Losing weight, strengthening muscles, and increasing flexibility may help you stave off joint replacement.

You may be putting off a doctor visit to address knee or hip osteoarthritis because you believe it will end with joint replacement surgery, but that's not always the case. "Exercise and weight loss are actually the first line of defense," says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital. "It may help prevent the pain and prevent surgery."

Q. An MRI of my knee shows I have a torn medial meniscus and mild osteo­arthritis. What treatment options should I consider?

A. A torn meniscus is a common cause of knee pain, and meniscal tears are especially common in people with osteoarthritis (OA). Menisci are small cartilage pads within the knee that help pad the bones in the joint and provide smooth knee motion. Meniscal tears may cause knee pain in people with OA. If you have knee pain and both conditions are detected, it is common to attribute the pain to the meniscal tear and to recommend surgical repair through an arthroscope. A surgeon inserts the scope and instruments into the knee joint through tiny incisions and trims the torn meniscus in a procedure called partial meniscectomy. Whether this approach results in better function has been debated.

Research We're Watching

Hands-on treatment helps low back pain

Osteopathic manual treatment (OMT) is a safe, effective way to relieve low back pain, according to a study published in the March/April Annals of Family Medicine. In this study, researchers randomly assigned 455 people (ages 21 to 69) to receive various combinations of OMT, ultrasound therapy, or sham (fake) versions of these treatments. At the end of six treatment sessions, participants who received OMT reported less low back pain than those who received sham treatments. OMT-treated participants were also more likely to be very satisfied with their back care, and they needed fewer prescription medicines to relieve their pain. Side effects from OMT were minimal. Ultrasound treatment was not effective, the study found. Researchers did not evaluate the cost-effectiveness of OMT treatments, which can run $100 or more per session. More research is needed to confirm the long-term effectiveness, and cost, of OMT for low back pain.

Many MRI scans for people with lower back pain are not medically necessary, according to a study in JAMA Internal Medicine. Experts used widely accepted criteria to decide, after the fact, if MRI scans ordered for back pain or headaches were really necessary to diagnose or treat the problem effectively. Sometimes a scan is not likely to reveal anything especially useful.

The study found that only 44% of scans of the lumbar spine (the lower back) were appropriate. Of the remaining scans, 56% were deemed either inappropriate or of "uncertain value." The study also looked at MRIs for headache, but found that the clear majority, 83%, were deemed medically valuable.

The idea of having a knee replaced is daunting. But what if both of your knees need repairing? Is one visit to the operating room better than two?

If you are otherwise in good health, it's a conversation worth having with your doctor and rehabilitation team. There are some benefits to replacing both joints during a single surgery (called simultaneous replacement). These include undergoing anesthesia only once, fewer days in the hospital, and only one (albeit prolonged) rehabilitation that lets you resume normal activities sooner than two separate ones. 

Just over the horizon, therapies are being developed to relieve osteoarthritis. But there's a lot you can do to feel better today.

There's a 50-50 chance that, at some point in your life, you'll develop osteoarthritis (OA). Not great odds, considering how much this joint condition can hamper your activity.

The latest research says this traditional Chinese healing practice is worth a try for chronic pain.

For chronic pain in the muscles and joints—lower back pain and arthritis are among the most common tormenters in men—the standard approach usually includes anti-inflammatory medications, physical therapy, appropriate exercise or stretching, and rest. But when usual care fails to get the job done, acupuncture is an increasingly attractive option.

Q. I'm 52 years old. Should I take glucosamine and chondroitin to relieve my osteoarthritis pain and maintain cartilage?

A. Glucosamine and chondroitin are compounds found in healthy cartilage. Because osteoarthritis involves the degradation of normal cartilage, it would seem to make sense that taking supplements of these compounds could help maintain cartilage in people with the condition. Early anecdotal reports and small studies did suggest that the two compounds held great promise for relieving pain related to osteoarthritis. However, glucosamine and chondroitin—either together or alone—did not pass muster when they were studied in large controlled clinical trials. Their effect on pain and cartilage was no better than that of a placebo (inactive treatment) in patients with osteoarthritis of the knee or hip.

Vitamin D supplements do not appear to be effective for reducing pain and slowing the progression of knee osteoarthritis.

Q. I've been diagnosed with shingles. Is there anything I can take for the pain?

A. If you're over age 50 and you've had the shingles pain for less than three days, the current recommendation is that you take a medicine that kills the virus that causes shingles—varicella-zoster virus. The two medicines recommended most often are famciclovir and valacyclovir.