Pink Prescriptions - October 2018

Snap ... crackle … POP!
If your hip and knee joints sound like a bowl of breakfast cereal when you stand up, sit down, or walk, what does it mean now and in the future? Why can body pain sometimes predict rain better than the local meteorologist? Should achy joints stay or should they go? We asked our Pink Magazine medical experts to weigh in on what can often be a very painful subject.

Why does hip pain often present as knee pain?
Problems with the hips can often cause you to feel pain elsewhere in the body, including the knees. This phenomenon is known as “referred pain.”

Patients with osteoarthritis in the hip may perceive pain that is generated in the hip as knee pain. That’s because one of the nerves in the hip also serves the knee. In some cases, there may be arthritis in both the hip and the knee, causing pain in both joints.

Issues in the lumbar spine, like a herniated disk, also may cause knee pain. Nerves from the lower spine branch out directly to the lower extremities, causing pain to radiate down to the knee. Sometimes patients suffering from lower back pain will change the way they walk, which could also result in hip or knee pain.

The only way to properly diagnose the source of knee pain is to perform a comprehensive evaluation. When a patient presents with knee pain, I typically like to get an x-ray of the knee, hip and spine.

Does running affect my knees and hips?
Running, in general, is good for your joints. It keeps you mobile, maintains your range of motion and can help you lose weight. But because it’s a high-impact exercise, it can be rough on your knees and hips, especially if you’re running down a slope or on a hard surface like a sidewalk or street.

Running on concrete or pavement can cause micro injuries to the cartilage surface and knee joint, which can lead to arthritis. If you’re overweight, the impact is compounded. Genetics may also play a role in a person’s risk of developing arthritis or suffering injuries from running. If you already have a knee injury, you can cause further damage.

You can counteract the impact by wearing good footwear that provides cushioning to the joints. Proper running form also is important. And know your limits. If you run too much too soon, you can strain your muscles and joints. Build up the distance you run gradually and rest every other day to avoid joint trouble.

Running on a treadmill or a soft surface like sod is better than running on concrete. If you’re experiencing pain when you run, I suggest exercising on a bicycle or an elliptical trainer. Both of those options create less force on the knees.

If done in moderation, the benefits of running outweigh the risks of not running. To reduce your chance of having knee problems, mix up your running regimen with cross training. If you experience any pain or swelling in your knees, give your body time to recover before you get back to running.



Dr. Vandit Sardana is a board-certified orthopaedic surgeon with Beaufort Memorial Orthopaedic Specialists in Bluffton and Beaufort. A graduate of the University of Ottawa, he is fellowship trained in hip and knee replacement. Dr. Sardana can be reached at (843) 524-3015.

I sit all day at work. What can I do to help with hip and knee pain?
First, make it a habit to get up and walk and stretch on a regular basis. Make sure your work station is set appropriately to your height so that you can maintain good posture. If possible, ask your employer if they would consider providing you with a variable height work station that you can raise and lower throughout the day so you can change your position and take the pressure off your back, hip and knees.



Dr. Laura Knobel is a board certified Family Physician seeing patients of all ages in Plantation Park in Bluffton. She has a direct primary care practice where you can get your primary care for $50 a month or less. Office phone: 843-836-2200. Website: knobelmd.com

Does hearing that snap, crackle, and pop mean I’m destined for a joint replacement—and what can I do to prevent it?
Chances are you know someone with arthritis. That’s because nearly one in five people have arthritis, making it the most common cause of disability in the United States.

Arthritis usually causes pain or swelling in the joints that can make your body feel stiff or make it difficult to move around. There are two main types of arthritis. Osteoarthritis (OA), the most common type of arthritis, affects 27 million Americans, most of who are over age 45. Rheumatoid arthritis (RA) can affect people of all ages, especially women. OA is a degenerative disease related to an injury or aging that occurs when tissue in the joints becomes worn down. RA happens when the body’s immune system attacks tissues instead of protecting them from infection. RA usually affects the same joints on both sides of the body, causing pain, swelling, discomfort and fatigue.

Arthritis cannot be cured, but there are ways to manage pain associated with the condition.

Some common treatment choices include:

Reducing stress: Practicing relaxation techniques and positive self-talk can distract you from arthritis pain and help you focus on what you can accomplish, not limitations caused by the disease.

