Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead
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Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to updated treatment guidelines from the Australian Commission on Safety and Quality in Health Care.
So what is knee osteoarthritis and what are the best ways to manage it?
More than 2 million Australians have osteoarthritis
Osteoarthritis is the most common joint disease, affecting 2.1 million Australians. It costs the economy A$4.3 billion each year.
Osteoarthritis commonly affects the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles.
Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs.
Is it caused by ‘wear and tear’?
Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is not caused by “wear and tear”.
Research shows the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are not required to diagnose knee osteoarthritis or guide treatment decisions.
Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have shown this in people with osteoarthritis, and other common pain conditions such as back and shoulder pain.
This has led to a global call for a change in the way we think and communicate about osteoarthritis.
What’s the best way to manage osteoarthritis?
Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These include education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines.
Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.
Health professionals who use positive and reassuring language can improve people’s knowledge and beliefs about osteoarthritis and its management.
Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as paracetamol and anti-inflammatories and can prevent or delay the need for joint replacement surgery in the future.
Many types of exercise are effective for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you.
Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time.
Weight management is important for those who are overweight or obese. Weight loss can reduce knee pain and disability, particularly when combined with exercise. Losing as little as 5–10% of your body weight can be beneficial.
Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. Recommended medicines include paracetamol and non-steroidal anti-inflammatory drugs.
Opioids are not recommended. The risk of harm outweighs any potential benefits.
What about surgery?
People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement.
Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain.
However, high-quality research has shown arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis.
Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, 53,500 Australians had a knee replacement for their osteoarthritis.
Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management.
The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments.
I have knee osteoarthritis. What should I do?
The care standard links to free evidence-based resources to support people with osteoarthritis. These include:
- education, such as a decision aid and four-week online course
- self-directed online exercise and yoga programs
- weight management support
- pain management strategies, such as MyJointPain and painTRAINER.
If you have osteoarthritis, you can use the care standard to inform discussions with your health-care provider, and to make informed decisions about your care.
Belinda Lawford, Postdoctoral research fellow in physiotherapy, The University of Melbourne; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney, and Rana Hinman, Professor in Physiotherapy, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Men have a biological clock too. Here’s what’s more likely when dads are over 50
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We hear a lot about women’s biological clock and how age affects the chance of pregnancy.
New research shows men’s fertility is also affected by age. When dads are over 50, the risk of pregnancy complications increases.
Data from more than 46 million births in the United States between 2011 and 2022 compared fathers in their 30s with fathers in their 50s.
While taking into account the age of the mother and other factors known to affect pregnancy outcomes, the researchers found every ten-year increase in paternal age was linked to more complications.
The researchers found that compared to couples where the father was aged 30–39, for couples where the dad was in his 50s, there was a:
- 16% increased risk of preterm birth
- 14% increased risk of low birth weight
- 13% increase in gestational diabetes.
The older fathers were also twice as likely to have used assisted reproductive technology, including IVF, to conceive than their younger counterparts.
Steven van Loy/Unsplash Dads are getting older
In this US study, the mean age of all fathers increased from 30.8 years in 2011 to 32.1 years in 2022.
In that same period, the proportion of men aged 50 years or older fathering a child increased from 1.1% to 1.3%.
We don’t know the proportion of men over 50 years who father children in Australia, but data shows the average age of fathers has increased.
In 1975 the median age of Australian dads was 28.6 years. This jumped to 33.7 years in 2022.
How male age affects getting pregnant
As we know from media reports of celebrity dads, men produce sperm from puberty throughout life and can father children well into old age.
However, there is a noticeable decline in sperm quality from about age 40.
Female partners of older men take longer to achieve pregnancy than those with younger partners.
A study of the effect of male age on time to pregnancy showed women with male partners aged 45 or older were almost five times more likely to take more than a year to conceive compared to those with partners aged 25 or under. More than three quarters (76.8%) of men under the age of 25 years impregnated their female partners within six months, compared with just over half (52.9%) of men over the age of 45.
Pooled data from ten studies showed that partners of older men are also more likely to experience miscarriage. Compared to couples where the male was aged 25 to 29 years, paternal age over 45 years increased the risk of miscarriage by 43%.
Older men are more likely to need IVF
Outcomes of assisted reproductive technology, such as IVF, are also influenced by the age of the male partner.
A review of studies in couples using assisted reproductive technologies found paternal age under 40 years reduced the risk of miscarriage by about 25% compared to couples with men aged over 40.
