Transcription:
Bone & Joint Health

Melanie Cole, MS: Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed. So you can make informed healthcare choices for yourself and your whole family. Back to health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. Today we're addressing signs and symptoms of bone and joint discomfort, musculoskeletal pain, and the rehab treatment options available to patients at Weill Cornell Medicine. Joining me is Dr. Nasser Ayed. He's an assistant professor of clinical rehabilitation medicine at we Cornell medical college.

Dr. Ayed, it's a pleasure to have you with us today. And I love this. Because it's something that in my 32 years, as an exercise physiologist, I have seen just so much bone and joint issues, musculo skeletal, pain, and discomfort. Tell us a little bit about joint pain and inflammation and what kinds of conditions that you see on a regular basis cause these joints to break down?

Nasser Ayaad: Well, thank you for having me. It's a pleasure to be here with all of you to talk about this important topic and very relevant topic. As all of us will likely experience some form of joint pain or inflammation during our. And that seems to happen. More often as time goes on. Joint pain and inflammation can happen for a myriad of reasons. You can have an acute injury or for example, a sports injury, or just twisting your ankle or twisting your knee.

Which is usually short lived as long as the injury is not serious. There are certain diseases that can cause joint, pain or swelling and even allergic conditions can cause it. I would say the most common condition that we see is arthritis or that I see in my practice is arthritis. There are many types of arthritis. Probably a hundred or more, however, the most common one is osteoarthritis.

Melanie Cole, MS: So then let's talk about osteoarthritis, Dr. Ayed, is it? And how does it differ? I know there's so many types, right? And we've heard about rheumatoid arthritis, but tell us about osteo. Since tHat's the one we're really addressing here today and the joints that it most commonly affects.

Nasser Ayaad: Yeah. So osteoarthritis is by far the most common type of arthritis. It can damage almost any joint but mainly occurs in the hips, knees hands and the spine. I would say the top three though, are the hands, hips and knees. It was once considered and I was trained this way. That was kind of a wear and tear disease. In which the cartilage, which is the protective layer on the ends of bones would gradually wear down with time with use.

And you would start to develop what we would call or kind of colloquially. We call bone on bone, joint pain. But we now know, and the thinking about osteoarthritis has really changed. And for physicians or people in the, in healthcare that work with patients with joint pain, we know that. Osteoarthritis is really a disease. And what I would call kind of total joint failure rather than just talking about the ends of the bones or cartilage, it's really the whole joint is being affected in becoming weaker.

So that includes the connective tissue that holds a joint together. The joint lining. The joint capsule at times can be involved. And what happens is the processes that maintain the joint, you can call the anabolic processes that maintain joint health, start to fade. And the processes that break down joint or the catabolic processes of joints kind of overwhelm it and you have this low grade inflammation that slowly deteriorates the joint over time. In the past, we thought inflammation was just associated with rheumatoid arthritis.

But now we know that many of the same processes that go on with rheumatoid arthritis are actually happening with osteoarthritis, but just at a much lower level. there are certain conditions that can put us at a predisposition for experiencing osteoarthritis. Sometimes we have arthritis that can be provoked by injuries. Some of the most common injuries would be like an ACL tear of the knee or a fracture or possibly a meniscal injury an earlier age.

We also know now that certain surgeries potentially can, if they happen at a later time, like arthroscopic knee surgery after 50 to 55 years old can put us at a predisposition for developing arthritis in the knee. There are some jobs that are very demanding on certain joints such. manual labor jobs and then lifestyle factors. Right? So, if we're carrying a lot of excess weight lack of exercise, have a poor diet, all of those factors can play a role.

I think a very important thing to keep in mind though, is that developing osteoarthritis isn't something that's gonna happen to everybody. And it's not something that we're all destined for. I would say the percentage of people in the population that develop significant osteoarthritis is somewhere between 10 and 20%. And there are things, the good news is there are definitely things that we can do to either avoid it or limit its impact on our lives.

Melanie Cole, MS: Well, then let's talk about that because I think that's the biggest issue here is how it affects the quality of life of patients, whether it's their knees or their hips or their lower back or their shoulder, I mean their elbow. And certainly we're seeing more of these types of injuries in chronic overuse injuries that are causing this decreased range of motion and pain in typing and text thumb. I mean, it's starting to affect so many different parts of our body. Dr. Ayed. So first line of defense. What are some of these approaches? What are we looking at? As far as rehab or medication? Ice bracing? There's so many modalities out there today.

Nasser Ayaad: There are, and there's also a lot of noise about the different things that we can try. There are different types of injections we can try. So we it's really important to try to filter out things that are effective, versus things that are people are just are trying to sell us. So I would say the first thing that we can do is motion is lotion, right? Motion is lotion throughout life. And the way to help prevent joint problems is by staying active.

And when I tell people that they sometimes look at me surprised because. They've been told or they just naturally think that doing certain types of activities is going to increase their risk. And I'll give you an example. There's a large study out there that looked at runners and it found that people that were moderate runners somewhere between 10 and 15 miles a week. And some people will think that's not moderate running. That's a lot of running, but relative to people who run 20 to 30 miles a week, it's moderate level of activity had a decreased incidence of developing knee arthritis compared to people who were sedentary.

