aerobics, yoga and tai chi can actually delay disabilities linked to arthritis as well. And finding comfortable ways to be active may let you reclaim some abilities lost to arthritis while strengthening muscles that help support joints and boosting your overall well-being, mood and joy in life.
mended for people at risk for falls, too. If this seems like far too much right now, don’t worry. Start small, say CDC experts: just do 3 to 5 minutes of activities, two times a day. Build up slowly, giving your body a chance to adjust before adding more active time. Before starting any new exercise program, discuss it with
WEIGHT, HEALTH AND EXERCISE
Photo courtesy of Arthritis Foundation
More than one in five American adults has a form of arthritis, a condition that causes painful joints. Once called rheumatism, this collection of ailments includes osteoarthritis, rheumatoid arthritis and gout. It is the most common cause of disability in the United States. “Arthritis affects more than 4.6 million African Americans and 3 million Hispanics and Latinos,” says Dr. Jan Cook, medical director of Innovation & Leadership at Blue Cross Blue Shield of Massachusetts. “And, unfortunately, African Americans and Hispanics are almost twice as likely as Caucasians to report experiencing work limitations and severe pain.” The news is not all bad. Simple activities can help ease arthritis
Controlling your weight is important if you have arthritis. It can help prevent, or at least slow, the progression of osteoarthritis in knee and hip joints. A healthy weight helps ease rheumatoid arthritis, too. Why should weight matter? As you walk, experts estimate that the amount of force on weight-bearing joints like your knees is three to six times your total weight. According to the Arthritis Foundation, every pound lost takes away 4 pounds of pressure on the knee. That benefits anyone, but especially people with tender, arthritic joints. One study showed losing 15 pounds of excess weight cut knee pain from osteoarthritis in half. Other research found that women who lost 11 pounds lowered their risk for developing osteoarthritis by 50 percent. Exercise is essential because it helps people control weight, ease pain and possibly limit disabilities. Arthritis can complicate other ailments, such as heart disease, high blood pressure and diabetes, by making it harder to exercise. Regular exercise helps people prevent or manage these illnesses, while staying more independent and able to handle every-day tasks.
STARTING AN EXERCISE PROGRAM Guidelines from the Centers for Disease Control and Prevention (CDC) encourage people with arthritis to accumulate 150 minutes (2 ½ hours) or more of moderate, low-impact aerobic activities like walking, cycling, dancing or water aerobics each week. Muscle-strengthening exercises, such as workouts with resistance bands or weights, are suggested twice weekly. Balance exercises like standing on one foot or practicing tai chi are recom-
Photo courtesy of Mindfulbody T’ai Chi (http://mindfulbodytaichichuan.net)
your doctor. He or she can help you set limits and recommend the right mix of activities, rest, joint protection and pain relief strategies based on your overall health and type of arthritis. If necessary, your doctor can refer you for physical therapy, too.
KEEP THESE TIPS IN MIND: • Guidance from experienced exercise professionals helps. The Arthritis Foundation offers joint-safe exercise programs taught by certified instructors (see www.arthritis.org/programs.php to learn if there is a class near you). Local community centers, hospitals or health centers may have similar classes, too. • Start slowly and step up activity gradually. Any activity is better than none. But if you do too much, your muscles and joints are likely to hurt in the next few days, which could discourage you from exercising again. So go slowly and let your body adjust to increased activity. •Stick with moderate activity (see sidebar below) unless your doctor advises otherwise. You should be able to carry on a conversation while exercising. • Short bouts of activity are fine. Work toward making sessions at least 10 minutes long. Three 10-minute bouts a day add up to 30 minutes. • A warm shower and pain medication before exercise may be helpful. Afterward, cold packs may help. Talk to your doctor about this. • Warm up before exercise and cool down properly afterward. Gentle stretches make a great cool-down while extending your range of motion. During and after exercise, it’s normal to feel some soreness or aching in joints and nearby muscles. It’s especially common in the first four to six weeks of a new exercise program. If necessary, slow down: exercise fewer days a week or for shorter periods of time until discomfort improves. Ultimately, most people find that sticking with a regular exercise program offers significant pain relief.