Having a male under 40 years also almost doubled the chance of a live birth per treatment cycle. With a man over 40, 17.6% of treatment rounds resulted in a live birth, compared to 28.4% when the male was under 40.
How does male age affect the health outcomes of children?
As a result of age-related changes in sperm DNA, the children of older fathers have increased risk of a number of conditions. Autism, schizophrenia, bipolar disorders and leukaemia have been linked to the father’s advanced years.
A review of studies assessing the impact of advanced paternal age reported that children of older fathers have increased rates of psychiatric disease and behavioural impairments.
But while the increased risk of adverse health outcomes linked to older paternal age is real, the magnitude of the effect is modest. It’s important to remember that an increase in a very small risk is still a small risk and most children of older fathers are born healthy and develop well.
Improving your health can improve your fertility
In addition to the effects of older age, some chronic conditions that affect fertility and reproductive outcomes become more common as men get older. They include obesity and diabetes which affect sperm quality by lowering testosterone levels.
While we can’t change our age, some lifestyle factors that increase the risk of pregnancy complications and reduce fertility, can be tackled. They include:
- smoking
- recreational drug taking
- anabolic steroid use
- heavy alcohol consumption.
Get the facts about the male biological clock
Research shows men want children as much as women do. And most men want at least two children.
Yet most men lack knowledge about the limitations of female and male fertility and overestimate the chance of getting pregnant, with and without assisted reproductive technologies.
We need better public education, starting at school, to improve awareness of the impact of male and female age on reproductive outcomes and help people have healthy babies.
For men wanting to improve their chance of conceiving, the government-funded sites Healthy Male and Your Fertility are a good place to start. These offer evidence-based and accessible information about reproductive health, and tips to improve your reproductive health and give your children the best start in life.
Karin Hammarberg, Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Brown Rice vs Wild Rice – Which is Healthier?
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Our Verdict
When comparing brown rice to wild rice, we picked the wild.
Why?
It’s close! But there are important distinctions.
First let’s clarify: despite the name and appearance, wild rice is botanically quite different from rice per se; it’s not the same species, it’s not even the same genus, though it is the same umbrella family. In other words, they’re about as closely related as humans and gorillas are to each other.
In terms of macros, wild rice has considerably more protein and a little more fiber, for slightly lower carbs.
Notably, however, wild rice’s carbs are a close-to-even mix of sucrose, fructose, and glucose, while brown rice’s carbs are 99% starch. Given the carb to fiber ratio, it’s worth noting that wild rice also has lower net carbs, and the lower glycemic index.
In the category of vitamins, wild rice leads with more of vitamins A, B2, B9, E, K, and choline. In contrast, brown rice has more of vitamins B1, B3, and B5. So, a moderate win for wild rice.
When it comes to minerals, brown rice finally gets a tally in its favor, even if only slightly: brown rice has more magnesium, manganese, phosphorus, and selenium, while wild rice has more copper, potassium, and zinc. They’re equal in calcium and iron, by the way. Still, this category stands as a 4:3 win for brown rice.
Adding up the categories makes a modest win for wild rice, and additionally, if we had to consider one of these things more important than the others, it’d be wild rice being higher in fiber and protein and lower in total carbs and net carbs.
Still, enjoy either or both, per your preference!
Want to learn more?
You might like to read:
- Brown Rice Protein: Strengths & Weaknesses
- Rice vs Buckwheat – Which is Healthier? ← it’s worth noting, by the way, that buckwheat is so unrelated from wheat that it’s not even the same family of plants. They are about as closely related as a lion and a lionfish are to each other.
Take care!
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Luxurious Longevity Risotto
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Pearl barley is not only tasty and fiber-rich, but also, it contains propionic acid, which lowers cholesterol. The fiber content also lowers cholesterol too, of course, by the usual mechanism. The dish’s health benefits don’t end there, though; check out the science section at the end of the recipe!
You will need
- 2 cups pearl barley
- 3 cups sliced chestnut mushrooms
- 2 onions, finely chopped
- 6 large leaves collard greens, shredded
- ½ bulb garlic, finely chopped
- 8 spring onions, sliced
- 1½ quarts low-sodium vegetable stock
- 2 tbsp nutritional yeast
- 1 tbsp chia seeds
- 1 tbsp black pepper, coarse ground
- 1 tsp MSG or 2 tsp low-sodium salt
- 1 tsp rosemary
- 1 tsp thyme
- Extra virgin olive oil, for cooking
- Optional garnish: fresh basil leaves
Method
(we suggest you read everything at least once before doing anything)
1) Heat a little oil in a large sauté pan; add the onions and garlic and cook for 5 minutes; add the mushrooms and cook for another 5 minutes.
