Baptist HealthTalk

Joint Health At Every Age

March 08, 2022 Baptist Health South Florida, Jonathan Fialkow, M.D., Charles Lawrie, M.D.
Baptist HealthTalk
Joint Health At Every Age
Show Notes Transcript

There are more than 200 joints in the human body, but chances are you take them for granted until you experience swelling, stiffness or pain. Joint pain is very common, especially as we age.  But is it inevitable?  What can we do to keep our joints as healthy as possible for as long as possible?  

Host, Jonathan Fialkow, M.D., welcomes Charles Lawrie, M.D.,  an orthopedic surgeon with Baptist Health’s Miami Orthopedic and Sports Medicine Institute, to answer some common questions about joint issues.

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Dr. Jonathan Fialkow:

Welcome podcast listeners to Baptist Health Talk. I'm Dr. Jonathan Fialkow, I'm chief population health officer at Baptist Health South Florida, and chief of cardiology, Miami Cardiac & Vascular Institute. There are more than 200 joints in the human body, but chances are we take them for granted until we experience swelling, stiffness or pain, joint pain is a very common condition, especially as we age. So is it inevitable, and what can we do to keep our joints as healthy as possible for as long as possible?

Dr. Jonathan Fialkow:

Today I've invited Dr. Charles Lawrie, an orthopedic surgeon, specializing in hip and knee replacements with Baptist Health, Miami Orthopedic & Sports Medicine Institute, to answer some questions about joint issues. Thanks for joining us, Charles.

Dr. Charles Lawrie:

Thank you, John. I'm excited to be here and talk about joint health today with you.

Dr. Jonathan Fialkow:

Great. So let's get started with some definitions. I always think sometimes we assume people know what we know, and that's not always a good way to start. So explain what is a joint and maybe how it's different from the tendon or muscle or other parts of our orthopedic system, our structural system that can go awry. What actually are joints?

Dr. Charles Lawrie:

Sure. So joints are the parts of our body that exist between bones that allow us to move in space. So they accommodate the motion that is then driven by muscles and tendons. So really the joints of the foundation for that motion, and there's layers and layers of tissue on top of the joints like I mentioned, like muscles and tendons that actually provide the movement for those joints.

Dr. Jonathan Fialkow:

But the joint you said are points where bones connect or where we have hinges or movements in our body, that's where we'd find our joints, right?

Dr. Charles Lawrie:

Correct. Yeah. We typically think of joints, like you mentioned hinges, the knee joint is like a hinge our finger or joints are kind of like hinges. The hip joint is more of a ball and socket type joint. So the different movements that are required by different parts of the body have different types of joints, but the general theme is that the joints allow us to move.

Dr. Jonathan Fialkow:

So what are the joints that more commonly... I'll say either, what are the joints that people complain about more commonly than others? And the second part of that, maybe for this point is there an age related change? In other words, do younger people complain about different joints than older people?

Dr. Charles Lawrie:

Sure. So I think the most common area that people complain about or have problems with during their life is the low back. Just about anyone you know, any age beyond teenagers has had an episode of back pain that usually is laid them up from work or from school. And the back is actually more complex. And it's comprised of many, many joints, different bones at different levels of the back that connect together through the discs. So the back I would say is number one.

Dr. Charles Lawrie:

Beyond the back, the knee is actually the second most common joint of the body that typically gets affected. So we're all very active. We're on our feet all day. We like to run, we like to jump, play sports, and the knees tend to get a lot of the force go through them and get beat up quite a bit over the course of our life. Other things we commonly see would be the shoulder joints, the hip joints, and then less commonly you get into the smaller joints like ankles, wrists, hands, toes, et cetera.

Dr. Jonathan Fialkow:

So is it that the larger joints produce more pain or they're more incapacitating, or let's say if my finger has a joint problem I won't do a thing about it or are they just more common because of whatever reasons you can describe overuse or et cetera? Is it the large joints tend to actually cause more problems or is it just that they rise to a level that people do things about it?

