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I recently received a review copy of Too Young To Feel Old: The Arthritis Doctor’s 28-Day Formula For Pain-Free Living by Richard H. Blau, M.D., F.A.C.R. with E.A. Tremblay. For frequent visitors to my blog, you may recall Dr. Blau from a video on arthritis exercises I posted a few weeks ago. Dr. Blau is the founder and medical director of The Arthritis Institute of Long Island and is a board certified rheumatologist.
To begin my review, I must say that I didn’t agree completely with everything in Dr. Blau’s book. I guess this shouldn’t be surprising though, because as the saying goes, if you ask 10 doctors the same question, you’ll get 10 different opinions (and in my experience it may be more like 12 or 15 opinions!). The main points of disagreement had to do with a few statements he makes regarding certain alternative treatment options, such as chiropractic and homeopathy. It is my impression that Dr. Blau may not have direct experience with these forms of treatment, and his opinions, particularly about chiropractic, may be based on either incomplete or outdated information. I consider this a minor detractor, as I don’t think it’s reasonable to expect Dr. Blau to be an expert on chiropractic or other forms of alternative medicine.
The only other area of disagreement I have with Dr. Blau is regarding his belief that all rheumatologists are as thorough in their evaluations and as broad in their treatment of arthritic disorders as he is. Perhaps the rheumatologists in his part of the country are as thorough as he is and are as willing to discuss diet, exercise, and other natural treatments with their patients. Unfortunately, judging from the reports I receive from patients about their experiences with rheumatologists in my area, this is far from the norm in my part of the country. All too often, patients are simply given one or more prescription medications and not one word is said about diet, nutritional supplementation, exercise, or any other self-help methods. I believe Dr. Blau is to be commended for his unusual level of dedication to achieving the best possible outcomes for his patients.
Now that those minor caveats have been addressed, I must say that I found Too Young To Feel Old to be a very well-written and useful book for anyone suffering from arthritis. The first portion of the book does an excellent job of explaining the main types of arthritis and their causes, using easy to understand language (no “medical-ese”).
Dr. Blau then moves into the topic of dietary recommendations and nutritional supplementation. This section provides a review of the various dietary and supplementation approaches to controlling inflammation and thereby easing arthritis symptoms.
The next section provides exercise recommendations, complete with illustrated instructions for gentle exercises for the joints most likely to develop arthritis. Many of these are demonstrated in the video I referred to earlier.
Dr. Blau then reviews a variety of miscellaneous treatments used for arthritis, including chiropractic, homeopathy, acupuncture, massage, hypnosis, and other alternative treatments.
Next comes the 28 day part of the “28 Day Formula” as Dr. Blau puts everything together with his daily exercise and supplement recommendations and reveals his 28 day meal plan. The meal plan includes complete recipes and nutrition information for breakfast, lunch, dinner, and an evening snack for 28 days. There are many great recipes in the book for making delicious, healthy meals for anyone, not just those with arthritis. Here are a couple of my favorites from the book(included here with permission):
Grilled Island Shrimp Wrap
Serves 2
1/2 lb shrimp (cleaned, deveined, with tails removed)
1 tbs olive oil
1/2 cup green peppers, diced
1/2 cup snow peas
2 tsps fresh chopped cilantro
1 tsp curry powder
2 tortillas, whole wheat (pre-packaged)
Heat oil in pan.
Saute’ green peppers and snow peas until tender.
Add shrimp, curry powder, and cilantro. Cook until shrimp are pink
Divide into two portions and spread in center of each tortilla.
Fold tortilla into wrap.
Scrambled Egg Whites Italiano
Serves 1
4 large egg whites
3 baby portabellas, diced
2 tsp olive oil
1/4 tsp tumeric
1/4 tsp fresh oregano, chopped
1/4 tsp fresh basil, chopped
2 tsp 1% milk
1 tsp flaxseed meal
1 dash salt
Put egg whites into mixing bowl.
Beat slightly using wire whisk.
Add milk, tumeric, oregano, basil, flaxseed meal, and salt to eggs. Beat until blended.
Heal olive oil in frying pan. Add mushrooms and cook until soft.
Pour in egg mixture. Cook over low heat, stirring occasionally, until reaching desired consistency.
