Transcription:
Joint Pain

Prakash Chandran (Host): Joint pain and stiffness are no fun. And unfortunately, painful, achy or stiff joints are fairly common in adults. The pain can affect many parts of the body and can often feel like grating, throbbing, tightness, or burning. And today we'll learn more about the potential causes of the pain and the treatment options that are available, if you have it.

Joining us today is Dr. Sanjeet Conda. He's the chair of orthopedic surgery at Jamaica hospital medical center.

This is to Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm your host Prakash Chandran. So Dr. Konda, thank you so much for being here today. Really appreciate your time.

Now we're obviously here to discuss joint pain, but before we begin, I'd love to unpack the different reasons why people experience joint pain in the first place.

Sanjit Konda, MD (Guest): Oh, great question Prakash. Thanks for the intro and happy to be here. You know, there are a lot of different reasons for people to have joint pain. And, you know, when we talk about young adults can have joint pain for various reasons and patients who are a little bit more elderly can have joint pains for other reasons. You know, I like to break up joint pain into, you know, really two different types of kind of large kind of high level reasons for pain.

One is acute trauma. You know, so patients can have pain because they've injured themselves. And this is what we usually see in more of our young adult population. This patient population is usually outside playing sports, more likely to get into accidents, whether they're car accidents or motor vehicle accidents, things like that.

But if there's a blunt force trauma to the joint or the joint is hit hard, then you know, the joint can become painful. You know, the joint is made up of cartilage which is the lining of the bones. It's a soft cushion, which is supposed to protect your knee joint from the time that you're about 16, 17, till the rest of your life, the body does not replace it. And any damage or acute trauma that happens will negatively affect it sort of for the rest of their life. So that's one reason for joint pain.

The other reason for joint pains can be what I call systemic. There are a lot of reasons for systemic joint pain. One more common thing that patients have heard about is something called inflammatory arthritis. Now this is sort of an auto-immune response. The body has antibodies, which are designed to fight different types of diseases. And sometimes those antibodies can start to attack the joint lining and that will cause inflammation in the joints. And that is a systemic type of arthritis, which can lead to pain.

And those are the two major types of arthritis. We talk about traumatic arthritis, or we talk about sort of systemic inflammatory arthritis. And that's the reasons why patients can have joint pain.

Host: Okay, thank you so much for that breakdown. Now I do want to talk about arthritis, but before, let's talk about that acute trauma, if you have joint pain caused by some sort of like blunt force trauma or impact, is that something that you can recover, like by exercising those supporting muscles, or you just have joint pain for the rest of your life?

Dr. Konda: Well, Prakash, that's a great question. You know, if someone sustains an injury to the knee joint there is a possibility that the joint can recover completely. You know, it really depends on the type of injury to the cartilage. Sometimes there's this bruising to the cartilage or kind of bruising to the lining of the knee joint. And that's an area I usually recommend to patients that they really work on physical therapy to strengthen the muscles around the knee joint. And typically those muscles are the quadriceps muscles, which are the front muscles around the thigh. And then the back muscles around the thigh, which are the hamstring muscles.

And by strengthening those muscles, it can really serve to stabilize the knee joint, almost distract the knee joint to protect the cartilage, allowing a full recovery to happen. But there are definitely certain instances where there can be injury to the cartilage that is what we call non-reversible. There can be some tiny pieces of cartilage that are broken off. This is typically presents with extreme pain. Patients are usually in significant amount of pain when this happens. Usually there's a large amount of swelling that happens in the knee because there's some blood that's coming into the knee from where that cartilage had broken off.

In that scenario, it's very important to see orthopedic surgeon as soon as possible, because we want to be able to identify that an injury has happened because there are steps that we can take as surgeons to try and try and minimize the amount of long-term effects and long-term damage to the knee joint.

Those would sometimes include getting x-rays and MRIs of the knees to see what's going on. And it's sometimes having to even do arthroscopic surgeries to try and do surgeries to minimize the risk of that long-term, you know, kind of problems with the cartilage.

Host: Yeah, that's really helpful. So the second thing that you mentioned was that systemic inflammatory arthritis, which comes on over time. I'm curious if there's anything that we can actually do to prevent that arthritis or at least minimize its effects.

Dr. Konda: Sure. So, there are a few things that we can do to minimize the effects of arthritis. You know, for some patients, you know, developing arthritis is genetic. You know, there's not much we can do. Maybe your, maybe their parents had it. Their grandparents had it. It's just the kind of quality of the tissue just degrades over time. However, even in those patients where there is a genetic predisposition to having arthritis, some of the things that we usually recommend, again, are similar to what we have when you have trauma, keeping the muscles around the joints is very, very important for the longterm sort of preservation of the cartilage.

