Millions of Americans suffer from joint pain.
It can keep you out of work, limit your activity and affect your quality of life.
Joints form the connections between bones.
Any damage to the joints from disease or injury can interfere with your movement and cause a lot of pain.
Jacob Brooks, DO is here to help you decide when to go to an orthopedic surgeon and when is surgery needed.
Selected Podcast
Orthopedics – Knees Got You Buckled Down?
Featured Speaker:
Jacob Brooks, DO
Dr. Brooks' specialty is Orthopedic Surgery. His Residency was at Pinnacle Heath Hospitals. He is a member of American Osteopathic Board of Orthopedic Surgery. Transcription:
Orthopedics – Knees Got You Buckled Down?
Bill Klaproth (Host): Everyone has a bit of knee pain now and then but, at what point should you go see your doctor or orthopedic surgeon? Dr. Jacob Brooks from Down East Orthopedics Associates, which is associated with St. Joseph's Hospital, is with us today. His specialty is orthopedic surgery and he's on the American Osteopathic Board of Orthopedic Surgery. Dr. Brooks, welcome to St. Joe's Radio. Thanks for being on with us. Are most knee issues wear and tear problems or are they more related to injury?
Dr. Jacob Brooks (Guest): That's a great question. So, I usually break down knee-related pain into two categories: the acute kind of injury where you have a specific time or incident where you remember the knee pain initiating and then, you have a second form of knee pain which is that chronic, indolent, progressive discomfort that's more related to a degenerative process typically within the knee. Those kind of classifiers are our two main sources of discomfort, whether being acute soft tissue injury or rather a chronic, progressive osteoarthritic condition, more or less arthritis in the knee.
Bill: Which one is the most common out of the two that you see?
Dr. Brooks: Really, we can break that down almost into two kinds of subcategories of age related issues. Typically, younger, active patients tend to sustain more of the inflammatory conditions in the knee or acute injuries such as a meniscal tear or a ligament tear. We've all heard of anterior cruciate ligament tears or medial lateral collateral ligament tears. So, this helps the younger patient kind of deal with those more activity related injuries whereas, the natural progression of the condition of the knee is that you can develop a more chronic inflammatory condition of osteoarthritis which would give you more of a persistent discomfort into the knee.
Bill: So, with each of these, whether it be the acute injury or the chronic discomfort, when is it time for someone to go see a doctor?
Dr. Brooks: So, when you have an acute injury to the knee, things that would be cues that you shouldn't be waiting for this to kind of go away would be persistent mechanical symptoms of clicking, popping, giving way, feelings of instability, swelling that is persistent and that limits ability for you to be able to perform the activities of daily living or your occupation. And then, discomfort that usually lasts more than 2 or 3 days at a time where the pain is so uncomfortable that it really prevents you from being able to do your ADLs. The other thing would be that if you are unable to bear weight at all onto the knee, then that would be a reason that prevents you from being able to walk, that you would need to seek medical attention sooner rather than later.
Bill: Can people treat this with aspirin, then, for the people that's not an acute injury? You said if the pain persists for 2-3 days. Is aspirin a good form of medication to try to deal with knee pain?
Dr. Brooks: Yes. The kind of typical pneumonic of RICE, would be: rest--avoiding the type of activities that tend to bother it and then, icing it in the acute phase to try and reduce some of the inflammation and the swelling in and around the knee. And then, your typical anti-inflammatory medication, whether it be an aspirin or an Aleve or an Ibuprofen or typical NSAIDs that you can take for a short period of time to help reduce that acute inflammatory process that's going on in the knee, which can give you some relief.
Bill: So, someone comes to see you and they have chronic knee pain or they know they injured it somewhere. What is a typical diagnosis like?