Finally, Dr. Blau reviews the various medication options for treating arthritis, including their indications, contraindications and common side-effects. I was impressed by the fact that Dr. Blau considers medications to be something that may need to be considered in addition to (not in place of) the program previously outlined. In my experience, many medical doctors think medication first, and things like diet and exercise second, if at all. Dr. Blau is clearly a “different breed” of medical rheumatologist.
To sum it all up, I highly recommend Too Young To Feel Old for anyone looking to take control of their arthritis problems. The book is available at most book stores and can be purchased online at Amazon.com, Barnes & Noble, and Borders.
Knee pain is a very common problem and considerable money and effort is dedicated to treating knee problems. Typically, the person with knee pain that is not due to a recent traumatic injury is diagnosed with arthritis and few people with knee pain go beyond treatments that merely suppress inflammation and pain, unless they wind up going to the extreme of surgical treatment. Occasionally, some of the new injectable drugs to promote joint lubrication are used, but rarely are the actual underlying causes of knee pain addressed. I guess one could argue that because inflammation is a cause of knee pain in the majority of cases, anything that helps inflammation is treating the cause of knee pain; however, I think it bears investigating what is causing the inflammation to occur in the knee joint.
Nutrition And Inflammation Control:
There are some individuals who have problems with widespread inflammation and who suffer with pain in most or all of their joints, and who may also suffer other effects of inflammation such as atherosclerosis. In these cases of an overactive inflammatory response, the underlying cause is often nutritional imbalance. One of the most common of these imbalances is between omega 6 and omega 3 fats. Due to changes in how much of our food is produced, there has been a drastic shift in the relatve amounts of omega 6 and omega 3 fats in the diet. In indigenous cultures that consume primarily vegetables and wild game, and very small amounts of grains, the ratio of omega 6 fats to omega 3 fats in the diet is approximately 1:1 to 3:1. In the not too distant past, this ratio was relatively common in the United States and other developed countries. But in the last few decades, the tremendous increase in grain products in the diet, and the consumption of grain-fed meat has radically shifted the ratio of omega 6 to omega 3 to approximately 20:1 or more. Through various biochemical mechanisms I won’t go into here, this huge shift to omega 6 fats has drastically increased the amount of inflammatory processes in the majority of people.
So, one of the first goals for anyone suffering from knee pain or any other arthritic conditions is to reduce their ratio of omega 6 fats to omega 3 fats. There are two relatively simple ways to do this. First, reduce the intake of grain-based products, such as bread, pasta, cereal, etc.. The second step is to supplement with omega 3 fats, which can be most easily achieved with either fish oil or krill oil supplements. Various supplements have different levels of the two main types of omega 3, known as EPA and DHA. I suggest supplementing with an amount of fish or krill oil that provides a dose of approximately 1,000 mg of EPA per day (check with your doctor or pharmacist first if you are taking blood-thinning medication).
Biomechanical Causes Of Knee Pain:
Foot And Ankle Biomechanics:
The next step in combatting knee pain is to correct any biomechanical misalignments or dysfunctions that are placing any undue mechanical stress on the knee joint, and thereby causing tissue damage and inflammation. Before working on the knee itself, though, I highly recommend looking to the alignment of the feet. In many knee pain cases, there is collapse of the main arch in the foot, which results in a change in the alignment of the ankle known as hyper-pronation. This then causes a compensatory rotation of the knee and exerts abnormal stress on the ligaments, tendons, and other supporting structures. The following video illustrates how this occurs:
As the video indicates, shoe insoles that support the foot are often beneficial in controlling pronation and consequently taking stress off of the knee and relieving pain. In my experience, there really is not a clear benefit of one type or brand of insoles for every patient. Different patients have different needs. For some people, it may be sufficient to simply wear shoes that have good arch support, while others do well with a very basic arch support such as Dr. Scholl’s, while still others really need a high-quality orthotic that is either custom-made for the patient, or can be easily modified as necessary to get a good result. My advice is to start with just wearing good shoes and then move up to more substantial arch support solutions if needed.
