Bones and joints Archive

Physical therapy may be an effective alternative to surgery in relieving joint and back pain.

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Exercising may be the last thing you want to do when you have a sore knee or aching back, but it might be the first thing you should do. Physical therapy has long been recommended following surgery. But for some, trying physical therapy before opting for surgery may be the better choice.

"You may be able to spare yourself the expense, pain, and recovery time of surgery," says physical therapist Karen Weber, clinical supervisor at Harvard-affiliated Spaulding Rehabilitation Outpatient Centers in Braintree and Quincy, Mass.

In the journals

Corticosteroid injections are used to ease short-term knee osteoarthritis pain, but a new study in the May 16, 2017, Journal of the American Medical Association suggests the treatment may not help in the long term.

Researchers recruited two groups of 70 people, average age 58, with knee osteoarthritis. One group received 40 milligrams of the steroid triamcinolone (Kenacort, Kenalog, Artistocort) every three months for two years, while the other group got placebo injections. By the end, pain scores — measured on a scale from zero for no pain to 20 for extreme pain — had dropped by only 1.2 points among the steroid group, while the placebo group's score dropped by 1.9 points, neither of which was clinically significant.

Aches or numbness may keep you from doing the things you love. Find out what's behind your pain, and do something about it.

Hand pain becomes common as we get older. Tingling and numbness, aching or locking joints, and difficulty grasping objects are frequent complaints. But don't make your own diagnosis and suffer in silence. "It's difficult to discern between different types of hand pain. Some have overlapping symptoms," says Dr. Sang-Gil Lee, a hand surgeon at Harvard-affiliated Massachusetts General Hospital.

Dr. Lee advises that you seek treatment as soon as possible for persistent hand pain, before it gets so advanced that it's tough to use your hands for even the simplest jobs, like brushing your teeth or buttoning a shirt.

Men considering surgery for back pain relief may benefit from more conventional treatment methods.

Back pain remains one of the top reasons people seek medical care for pain. For many older men, the source of their pain is spinal osteoarthritis.

Finding relief is an ongoing struggle, but men should think hard before turning to surgery without first trying less invasive treatments. "No one ever goes from initial back pain to needing surgery, unless the pain is due to something like cancer or an infection," says Dr. Steven Atlas, an internist with Harvard-affiliated Massachusetts General Hospital. "You can't fix arthritis. Surgery may help control the pain in some cases, so you can function better, but it won't cure your pain — no matter what doctors may promise."

This common type of arthritis can show up suddenly and cause debilitating pain.

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The great artists Ludwig van Beethoven, Luciano Pavarotti, and Leonardo da Vinci had more than extraordinary talent in common; they were also sufferers of a type of inflammatory arthritis called gout. You may be at risk of joining their ranks if you have any potential triggers for the condition. "Most people are surprised by their initial gout diagnosis, unless they have a strong family history," says Dr. Mark Fisher, a rheumatologist at Harvard-affiliated Massachusetts General Hospital.

About gout

Gout is mostly a man's condition, although women can experience it, too. It's caused by a buildup of uric acid — a waste product from the breakdown of natural chemicals called purines (an essential part of DNA).

In the journals

Studies have shown that regular activity can help older adults with arthritis stay independent. How much is enough? Research published online Dec. 28, 2016, by Arthritis Care & Research suggests you may need as little as 45 minutes per week.

Federal guidelines recommend 150 minutes of moderate activity per week to prevent premature death and serious illness. However, reaching that number is tough to reach for people with arthritis; in fact, only one in eight men with knee arthritis meet this standard. In this study, researchers tracked several years of fitness activity for 1,629 adults (44% of whom were men), ages 49 to 83, with osteoarthritis in the hip, knee, foot, or some combination. Specific exercises or activities were not recorded, only the time invested per week.

How to distinguish the symptoms from other conditions, and what to do about treatment.

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When your joints ache, you may chalk it up to an old injury or to osteoarthritis — the wearing away of cartilage that's common in older age. But for two million people in the United States, aching joints are caused by rheumatoid arthritis (RA) — when the immune system mistakenly attacks the tissues lining the joints.

"People commonly assume RA pain is due to aging, overuse, or even the flu," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center, and medical editor of the Harvard Special Health Report Rheumatoid Arthritis (health.harvard.edu/RA).

Research we're watching

Because several studies have connected inflammation to bone loss and fractures, researchers from Ohio State University wondered if dietary choices that contribute to inflammation are also related to declines in bone density.

The team looked at the diets of 160,191 postmenopausal women enrolled in the Women's Health Initiative and assigned each of them a dietary inflammation score based on 32 foods the women reported consuming in the three months prior to their enrollment. All the women completed dietary questionnaires and had scans to measure bone density at the beginning of the study and three and six years later.