2) Add the pearl barley and a cup of the vegetable stock. Cook, stirring, until the liquid is nearly all absorbed, and add more stock every few minutes, as per any other risotto. You may or may not use all the stock you had ready. Pearl barley takes longer to cook than rice, so be patient—it’ll be worth the wait!
Alternative: an alternative is to use a slow cooker, adding a quart of the stock at once and coming back about 4 hours later—thus, it’ll take a lot longer, but will require minimal/no supervision.
3) When the pearl barley has softened, become pearl-like, and the dish is taking on a creamy texture, stir in the rest of the ingredients. Once the greens have softened, the dish is done, and it’s time to serve. Add the garnish if using one:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- The Magic Of Mushrooms: “The Longevity Vitamin” (That’s Not A Vitamin)
- The Many Health Benefits Of Garlic
- Chia: The Tiniest Seeds With The Most Value
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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Which Gadgets Help, & Which Are A Waste Of Time?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝I’m a 67- year old yoga teacher and runner. A lifelong runner, I started long distance running when I was 58. One of my friends loves rucking? I recently bought a rucking vest. Your thoughts? Any risks?
As a perk of my yoga instructor job I get cryotherapy, red light therapy, infrared sauna, and Normatec boots for a nominal fee. Even though they are almost free, I don’t take advantage of them as I can’t find evidence of their value and don’t want to waste my time. Do you recommend any of them?❞On rucking and rucking vests
First, for any unfamiliar, this is about walking/running/exercising in general, with a weighted backpack or weight vest.
As for whether this is beneficial, it depends on your goals. Once upon a very long time ago when this writer was a soldier, it was vitally important to for me be able to [fall from the sky and then] run about 2km carrying a certain (hefty) amount of weight and still be able to fight at the other end of it, or else I would die. Thus, between deployments, I’d often carry a sturdy rucksack with concrete slabs in it, to keep myself accustomed to that burden (funny story: someone once tried to steal that when I had put it down while doing something—the would-be thief fell over instantly and then ran away empty-handed). And, here’s the thing: this kind of training did for me what I needed it to do for me. As a 67-year-old yoga teacher, your needs are probably very different.
A common reason to use weight vests is in an effort against osteoporosis, but the evidence is lacking (or very weak, at best), as we wrote about a while back:
Weight Vests Against Osteoporosis: Do They Really Build Bone?
With regard to risks… Let’s put it this way: my old regiment, in addition to the usual soldierly problems like hearing damage and PTSD, has quite a reputation for producing veterans with spinal compression injuries. And that’s entirely because of the whole “running with a large amount of weight strapped to us” thing. So, you probably don’t want that.
If you are going to do that though, then:
- a weight best is a lot better than a backpack (better distribution of weight)
- start with low weight and work up, and don’t push your limits
We’re not the boss of you, so by all means do as you see fit, but unless there’s a special reason why being able to run with a heavy weight is important to you, then running with a light weight is already more than good enough.
About those job perks
Again, of course, it depends on what you hope to get out of them, but in some cases there is a lot of evidence for benefit.
On cryotherapy: Ice Baths: To Dip Or Not To Dip? ← there are definite benefits for most people!
On red light therapy: Red Light, Go! Casting Yourself In A Healthier Light ← there are some caveats re people who should not do this or at least should be very wary, but for most people, this does a lot of good, and is very well-evidenced to be beneficial
On infrared saunas: we’re unaware of any special evidence in favor of these. However, traditional saunas have plenty of well-evidenced benefits: Saunas: Health Benefits (& Caveats)
On Normatec boots: for the unfamiliar, this is a brand name for compression technology. Again, it depends on what you want to get out of it, though. If you are in good health, then what it’s generally being advertised for is to prevent/reduce exercise-induced muscle damage caused by the stress that endurance training can place on skeletal muscle. Just one problem—it doesn’t seem to work:
❝Athletes attempt to aid their recovery in various ways, one of which is through compression. Dynamic compression consists of intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System and Recovery Pump
Clinical Question: What are the effects of IPC on the reduction of Exercise-Induced Muscle Damage (EIMD) in endurance athletes following prolonged exercise? Summary of Key Findings: The current literature was searched to identify the effects of IPC, and 3 studies were selected: 2 randomized controlled trials and 1 randomized cross-over study. Two studies investigated the effect of IPC on delayed onset muscle soreness and plasma creatine kinase in ultramarathoners. The other looked at the impact of IPC on delayed onset muscle soreness in marathoners, ultramarathoners, triathletes, and cyclists.
