Got Achy Knees?

I came across this on a massage therapist Facebook page. If you've got achy knees from osteoarthritis (not any other kind), this is helpful information.

Posted by Harriet Hall on June 11, 2013

Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older. Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur. This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients.

Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound. Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)

Exercise – strong evidence for effectiveness
Weight loss – moderate evidence for
Acupuncture – strong evidence against
Physical agents (TENS, ultrasound, etc.) – inconclusive
Manual therapy (chiropractic, massage) – inconclusive
Valgus-directing force brace – inconclusive
Lateral wedge insoles – moderate evidence against
Glucosamine and chondroitin – strong evidence against
NSAIDs – strong evidence for
Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
Intraarticular corticosteroid injections – inconclusive
Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
Growth factor injections and/or platelet-rich plasma – inconclusive
Needle lavage – moderate evidence against
Arthroscopy with lavage and debridement – strong evidence against
Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
Valgus-producing proximal tibial osteotomy – limited evidence
Free-floating interpositional device – no evidence; consensus against

This is Kelly again....I've re-organized the list, below, grouping things by the study's findings about them.

Exercise – strong evidence for effectiveness
NSAIDs – strong evidence for

Weight loss – moderate evidence for

Physical agents (TENS, ultrasound, etc.) – inconclusive
Manual therapy (chiropractic, massage) – inconclusive
Valgus-directing force brace – inconclusive
Acetaminophen, opioids, pain patches – inconclusive
Intraarticular corticosteroid injections – inconclusive
Growth factor injections and/or platelet-rich plasma – inconclusive
Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive

Lateral wedge insoles – moderate evidence against
Hyaluronic acid injections – strong evidence against
Needle lavage – moderate evidence against
Acupuncture – strong evidence against
Glucosamine and chondroitin – strong evidence against
Arthroscopy with lavage and debridement – strong evidence against

Valgus-producing proximal tibial osteotomy – limited evidence
Free-floating interpositional device – no evidence; consensus against

What I found most interesting was that weight loss only had moderate evidence of effectiveness. Doesn't mean it's a bad idea but it's not as effective as exercise (movement) and NSAIDs (such as aspirin, ibuprofen, naproxen, etc.).

And, yes, I noticed that massage therapy was "inconclusive". That, frankly, matches my experience too. I can bring some small temporary relief but I haven't been able to do any better than that with osteoarthritis.

Get Your Body Ready for the Fourth

Have you got some time off for Independence Day? Do you need to get your body ready for your 4th of July weekend? Let's do something about that with massage therapy. Your options next week are:

 

CAPITOL HILL

 

Tuesday, July 2: noon - 4 pm

Wednesday, July 3:  6 pm - 9 pm (change in schedule because of the holiday)

 

To schedule a massage on Capitol Hill, go to Schedulicity and schedule yourself, OR email me or text/phone me (202-744-1878).

 

TENLEY

 

Monday, July 1:  2 pm - 8 pm

Wednesday, July 3: noon - 4 pm

 

To schedule a massage at Tenley Sport & Health, call the gym directly (202-862-3000).

 

Be well, enjoy the holiday, don't forget your sunblock (!), and I look forward to working with you again.

Massage at your desk

Just finished a great lunch-time presentation on doing self-massage at your desk over at GAO. Lot of fun, lot of "oooohs!" from the participants.

Would you like a similar offering at your place of work? Let's talk!

Different Hours for the 4th of July week

Since next Thursday is a holiday, I'm opening up evening hours on Wednesday, July 3. You can get a massage between 6 pm and 9 pm at my Capitol Hill location.

Easiest way to schedule? Go to Schedulicity and schedule yourself! Quicker and easier than playing phone tag with me.  :)

A Fibromylagia Break-Through

It looks like researchers may have finally figured out what causes fibromyalgia, which means it could be treated at the source. Given how many people I know with this condition, this could be some of the best medical news I've heard in a while.

What I See, What I Don't

LOVE this blog entry.

 

There are a lot of people who land on my table who believe that all their body problems would be eased if just lost some weight. Some times it would help. Sometimes it would make very little difference.

Here's the thing that matters so much to me in my practice: you are beautiful and perfect just the way you are. Your body is doing the very best it can and is always moving towards health. It is working, for heavens sake, because you are still breathing and can still move.

Can I help you hurt a little less, move a little more smoothly, breathe a little easier? Sure and it makes me happy. But, trust me, I don't look at you and think "fat". I *may* look at you and think "shoulders look tight" or "looks uncomfortable" or "wonder what I can do to make his/her day better" or "what challenge will this new person bring me". But I'm never thinking "fat".

Get your massage on next week

It's a beautiful day, my schedule is getting full, and I think you would love a massage (I'm not wrong, am I?). Here are your options next week.

 

Tuesday, June 25:  5 pm, 6 pm (Capitol Hill)

 

Yes, that's all I've got!

 

To schedule a massage, you have heaps of options:

 

1.  Go online and schedule yourself.

 

2.  Email me.

 

3.  Call / text me (202-744-1878)

 

Go get yourself a dose of sunshine and I look forward to working with you again.

Insights into a pain syndrome

The Washington Post Health section had an article this Tuesday about myofascial pain syndrome. It's a good piece. I don't do the dry-needling mentioned in the article but I am certified in myofascial release, which can provide another treatment option.

It's also got some good illustrations explaining knots / trigger points in muscles. I recommend giving it a read.

How much does your head weigh on the computer?

I know how very very difficult it is to sit up straight at a computer (she says, pulling her head back and sitting up straight). This graphic (via Erik Dalton and the Back 2 Health FB page) should provide some encouragement.

I'm thinking of printing it out and taping it to the wall behind my monitor.

Belly rubs

Last month I ended up back in the hospital for 5 days. It turns out that the scar tissue from my surgery in December has wrapped itself around my small intestine. The small intestine can't move the way it needs to (I didn't realize it needed to move that much!) and I ended up with an intestinal blockage.

Very very painful. Would have sworn it was appendicitis if I still had an appendix!

The docs got me past the worst of it and said my body would, somehow, clear all this up on its own. I'm thinking "on it's own, my body got things gummed up, how is it going to straighten itself out on its own?".

So, I called Mike Duggan, the instructor for the myofascial release class I took last year. He's doing fascial release work on my abdominal viscera -- not just the small intestine but the large intestine and all the organs in my abdomen (scars occur in the fascia). He's working to get that fascia un-stuck and free-moving again.

It's very gentle patient work but it's, slowly, starting to have an effect. I think it will take 4-8 sessions to really get things unstuck and moving well again. I suspect my abdominal fascia has been a bit "sticky" for a very long time.

I love that I know someone who can help me with this. I love that I've taken this training so I understood what was happening and how I could help things along. I love that I also know how to do this for you as well.

Fascia is cool stuff. Scars are fascinating. I'm happy that I took the certification series last you so I can help you and myself!