Right. And that doesn't mean if you're not a runner, it doesn't mean you have to go start running tomorrow to decrease your chance of developing knee arthritis. But the key is, to stay active and even having walking routine of 30 to 45 minutes a day is going to decrease your chance of developing. And joint problems down the line. Other things that we can do that are just natural choices for us are maintaining a healthy weight. And limiting foods that stoke inflammation. Does that mean not enjoying your favorite foods out there?

No. It just means having a balanced diet and making sure that the majority of your diet isn't made out of red meat or highly processed foods and sugars, and still incorporating things like berries and leafing greens and salmon which are delicious as well. And choosing oils like olive oil instead of high saturated fats. All of these factors will limit the incidents or the chance that you'll develop, joint pain, being your knees, your hips, your hands, your elbows. You also bring up a really good point. Like our activities are changing a lot.

People were working on farms 50 to a hundred years ago and not so much anymore. Now we're working at computers and sitting has had such an impact on our life. actually, if you look at the, in incidents of arthritis, it's actually increasing as we're becoming more sedentary in our work and our activity. So, we're becoming more cognizant of it. And we're developing kind of different work environments and realizing we can't sit all day because it puts more pressure on our joints. It decreases our circulation, it decreases the circulation of healthy joint fluid.

And we have to get up, we have to move, we have to take breaks for ourselves. We have to check our ergonomics. So all of those things are things that we can do without taking medication using ice an an injection, and they're really the mainstay and the first line of both prevention and treatment of developing joint pain.

Melanie Cole, MS: That was an excellent answer Dr. Ayed, we try ergonomics. We look at our balance and our posture and the way we're sitting and all of these things that you're talking about. And we're trying to get good exercise. Maybe we're even doing classes and yoga and all of these things, trying to reduce our stress, because we know that stress contributes to inflammation as well. And we're learning more about that. And even if we're trying to get good sleep, because again, another thing that can contribute, but now we've got the pain.

We're 65 or 70, we've got some hip pain, knee pain. Are we bracing? Are we using ice? Are we using NSAIDs? Speak about some of those things and those modalities you might try. And also you could talk about physical therapy and rehabilitation.

Nasser Ayaad: Absolutely. Absolutely. So once we develop joint pain, I would say the first thing we need to do is try to determine provoking factors. And if there are certain activities that are provoking us to have more inflammation and more pain, we need to modify those. So for example, if you're a runner or even spend a lot of time on your feet, maybe you move to the pool for more exercise, or maybe you incorporate biking to decrease certain weight bearing, pressure on certain joint. From there, we start looking at treatments.

First line for treatments for most joints will be topicals. We have topical anti-inflammatories, which are essentially non-steroidal anti-inflammatories in a cream which can be used for most of our joints, such as our knees or ankles, our hands. They don't work as well for hip joint pain because the hip joint is just so much deeper. Another type of topical is Capsaicin. So capsaicin is made out of chili peppers and it can help with pain. However, patients have to tolerate it because it does have some, it does bring the heat.

So, but they are safe. First line treatments people who have prob heart problems or stomach problems or kidney problems who normally can't take, anti-inflammatory such as a ibuprofen or Naproxen. They are candidates for using topical anti-inflammatories. Sometimes heat can be beneficial or sometimes ice can be beneficial, after certain activities. After that, we start looking at medications we can use by mouth. Tylenol is a safe one and for some people it works. And for other people it doesn't provide all the pain relief they need.

I would say it's reasonable to try it, but our expectations may be muted a little bit, but it's a safe first line medication to take by mouth. If you don't have a reason that you can't take an anti-inflammatory like ibuprofen or Naproxen, then that is a significantly effective drug for joint pain and joint inflammation. But you want to check with your physician to ensure there's not a reason you can't take it. And as we get older, there are three main reasons why anti long term anti-inflammatory use or non-steroid anti-inflammatory use or contraindicated.

Those are people with significant history of stomach ulcers, or stomach bleeding, significant cardiac health or history of heart disease and or renal function problems, or I should say kidney problems. Those three reasons are often contraindications in taking medications like ibuprofen and Naproxen. We often will engage the physical therapy team to work with patients with joint pain. There are several things that we can look at. Number one, activities and exercises to strengthen the muscle surrounding the joints.

So for example, knee joint pain will almost always benefit from strengthening the quad muscles or the thigh muscles above the knee joint and the calf muscles below the knee joint. The idea is the stronger your muscles are. They're going to bear some of that force and pressure and decrease, some of the direct pressure on the joint and also strengthen the ligaments and tendons, around the joint. In addition, exercise, almost always decreases pain. It's one of the most effective pain relief activities or modalities that we have.

