Dr. Lux on the knee

Knee pain forced me to see a doctor, and it also prompted me to research and learn more about how to manage and live with knee pain, and what is best: medication, rest, or surgery? I found what I was looking for in Dr. Howard Lux, a renowned American orthopedic surgeon with nearly 30 years of experience, whose medical career was built on the idea that our joints, especially the knees, can remain strong and functional throughout life, provided they are cared for and maintained. He believes that knee pain, stiffness, tissue tears, and even osteoarthritis should not restrict our movement; they do not necessarily require stopping activities we enjoy or need to do, nor do they mean the person has aged. Rather, they may signal the need to reconsider certain aspects of our lives and that it is time to get up and walk. A torn meniscus, which acts as a cushion between the knee bones, does not necessarily mean the person will develop arthritis. Even if some meniscus is present, it will not necessarily progress to bone-on-bone friction. And even if it reaches that stage, it does not always mean physical activities must be restricted; some patients with bone-on-bone arthritis continue to run, and some still do. But don’t running, walking, and other high-impact movements wear down the cartilage? Dr. Howard’s answer: No. Movement and using the knee do not wear down cartilage; on the contrary, movement nourishes it. Cartilage does not derive nutrients from the blood but obtains them exclusively from synovial fluid (the viscous fluid that fills the knee joint). When you take a step, you bend the knee and bear weight on it, which distributes synovial fluid around and into the cartilage, delivering nutrients to it. This movement also stimulates cellular processes that drive cartilage to build new collagen and repair itself. Thus, using your knees helps maintain their integrity; the biggest mistake people with knee pain make is stopping movement. Rest is the enemy of the knees. Moreover, most knee arthritis cases are not caused by wear and tear, although some are. Knee injuries, such as an anterior cruciate ligament (ACL) tear, can change a person’s movement pattern, contributing to wear that eventually leads to arthritis. Genetic factors also play a role, although studies suggest their overall impact is limited. Surprisingly, being overweight is not a primary cause of arthritis. This may seem counterintuitive, but obese individuals are more prone to hand arthritis compared to others, an issue that cannot be explained if arthritis results solely from excess pressure due to body weight. So, what can we do to prevent knee pain or manage it if it occurs? The first thing I ask my patients to do is walk for 10 minutes daily. Engage in sports that place load on the joints, which benefits metabolic health, and walk for 30 to 60 minutes daily, if possible. Walking is like medicine for arthritis; it helps improve metabolic health, reduce inflammation, and relieve pain. Some believe exercise will cause them pain or worsen their joint condition, and exercises may seem strenuous or uncomfortable, but this does not mean they are incapable of performing them or that they will wear down cartilage. Discomfort can be felt without causing actual damage.

Furthermore, advancing in age does not mean losing the ability to train, adapt, and evolve. Ahmed Al-Sarraf