I often hear my contemporaries talk about pain in the knees, hands, shoulder, back. When I ask them what is going on, a common response is: “It is just arthritis.”  When I probe further about what kind of arthritis or what are they doing about it, I may get answers like:

• No idea, have not talked to a doctor yet
• Just have to live with it, I guess
• Managing with pain meds
• I could have surgery, but it is not that bad yet.

So, I thought I will go ahead and share what I have experienced and learned over the years on this topic

My ambition to run a marathon thwarted

Almost twenty years ago, I met Stu Mittleman, an ultra-distance running champion. He won the 1,000 Mile World Championship and set a new world record by running the distance (1 609.344 kilometers) in 11 days, 2 hours, 6 min. 6 sec. (Yes, that is right one thousand mile!). After winning that race, he got himself admitted to a graduate school to figure out how he did what he did.

With that knowledge and experience, he started teaching mere mortals how to run marathons.  When I met, I was so inspired, I signed up.

So, with his coaching program, I started building up my endurance. I ran my first 5K. And, then, my knees started hurting. He had no ideas on how to fix my knees.  So, I quit running.

Knees got worse over the next few years. I went to a Sports Medicine guy. He took a quick look at the X-ray of my knees and said, “Looks like arthritis. Do some physical therapy. When they are not good enough to do what you want to do, we can always go in and clean them up.”

So, what the heck is this Arthritis?

There are two excellent, very accessible resources for arthritis:  Arthritis Foundation and NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases.  Per the Arthritis Foundation website:

Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is most common among women and occurs more frequently as people get older.

Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints.

There can be many underlying causes for swelling, inflammation, stiffness and pain in the joints. For example, Rheumatoid Arthritis, Lupus, Infectious Arthritis and Osteoarthritis can all cause these symptoms, but they are all very different diseases. It is very important to figure out with the help of a doctor what you are dealing with.

Osteo-arthritis is the most common type of arthritis. Per NIH website on Osteoarthritis:

Osteoarthritis (AH-stee-oh-ar-THREYE-tis) is the most common type of arthritis and is seen especially among older people. Sometimes it is called degenerative joint disease. Osteoarthritis mostly affects cartilage (KAR-til-uj), the hard but slippery tissue that covers the ends of bones where they meet to form a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, small deposits of bone—called osteophytes or bone spurs—may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

Figure Showing a Healthy Knee

Figure Showing Knee with Severe Osteoarthritis

A doctor friend of mine told me that when doctors don’t know what the disease is, they call it osteoarthritis.  And, that is not far from the truth. If you eliminate, other diseases that might be causing inflammation, e.g., auto-immune diseases, it is osteo-arthritis.  Underlying disease causing damage to cartilage is not known at this point – if it is not one of the other specific diseases.

So, what can you do?

Well treatment can be quite different based on the type of arthritis or the condition that might be causing the joint issues.

However, in case of osteoarthritis, which is often the most common and age related, here are the treatment options, according to NIH:

• Exercise
• Weight control
• Rest and relief from stress on joints
• Nondrug pain relief techniques and alternative therapies
• Medications to control pain
• Surgery

Notice that exercise is on the top of the list. As soon as most people start to feel pain in the joints, guess what do they give up? Yep, exercise.  And, what do they need most to keep ostearthritis in check? Yep, exercise.

And, that is an interesting paradox I have seen played out again and again – including with my own mother.

Back to My Knee

Having learned the theory, I took on three things aggressively:

1. Strength training to strengthen everything involved in functioning of my knee: quads, calves, hamstrings, and stabilizers muscles and ligaments.
2. e-cises by Pete Egoscue to realign my knee since my knees were a little pronated and that was probably the reason why running aggravated my knees.
3. Doing Bikram Yoga to help flush out any bone spurs or lose particles
4. Started on supplement of Glucosamine Sulfate with Chondroitin and MSM that help rebuild the cartilage. See http://www.lifeextension.com/vitamins-supplements/item03157/glucosamine–chondroitin–msm#panelSupplements.

My goal was to be pain-free when I doing lunges with free weight, squats and single leg jump ropes. And, I am happy to say that I have been able to get there.

In my last X-ray, I still noticed some bone spur and what radiologist called “mild arthritis”.   I would really like to reverse that without any surgery. So, the chase is still on.

Bottomline

1. If you have any stiffness, swelling, inflammation, or pain in the joints, it is important to get it checked out with the primary physician and if necessary with a Rheumatologist to first figure out what are you dealing with.
2. If it is osteoarthritis, the following is a good list in order of priority:
   1. Exercise
   2. Weight control
   3. Rest and relief from stress on joints
   4. Nondrug pain relief techniques and alternative therapies
   5. Medications to control pain
   6. Surgery
3. If it is other than osteoarthritis, use Arthritis Foundation and NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases  to study up and pursue your options.

I would love to hear your perspective on this topic.

What is your experience and knowledge from which I and others could learn?