THE CDC RECOMMENDS CHECKING WITH YOUR DOCTOR IF: • Pain is sharp, stabbing and constant • Pain makes you limp • Pain lasts longer than two hours after activity or worsens at night • Pain fails to respond to rest, medication or hot or cold packs • A lot of swelling occurs or joints feel hot or appear reddened
STEPPING IT UP One hundred and fifty minutes of moderate exercise a week is a big time commitment for many people. You can shave off time by doing a mix of moderate and vigorous exercise, if your doctor agrees this is safe for you to do and will not aggravate your arthritis by twisting or pounding joints. Here’s the general rule: One minute of a vigorous activity like swimming laps equals two minutes of a moderate activity like walking. Thus, 150 minutes of moderate exercise equals 75 minutes of vigorous exercise. During moderate activities, you can talk, but not sing. During vigorous activities, you can say just a few words without stopping to catch your breath. 2 BE Healthy • http://behealthy.baystatebanner.com
Questions & Answers 1. Is osteoarthritis (OA) preventable? Sometimes. Some risk factors, such as older age, female gender and family predisposition for OA are not controllable. However, a variety of factors including obesity, joint injury, repetitive use of joints and muscle weakness can be monitored, thereby decreasing the risk of OA.
Paulette Denise Chandler, M.D. Internal Medicine Brigham and Women’s Hospital
2. Is there a cure? No. However, people can maintain their independence by improving their strength, balance and coordination. The combination of exercise and weight loss provides greater improvement in mobility and frailty than either alone. 3. Is it possible to prevent the disease from progressing once a person is diagnosed? Yes. Exercise, physical therapy and a healthy diet may slow the progression of OA. Obese people should aim for at least a 10 percent reduction in weight to reap the benefits of improvement in symptoms of OA. Also, slower progression of the disease may occur in persons with moderate intake of vitamin C-rich foods (e.g. brussel sprouts, tomatoes, kiwi) and high blood levels of vitamin D, but it is not known if supplementation with these vitamins has the same effects. Also, emotional outlook may have a greater influence on pain and mobility than joint abnormalities. Psychological stressors such as depression or anxiety may worsen joint pain. 4. Why is weight a risk factor for osteoarthritis? Hormones and mechanical factors drive the impact of weight on the development of OA. Excess weight puts more stress on the joints and wears down the cartilage that lines the joints and contributes to malalignment of the joints. Excess body fat also releases hormones and other chemicals that promote chronic inflammation in the joints. Even modest weight loss lowers the risk of developing knee arthritis. For each pound lost pressure on knees decreases by about 4 pounds.
THE HAND is another common site of osteoarthritis. Bony prominences called Heberden’s nodes may develop near the joint closest to the nail, while Bouchard’s nodes are bony enlargements of the middle joints. Heberden’s nodes are more common in women and may have a genetic link. Copyright 2011 American College of Rheumatology
Bouchard’s node
KNEES are commonly afflicted by osteoarthritis causing pain, stiffness and difficulty in walking and performing normal day-to-day activities. The cartilage, a smooth tissue covering the surface of joints, begins to wear away, which can lead to bone rubbing against bone, muscle weakness and malalignment of the knee.
