Osteopath Dr Phil's Tips

Grotty Hips and Knees

Competitive athletes know that between 25 and 35 their injuries repair much more slowly and incompletely. For most the worn joints and soft tissue damage will soon end their chances of peak performance; and they must bow to the inevitable. For the rest of us the gradual process of attrition comes on more slowly, and there are many factors in this. The longevity of hips and knees is much better when people do lots of non-traumatic movement. Plenty of regular good walks or swimming, and staying alert and active most of the day help to build smooth well coordinated joint function. More vigorous fun playing games of table tennis, salsa, tango and rock and roll also improves heart and cholesterol health. The worst outlook comes when “middle aged spread” becomes a sort of defeated slothful obesity, so that massive compression forces accelerate knee and hip wear. This also seems to occur when people undergo severe or sustained stress of all sorts: not just physical impact. So anxiety and panic disorders, fear of movement, and reactive depression may make the picture much worse.

Is it arthritis? A disease?

No, this is generally not part of a whole body disease pattern; just a local reaction to imbalanced friction and irritation of the “pain” nerves. X-rays of joints usually don’t give a true picture of the actual disability. Some joints look terrible on X-ray but function very well with little discomfort; others look quite good, but can make life hell for the patient. Some other general factors can be crucial to this, for example falling oestrogen around menopause, or inadequate levels of calcium or vitamin D. The brittleness of the body’s collagen fibers and joint lubrication can become very poor.

What helps?

Before considering drugs, cortisone or surgery we osteopaths may be able to help with slow easing manual therapy. All the external ligaments, muscles and tendons around the knee are quite easily accessible to expert touch and treatment. Often they are “just waiting to be released”. Restrictions around the hip are, again available to skilled testing and “release” work; especially of the deep rotators and “anterior impingement” that are so common, and aggravate all of the joint wear.

Other factors

Good posture helps; bad posture aggravates. Good gait helps; bad gait aggravates. A few kilos of excess weight lost usually helps a lot! So whether you do it alone or have excellent Pilates instruction, yoga, feldenkrais, Alexander or a skilled personal trainer (not boot camp bullying) you must actually do it and stick to it long term; regardless of all else. Learn to manage time and stress much better; patience, planning and persistence really work here. The excess weight is best reduced slowly: relapse is the biggest problem.

Pain management

To begin with your different activities make things more sore: and if this is only for a couple of hours that’s fine. If it’s for a day or so you are overdoing it: ease off. All of the anti-inflammatory drugs, even aspirin, can damage your stomach and gut lining; they may also mask a rapidly worsening state of affairs. Nevertheless they may help subdue a temporary flare-up of pain and inflammation.To me it seems that individuals respond very differently to their choice of medication; whether it be fish oils, wild krill, caltrate, glucosamine, chondroitin, green-lipped mussels or rub-on creams whatever you think helps ...probably does! I think there is now good evidence that keeping up a sustained full dose of panadol Osteo (not a corrosive antiinflammatory drug) is best for mild pain relief... with very minimal side-effects; but all cases are different.

Injections and surgery

Cortisone injections can be very effective in the right hands; but are limited and best kept as a last resort. Surgery should always be reserved till it is completely unavoidable; either due to excessive pain, muscle wasting or deteriorated bone structure. Hospitals are not the safest place to dwell with open wounds these days. The standards of hygiene, reporting of bad results, and follow-up after rehab are not the best; though I do think there are still individuals and centres that aspire to excellence when we can find them. So please do your research thoroughly.