Considering bone or joint surgery? In many cases, surgery may be no more effective than options like exercise, physical therapy and drug treatments.
Hip and knee replacements, surgery for carpal tunnel syndrome and other orthopedic procedures are among the most common elective surgeries performed today, but they involve cost, risk and sometimes weeks or months of recovery. Many of these surgeries are not supported by evidence from randomized trials, a review found. Even when surgery has been shown to be effective, the review concluded, it may not be significantly better than nonsurgical care.
British researchers looked at studies of 10 common orthopedic operations, including surgeries of the knee, hip, shoulder, spine and wrist. They found good evidence of the superiority of surgery over other treatments for carpal tunnel syndrome and total knee replacement.
For six other common surgeries, randomized trials found little advantage over interventions like exercise, weight management, physical therapy and drug treatment. In fact, the British Medical Journal reported, “The evidence base for orthopaedics and sports medicine: scandalously poor in parts” and they found no controlled trials that had compared hip replacement or knee cartilage repair with nonsurgical care.
“Our study doesn’t show that these operations don’t make patients better,” said the lead author, Dr. Ashley W. Blom, a professor of orthopedic surgery at the University of Bristol in England. “And it does not say that treatments do not work if they have not undergone testing by randomized controlled trials. It’s just that some don’t work any better than the best nonsurgical treatments.”
Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco, said there may be no randomized trials of hip surgery, but there is overwhelming observational evidence for its effectiveness compared with nonsurgical treatment. Many people wait too long and their options become limited.
An arthroscopic operation to repair the anterior cruciate ligament, or ACL, in the knee, among the most common sports-injury surgeries in the United States, has a rate of success as high as 97 percent in some studies. But when the operation was compared with nonsurgical treatments, the review found, there was little difference in pain scores or the need for further surgical or nonsurgical treatment.
The researchers describe a large review of studies of the operation to repair the rotator cuff, the group of tendons and muscles that keeps the upper arm bone in the shoulder socket. Compared with exercise and steroid injections, the review found, there was little or no clinically significant difference in pain, function, quality of life or patient satisfaction with the results.
Some studies were randomized controlled trials, giving one group of patients real surgery and a matched group a placebo operation. (Placebo operation! So-called sham surgeries are a kind of extreme placebo, where patients undergo all the rituals and scars of a surgical procedure except for the part meant to help. These patients benefit surprisingly often: In about three-quarters of sham-controlled studies, there’s some improvement, according to a 2014 review.) In two such studies of surgery for shoulder impingement, a condition that causes pain on raising the arm, there was no difference between surgery and placebo surgery in patient-reported outcomes or adverse events.
Lumbar spine decompression is an operation to relieve the pain caused by a ruptured or bulging disk, sometimes called a pinched nerve, in the lower spine. Although the quality of the evidence was low, three analyses showed that surgery and nonsurgical treatments provided equivalent improvements.
There were no studies that compared surgical repair of the meniscus, the cartilage that covers the knee, with nonoperative care or a placebo. But in 10 randomized trials comparing a different procedure known as meniscectomy, or partial removal of the meniscus, with more conservative treatment, the operation did not provide meaningful improvement in knee pain, function or quality of life.
“The best nonoperative care is often multimodal and may involve a combination of physical, medical and psychological interventions, and it should not be assumed that these are necessarily the easiest or most cost-effective options for patients,” Dr. Blom said. “Clinicians should discuss both operative and the best nonoperative care with patients so that patients can consider all options and thereby make informed choices.”
Some alternatives to consider:
Exercise to keep your joints moving – Flexibility exercises encourage the full range of motion that joints need. Active stretching exercises such as yoga, tai chi and pilates all help our joints stay mobile.
Lose weight to reduce pressure on your knees and hips – More than 71% of adults in the U.S. over the age of 20 are overweight or obese, according to the CDC, so it is not surprising that weight-induced joint issues are so widespread. “Maintaining an ideal body weight is important, and if overweight, losing as little as 10 pounds can decrease the progression of your knee osteoarthritis by 50 percent, according to a published study,” says rheumatologist Elaine Husni, MD, MPH, director of Cleveland Clinic’s Arthritis and Musculoskeletal Treatment Center.
Joint Supplements – A good joint supplement should provide a multiple level approach to relieving and managing joint pain and stiffness and other associated symptoms. It should contain clinically proven ingredients, which include – Glucosamine Sulfate, Methylsulfonylmethane (MSM), Cetyl Myristoleate, Ginger, Turmeric and a veggie/vegan form of chondroitin sulfate (it absorbs more effectively). The brand you chose should provide pain relief, reduce inflammation, support healthy bone and joint health and minimize deterioration. Most brands do not pass this criteria. Some companies included the right ingredients, but have too low dosage, which is the key to optimizing joint relief and management of other symptoms. They use much less than what is used in clinical studies. Other companies filled their products with cheap additives and other synthetic ingredients. Almost all of them avoided quality control testing.