It does really help to stabilize the joint, minimize the amount of kind of friction around the cartilage. When we think about friction, the reason the cartilage starts to break down is that the cartilage was rubbing up against the kind of the other surface of the cartilage, and so for the knee, that would be the top of the knee and the bottom of the knee keep rubbing together.

And over time that cartilage starts to wear down. So, strengthening the muscles around the knee is very important. Start strengthening the muscles around the ankle and the hips. And even the back because all of these areas have joints really can kind of minimize the long-term effects.

Host: Yeah, it makes sense to strengthen the supporting muscles around the affected area, but for the people that are living with that arthritis, that really isn't going away, what treatment options are available?

Dr. Konda: Yeah. So for patients who are living with arthritis, there are a lot of you know, what I would call non-operative treatment options available. And then there are a lot of operative treatment options available. I always start off with the kind of the least invasive treatment options and the standard treatment options include physical therapy. We talked about why that's important with regards to the muscle strengthening, but certainly anti-inflammatory medication can be very helpful. There are definitely over the counter anti-inflammatory medications. Some common ones are like Advil and Motrin and Aleve. There are prescription strength anti-inflammatories a little bit stronger and always should be kind of taken under the guidance of a doctor who can kind of explain to the patient some of the side effects.

Although the side effects generally are pretty minimal. The joint is swollen and painful because there's inflammation going on. And that's the reason why the anti-inflammatories can really minimize the pain and allowing patients to continue with some of their activities of daily living or even some of the activities they like to enjoy outside such as, you know, sporting activities or things like that.

You know, aside from the anti-inflammatories and the physical therapy, activity modification can certainly help. If there are activities that patients are doing that are causing pain, usually would want to avoid those. And for instance, impact activities, running or any activity where your feet are leaving the ground and then impacting the ground, jumping activities really should be avoided in patients with arthritis.

We really like to recommend non-impact activities such as bicycling or swimming. These are activities where the joints really don't have to see much force, but you can still get really good muscle strengthening and muscle conditioning. And it's just good generally speaking for the cardiovascular system, these exercises.

Those are kind of the main non-operative treatment measures. And then we can talk about operative treatment measures. You know, one of the things that we like to do is the procedure done really in the office is just injections. And there are different types of injections that we give. We can give cortisone injections, or a type of anti-inflammatory, about a hundred times stronger than a pill that we can give.

And it's very easily administered in the office and it can provide some long lasting relief for patients by kind of creating a very local anti-inflammatory effect. There are other newer things on the market, such as visco supplementation. These are kind of gel injections and these gel injections mimic the type of fluid in the knee joint and can kind of help lubricate the joint. Again, minimizing that kind of effect of the cartilage kind of pounding on the cartilage and wearing away. And then finally when those sort of conservative measures fail, the thing that we would then recommend to the patient is usually when the cartilage was completely gone, is a knee replacement. And that's just for the knee.

There are things like a hip replacement for the hip and ankle replacement for the ankle. And these are joint replacements where the kind of the bone has already eroded away. There's really no more cartilage left. And these are very kind of what I call safe procedures that really improve patient's quality of life by really taking away the diseased bone and replacing them with these metal prostheses, which can really have long lasting benefits for patients.

Host: And regarding the joint replacement, and I do want to get into this further, but just high-level question. Does it like, feel like you have a new leg altogether or a new knee or whatever joint you have replaced?

Dr. Konda: Yeah, that's a great question. You know, I think it's really what I would say is joint specific. I'd say pretty universally, if someone were to go out and have a hip replacement, because their hip has been really painful; most patients will tell you, as soon as the hip replacement is in, they will wake up in the recovery room and their hip pain is gone completely.

You know, that grinding from the bone on the bone has gone. The hip is very stable. They're able to get up and walk immediately. Within about, I'd say about two to four weeks, maybe even up to six weeks, patients will start to feel like their hip is like, they were like a 20 or 30 years old again now.

Yeah. It's pretty amazing. And it's, it's actually the surgery that I would say that across all surgical specialties, whether it's cardiac surgery or bariatric surgery, the hip replacement has really been shown to be like the most effective surgeryin sort of improving patient's quality of life. So it's really powerful procedure for patients who are really debilitated.

