 Hi, my name is Jennifer Root. I'm a physical therapist at Whitman, Michigan Health. I'm here today to provide you with more knowledge on managing your joint pain. Let's look very briefly at normal anatomy to help you understand what can go wrong. This picture is of a normal hip. The hip joint consists of two bones, the pelvis and the femur or thigh bone. These two bones join together to form a ball and socket joint. This joint allows for a lot of movement in many directions. The surfaces of both bones are covered with articular cartilage where they come together. This protects the bones from friction. The stability of the hip is provided by several ligaments that are not pictured here. These ligaments are deep, short and strong, so it is very difficult to strain them. To protect the tissues that are close to the bones, we have what are known as bursa. These are fluid filled sacs that sit over the bony prominences and prevent the muscles and ligaments from rubbing on the bones as we move. One of the most commonly irritated bursas sits over the greater trochanter, which is the large bone you can feel on the outside of your hip. This is a picture of a normal knee. The knee is made up of four bones, the femur or thigh bone, the tibia or shin bone, the fibula, which is the small bone on the outside of your leg, and the patella or your kneecap. The knee is a hinge joint, which basically means that it has two motions, bending, reflection, and straightening or extension. There are two kinds of cartilage in the knee. The first is articular cartilage, like in the hip, which covers the ends of the bones and protects them from friction. The second is fibrous cartilage, which in the knee is called a meniscus. These provide cushion and shock absorption for the joint. There are two menisci in the knee, a lateral, which is on the outside, and a medial, which is on the inside. There are also four major ligaments that provide stability in the knee. First, the medial collateral ligament and the lateral collateral ligament are on each side of the knee. These prevent too much side-to-side movement of the joint. On the inside of the knee, we have the anterior cruciate ligament, or your ACL, and the posterior cruciate ligament, or your PCL. These ligaments prevent too much front-to-back movement or twisting. There are also bursa in the knee. These are fluid-filled sacs, like we saw in the hip. One of the most commonly irritated ones is under the patella. Osteoarthritis is also known as degenerative joint disease, or DJD, or it's known as wear and tear. It occurs as the articular cartilage of the joint surfaces gradually wears away over time and becomes rough and gets little holes in it. You may hear the term bone-on-bone. This means the cartilage protection is worn away and the two bones directly contact each other. Osteoarthritis causes the joint to become stiff and painful. Symptoms of osteoarthritis include limited motion, difficulty walking, pain, stiffness, and swelling. But not all joint pain is arthritis. There are many things that can go wrong with a joint, and just because you have pain does not mean you have arthritis. Some of the common things that can go wrong are as follows. Bursitis is an inflammation of the bursa. It is usually caused by repetitive movements or a new activity. Tendonitis is more common in the knee than in the hip. Like bursitis, it is usually caused by repetitive movements or a change in activity. Tendonitis is an inflammation of the tendons, which connect muscle to bone. Ligament tears are usually due to a traumatic injury and again are more common in the knee than in the hip. Most commonly these injuries occur with sudden forces such as being hit in the joint or with twisting motions. Muscles can be injured or overused or are injured with trauma such as a fall. There are many muscles around both the hip and the knee joint. A meniscus in your knee can be torn easily, especially with a twisting injury. And finally, sometimes what you think is hip or knee pain is actually caused by irritation to the sciatic nerve in the low back, buttock or back of the leg. This nerve runs down the outside of your leg and can give you pain into the hip or knee. Looking at all these types of injuries, sometimes it's difficult to determine what is wrong because the symptoms are all very similar. Most of these injuries result in pain, swelling, limited motion or difficulty walking. It's important to see your doctor so that you can get an accurate diagnosis. These injuries can be treated conservatively with rest, medication, physical therapy and sometimes injections. However, sometimes surgery is necessary. I want to speak a little more in depth about the management of arthritis. Although arthritis cannot be cured, that does not mean you have to live with the pain. There are many options you have to help manage the symptoms and live a full and active life. We're going to cover the importance and implications of diet, supplements, exercise, medication, injection, surgery, physical therapy and what you can do to protect your joints. When someone says the word diet, the first thing that most people think of is losing weight. Although this may be necessary, it is also important to remember that a well-balanced diet with good nutrition and tissue hydration is vital to your health. Further, by reducing your weight, you will decrease the amount of stress that is placed on your joints. Along with good nutrition comes supplements. Diet supplements are not regulated by the FDA and this means that manufacturers can make claims about the effectiveness that are not independently evaluated. This also means that different brands do not necessarily contain the same proportions of the active ingredients. You should always contact your physician or pharmacist before beginning any regimen of supplements to make sure that they will not interact with any other medication that you are taking. Glucosamine chondroitin is a well-known supplement that claims to reduce arthritis pain by increasing cartilage and making it stronger. Approximately 50% of people taking this supplement report that they have a decrease in pain after about two to three months. MSM is another common supplement. It is found in most foods as sulfur, but it is destroyed in most forms of cooking and preparation and therefore supplementation may be beneficial. It is claimed that this supplement helps in reducing inflammation, strengthening cartilage and supporting healthy joints. Cod liver oil has also been suggested to slow down cartilage degeneration and also to reduce the chemicals that cause pain and inflammation. Exercise is important as it keeps our joint lubricated, our muscles strong, and helps to keep your weight under