Pain Doc - Ask Dr. P - The Pain Doc

Can You Grow Cartilage By Eating Certain Foods or Supplements?

by Pain Doc | Feb 21, 2011 | Uncategorized

Cartilage, specifically, hyaline cartilage is the tissue that lines the articular (contacting) surfaces of bones. If the cartilage deteriorates it can lead to pain and inflammation in the weight bearing joints, mostly the knees and hips, as nerve endings in the joint get exposed to abrasive action. This can force the sufferer to elect for knee or hip replacement surgery, as well as artificial disc surgery. Smaller joints such as in the fingers can be affected as well.

Cartilage is made by special cells called chondroblasts. These cells make the extracellular matrix of cartilage, comprised of Type II collagen and ground substance, which is comprised of proteoglycans and elastin. Another important constituent is hyaluronic acid, which improves the resiliency and hydration of cartilage. Without going into too much detail, a proteoglycan is a protein molecule with a chain of sugar molecules attached called glycosaminoglycans, or GAGs. The two GAGs that are best known to the public are glucosamine sulfate and chondroitin sulfate, the key ingredients in most cartilage and bone supplements. Glucosamine sulfate is the one found in the exoskeletons of shellfish, as well as some fungi.

Persons suffering from the various forms of arthritis such as osteoarthritis and rheumatoid arthritis have cartilage tissue that is undergoing inflammation and degradation, either mechanical in nature or auto-immune.

Collagen is a group of naturally occurring proteins found mostly in animal connective tissues– tendons, ligaments, and skin. What makes collagen useful in cartilage is its ability to withstand pressure and return to its original shape (deform and rebound). This is what is necessary in joints of the human body, which are subjected to forces multiple times throughout the day. The simple act of sitting or standing places enormous pressure on the joint surfaces of the feet, knee, hip and lower back. Using one’s hands to type or grip things places pressure on the smaller joints of the fingers and wrists.

So, if your have thinning cartilage in your knees, can you grow it back simply by taking glucosamine sulfate and chondroitin supplements? Unfortunately, the latest research on their ability to reduce joint pain show minimal improvement. Why is this?

It’s because that, just because you give the body supplements through your diet, it doesn’t guarantee that your body will do things you want it to do with these nutrients. They could be going somewhere else besides you joint, which is more likely the case.

The harsh reality regarding all muscle and connective tissue building dietary supplements such as collagen, bone broth, protein powder, etc. is that they get broken down in your GI tract into their amino acid constituents, and need to be reassembled. But as mentioned, your body will not reassemble them into the desired tissue 100%. These proteins may go to your skin, hair, nails, or may be made into an enzyme or cell receptor. In other words, the amino acids in those glucosamine sulfates pills may wind up forming new hair, not cartilage.

That being said, if you hope to build cartilage through your diet, it may be more effective to eat the actual cartilage. At least it consists of the actual amino acid sequences in the proper percentage the body uses to build cartilage..

Consider consuming bone broth soup regularly if you are suffering from achey joints; or do so as a preventative measure. Most butcher shops in the grocery store will have large joints of beef or pork, usually the hips, knees and spine. And they are cheap, usually less than $2.00 a pound. They will saw them in small pieces for you if you request. What’s great about them is that they still have tendons and cartilage pieces attached. Get a large pot, add a gallon of water and bring to boil; lower temperature and boil for two hours. The broth will be rich in nutrients that your body can use to help regenerate damaged cartilage.

For preventive measures to protect the health of your joint cartilage, remember to:

do functional exercises regularly to improve whole-body muscle & joint responsiveness
avoid sitting for too long at your work
avoid activities that require repetitive trauma to the joints such as long distance running
avoid ingesting toxins like cigarette smoke, alcohol, and highly processed food
get enough daily rest to allow your body to regenerate
drink filtered water (not distilled)
get enough sun exposure for Vitamin D synthesis

Burt’s Bees Res-Q Ointment for Minor Injuries

by Pain Doc | Feb 17, 2011 | Uncategorized

Today, a patient of mine returned from a trip to Australia. She relates how her vacation was interrupted by the recent flooding in that country, and by something else– a nasty spider bite.

Now, if you’ve ever watched Discovery Channel and saw one of those nature shows on extreme insects, you’ll know that many come from Australia. There’s something about that country, perhaps its isolation that makes it a haven for dangerous, poisonous creatures.

Anyways, this patient says she was bitten on the leg by a black spider (probably a funnelweb spider). She said she “saw” the poison slowly work its way up her leg towards her knee (there was probably some reddening/ inflammation that spread outwards from the spider bite). Her companion told her not to move her leg, as it would spread the poison faster. Panicking, she took out the only first aid item she had on her– a small tin of Burt’s Bees Res-Q ointment— and rubbed it around the spider bite.

Almost instantly, she started to feel relief. An hour or so later, the swelling was gone. She said that the product literally “saved her life.” She was absolutely thrilled, from not knowing whether she would die from this bite, to feeling much better in a matter of minutes. She couldn’t say enough good things about the Res-Q ointment, and made sure I knew about it.

Curious, I decided to check it out. The main ingredient in Res-Q is comfrey, a controversial herb that has shown to have therapeutic benefits, but may also cause liver toxicity if taken internally. Comfrey contains allantoin, a cell proliferant that speeds up the natural replacement of body cells.