Regular exercise: A carefully balanced exercise program can actually help lubricate joints and even strengthen muscles around the joints.

Healthy diet: A balanced diet can help keep your body weight normal and contribute to overall health and management of the disease.

Learning how to protect your joints: Wear the right shoes to protect your feet and use a cane or walker to lessen pain when walking. Gadgets are available to help open jars or turn door knobs in your house.

Taking medications prescribed by your doctor: Acetaminophen some or non-steroidal anti-inflammatory drugs can be taken to ease arthritis pain. If you have RA, your doctor may suggest anti-rheumatic drugs to slow damage from the disease, prednisone to reduce swelling, or biologic response modifiers to block damage caused by the immune system.

Topical pain killers may help relieve mild OA discomfort. Aspirin-like pain rubs, hot/cold applications, and chili pepper creams popular choices. Pain gels and patches may be prescribed to relieve pain in the hands, wrists, elbows, feet, ankles or knees. Check with your doctor before taking any over-the-counter drugs, because products that contain salicylates may not be safe if you are allergic to aspirin or are taking blood thinners. Severe OA or pain that does not improve with other medications may require a steroid injection into the affected joint. When even strong medications or injections are ineffective, you may be a candidate for joint replacement surgery.



Dr. Mihelic is Board Certified Orthopedic Surgeon with over 40 years of experience in bone and joint surgery and orthopedic conditions. His office is located at 15 Moss Creek Village, Hilton Head 29926.  For more information or to schedule an appointment call 843-342-5200.

Why do my knees hurt when it rains?
According to a 2016 study in the Journal of Osteoarthritis and Cartilage, the idea that patients with joint pain are able to predict changes in weather has been under discussion since the 18th century.

Well, the jury is still out.

Biometerology is the study of the impact of climate and weather on living organisms. Researchers are focusing on finding connections between climate and its effect on joint pain, asthma, cardiovascular events, headaches, and even blood pressure. Although research conclusions are mixed, one prominent hypothesis states that a drop in barometric pressure may be to blame when your knees start to ache. Barometric pressure is the weight of the atmosphere that surrounds us. Barometric pressure tends to drop prior to an incoming storm causing microscopic changes in the tissues surrounding your joints. These changes allow the tissues to expand like a balloon, which can lead to increased stiffness and pain within the joint. Changes in cabin air pressure on a long flight, along with immobility, can also lead to increased leg swelling and pain during travel.

The good news is any increase in joint pain related to weather is only temporary. The body will adapt to the change by moving fluid from the joint into circulation and reducing stiffness and pain. In the meantime, make sure you keep moving and try to stay warm to reduce the effects.



Mary K. Benedict, PT, DPT, is a Physical Therapist at Beaufort Memorial’s Outpatient Adult Rehabilitation Services at the hospital’s Bluffton Medical Services in Westbury Park. Originally from Upstate New York, she holds a Doctorate in Physical Therapy from MUSC and is the current Lower Coastal District Chair for the South Carolina American Physical Therapy Association.

How can CBD oil help with knee and joint pain?
Cannabidiol (CBD) is a naturally occurring compound found in the hemp plant. It is one of the many cannabinoids that has been studied for medicinal purposes. CBD stimulates receptors in the brain which play a role in regulation of pain sensation and inflammation. This creates anti-inflammatory and painkilling effects that help with pain management. CBD can be applied directly to the skin, which has shown benefits in relieving pain and inflammation due to arthritis. CBD taken by mouth is helpful to inhibit inflammatory and neuropathic pain. Depending on the type of knee or joint pain you may be experiencing, CBD oil is a good option to try to help alleviate it. CBD is not habit forming, nor do you get “high” from it, making it a good opioid free pain relief option. Note: It is important to make sure you purchase CBD products from a reputable source. The manufacturer should have outside lab tests conducted for consistency and safety on every batch. This testing provides assurance that you are receiving accurate active ingredients free of harmful impurities.



Dr. Wilhemina Fry, PharmD, Stephens Compounding Pharmacy  |  843.686.3040 55 Mathews Drive, Suite 215 Hilton Head Island, SC  |  Located in the Public Storage shopping plaza (In the same plaza as Bike Doctor, Jiva Yoga, and Good Health Nutrition).