If you are unsure as to whether you need arch support, you can do a simple test at home. You’ll need to have a few sheets of paper (just about any kind will do), and a damp cloth or sponge. Begin by sitting in a chair where your feet can rest flat on the floor (smooth, uncarpeted floor is best for this). Place a sheet of paper flat on the floor next to one of your feet. Bring that foot up and apply moisture with the cloth or sponge to the bottom of the foot and immediately place it on the sheet of paper and press your foot down firmly using only your leg muscles. Now lift your foot up and notice the moisture pattern on the paper. Start again with a new sheet of paper, and again bring your foot up, moisten it, and place it on the paper, but this time stand up once your foot is on the paper. Once again, raise the foot up and notice the moisture pattern on the paper. If there is a big difference in the moisture pattern between sitting and standing, it usually indicates that you have arch instability and that you’d benefit from at least some amount of extra arch support. Be sure to test both feet in this manner. In most cases, if there is arch instability, it will be on both sides, but in a few cases, it is much worse on one side (usually the side where the knee pain is).
Knee Biomechanics:
In some cases, there is a direct mechanical problem in the knee joint. Usually, this is a subtle rotation misalignment of the joint that may occur from minor trauma that may not even be noticed when it occurs. Evaluation and treatment by a sports chiropractor or other professional trained in joint manipulation usually solves these types of problems pretty quickly.
Biomechanical Treatment:
Massage And Stretching:
In many cases of knee pain, muscular restrictions and trigger points can develop around the knee that can interfere with normal joint biomechanics and cause pain either directly or indirectly. Stretching and massage of the quadriceps, hamstrings, “abductors” (muscles on the outside of the leg that pull the leg sideways out from the body), “adductors” (muscles on the inner side of the thigh, also called the groin muscles, that pull the leg sideways toward the midline of the body), and calf muscles. If you’re not sure if you are having problems with trigger points, I suggest finding a massage therapist or chiropractor who is experienced with trigger point massage and stretching techniques to be evaluated, and treated if appropriate.
Stengthening And Endurance:
In addition to tightness, muscles can contribute to knee pain if they become weak and/or imbalanced. A physical therapist, sports chiropractor, or certified personal trainer can provide professional guidance in rehabilitative strengthening. Pilates exercises work quite well in most cases, as they provide both stretching and strengthening. Most Pilates classes are general-purpose, but some Pilates instructors are willing to give additional instruction for specific areas like the knees. I have also come across a self-treatment program for knee pain that utilizes Pilates exercises, that I think is a good option for those who are too limited on time and/or money to get professional instruction.
While there are situations in which the damage to the knee joint(s) is too far advanced to get relief from natural treatment approaches, the vast majority of patients I’ve seen do get better through a combination of natural inflammation control and biomechanical correction.
The video above provides some good basic exercises to help with arthritis in the knees, ankles, hands and shoulders. There are many other exercises that can help with arthritis depending on which joints are involved, but these are a good start for general mobility.
The claims made in the above video may seem a little hard to believe, but my 17 years of practice experience treating musculoskeletal pain and arthritis puts me in complete agreement with the doctor in the video. I often tell patients that there is a huge difference between having arthritis and having arthritis pain. In the vast majority of cases, as is indicated in the video, the pain of arthritis is not due to the joint degeneration itself, but the muscle and soft tissue reaction around the area of degeneration. While in some cases, the problem is so advanced that it is not possible to get the soft tissue reactions to subside, in the majority of arthritis cases, even very severe cases, pain can be alleviated by soft tissue release methods.
Unfortunately, few practitioners who treat arthritis actually address these soft tissue problems, so it can be difficult to find someone who can help. As a starting point, I suggest looking for a chiropractor or osteopath who either does deep massage in addition to joint manipulation/mobilization and/or who works closely with an experienced massage therapist. By increasing joint mobility and decreasing reactive tightness in the muscles and soft tissues, miraculous changes can happen very quickly. Even patients who have been in severe pain for many years and who have had many other types of treatment can sometimes get dramatic relief in the very first treatment session.
It is important to mention though that in some cases, symptoms may actually increase in the first few treatment sessions before things begin to improve. It may be frustrating when this occurs, but if you stick with it, things will usually get better after a week or two of treatment. Remember, arthritic conditions may take 10 to 20 years or more to develop before they start to create significant symptoms, so it may take some time to get the problem resolved.
As the video says, arthritis is caused by abnormal joint function and/or insufficient nutrient supply for the body to repair and rebuild joints. Nutrient deficiencies vary from person to person and getting the right nutrition for your particular problems is important. For a FREE email consultation on your case, Contact Me.
Stay tuned for more about arthritis on future blog entries.