Heberden’s node Copyright 2011 American College of Rheumatology
SIGNS AND SYMPTOMS • Pain during or after joint movement • Limited range of motion or flexibility • Cracking noise during joint movement • Stiffness, especially after long periods of inactivity
• Swelling or tenderness in afflicted joints • Bone spurs — extra pieces of bone that form around affected joint • Muscle weakness • Joint deformity
5. When is surgery recommended as a treatment? Surgery is a necessary part of treatment if severe arthritis limits activities and does not respond to other arthritis treatments. It is important to have surgery before severe complications of arthritis such as muscle loss and joint deformities occur. Surgery can be done to remove the damaged joint cartilage or replace or fuse the damaged joint. 6. If joint movement is painful in osteoarthritis, why is exercise recommended? Mild to moderate exercise reduces joint pain, boosts mood, improves movement and strengthens muscles. Exercise contributes to cartilage healing and reduces risk for injury. Less exercise can lead to an increase in joint stiffness and loss of joint motion. Start slowly and increase exercise gradually. Exercise increases the ability to perform daily activities such as light housework, shopping and gardening. Exercise should be done daily. Water exercises may be beneficial for patients with severe pain. Exercise with a friend or group class may improve chances of sticking with an exercise routine. Walking is a great exercise option because it requires minimal equipment. 7. Can a healthy lifestyle, such as exercise and healthy eating reduce the risk of osteoarthritis? Yes. Good foods keep the joints lubricated and burn fat. A well balanced diet abundant in fruits and vegetables, whole grains, beans and nuts is satisfying with fewer calories than a diet with more processed foods. Limit overeating. Chronic overeating with excessive sugar and caloric intake contributes to joint inflammation and cartilage damage. 8. Does genetics play a role in the development of osteoarthritis? Yes. Further work is needed to determine the nature of the genetic influence. It may involve a structural defect in cartilage or bone development or a risk factor for OA such as obesity. Family history of OA can come from your father as well as your mother. It is important for you to know your family history of OA and joint replacement for OA and share it with your health care provider.
RISK FACTORS • Age — the incidence increases with age • Gender — women are afflicted more than men after age 45 • Continued overuse of or trauma to joints • Overweight and obesity • Fractures and other joint injuries or infections • Congenital defect or weakness in a joint • Occupations that include tasks that place repetitive stress on a particular joint • Other types of arthritis, such as gout and rheumatoid arthritis • A genetic defect in joint cartilage
It took two orthopedic surgeons, one rheumatologist, one neurosurgeon, and a devoted mother to get Courtney back on her feet. A few years back,Courtney was a college basketball player. But inexplicably, she gradually became debilitated by severe bone and joint pain. As her mother Muriel says, in a relatively short time, Courtney “went from being able to run up and down a basketball court to struggling to walk a hundred yards.” Referrals led Courtney here, to one of the most advanced orthopedic centers in the world. A multidisciplinary team found her most urgent problem was a malformation of the brain—Arnold-Chiari— a life threatening condition. An orthopedic surgeon and a neurosurgeon performed one of the most delicate and difficult surgeries imaginable. But Courtney was afflicted with another
The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors275109a2_MurielBay.indd and make timely visits to 1 your primary care physician.
serious issue, rheumatoid arthritis—unusual for her age. She is now under the care of physicians in our rheumatology program, one of the largest and most comprehensive in the country. “Brigham and Women’s has made all the difference,” says Muriel. A significant amount of Courtney’s mobility has returned, and though she doesn’t play basketball now, she’s coaching it. Muriel adds,“It’s a hospital that really seems to pride itself on including the family.” To see more of Courtney and Muriel’s remarkable story, or to make an appointment at the Orthopedic and Arthritis Center, visit everythingpossible.com.