Dr. Charles Lawrie:

Well, we always, being a lower extremity surgeon and a hip and knee surgeon, we always like to poke at our upper extremity colleagues saying we're more important because you can't walk on your shoulders. I mean, I guess you've seen the YouTube videos of guys doing handstands and walking around on their hands [crosstalk].

Dr. Jonathan Fialkow:

Not a solution, Charles, not a solution.

Dr. Charles Lawrie:

I think you kind of nailed it when you said, the joints that we typically see more commonly in the office people complaining of or wanting treatment for are the ones that we have to use during our daily activities. We have to use our knees, we have to use our hips. The back is probably the worst one, because whether you're sitting, standing, lying down, crawling, the back is going to... You're going to feel it if there's a problem back there. So like you said, I think the most common things we see in the office may not be the most common places people have pain, but they certainly are the most used or most necessary parts of our body.

Dr. Jonathan Fialkow:

So as related to the large joints like you talked about lower back or the back, hips and knee, and we'll talk about medical conditions to follow, but what are the more common injuries that you see to those joints? Are there any patterns that we see?

Dr. Charles Lawrie:

Sure. So I think the pain patterns and the pathology or the problems that we see in any given joint change through the spectrum of age.

Dr. Charles Lawrie:

So as we're developing, as we're younger kids, we typically develop growing type pains. When we get into teenage years or early adolescents, early adulthood, we start to see more injuries, traumatic type injuries, sports injuries, things like meniscus tears in the knee, ligament tears in the knee, labral tears in the hip. And then as we get even a little bit older, we start to see more of the degenerative type conditions take over. So things like degenerative disc disease in the back where the spongy material that's in between the vertebral bodies in the back, it's a little bit degenerated and affected, or things like shoulder rotator cuff tears, labral tears.

Dr. Charles Lawrie:

And then finally, as we finally get even older into age, more into a senior citizen territory, we start to see typically more arthritis. So degenerative conditions affecting the entire joint, but most pronounced and most commonly thought of is affecting the cartilage services of the joint, which are the smooth gliding services that the bones are using to protect themselves as they rub against each other. When cartilage is healthy, it's actually more frictionless than rubbing ice on ice. And as it gets degenerated, I'd tell my patients, it's like a horse-drawn carriage being driven down a cobblestone road, very rocky, very bumpy services rubbing against each other.

Dr. Jonathan Fialkow:

Mm-hmm (affirmative). And I think we've all seen people who have those types of experiences. And as I'm getting older, I can share, I'm starting to feel certain complaints like that as well. So how can we keep our joints healthy? I guess you did stratify the different conditions between an injury and maybe a degenerative condition.

Dr. Jonathan Fialkow:

So let's start with injuries. So is there any kind of common type of recommendations you would have as an orthopedic specialist as to how to decrease the chances of injuries? I mean, grant that some we can't, but is there any kind of recommendations, especially for the people who are more active to avoid those types of injuries that can cause joint problems?

Dr. Charles Lawrie:

Sure. So a lot of the injuries, not talking about the high school athletes or even the college athletes, because I think that's a totally different realm and I don't typically see or treat those patients, but people in their 20s, 30s, 40s, who typically show up with injuries or what we dub the weekend warriors who really aren't very active during the week and then they go out on the weekends, and all of a sudden expect to go from zero to a hundred and their muscles just really aren't ready to accommodate the types of activities they're trying to get into.

Dr. Charles Lawrie:

So strategy for injury prevention for the majority of us in our 30s, 40s, 50s, that still like to get out there and play sports or be active, is to really focus on a variety of activity, a variety of exercise, total body strengthening and making sure there aren't any particular deficiencies in any one area, and really making sure that you appropriately ramp up your activity level before you try to jump into something. So if you're going on a big ski trip, maybe starting to think about conditioning a couple months prior, instead of showing up on the slopes and expecting to feel good and be injury free for your trip.

