Intro: This is Weekly Dose of Wellness brought to you by Memorial Healthcare System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the podcast. I'm Deborah Howell. Joint pain can happen at any age, especially in those who are very active or involved in sports. In this podcast, we'll explain how joint pain can affect young adults, how to manage joint pain, and when medical intervention is necessary. Our guest today is Dr. Andrew Wassef, board-certified orthopedic surgeon and Medical Director at Memorial Care Joint Replacement Center at Long Beach Medical Center. Welcome back, Dr. Wassef. So good to have you.

Dr. Andrew Wassef: Thank you, Deborah. It's a pleasure to be here again, and I always look forward to our meetings.

Host: Right back to you. So, how early can people start to experience joint pain?

Dr. Andrew Wassef: Well, joint pain can be for really so many reasons. There are a lot of people who experience joint pain at a very young age, even in childhood. And oftentimes, we say those could be growing pains. Those are the layman terminology to some medical issues that can be occurring. But we see a lot of people early in life having joint pain that usually resolves. The more serious joint pains are the pains that are either secondary to an injury or joint pains that become chronic and that are not leaving.

Host: Okay. And, you know, we're all kind of tearing around the planet these days. So, how do our everyday activities contribute to the wear and tear of our joints?

Dr. Andrew Wassef: Well, there's been quite a bit of research to look at what types of activities can be a problem and how our everyday activities can contribute to arthritis. Really, what we found is that there is a lot of inconsistency in what we previously believed. We know that it's very important to remain active and motion is very important for joints so that they do not get stiff and get painful, right? Especially we see a lot of people with the cold weather begin to have significant pain in their joints, because really they're more stagnant. So, what's important is that people stay active and keep their muscles strong. And if that includes repetitive higher impact activities, such as running on marathons, things of that nature, then I think most of us agree that that's in the best interest for the person, regardless of what kind of impacts that may have on the joint when you look at the x-rays versus really how people feel clinically.

Host: Boy, is that refreshing to hear.

Dr. Andrew Wassef: it's good to stay active.

Host: Yeah. And why does joint pain occur in younger adults, and sometimes it doesn't occur until people are much older?

Dr. Andrew Wassef: Well, I think that ties into the fact of how fit we are, that definitely plays a significant role. What we do see is when people have weak muscles surrounding the joint, the joint does not function as well and people tend to actually feel the arthritic pain more often. What you do find is that people that actually Injure themselves as a younger adult, especially people that are playing very high level sports, very competitive sports. We really like to leave it all out on the field. And of course, that in time can increase the risk of certain injuries around a joint. People that have torn their ACLs, things like that.

Host: Raising my hand.

Dr. Andrew Wassef: A lot of people that have gone through those types of injuries at an early age and maybe even required surgery to repair that, we find that earlier in adulthood, they begin to have arthritic changes sometimes secondary to those injuries that may have been years in the past. I think the more important thing to consider is really at what point do we start to notice the pain and when do our symptoms begin, right? Because there are a lot of people who have arthritis of a joint and wear and tear of a joint. However, they don't feel it because they have maintained such good muscle tone around the joint and have remained so fit and also have a healthy weight where they're not putting excessive stress on the joint.

Host: I was wondering that exact thing because I have bone-on-bone in my right knee, having had the cartilage taken out. It was so torn from playing squash that they actually took it out. So, I'm truly bone on bone, but I feel great, and I just got off the court playing three hours of pickleball. And I'm wondering, "Why is this not hurting me?"

Dr. Andrew Wassef: That's excellent. Well, I think, Deborah, you answered it yourself. The fact that you keep yourself in great shape and you maintain a healthy weight and you stay active and keep your joints moving and also playing pickleball obviously is a huge rave now and really just keeping the muscles around the knee and the hip strong really helps reduce the amount of pain that you feel from the arthritis.

Host: And how do you do that? Are there exercises or...?

Dr. Andrew Wassef: There's quite a bit of exercises you can do just to isolate the muscles around the joint. When we talk about the knees, we really speak about quadriceps strengthening. And not just quadriceps, but also what we don't speak about as much is the importance of hamstring strengthening.

Host: Oh.

Dr. Andrew Wassef: Yeah. So, what most people don't know is that the quadriceps and the hamstrings are really the secondary stabilizers of the knee. So even if you have an ACL tear, or a PCL, which is the posterior cruciate ligament tear, if you have very robust quadriceps and hamstrings, you can overcome a significant amount of that instability just by the work of the muscles.

Deborah Howell (Host): Interesting.

Dr. Andrew Wassef: Yeah. So, it's very, very, very important to work on the quadriceps and the hamstrings when we talk about the knee. And with the hip, we talk about the abductors,. The glute muscles, right? And fortunately, a lot of people work on their glutes anyway, because there's also an aesthetic issue of that that people enjoy. So, it tends to be one of the muscles that's worked out pretty well, but it is very important really in terms of just being able to balance your pelvis.

Host: Glutes, hammies, and quads, people. All right. Okay. So, what are some of the activities or risk factors that can contribute to younger people having joint pain?

Dr. Andrew Wassef: So really, the risk factors are traumatic injury. So, we see people after having, like I said, an ACL tear or, you know, a bad meniscus tear where a good portion of the meniscus had to be removed. Also, people that have injured their actual cartilage during a younger age. People that have had broken bones that are close to or into the joint also often have significant early arthritis in early adulthood.

There's also people that have certain conditions that they're born with that predispose them to earlier arthritis. We speak about hip impingement quite often now, and there's a lot of research that's been done just I'm looking at arthroscopic procedures around the hip to reduce some of the problems that can occur and hopefully ward off early arthritis.