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tory drugs, such as aspirin and ibuprofen. More adulthood. Females are impacted more than men, severe pain may require narcotics or injections of and are more afflicted in the knees and ankles. steroids into the joints. It is hard to predict the path of the disease. Topical analgesic creams are helpful to Its onset is gradual. Typically, the joints afsome, while heat or cold can relieve others’ fected are the weight bearing joints — hips, pain. A study conducted by the National Instiknees and lower back — but the neck and tutes of Health determined that the supplement hands are targets as well. Knobby protuberglucosamine chondroitin sulfate did not imances on the sides of the joint closest to the prove joint structure or significantly reduce the nail — called Heberden’s nodes — are signs of pain of OA of the knees. The authors, however, OA in the hand. were quick to point out that if patients report But unlike rheumatoid arthritis, OA folbenefit, there is no reason to suggest they should lows no set pattern. It can damage one hip and be taken off of their supplements. leave the other intact. Another alternaSymptoms can be tive form of medicine so mild that people has shown measurable are unaware of its improvements in knee existence, or severe function and pain enough to prevent relief. A 2005 study normal activities. published in the Annals In addition, the of Internal Medicine magnitude of pain was able to demondoes not always strate that acupuncture correlate to X-ray — in conjunction with images. A severely other therapies — was deteriorated joint may successful in improvbe pain free, while aning knee function and other that shows little relieving pain in people damage can result in with OA of the knee. pain and decreased Bertrand admits function and stability. Elinor A. Mody, M.D. that her OA has made OA is not revers- Director, Women’s Orthopedic and some activities harder ible. Once joint dam- Joint Disease Program to do. “I can’t drive for age occurs there is no Brigham and Women’s Hospital more than an hour,” turning back and there she said. “My knees is no cure. But it may be possible to prevent or stiffen up and get painful.” Her car poses another delay its incidence and reduce its impact once problem. It takes her a while to get out. “You established. For instance, experts have found should see me,” she laughed. “Seventy-year-old that for every one pound of weight loss, there people are passing me. I look elderly.” is a four-pound reduction in the load exerted on She laments that she cannot clean her house each knee. as well as she used do. The bending and squatting That’s the theme behind the action plan are too hard on her knees. She says she can’t called a National Public Health Agenda for Osdance like she used to. “I like dancing, but I can’t teoarthritis, a collaboration between the CDC and do my James Brown moves anymore.” the AF. The overall goal is to prevent osteoarthriIn the interim, she uses acetaminophen and tis and “dispel the myth that osteoarthritis is an NSAIDS to ease the pain. She rarely requires inevitable part of aging.” The blueprint includes cortisone injections. She is not sure if glucoseducation, physical activity, injury prevention and amine is effective, but she takes it anyway. weight control. “Maybe it would be worse if I didn’t take it,” The key is exercise. “Exercise and muscle she reasons. strengthening take force off the joints,” Mody She sleeps with a heating pad. And she said. “Work on the core (trunk), quadriceps makes sure she takes a bath instead of showers at (muscles of the knee) and balance. This is parleast three times a week. Not only does the warm ticularly helpful for women.” water help, but she wants to maintain the ability For the most part OA can be handled to climb in and out of the tub. without surgery. Often the first line of attack is In spite of everything she keeps moving. over-the-counter drugs, such as acetaminophen “I don’t want to be dependent on anyone,” and NSAIDS, or non-steroidal anti-inflammashe said.
Relief
from pain
Over-the-counter (OTC) drugs are often the first remedy patients use for relief from the pain of osteoarthritis. But improper use of these drugs can result in another problem altogether. There is a common misperception that OTC drugs are not powerful and do not require the same attention to detail as prescription medications. That is not true. Overuse and misuse of OTC drugs, including NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen, can result in serious illnesses and even death. One should take these drugs only as the label dictates or as prescribed by a doctor. Acetaminophen Advantages: • Reduces pain • Does not cause stomach bleeding Disadvantages: • Is an ingredient in many drugs; overuse can cause liver damage
Glucosamine and chondroitin Advantages: • May reduce moderate pain in some Disadvantages: • Unregulated in the United States
NSAIDs