Now, a knee replacement is also a great procedure. But, you know, for knee, for knee replacements, I always educate patients that the knee will feel different. The pain will go away. So the pain that they were having that going up and down stairs and walking long distances, you know, patients are usually very painful, that pain goes away, but there is a little bit more what I would say, physical therapy and educational component with regards to, you know, trying to understand that you do have to relearn to walk.

You do have to relearn to really strengthen the knee. Now again, with the knee replacement, patients can get up and walk immediately after surgery. You'll be using a walker, usually transition to a cane within about a week. And most patients are without a cane after about two to four weeks and can go back to work, even if it's kind of a physically demanding job within about four to six weeks.

But you know, there is, there's more therapy involved with the knee replacement to really feel like your knee's your knee again.

Host: So you talked about some of the lifestyle factors that can actually contribute to joint pain beyond arthritis and that acute trauma, some of those things might be impact activities or jumping activities. Is there anything else that can contribute to joint pain that people should be aware about?

Dr. Konda: Sure. I think, you know, one important factor which, you know, I think affects a lot of patients, especially as we get older is being, you know, a little bit overweight you know, being a little bit overweight or even a lot overweight. You know, what it is is it's creates an kind of abnormal amount of force across the joints.

You can imagine that, you know, when you're walking, okay, your back, your hips, your knees, and your ankles really need to support your entire body weight. Every five pound or 10 pound increase in body weight really adds significant amount of pressure to each of those joints. And a joint is just like another machine part, the more wear and tear that goes across the joint over time, the faster that joint will start to wear down and that wearing down of the joint is arthritis.

So, you know, you know, advise patients if possible, it's not easy, but you know, weight loss is a very important key component to like a modifiable lifestyle change that patients can make. And there are a lot of, you know, we have partners here within Jamaica. We have a great, what I call bariatrics surgery team, you know, just because they're surgeons, they don't always all do operations.

There are a lot of non-operative ways that they have counsel and treat patients with medications, for weight loss. But there are also a lot of really minimally invasive surgical techniques that they do now for weight loss as well. And I do refer to a lot of patients in my practice who have joint pain for bariatric referral for, you know, weight loss management, prior to undergoing any type of joint replacement.

Host: So let's talk about the exercises that go to actually alleviate that joint pain. One of the things that I remember you mentioning was non-impact activities, but can you talk a little bit about what those are and how they might be beneficial?

Dr. Konda: Sure. Yeah. You know, there are a few standard set of exercises that I always recommend to patients to alleviate joint pain. You know, typically we try and do exercises, if you're, let's say you're having knee pain, I'll use that as an example, and you're having knee pain from arthritis, you know, some great exercises that you can do all by yourself at home that are very simple to do something like called a straight leg raise. With this type of maneuver, the patient's laying down on the bed. So we call on their back and you're really just trying to raise your heel off the bed as high as you can. And that simple motion can really improve your abdominal strength, your back strength.

It's working your hip flexors. And it's also working your quadricep muscles. All of those muscles are very important to help stabilize the body when you're walking. But then to also stabilize the knee when you're walkin. Another exercise I'd like to recommend is a seated leg extension. So with this kind of exercise, you're sitting in a chair with your knees bent to 90 degrees, and you're very simply just again, raising your leg and heel off of the ground. So your leg is straight. This seems like a very simple exercise. I often recommend to patients if you can get an ankle weight or even a resistance band, tying it to the chair, to give you some added resistance as you go up, this exercise really works to strengthen the quadriceps muscle. Again, this is one of those muscles that crosses the knee joint and the simple exercise can really help stabilize the knee and kind of really improve that pain that patients feel from arthritis.

Host: Yeah. You know, I think that there needs to be more of a focus on this whole like functional fitness and mobility. I think that so many people, when they exercise, they think they have to do the more traditional weight training and things of that nature. When, like you're saying, just sitting down and making sure that you can extend your leg or laying down and moving your leg back, work on all of the supporting muscles that contribute to alleviating joint pain over time. And I imagine for the rest of your life, isn't that the case?

Dr. Konda: Yeah, Prakash, I think you're right. I mean, I think that this idea of the functional mobility is it's really important. I think that patients don't learn enough about it when they go to visit their physicians. You know, we do a great job as physicians in general taking care of a lot of the other organ systems in our body, right? We take all these medications for our heart. We take all these medications for what other, you know, kind of illnesses we may have diabetes or whatnot, but there's really very few things that we're educated upon to take care of that other organ system, which is kind of our musculoskeletal system.