So, the majority of the people that have early onset arthritis we see have had some traumatic injury in the past, whether or not they remember it, they may just be a very high level athlete that really didn't pay attention some of their injuries and worked through them and had a little earlier degeneration. And then of course, we have people that have a genetic predisposition as well. You see some people who have their brothers and sisters, and everyone had a total hip before the age of 50. And there's really no other factors that would contribute to that.

Host: Wow. It seems awfully unfair. All right. Now, what activities should younger people actually avoid to prevent further joint injury?

Dr. Andrew Wassef: Repetitive high impact activities are usually frowned upon when we speak about the potential of joint injury. However, I will say the verdict is still out on that. There has been some more recent research looking at runners and whether or not those types of activities do actually predispose you to arthritis. And what we have found is that everyone runs differently. So, if you're a great marathon runner, then your probably very light on your toes. If you run like me, then you're a little bit heavier slapping your feet on the floor. So, there's really not one activity.

I think what's most important, what people can really do to prevent injuries is work on normal maintenance, stretching, very important, right? Normal maintenance and muscle tone. You don't want to do things that are outside of your normal realm too quickly. Always work your way up. Injuries usually happen when people are fatigued, they happen in the fourth quarter. So, you want to make sure that you're doing everything that, you know, is in your power to be ready for whatever activity you're doing. It's really not the activity as much as it is as being prepared for that activity and having the correct muscle strength and tone that will support that activity.

Host: Yeah. And, like, it's always the last ski run of the day when people get injured, right? Yeah?

Dr. Andrew Wassef: it really is. I mean, I can't tell you how many times I hear people saying it was the last quarter, the last ski run. And it's always when you're just a little bit more fatigued, you're tired and your muscles aren't able to support the movements that you're trying to make.

Host: Right. Known when to quit.

Dr. Andrew Wassef: Know when to quit and also know how to prepare. I think that's very important.

Host: Okay. How can people prevent joint pain and/or injury from occurring at any age?

Dr. Andrew Wassef: So, I think the most important thing again is really staying active. We always say motion is the lotion for the joints, right? So keeping the joints moving is very important. As we start to reduce the amount of motion and activity that we perform, then the joints start to feel the pain more and more.

There's of course a lot of treatment options that we talk about, including rest, ice, elevation, anti inflammatory medications. There's a lot of topical anti-inflammatory options and also anti-inflammatory diets that have been a really hot topic, and there's a lot of research going on in terms of understanding how our diet affects the inflammation of our joints.

So, I think between all of these things and really keeping your weight at a consistent healthy level, that's very important. Every pound on our torso on our body is about five pounds of force through our hips and our knees. So, when we gain five pounds, which doesn't seem like a lot, that's 25 pounds force through every step we take that's being realized through our hips and our knees. So, it's really important to try to keep a healthy weight, keep the muscles strong and, of course, stay active.

Host: All right. Dr. Wassef, if I just have two more questions for you. Are there some exercises young people can do daily to help with their joint pain?

Dr. Andrew Wassef: Yes. Definitely, stretching is of utmost importance. I think a healthy stretching regimen, 15 minutes a day at least, is a great way to reduce the pain in joints. Secondly, again, just easy. strengthening exercises even having just ankle weights that you are able to use, like two pounds or five pound ankle weights. And you can do several easy quadriceps sets and also doing straight leg raises in order to strengthen the hip flexors and the abductors, then all of a sudden you're able to gain muscle tone around those joints with doing very simple exercises.

Host: And the dreaded squats and lunges.

Dr. Andrew Wassef: The squats and lunges are definitely dreaded for most. And I will say, you know, with squats and lunges, we usually recommend not going into a very deep squat or deep lunge because you do place a substantial amount of stress in the patellofemoral joint. So, the stress that the kneecap sees is actually significantly increased when we're squatting at a pretty deep squat. So, you know, easy squats, kind of where you're going a half squat or quarter squat and lunges like that can really help increase your muscle tone without putting excess stress on the joint.

Host: Got it. Now, how do you know when joint pain needs medical intervention?

Dr. Andrew Wassef: There are a few signs that I would say are important to pay attention to. A, if there is pain that is unwavering and is chronic, pain that does not go away after a few days or a week of resting and elevating and icing I think is always worth getting checked into, when you're having mechanical symptoms such as significant catching, clicking, giving way of the knee or the hip, I think that that's a good time to have the joint looked at and make sure that there's nothing significant causing that. And of course, anytime that the pain is significant enough that it's giving you a difficult time to perform your normal activities If you find yourself limping for a prolonged period of time. You know, it's not abnormal for all of us to feel joint pain at some point. And the key is that it resolves on its own with just minor changes in your lifestyle. If it's continuing and it's a problem that you're noticing on a daily basis for a prolonged period of time, that is definitely worth getting it checked out.

Host: Okay. Good to know. And where can people learn more about joint care and treatment?

Dr. Andrew Wassef: Of course, the internet. If you look at the website of Memorial Care, we have quite a bit of information about joint pain what we can do for joint health. Also, if you look at the American Academy of Orthopedic Surgery, it's aaos.Org. There is a wealth of information about joint pain and injuries and what you can do about that.

Host: Got it. Well, thank you so much, Dr. Wassa, for your time and your expertise today. Always a pleasure to have you. We really enjoyed having you on the show today.

Dr. Andrew Wassef: Thank you, Deborah. It's my pleasure and hopefully we'll talk again soon.

Host: And I have a phone number to add to that. If you'd like more information, you can call 562-933-4004 or visit memorialcare.org/lbjointreplacement. That's all for this time. I'm Deborah Howell. Have yourself a terrific day. I'm going to go do some stretching.