Dr. Brooks: So, for a person that has an acute injury, or they say, “Doc, I was kneeling down to work in my garden and I felt a snap in my knee. I felt that click and that clicking and popping have been persistent since that time”, those tend to be a meniscal tear. What that is, is one of the shock absorbing cartilages in your knee which can become friable with age, which predisposes you to tearing them. Or, as you hear about young athletes with a twisting mechanism and then, they have an acute pop or an incident where the knee gave way followed by swelling and difficulty with ambulation because of the pain, and the mechanical symptoms of clicking, popping and giving way. That's one source of acute pain into the knee. Another one would be a ligament tear, such as an anterior cruciate ligament or an ACL tear. Again, more common with a specific mechanism, a twisting or a pivot mechanism, specifically with some sports-related activity: soccer, football or even downhill skiing, can predispose you to one of the ligament injuries which would require potentially surgical intervention.
Bill: So, can you quickly tell me, what are the general treatment options for each: the acute injury and then, the wear and tear discomfort type of an injury?
Dr. Brooks: Yes. In the acute phase, our preference would be to treat you symptomatically with typical anti-inflammatories, rest, avoidance of the activity and then, for a lot of people, a short period of physical therapy to work on both the range of motion, the strengthening, the rebalancing of the knee, to help both with the ligaments and stability of the knee. So that would be the acute phase. And when those fail to give you any improvement, there are injections with corticosteroids or hyaluronic acid, which would be an option for more the degenerative conditions in the knee or for acute injuries that tend to be plaguing people that don't resolve after a short period of time.
Bill: Speaking to you about knees, I just started to think that we all take our knees for granted. This may be a silly question but how do we keep our knees in shape? Is there a way to practice good knee health?
Dr. Brooks: That's a great question and one that I hear from a lot of patients in the office day to day. For a lot of people it's counterintuitive. We know that the cartilage or the covering of the bone and the joint that is prone to wear and tear with age is fed through the synovial fluid of the lining of the knee. The best way that that happens is through diffusion. There is no direct supply of blood to that cartilage. The nutrients get to that cartilage through moving the knee. So, I tell people, you know, keep it moving. If you don't use it, you lose it and that's very true when it comes to knee health. We want people to stay active. We want them to maintain a healthy weight, which reduces the amount of wear and tear on that cartilage and to maintain regular exercise and cardiovascular activity because that helps bathe the cartilage and maintain the health of the knee.
Bill: Great advice. Let me ask you this, for someone that has a knee problem that the RICE doesn't work or medication doesn't work and it's time for surgery. What does someone need to know about that?
Dr. Brooks: So there multiple reasons that you can require surgery. It's part of your workup when we'd see you in the office. We want to get x-rays to be able to better demonstrate to you the condition of your bone, the location of the bone, the morphology of the bone. If surgery is anticipated to needing to be taken place, we can do additional advanced imaging such as MRIs, where we're able to more definitively demonstrate to you the tears in the cartilage and so that we can preoperatively plan for fixation through surgery.
Bill: So, someone does have surgery. Has this become kind of common now and what is the recovery time for somebody that does have to have surgery on their knee?
Dr. Brooks: So, for arthroscopic procedures which would be for typical meniscal tears or ACL tears in the knee, those would be through two very small incisions in the anterior aspect of the knee. Through that, we're able to use a very specialized small camera that allows us to directly visualize both the injury as well as the surrounding tissue and cartilage within the knee through a second, again, small incision about a centimeter. We're able to work through that incision to be able to surgically repair and/or remove torn cartilage to be able to provide surgical fixation. These are advances that have allowed us to do the procedure very minimally invasive, which allows people to get up and get back to their occupation, their recreation or just living their day to day life with a minimum amount of recovery with the goal of being able to restore the function and the pain-free motion into the knee.
Bill: And, as we wrap up, Dr. Brooks, what is your best advice for someone dealing with knee pain?
Dr. Brooks: So, for patients that are dealing with pain that is more than the day to day discomfort that is associated with either an overuse or you are doing your occupation or your favorite recreational activity and that pain tends to be persistent, then my recommendation is that there's always a reason or a cause for that. With the help of a trained orthopedic surgeon, through one of these physicians, we're able to better identify that so that we can, hopefully, non-surgically provide you with solutions for this and then, if necessary, provide you with surgical interventions to get you back to the quality of life that you're used to living with a minimal amount of recovery.