And so, you know, I think doing these, what I would call self-directed exercises or functional mobility, it really does just keep the muscles active. As we get older, I think that it's easy to get complacent and not exercise that much because we may find it difficult to get to a gym or that kind of thing. But the reality is that we can do a lot of these exercises within the confines of our own room much less our house.

Host: Now, up to this point, we've been talking a lot about non-operative treatments for people with arthritis. But then there's also that surgical approach, right? That's for people that have no more cartilage where the surgery is the only way to really give them a better quality of life. People that are listening are probably going to be intimidated by that. So can you share a little bit more about what that actually looks like and what they can expect from recovery?

Dr. Konda: Sure. Yeah. I mean, it's certainly daunting for anyone to consider the idea of having to undergo a joint replacement surgery. It sounds like a major surgery and I would consider it's still a big surgery. I mean, the reality is though that whether it's a knee replacement, which really is like a one-hour procedure or a hip replacement, also about a one hour procedure; they're both procedures at this point that are very kind of, let's say, routine and done in relatively minimally invasive fashion where patients can even go home the same day, if not within 24 hours of surgery. The surgeries are designed to improve quality of life. So the patients who would really benefit from this are patients who are having a lot of problems with what I would call routine activities of daily living and activities of daily living is things that you need to do to just kind of get by.

That means going up and down stairs, standing for extended periods of time, walking, whether it's one block, two blocks, whatever it may be. If you're having a lot of difficulty doing those types of activities, you may be a candidate for joint replacement. I usually tell patients, try and rate your pain on a scale of one to 10.

And if your pain is anywhere above a six, a six or above; then you may be someone who's a candidate for joint replacement. If you've trialed all of the other conservative measures that we talked about before, the physical therapy, the anti-inflammatories, the activity modification and the injections, and you continue to have significant amount of pain; you know the reality is that as we get older, we start to develop more comorbidities or illnesses, you know, whether it's heart disease or diabetes or some other diseases. So the older, the longer you wait to consider getting a joint replacement, it is true that you're probably going to develop illnesses that would make any type of surgery more risky.

So, you know, the age that we start to see arthritis that may affect the quality of life, where patients still really get a lot of benefit out of it, it's usually around that late fifties, early sixties, age range, and, you know, patients are still pretty active so they can get a lot of benefit if they were to have a joint replacement and they still have a lot of pain before that those are the patients that can get good 15, 20 years plus of a good pain relief without having to undergo any that pain associated with severe arthritis.

Host: Dr. Konda, the last question that I always like to ask is, you know, I know in your experience, you've probably seen hundreds of different types of patients with different types of joint pain. If there's one thing that, you know, to be true, that you just wish more patients knew before they came to see you, what would that be?

Dr. Konda: That's a great question Prakash. I think, you know, I think the one thing I wish patients knew before they came to see me, and then I certainly make a point to educate patients about this. And we've touched about this kind of throughout in our talk today is that, you know, maintaining the muscle strength and mobility kind of throughout your life is really key to preserving your musculoskeletal health and preserving your joint health.

You know, it's easy that when you're not having any pain to kind of work out and do exercise, and when you start to have pain in your joints to kind of think, all right, well maybe I don't need to work out as much because I'm having a little bit of soreness and pain. The reality is when you start to have a little bit of pain in your knees or your hips, your ankles, wherever it may be, that's the time to really start to focus and really focus on the muscles around those joints. And when your exercises start to work, you start to feel better. Then the key is to maintain, you know, you can't get complacent again and say oh, I got myself better. And now I'm going to just, you know, I can go back to what my normal lifestyle was.

The reality is, is that you reason you got better was because you started to strengthen the muscles around the joints and that sort of daily exercise, whether it's only 10 or 15 minutes, is what I tell patients. That's really all it takes. And again, those are exercises you could do just at your desk. You could do it at your home. You know, when you wake up in the morning easy to do and easy to maintain can really preserve the joint health.

Host: Well, Dr. Konda, I think that is the perfect place to end. Thank you so much for your time today.

Dr. Konda: Awesome. Okay. You're very welcome Prakash. Take care.

Prakash Chandran (Host): That was Dr. Sanji conduct the chair of orthopedic surgery at Jamaica hospital medical center.

Host: Thanks for listening to Jamaica Hospital Med Talk. To schedule an appointment with an orthopedic surgeon at Jamaica Hospital, you can call 718-206-6923. For more information about the services Jamaica Hospital has to offer, you can visit our website at Jamaicahospital.org/podcast.

My name is Prakash Chandran. Thanks again for listening and we'll talk next time.