Historically, comfrey was used in an attempt to treat a wide variety of ailments ranging from bronchial problems, broken bones, sprains, arthritis, gastric and varicose ulcers, severe burns, acne and other skin conditions. It was reputed to have bone and teeth building properties in children, and have value in treating “many female disorders”.

Most recently, in a placebo controlled study comfrey was found to decrease back pain when used topically.

If you visit the Burt’s Bees website and check out their Res-Q product, you will notice a lot of positive reviews– people raving about how the product helped reduce the “red nose of colds,” bruises, skin irritations, minor burns, bug bites, and cracked and chapped skin.

While these reviews are no substitute for a properly conducted scientific study with control group, most doctors agree that anecdotal evidence can be equally compelling when evaluating a particular therapeutic product or procedure.

Now, time to sign off to buy a can of Res-Q myself…

How to Improve the Ergonomics of Your Computer Workstation Set Up

by Pain Doc | Feb 11, 2011 | Uncategorized

If you have a job that requires continuous sitting and typing at a computer workstation, it is extremely important to ensure that your workstation is set up ergonomically, with respect to your body.

“Overuse injuries,” or repetitive strain injuries (RSIs) can develop in the fingers, hands, wrists, forearm, elbow and shoulder if you are not careful. RSIs, if allowed to take root can lead to chronic, recurring pain in some people, even when they stop the offending movements. I”ve seen extreme cases where the individual developed bilateral carpal tunnel syndrome and resorted to surgery in both wrists, all because of repetitive use on the keyboard.

A key factor in these types of injuries is the placement of the keyboard. It needs to be placed low enough and close to your body so that you aren’t required to lift your upper shoulders and arms to type. The shoulders should be loose and relaxed; upper arm in line with the torso, elbow at 90-110 degrees, and wrist straight.

In most cases, an adjustable computer keyboard tray that fits underneath the desk surface is necessary. Most desk surfaces are simply too high to be able to use your keyboard and mouse without having to contract your upper trap and arm muscles.

However, with wireless technology it is much easier to accomplish. All you need is a portable keyboard/laptop flat table, a space-saving wireless keyboard, and a wireless mouse. Place the keyboard flat table on your lap, place the wireless keyboard and mouse on the table (don’t forget to turn them on), and you’ll be all set.

Melatonin for Migraine Headaches

by Pain Doc | Feb 10, 2011 | Headaches

Image via Wikipedia

If you suffer from migraine headaches, take note: a small study done in Brazil concluded that taking melatonin 30 minutes before bed time can reduce migraine frequency and intensity.

The study involved 34 subjects; 29 of which were female. The participants reported experiencing 2-8 migraines per month, on average. Some had migraines with auras– visual disturbances such as seeing wavy lines, spots, or sparks.

Of the 32 participants completing the study, more than two-thirds said their migraine frequency was reduced by half or better after taking melatonin for three months.

This included eight patients who reported no migraines, seven who reported a 75% drop in migraines, and 10 who said their migraine frequency decreased by 50% to 75%.

The findings, which come from a team of researchers led by Mario F.P. Peres, MD, PhD, of Hospital Israelita Albert Einstein in Sao Paolo, Brazil, show that melatonin may be used as a preventive therapy for frequent migraine sufferers. However, since it was a small study with no control group, the researchers suggested a controlled study to test the idea further.

What Makes a Migraine a Migraine? (everydayhealth.com)
Could oxygen help a migraine? (zocdoc.com)
Migraine Surgery Seems To Have Nearly 90% Success (lockergnome.com)

Recommended Back Exercises

by Pain Doc | Jan 18, 2011 | Low Back Pain

I am a firm believer that strengthening and conditioning the core, back and leg muscles is the best way to guard against getting back pain.

If you’re prone to having your back “go out”, then these exercises are the best way to guard against recurrence. Don’t wait until you get degenerative disc disease, because once you reach this point the chances of living a pain- free life take a big nosedive. The reason is that the best exercises for strengthening your back are more risky for those with disc degeneration.

What typically happens is the disc degeneration patient will naturally stay cautious or apprehensive and will avoid back exercises for fear of re-injuring his back. This eventually leads to back muscle weakness and loss of muscle coordination–precursors for back injury and chronic pain.

So, if you don’t have back pain or degenerative joint disease (weak, thinning and/or herniated discs with accompanying bone spurs and cartilage degeneration) consider yourself lucky. Make sure your exercise regimen involves engaging the primary muscles of the trunk primarily, and the whole body, secondarily.

Do functional exercises which force the muscle groups to work synergistically rather independently. Such exercises can mimic common body movements; for example, carrying something on your shoulder while walking.

In strengthening the back, I like to do squats using a 20 lb bar on my back with feet apart in different distances.

Throwing a 12 lb. medicine ball using your whole upper body is another great functional exercise. Get a partner and have him stand 10 feet to your right. Throw the ball to your partner while using your core as well as arms. This simple exercise will strengthen your abs, your paraspinals, arms, and even your leg muscles.

Next, use a Freemotion or similar cable-weight machine where you can raise an arm above your head. With both hands, grip the cable handle and swing it down towards your feet, as though you were chopping wood with an axe. Boy, this is a great exercise as you will feel just about every muscle in your back, arms and chest work together to move the weight.