Bill: Dr. Brooks, that's great advice. Thank you so much for your time today. We really appreciate it. For more information, visit StJoesHealing.org. That's StJoesHealing.org. This is St. Joe's Radio. I'm Bill Klaproth. Thanks for listening.
Orthopedics – Knees Got You Buckled Down?
Bill Klaproth (Host): Everyone has a bit of knee pain now and then but, at what point should you go see your doctor or orthopedic surgeon? Dr. Jacob Brooks from Down East Orthopedics Associates, which is associated with St. Joseph's Hospital, is with us today. His specialty is orthopedic surgery and he's on the American Osteopathic Board of Orthopedic Surgery. Dr. Brooks, welcome to St. Joe's Radio. Thanks for being on with us. Are most knee issues wear and tear problems or are they more related to injury?
Dr. Jacob Brooks (Guest): That's a great question. So, I usually break down knee-related pain into two categories: the acute kind of injury where you have a specific time or incident where you remember the knee pain initiating and then, you have a second form of knee pain which is that chronic, indolent, progressive discomfort that's more related to a degenerative process typically within the knee. Those kind of classifiers are our two main sources of discomfort, whether being acute soft tissue injury or rather a chronic, progressive osteoarthritic condition, more or less arthritis in the knee.
Bill: Which one is the most common out of the two that you see?
Dr. Brooks: Really, we can break that down almost into two kinds of subcategories of age related issues. Typically, younger, active patients tend to sustain more of the inflammatory conditions in the knee or acute injuries such as a meniscal tear or a ligament tear. We've all heard of anterior cruciate ligament tears or medial lateral collateral ligament tears. So, this helps the younger patient kind of deal with those more activity related injuries whereas, the natural progression of the condition of the knee is that you can develop a more chronic inflammatory condition of osteoarthritis which would give you more of a persistent discomfort into the knee.
Bill: So, with each of these, whether it be the acute injury or the chronic discomfort, when is it time for someone to go see a doctor?
Dr. Brooks: So, when you have an acute injury to the knee, things that would be cues that you shouldn't be waiting for this to kind of go away would be persistent mechanical symptoms of clicking, popping, giving way, feelings of instability, swelling that is persistent and that limits ability for you to be able to perform the activities of daily living or your occupation. And then, discomfort that usually lasts more than 2 or 3 days at a time where the pain is so uncomfortable that it really prevents you from being able to do your ADLs. The other thing would be that if you are unable to bear weight at all onto the knee, then that would be a reason that prevents you from being able to walk, that you would need to seek medical attention sooner rather than later.
Bill: Can people treat this with aspirin, then, for the people that's not an acute injury? You said if the pain persists for 2-3 days. Is aspirin a good form of medication to try to deal with knee pain?
Dr. Brooks: Yes. The kind of typical pneumonic of RICE, would be: rest--avoiding the type of activities that tend to bother it and then, icing it in the acute phase to try and reduce some of the inflammation and the swelling in and around the knee. And then, your typical anti-inflammatory medication, whether it be an aspirin or an Aleve or an Ibuprofen or typical NSAIDs that you can take for a short period of time to help reduce that acute inflammatory process that's going on in the knee, which can give you some relief.
Bill: So, someone comes to see you and they have chronic knee pain or they know they injured it somewhere. What is a typical diagnosis like?
Dr. Brooks: So, for a person that has an acute injury, or they say, “Doc, I was kneeling down to work in my garden and I felt a snap in my knee. I felt that click and that clicking and popping have been persistent since that time”, those tend to be a meniscal tear. What that is, is one of the shock absorbing cartilages in your knee which can become friable with age, which predisposes you to tearing them. Or, as you hear about young athletes with a twisting mechanism and then, they have an acute pop or an incident where the knee gave way followed by swelling and difficulty with ambulation because of the pain, and the mechanical symptoms of clicking, popping and giving way. That's one source of acute pain into the knee. Another one would be a ligament tear, such as an anterior cruciate ligament or an ACL tear. Again, more common with a specific mechanism, a twisting or a pivot mechanism, specifically with some sports-related activity: soccer, football or even downhill skiing, can predispose you to one of the ligament injuries which would require potentially surgical intervention.
