Dr. Thomas Schmaltzried suffers from the very thing that helps keep him in business.
The 53-year-old Rolling Hills Estates resident - who is the medical director at the St. Vincent Medical Center Joint Replacement Institute in Los Angeles - has osteoarthritis.
More specifically, Schmaltzried suffers from knee osteoarthritis, which occurs when the articular cartilage of the knee wears down, he says.
"As the cartilage starts thinning, it starts altering the mechanics of the knee and can be associated with an inflammatory response, with the end point being when all the cartilage is worn away and you're rubbing bone on bone, and that hurts," said Dr. Ronald Reichman, an associate clinical professor of medicine at UCLA Medical Center and Cedars-Sinai Medical Center.
People with knee osteoarthritis have pain, stiffness, loss of motion and inflammation, Reichman says. These factors can lead to a decreasing ability to walk, run or do other normal activities.
Ironically, though, walking and otherwise keeping active helps prevent the arthritis from progressing.
So the Arthritis Foundation hopes to raise awareness and encourage people to keep active during its annual Arthritis Walk, taking place Saturday in Santa Monica and Sunday in Valencia.
"The joints need to be
moved," Schmaltzried said. "Synovial fluid is what nourishes cartilage. Synovial fluid is what is produced in response to motion. So I encourage people to do what they can, to keep moving, and I try to follow the same advice myself."There are two forms of exercise Schmaltzried and Reichman recommend for knee osteoarthritis patients: exercises that strengthen the muscles around the knee and range-of-motion exercises.
"Our bodies are magnificently designed, and the knees are an incredible joint that are designed to do so much work," Reichman said.
"But if we change the anatomical alignment of the knee, then you start wearing out the cartilage at a more rapid rate," he said. "So by strengthening the muscles around the knee joint that help hold the knee in the proper position, it will eliminate the wobbling, which accelerates the osteoarthritis."
The two main muscles impacting the knee are the quadricep, which helps pull the knee straight, and the hamstring, which is responsible for bending the knee, Reichman says. Another important muscle is the pes anserinus, which is where three muscles join together in the knee.
Range-of-motion exercises are what keep these muscles stretched and flexible and preserve the joint's function.
People with full range of motion should be able to sit in a chair and straighten their leg parallel to the ground, and then take their foot and tuck it underneath them so the knee is bent more than 90 degrees, Reichman says.
"If you've lost any range of motion, by reclaiming that range of motion by doing range-of-motion exercises it will decrease the stress and the strain both on the joint and the muscles in the rest of your body," Reichman said. "If you haven't lost motion, then by doing range-of-motion exercises to maintain that motion is important."
One basic exercise Reichman recommends is sitting in a chair and straightening the knee all the way out. You can add ankle weights if the exercise is too easy, he says.
But people who suffer from osteoarthritis should consult a doctor before beginning an exercise regimen, Reichman says, because there is a fine line between discomfort and pain.
Reichman recommends working the joint just to the point of discomfort, but to make sure not to overdo it, or the pain may cause you to postpone future workouts and therefore the range of motion and function will decrease.
"You need to go up to the point just where it starts to feel uncomfortable, not beyond," Reichman said. "And by doing that repetitively you will increase the motion very gradually.
"So if you've lost motion, you're not going to recapture it in a week or a month," he said. "The old stand-by was it takes three times as long to regain the motion as it took to lose it."
Schmaltzried has not lost any range of motion and to ensure he doesn't, he has a regimen of moderate, regular exercise that includes light jogging, cycling, and work on an elliptical machine and StairMaster. He also stretches every day.
For Schmaltzried, a 6-foot-10 former Stanford University basketball player, being able to bend his knee is important because it allows him to do simple things, such as get into a car.
He believes his height, , contributed to his knee osteoarthritis.
However, the most significant risk factor for the condition is being overweight, because those with extra weight put additional pressure onto the joint, which isn't made to handle the excess stress, Reichman says.
For those who are overweight and have osteoarthritis, the best way to prevent it from progressing is to lose weight, he says, though cartilage loss that already has occurred is irreversible.
Anti-inflammatory drugs, which Schmaltzried uses, can be used to block the inflammation, Reichman says.
If the cartilage in the knee completely wears away, then joint replacement is a treatment option.
"There's a lot that happens before joint replacement," . "The real indication for joint replacement is what we call end-stage osteoarthritis, where the articular cartilage is completely worn away and you've got bone to bone contact. And it's painful because of that. The real reason to have joint replacement is for unremitting pain."
So far, Schmaltzried's exercise and stretching regimen have kept him from becoming like the patients he sees at work every day.
His advice, as both a doctor and as someone with first-hand experience of osteoarthritis: "You have to listen to your body and every patient has to find a regimen that works for them."
Source: http://www.dailynews.com/news/ci_18186451?source=rss
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