And it's very helpful to work with physical therapists as they can educate us on our, the way we're doing our exercises, kind of take us from a, beginning point in our physical therapy regiment and then progress the patient in a very step wise and safe manner. So the last thing they can work with is looking at any sort of equipment. what may be able to use for an really common example is using a cane. And a lot of patients will bock at the idea, because the last thing they want to do is be carrying a cane around if they have knee pain.

However, it's a very effective way of reducing the pressure and force and you can be stylish with a cane. There's lots of ways to dress a cane up. So it may not be forever, but sometimes the bridges as we're recovering from an injury or decreasing joint pain.

Melanie Cole, MS: I love that, the ambulatory aids nowadays are just absolutely different than they were. They're not your grandfather's cane, just like you're saying. And so thank you for that. Now I have a few more questions, Dr. Ayed. What about the complimentary or alternative therapies that you might recommend, or that you get asked about? Because over the years we've heard about condroitin and glucosamine and CBD oil, acupuncture, chiropractor.

And back in my early days, we were all separate, you know, people that like me and the acupuncture and the physical therapist and the ortho people, everybody was separate, but we're all kind of same umbrella nowadays. So tell us where those things fit into this help for joint and bone pain?

Nasser Ayaad: It's a really good question. These are topics that, we address daily, multiple times in our practice, as there's a lot of information out there about alternative and complimentary treatments, let's take a few of the most common ones. So, condroitin, glucosamine have been around in the marketplace for a long time. If you look at the studies associated with these supplements when they're non-industry or company sponsor, they're not very impressive. Now, are there people, are there patients of mine who have taken condroitin or glucosamine have had success? Yes. And so I don't necessarily recommend it on a regular basis or recommend them on a regular basis.

However, I tell them the greatest adverse effect or complication will probably be on your wallet and not on you, as these sometimes can be expensive. So if it's something you want to try and you are, willing to put the investment into it, it's probably not going to hurt you. So other ones out there these days, we also may hear quite a bit about Tumeric or Tumeric which is a spice that's very common in the south Asian and Eastern diets.

And that's something that seems to have some evidence around possibly reducing inflammation. As well as pain. However, the question is how much are you supposed to take? And how often are you supposed to take? I don't think we know that yet, and it's definitely not a panacea, but something else you can try. There are some other alternative medications or alternative practices, I should say that can be considered yoga, Tai Chi out of all the alternative or complimentary activities, I would say Tai Chi definitely has the best evidence on reducing joint pain.

I think is a combination of movement, balance propreoception and mind body. So any of the mind, body practices are likely going to benefit you from what we know Tai Chi seems to have the greatest impact. Other practices are mindfulness practices. So, that's most often known as meditation, but there's a many, many forms of meditation. And then the nice thing these days, there's a lot of different applications or ways we can leverage technology out there to help guide us through different meditations.

And I think the key is just finding the one that's most effective for us or for the person as an individual, and then trying to do it as consistently as possible. And I think if you combined all these things, then, you'll notice that the need for further intervention is limited. So then the question is when do we need to have further intervention? If despite our best efforts with education, diet, complimentary things such as vitamins trying to Tumeric, engaging in mind body practices, we do have other tools in our tool box. And one of the things that I'm trained in rehab medicine, but also as a spine and sports vision is we do injections.

The most common one that I do for patients who have signs of inflammation in the joint, are steroid injections. Also known as glucocorticoid injections. There's been some talk about how safe these are, but I'd say they've been used many years, and they're very good at reducing pain in inflammation in the short term. However, the question is what happens over the long term and generally the pain usually comes back. But it does provide pain relief for weeks to months in the early to moderate stages of foster arthritis, as the arthritis gets more severe, the effectiveness of those injections decreases.

Melanie Cole, MS: Wow. This is such an informative podcast. Doctor Ayed, as we get ready to wrap up, you've given us a lot to think about. And so many people suffer from bone and joint pain. And you've given us so many great bits of advice and ways to prevent and keep ourselves healthy. I'd like you to do that one last time for us, as we wrap up with your best advice about behavioral and lifestyle, things that we can do, whether we are living with one of the types of arthritis as of now, or whether we are hoping to prevent it. Whether we are active for a job, or whether we sit at a computer, give us all of your best advice to help us stay as strong as possible when it comes to our bones and joint.

Nasser Ayaad: I think the one point I wanna leave, all of you with is motion. Is lotion. The more we're able to stay active and engage in activities, exercise that we enjoy, the better off we'll be, in terms of our overall health and our joint and bone health. You incorporate other activities as life progresses, such as Tai Chi water based activities and maintaining a healthy but delicious diet. I think that's going to be the foundation of our overall health and cross your fingers and wish her some good luck as well. And keep a great attitude as best as we can. And I think that's gonna be the foundation of our physical, mental, spiritual, and joint health.

Melanie Cole, MS: Thank you so much, Dr. Ayed, what a great educator you are. And I can hear the passion for your vocation in your voice. And thank you so much for joining us today and sharing your incredible expertise. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on apple podcast, Spotify and Google podcast. For more health tips, please visit weillcornell.org and search podcasts. And parents don't forget to check out our Kids' HealthCast I'm Melanie Cole.

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