Advantages: • Reduces general pain and pain caused by swelling Disadvantages: • Can cause stomach bleeding
Capsaicin skin cream Advantages: • Reduces mild pain • Has fewer risks than pain pills Disadvantages: • Initial burning or stinging feeling
Source: “Choosing Pain Medicine for Osteoarthritis,” Agency for Healthcare Research and Quality
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A weighty situation Being overweight or obese increases a person’s risk of type 2 diabetes, heart disease and stroke, some types of cancer, sleep apnea, metabolic syndrome and gallbladder and fatty liver disease. Add osteoarthritis to the list. Excessive weight overly stresses weight bearing joints, such as the hips and knees, causing the cartilage to break down. Weight loss of at least 5 percent of body weight may decrease stress on knees, hips and lower back and improve symptoms. Calculate your body mass index (BMI) to determine if your weight is a potential risk to the health and structure of your weight bearing joints. The BMI is a measure of body fat based on height and weight. Weight in pounds
HEIGHT
Bertrand, continued from page 1
100 110 120 130 4’10” 21 23 25 27 4’11” 20 22 24 26 5’ 20 21 23 25 5’1” 19 21 23 25 5’2” 20 22 24 5’3” 19 21 23 5’4” 19 21 22 5’5” 20 22 5’6” 19 21 5’7” 19 20 5’8” 20 5’9” 19 5’10” 19 5’11” 6’ 6’1” 6’2” Underweight 6’3” 6’4”
140 29 28 27 27 26 25 24 23 23 22 21 21 20 20 29
150 32 30 29 28 27 27 26 25 24 24 23 22 22 21 20 20 19 19
160 34 32 31 30 29 28 28 27 26 25 24 24 23 22 22 21 21 20 20
170 36 34 33 32 31 30 29 28 27 27 26 25 24 24 23 23 22 21 21
180 38 36 35 34 33 32 31 30 29 28 27 27 26 25 24 24 23 23 22
190 200 210 220 230 240 250 260 270 280 290 300 38 37 36 35 34 33 32 31 30 29 28 27 27 26 25 25 24 23
39 38 37 36 34 33 32 31 30 30 29 28 27 26 26 25 24
38 37 36 35 34 33 32 31 30 29 29 28 27 26 26
Normal weight: 18.5-24.9 Overweight: 25-29.9 Obese: 30 and above 39 38 37 36 35 34 33 32 31 30 29 28 28 27
38 37 36 35 34 33 32 31 30 30 29 28
39 38 37 36 35 34 33 32 31 30 29
39 38 37 36 35 34 33 32 31 31
39 37 36 35 34 34 33 32
Extremely Obese 39 38 37 36 35 34 33
39 38 37 36 35 34
39 38 37 39 36 38 35 37
In addition to weight loss, many treatments are available for people with osteoarthritis. • Medications • Self-management strategies • Physical therapy and exercise • Guidance on the use of nutritional • Heat and cold supplements • Bracing and orthotics • Surgery
Source: Osteoarthritis information
A landmark study funded by the National Institutes of Health found that acupuncture can provide pain relief and improve function for some people with OA of the knee. Acupuncture can serve as an effective complement to standard care. Talk to your health care provider if considering adding acupuncture to your treatment regimen.
be required. Haynes was 52 years old when she contributing factor to OA, but he cautions had her second knee surgery. By all accounts, it went well. that obesity does not preclude the surgery. She said she was the best patient a Losing weight “is not necessary to fix surgeon could have. the problem,” “If they told me to do Wright said. “If someone’s knees five repetitions, I did 10,” she said. are worn out, the Her hard work time is then. If paid off. Even today you come back — four years after later and you are her surgery — she bigger, you are experiences very a worse surgical little pain. When she problem.” does, she knows the Wright is drill so well that she among the first to gets a jump start. “I say that knee or take ibuprofen and hip replacement ice my knee,” she surgery is not the says. “If I don’t, I only recourse. Many things know the pain will John Wright, M.D. start.” can be done Orthopedic Surgeon Haynes got before surgery is Brigham and Women’s Hospital much more from recommended. Assistant Professor her surgery than Exercise, muscle Harvard Medical School relief from pain. “I strengthening and had no idea of the physical therapy cosmetic impact,” she said. “That’s huge.” are a few. “Get going,” he recommended. “Patients return and admit they did get bet- Her knock-knee had caused a change in her posture, gait and appearance. She now ter with exercise.” marvels at her straight left leg. But when pain is severe and nonHaynes, 56, continues to exercise. At responsive to medications and physical her home gym, she uses the recumbent bike therapy, surgery may be warranted, particand treadmill, but tennis is her passion. ularly when reduced function is involved. “I don’t push it as much as I used to,” Loose pieces of cartilage or torn menisci she said, noting she might not run flat out can be repaired through arthroscopy, an to chase an errant ball. “I don’t do things as out-patient minimally invasive surgery. aggressively as I once did. I limit myself. Often joint surfaces can be smoothed out. But I’m not worried about it. I have a lot of When a joint is destroyed beyond repair, life ahead of me.” joint replacement using a prosthesis may Haynes, continued from page
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