Dr. Jonathan Fialkow:

I think that's great recommendations. And maybe I'll just add that for people who have a regular cadence of physical activity as we get older, we decondition a little faster. So if you go out and you're fairly active and you don't do it for a while, you think may get right back to it. But like you said, ramp up slowly, because you might not have the muscle strength and then you wind up injuring your joints. Right?

Dr. Jonathan Fialkow:

Let's talk a little bit about the generative conditions now more of the, again, as you said, probably more with age, but not necessarily, what kind of lifestyle or what kind of situations might increase the risk of that? And I guess the follow up to that would be what can one do to decrease the chances of significant degenerative joint disease, if anything?

Dr. Charles Lawrie:

Sure. So I think unfortunately a lot of the degenerative joint disease causes are kind of unknown or multifactorial. So there's a variety of different factors that go into the actual finished product, which is arthritis.

Dr. Charles Lawrie:

You know, things that are controllable would be injuries, activity level when we're younger, avoiding really extreme activity, extreme heavy weights in the gym, avoiding injury when we're playing sports, can all help increase the longevity of our joints as we get older. Doing varied levels of activity, I think we all tend to find one thing we enjoy and then we only do that one thing. So some people, run, run, run, run, run, and then they show up with some joint pain because they haven't varied their activities have muscular efficiencies. But unfortunately, like I said, a lot of this is just bad luck. To be honest, things that are out of our control, like the genetic makeup of our cartilage surfaces, the joint surface, the way that our bones and joints developed, so the different angles that our bones developed as they were forming against each other can affect the risk for arthritis.

Dr. Charles Lawrie:

The one major factor that we do have control over, I would say is weight. And we all know that in the US, we've got a bit of a weight problem, obesity epedemic on our hands. The knee, for example, every pound of body weight that people have carrying around in simple daily activities like walking or going up and downstairs up to four or five times, your body weight actually will go through the knee. So I tell patients that the best thing for their buck with their back, with their knee pain for example, is losing one pound, because that's actually your knee losing four pounds, you get exponential results of your weight loss there.

Dr. Jonathan Fialkow:

And have you seen people who, for example, are overweight, have significant hip, knee pain, and by losing weight, the pain I'll say improves, but even resolves. And do you see people who control their pain by losing weight, or by the point they may need surgery or something, it's not going to be improved at that point?

Dr. Charles Lawrie:

Yeah. We absolutely see that. The most extreme example are patients who have gained quite a bit of weight and we refer them from bariatric surgery. We tell them lose the weight and then come back for surgery when your weight is down in the appropriate range for surgery. A lot of those patients come back after they've lost the weight and say, "Well, doc, now I don't think I even need the surgery because my joints are feeling so good after losing all that weight." I'll come back in five or 10 years if things get worse. Which is the happiest thing we can hear, is a doctor who made someone happier without having to intervene on them. So certainly the weight coming off makes a big difference.

Dr. Jonathan Fialkow:

So let me ask you a couple of quick questions, because I think these are things that come up in the community and I even sometimes get asked as a cardiologist, which shows you how much people want to know things that they may not have information about. So how about any interaction with smoking and a joint injury, a joint degeneration.

Dr. Charles Lawrie:

So as far as I'm aware of, there's no link between increased smoking levels, cigarettes, tobacco, and joint injuries as far as I'm aware of.

Dr. Jonathan Fialkow:

Okay, good. Doesn't mean it's okay to smoke, but a correlation. How about alcohol?, any direction with alcohol?