All studies concluded IPC was not an effective means of improving the reduction of EIMD in endurance-trained athletes.❞
However! If you have lipedema and/or lymphedema and want to manage that, then compression gear may help:
Take care!
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Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?
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Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?
Yesterday, we asked you for your opinions on waist trainers and posture-fixing harnesses, and got the above-depicted, below-described set of results:
- The most popular response was “Waist trainers are purely cosmetic, so useless. Posture-fixers have merit”, with a little over a quarter of the votes.
- The least popular response was “Both are great tools to help us to optimal waist size and posture, respectively!”
- The other three answers each got a little under a quarter of the vote. In terms of discrete data, these were all 7±1, so basically, there was nothing in it.
The sample size was smaller than usual—perhaps the cluster of American holiday dates yesterday and today kept people busy! But, pressing on…
What does the science say?
Waist trainers are purely cosmetic, so, useless. True or False?
True, simply. Honestly, they’re not even that great for cosmetic purposes. They will indeed cinch in your middle, and this shape will be retained for a (very) short while after uncinching, because your organs have been squished inwards and may take a short while to get back to where they are supposed to be.
The American Board of Cosmetic Surgery may not be an unbiased source, but we’re struggling to find scientists who will even touch one of these, so, let’s see what these doctors have to say:
- Waist training can damage vital organs
- You will be slowly suffocating yourself
- Waist training simply doesn’t work
- You cannot drastically change your body shape with a piece of fabric*
Read: ABCS | 4 Reasons to Throw Your Waist Trainer in the Trash
*”But what about foot-binding?”—feet have many bones, whose growth can be physically restricted. Your waist has:
- organs: necessary! (long-term damage possible, but they’re not going away)
- muscles: slightly restrictable! (temporary restriction; no permanent change)
- fat: very squeezable! (temporary muffin; no permanent change)
Posture correctors have merit: True or False?
True—probably, and as a stepping-stone measure only.
The Ergonomics Health Association (a workplace health & safety organization) says:
❝Looking at the clinical evidence of posture correctors, we can say without a doubt that they do work, just not for everyone and not in the same way for all patients.❞
Source: Do Posture Correctors Work? Here’s What Our Experts Think
That’s not very compelling, so we looked for studies, and found… Not much, actually. However, what we did find supported the idea that “they probably do help, but we seriously need better studies with less bias”:
That is also not a compelling title, but here is where it pays to look at the studies and not just the titles. Basically, they found that the results were favorable to the posture-correctors—the science itself was just trash:
❝ The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity.
The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence.❞
Since the benefit of posture correctors like this one is due to reminding the wearer to keep good posture, there is a lot more (good quality!) science for wearable biofeedback tech devices, such as this one:
Spine Cop: Posture Correction Monitor and Assistant
Take care!
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Intermittent Fasting for Women Over 50 – by Emma Sanchez
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Intermittent fasting is promoted as a very healthful (evidence-based!) way to trim the fat and slow aging, along with other health benefits. But, physiologically and especially metabolically, the average woman is quite different from the average man! And most resources are aimed at men. So, what’s the difference?
Emma Sanchez gives an overview not just of intermittent fasting, but also, how it goes with specifically female physiology. From hormonal cycles, to different body composition and fat distribution, to how we simply retain energy better—which can be a mixed blessing!
We’re given advice about how to optimize all those things and more.
She also covers issues that many writers on the topic of intermittent fasting will tend to shy away from, such as:
- mood swings
- risk of eating disorder
- impact on cognitive thinking
…and she does this evenly and fairly, making the case for intermittent fasting while acknowledging potential pitfalls that need to be recognized in order to be managed.
Lastly, the “over 50” thing. This is covered in detail quite late in the book, but there are a lot of changes that occur (beyond the obvious!), and once again, Sanchez has tips and tricks for holding back the clock where possible, and working with it rather than against it, when appropriate.
All in all, a great book for any woman over 50, or really also for women under 50, especially if that particular milestone is on the horizon.
Get your copy of Intermittent Fasting for Women over 50 from Amazon today!
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