control. Sometimes, however, it is hard to exercise because it can make your joint pain worse. There are many different forms of exercise that you can try. Aquatic therapy takes all the weight off your painful joints and the warmth of the water can be very soothing. Low-impact activities such as walking or bike riding can be helpful to increase joint motion and strength without excessive weight-bearing. If you can tolerate it, some form of weight-bearing or resistance exercise is very beneficial in strengthening and can also help to improve bone mass and reduce the risk factors of osteoporosis. If exercise is difficult, then sometimes physical therapy can help you to get started with a carefully designed program to meet your individual needs. Physical therapy can be beneficial to those that do not require surgery and also pre- and post-operatively. There are many types of therapy that can be used. These include exercises to stretch and strengthen your muscles. Modalities such as ultrasound and electrical stimulation can be used to ease pain and stimulate healing. And manual therapy can be used to increase joint motion and reduce tissue tension. Gate training is important to improve the quality and safety of mobility both at home and in the community. And aquatic therapy is used to improve strength and mobility using buoyancy to reduce weight-bearing on the joints. There are many different medications that your doctor may prescribe to help manage your symptoms. These can be broken into two groups. The first group would be anti-inflammatory medicines. These include ibuprofen, naproxen, and Celebrex. These all have side effects, and as you may be aware, the use of anti-inflammatory drugs has been significantly reduced in recent years due to the risk of heart-related side effects. Your physician would be able to discuss the risks and benefits of any medication that they prescribe for you. The second group of medications would be pain medications. They can be over-the-counter, such as Tylenol or acetaminophen, or aspirin. Other prescription pain meds can include acetaminophen-opiate combinations, such as Lortab, Vicodin, Tylenol with codeine, or long-lasting opiates such as Oxycontin. Again, your physician can discuss the risks and benefits of each medication. Injections can be used to deliver medication directly to the joint. These are commonly used in the knee, but rarely used in the hip. Corticosteroids are used to reduce inflammation and pain in the joint. They can be given alone or combined with a painkiller to give more immediate pain relief. They can be given once or sometimes in a series, and their effects last anywhere from one week to about six months. Sinvisc and suparts injections are performed only for the knee. These injections are designed to increase the lubrication of the joint and therefore reduce pain. This is sometimes mistakenly referred to as artificial cartilage injections, where in reality the injection stimulates the body's production of joint fluids, which increase the cushioning in the joint. These injections are given in a series of three to five injections spaced over several weeks. There are several forms of surgery that can be performed to ease joint pain. The least invasive of these is arthroscopic surgery. This is often performed to debride or clean out arthritic joints and also repair or remove torn cartilage or meniscus. This is commonly performed on the knee and less commonly on the hip. Joint resurfacing is performed primarily for arthritis of the hip. It is a relatively new procedure that leaves more of the original joint intact than a total joint replacement. The recovery time is less than for a total joint replacement, but not everyone is suitable for this surgery. Your orthopedic surgeon would be able to discuss the most appropriate surgery for you. A partial replacement can be performed in knee joints. This is typically indicated if one portion of the joint is severely damaged, but the rest remains relatively healthy. Again, the recovery time is less than for a total joint replacement, but not everyone is appropriate. Here we have pictures of a total hip replacement and a total knee replacement. Looking at the hip, you can see that there are two primary components to the prosthesis. The surgeon replaces the ball of the joint by removing the bone and then drilling a hole down the center of your thigh bone, where the shaft of the prosthesis is placed to hold it in place. The socket is then shaved down and a cup is put into place. In a total knee replacement, both joint surfaces are ground down and then a cap is tapped into place. A spacer is placed in the joint to act as the cushioning. The prosthesis in either case can be made of several different materials. Each surgeon has their own preference. However, some of the options include stainless steel, titanium, ceramic, and polyethylene. Following joint replacement surgery, some form of rehabilitation is necessary. For total knees, this tends to be a little more intensive and lengthy than for total hips due to the muscles involved in the design of the joint. Finally, there are many daily activities that we perform that cause general wear and tear or stress on our joints. By adjusting the way that you perform basic activities, you can protect your joints from further damage and help to reduce pain and increase function. You should be careful to avoid static holding positions such as holding up the newspaper when reading. Try laying it on a table. Make sure that you use good posture. Always use good lifting techniques and make sure that your shoes fit correctly and have good support. The key takeaways for optimal joint health are number one, eating a balanced, healthy diet and staying hydrated. Number two, engaging in a regular exercise. And number three, identifying the source and cause of your joint pain so that it can be treated properly. As you can see from everything we have discussed today, the hip and knee are not simple joints. There are quite a few things that can cause you pain, loss of motion and difficulty walking. There are also quite a few things that can be done to treat your problem. The key is identifying the root cause of your symptoms and then designing a treatment program to address them. Some options for taking the next step in managing your joint pain are number one, take our free five minute online joint pain assessment and then discuss those results with your doctor. Or number two, for more information on our comprehensive orthopedic and rehabilitation services, visit www.midmichigan.org backslash bones and joints. I hope that you found this information on managing your joint pain helpful. At MidMichigan Health, we celebrate the power of health throughout life with you.