Bill: So, can you quickly tell me, what are the general treatment options for each: the acute injury and then, the wear and tear discomfort type of an injury?
Dr. Brooks: Yes. In the acute phase, our preference would be to treat you symptomatically with typical anti-inflammatories, rest, avoidance of the activity and then, for a lot of people, a short period of physical therapy to work on both the range of motion, the strengthening, the rebalancing of the knee, to help both with the ligaments and stability of the knee. So that would be the acute phase. And when those fail to give you any improvement, there are injections with corticosteroids or hyaluronic acid, which would be an option for more the degenerative conditions in the knee or for acute injuries that tend to be plaguing people that don't resolve after a short period of time.
Bill: Speaking to you about knees, I just started to think that we all take our knees for granted. This may be a silly question but how do we keep our knees in shape? Is there a way to practice good knee health?
Dr. Brooks: That's a great question and one that I hear from a lot of patients in the office day to day. For a lot of people it's counterintuitive. We know that the cartilage or the covering of the bone and the joint that is prone to wear and tear with age is fed through the synovial fluid of the lining of the knee. The best way that that happens is through diffusion. There is no direct supply of blood to that cartilage. The nutrients get to that cartilage through moving the knee. So, I tell people, you know, keep it moving. If you don't use it, you lose it and that's very true when it comes to knee health. We want people to stay active. We want them to maintain a healthy weight, which reduces the amount of wear and tear on that cartilage and to maintain regular exercise and cardiovascular activity because that helps bathe the cartilage and maintain the health of the knee.
Bill: Great advice. Let me ask you this, for someone that has a knee problem that the RICE doesn't work or medication doesn't work and it's time for surgery. What does someone need to know about that?
Dr. Brooks: So there multiple reasons that you can require surgery. It's part of your workup when we'd see you in the office. We want to get x-rays to be able to better demonstrate to you the condition of your bone, the location of the bone, the morphology of the bone. If surgery is anticipated to needing to be taken place, we can do additional advanced imaging such as MRIs, where we're able to more definitively demonstrate to you the tears in the cartilage and so that we can preoperatively plan for fixation through surgery.
Bill: So, someone does have surgery. Has this become kind of common now and what is the recovery time for somebody that does have to have surgery on their knee?
Dr. Brooks: So, for arthroscopic procedures which would be for typical meniscal tears or ACL tears in the knee, those would be through two very small incisions in the anterior aspect of the knee. Through that, we're able to use a very specialized small camera that allows us to directly visualize both the injury as well as the surrounding tissue and cartilage within the knee through a second, again, small incision about a centimeter. We're able to work through that incision to be able to surgically repair and/or remove torn cartilage to be able to provide surgical fixation. These are advances that have allowed us to do the procedure very minimally invasive, which allows people to get up and get back to their occupation, their recreation or just living their day to day life with a minimum amount of recovery with the goal of being able to restore the function and the pain-free motion into the knee.
Bill: And, as we wrap up, Dr. Brooks, what is your best advice for someone dealing with knee pain?
Dr. Brooks: So, for patients that are dealing with pain that is more than the day to day discomfort that is associated with either an overuse or you are doing your occupation or your favorite recreational activity and that pain tends to be persistent, then my recommendation is that there's always a reason or a cause for that. With the help of a trained orthopedic surgeon, through one of these physicians, we're able to better identify that so that we can, hopefully, non-surgically provide you with solutions for this and then, if necessary, provide you with surgical interventions to get you back to the quality of life that you're used to living with a minimal amount of recovery.
Bill: Dr. Brooks, that's great advice. Thank you so much for your time today. We really appreciate it. For more information, visit StJoesHealing.org. That's StJoesHealing.org. This is St. Joe's Radio. I'm Bill Klaproth. Thanks for listening.