Dr. Charles Lawrie:

Yeah. Heavy alcohol use actually is a known risk factor. And probably one of the most common reasons we'd see a condition called avascular necrosis, which is a specific type of degenerative joint disease that most commonly develops in the hip, but can appear in the shoulders, it can appear in the knee, it can really appear anywhere in the body. And excessive alcohol abuse, even if just for short periods of time in one's life can actually predispose them to developing this. So everything in moderation, enjoy a glass of wine, beer cocktail here or there. But certainly if you're doing any heavy drinking, you need to recognize the overall health consequences and that includes the joints.

Dr. Jonathan Fialkow:

Does avascular necrosis generally require surgery?

Dr. Charles Lawrie:

In most extreme form, it absolutely does. And oftentimes, once it starts, it's very hard to stop in its tracks. So it's certainly something that you want to avoid if you can.

Dr. Jonathan Fialkow:

So you mentioned obviously weight, being overweight puts pressure stress on your joints, any particular food substances or anything dietary that's in correlated with any kind of joint to help and joint disease.

Dr. Charles Lawrie:

Unfortunately I think the studies on nutrition and diet, you probably know better than I do as a cardiologist. Extremely difficult to get any sort of meaningful objective data on that information, but certainly weights and you know what you eat go hand in hand. So healthy, well balanced diet, fruits and vegetables, lean proteins, all the stuff that you would tell your patients, I would say, I would echo from my arthritis and joint patients as well.

Dr. Jonathan Fialkow:

You're pushing my buttons because I like to say nutritional scientist is an oxymoron, there's so many variables we draw conclusions at.

Dr. Charles Lawrie:

It's frustrating.

Dr. Jonathan Fialkow:

Because that's one of the most common questions we get to the office is-

Dr. Charles Lawrie:

What they're eating and it's like-

Dr. Jonathan Fialkow:

You're looking for a solution.

Dr. Charles Lawrie:

You have to tell them you have some objective data and there's nothing.

Dr. Jonathan Fialkow:

There's nothing. What about supplements? I mean, big industry out there, TV late at night and whatnot to pushing these medicines for joint health or whatnot. Any real data supporting them in the medical literature?

Dr. Charles Lawrie:

So I don't want to burst the placebo effect of any listeners out there taking things like glucosamine, chondroitin, but there's really no solid data to support using any of those joint health supplements that are available. And you know as well as I do the supplement industry isn't quite as regulated as something like the prescription drug industry. So you may not even be taking what is written on the bottle or what you think you're taking depending on the brand and where you get it.

Dr. Charles Lawrie:

So I always tell my patients, save your money and spend it somewhere else because I don't think that's going to make a big difference. It certainly is not going to do what a lot of the company's advertise, which is promote joint health or slow the progression of a degenerative condition.

Dr. Jonathan Fialkow:

As I say, you'll have expensive urine if you buy a lot of those supplements.

Dr. Charles Lawrie:

That's absolutely right.

Dr. Jonathan Fialkow:

So great information, Charles, and again, I think it'll be very well received. When, again, I ask you loaded questions, you're doing a great job answering them. When should someone see a doctor? Is there any particular joint related finding symptom or sign that's like, hey man, get it checked out right away or is it generally when it becomes a pain tolerance issue. Any indications as to when or what kind of things it's like, yeah, don't wait, get checked out versus when you're ready to come see us.

Dr. Charles Lawrie:

One of the great of things about working in the Baptist system is there is we are like an army of musculoskeletal providers. There are so many providers that are hyper specialized, hyper focused that I just tell patients if something doesn't feel right to you know your body better than anyone else, that's the time to go and get it checked out. Whether it into an urgent care after an injury to get a quick x-ray and make sure nothing's broken or a longstanding pain you've had that all of a sudden got worse in the hip or knee and you want to come see us to get an x-ray and see if it's arthritis, anything we can do to make you feel better. If something doesn't feel right or you feel like it's slowing you down in your daily activities that you enjoy, that's the time you should go and get it looked at.

Dr. Charles Lawrie:

Emergency is things that are emergent or urgent, are more related to the spine, neurologic type conditions, sudden weakness, sudden numbness, loss of function. Those types of things are emergencies. But for the most part, the musculoskeletal pain we're talking about can wait a day or two in most cases, but there's nothing wrong with getting it checked out. We're here and ready to see you and happy to take care of you.

Dr. Jonathan Fialkow:

And to clarify, are you saying if it's an acute injury that's associated with weakness, tendons or whatever it should, if someone wakes up in the middle of the night and their arms tingly or something, is that the kind of thing you're talking about? So, in other words, the weakness, the lack of sensation, those are important things to differentiate. Is it across the board or is it only what a scenario of if it's like with an injury or something acute?

Dr. Charles Lawrie:

Those things can happen. Those can sometimes happen out of the blue. So if there's something funny going on in your body and it doesn't get better quickly, or it gets worse suddenly, then I think those are good reasons to go to your local urgent care emergency room to get it checked out, make sure there's nothing serious going on.

Dr. Jonathan Fialkow:

Yeah. That's a good point as well. If it doesn't resolve within a couple of seconds or whatever, and even that makes sense. All right, last question. Stiffness, again, trying to differentiate to the listeners about what's kind of, we'll say normal or expected and what's more problematic, if someone wakes up in the morning and the joints are stiff, but then by a little bit of movement, they loosen up and they're okay, is that a sign of a pending problem, or a concern, or is that relatively expected with aging or other situations?

Dr. Charles Lawrie:

I think stiffness could be related either to muscle soreness, it could be related to activity, or it could be related to degenerative conditions like arthritis. Those types of conditions that are more of a slow burn where people feel soreness, stiffness when they wake up, it improves to the course of the day. A lot of people would just kind of live with those and shrug them off. And I think that's an okay approach to take. At some point, a lot of those patients will have an acute worsening, so a sudden worsening of their symptoms, it really starts to affect them, whether it's an increase in pain, increase in stiffness or something just doesn't feel right to them. And that's when they typically come in, they get checked out. So, again, people know their own bodies better than we do, so I would just advise people again, if something doesn't feel right or it's slowing them down, that's the time they should come and get it looked at.

Dr. Jonathan Fialkow:

Great, great stuff. And along with the stiffness, of course, swelling, redness, warmth, that's a different situation as well and you would want to get something like that checked out, but that's you. Do you usually see swelling and redness, for example, and warm joints for again, the general conditions? I'm just throwing out a couple of things that people could see, anything you can lead in explanation of those concerns?

Dr. Charles Lawrie:

Every once in a while, as our joints degenerate, they can get swollen, they can get hot, and generally patients will recognize those things happening to them slowly. Certainly any sort of rapid swelling or really sort of beefy red appearance to joints that happens fairly quickly or doesn't resolve on its own just with kind of at home treatments, be reasonable to go get that checked out sooner rather than later.

Dr. Jonathan Fialkow:

Great information, Charles. Again, obviously your expertise comes through in your responses to my questions, somewhat these are types of points we want to make. Any final comments? You did mention feel, notice your body, pay attention to your body. If you feel something wrong, get it checked out is probably the best overview of recommendations. Is there anything particularly want to reiterate or anything you want to bring up that we didn't talk about.

Dr. Charles Lawrie:

Yeah, I would just say, like I said, we have a very large team here at Baptist, a multidisciplinary surgeons, non-surgeons, people who focus on all types of the bodies. So certainly if something is really affecting your lifestyle or slowing you down, there's someone available who can take a look at it and hopefully do something to get you feel going better.

Dr. Jonathan Fialkow:

Great stuff. Dr. Charles Lawrie, hip and knee specialist, orthopedic surgeon at the Miami Orthopedics & Sports Medicine Institute. Thanks again. And to our listeners, please feel free to send us any thoughts or ideas for future podcast topics to Baptist Health Talk @baptisthealth.net. That's Baptist Health Talk @baptisthealth.net. Stay safe, everyone.

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