Research Verified Joint Relief Research Verified’s joint support supplement provides an all-inclusive effective total-care solution for joint pain relief, overall bone and joint health management and prevention of further deterioration. It contains a unique vitamin, mineral and herbal blend of Glucosamine Sulfate (vegan source), Methylsulfonylmethane (MSM), Cetyl Myristoleate, Mythocondro® (vegan-friendly Chondroitin Sulfate) and Turmeric.
Physical therapy to target joint pain – A 2000 study found that a combination of manual physical therapy and supervised exercise has functional benefits for patients with knee osteoarthritis and may delay or prevent the need for surgery. A physical therapist uses both passive and active treatments for chronic joint pain. Passive treatments include cold therapy, heat therapy, and hydrotherapy. By reducing circulation, cold therapy reduces inflammation. Heat therapy increases blood flow and decreases stiffness. Hydrotherapy is a gentle exercise in the water that helps facilitate motion. A physical therapist will also have you engage in specific strengthening and flexibility exercises during a session and at home. These exercises increase range of motion and make the joints stronger. They are very effective in reducing pain and increasing mobility.
Injections for knee pain – Depending on your individual treatment plan, there are different types of therapeutic injections that your orthopedic specialist may recommend.
- Corticoid steroid injections are one of the most common types of therapeutic injections. These injections use an anesthetic numbing agent combined with a corticosteroid to relieve joint pain and inflammation. Common corticosteroids used include: triamcinolone, methylprednisolone, and dexamethasone.
- Epidural injections are performed to alleviate spinal pain, as well as pain in the legs or arms that results from an inflamed spinal nerve. Like corticosteroid injections, epidural injections use an anesthetic combined with a corticosteroid. What makes an epidural different from a traditional corticosteroid injection is that it is injected into the epidural space just outside the spinal cord.
- Facet joint injections are another type of spinal injection used to relieve pain in the neck, middle back, or lower back. The facet joints are tiny joints near the back of the spine that connect each vertebrae. When these joints begin to degenerate or are injured, injections are used to alleviate spinal pain, as well as pain that radiates into the shoulders, buttocks, or upper legs.
- Sacroiliac injections are similar to facet joint injections, with the exception that they are injected into the sacroiliac joint, which connects the sacral region of the spine to the pelvis. These injections are used to relieve pain in the sacroiliac joint, as well as pain in the lower back, buttock, and leg. In most cases, pain is only reported on one side.
- Visco supplementation injections inject hyaluronic acid into the joint in order to improve the viscosity of joint fluids, which improves joint mobilization. Visco supplementation is used for patients with osteoarthritis who are looking for an alternative to surgery. While joint replacement surgery still may be necessary at some point, visco supplementation has effectively helped some people manage their pain without joint replacement surgery.
Orthobiologics – Stem cell therapy is performed by injecting the patient’s own stem cells to stimulate the body to repair and replace damaged tissue in any joint or soft tissue structures – such as knees, shoulders, hips, wrists, ankles, elbows, tendons, ligaments and non-healing bone fractures.
Foods For Healthy Joints
Seeds and nuts are packed with healthy Omega-3 fatty acids known to fight inflammation and help reduce it in your connective tissue and joints. Omega 3s are best known for improving heart and brain health, but they also reduce inflammation from arthritis. Research from the Mediterranean Journal of Rheumatology states that omega-3 fatty acids may diminish and even prevent pain from arthritis.
Researchers discovered that omega 3 fatty acids help control the release of cytokines into the body. Cytokines are small proteins released by immune system cells that help all cells in the body communicate. Certain types of cytokines are inflammatory and can create a strong immune response. In people with arthritis, cytokines can lead to chronic inflammation in joint tissue.
Some nuts contain high amounts of magnesium, l-arginine and vitamin E, three nutrients that can regulate inflammation. Animal studies have shown that a magnesium deficiency can heighten the body’s inflammatory response. L-arginine, an amino acid that the body uses to make protein, may also work to prevent a strong inflammatory response in body cells. Vitamin E reduces inflammation by also preventing cells from releasing inflammatory cytokines.
Nuts and seeds can also reduce your risk of heart disease. Paying attention to your heart health is crucial if you have arthritis. According to the Arthritis Foundation, you are almost twice as likely to get heart disease if you have arthritis as compared to those without the illness. Chronic inflammation can damage blood vessels and cause plaque to collect in arteries. A study published in the American Journal of Clinical Nutrition found that eating more nuts significantly reduced inflammation in over 5,000 participants. The nuts they tested included peanuts, peanut butter, and all tree nuts, such as almonds, Brazil nuts, walnuts, cashews, hazelnuts, pecans, and pistachios.
Certain seeds also have excellent anti-inflammatory benefits. Chia seeds and flaxseed are high in alpha-linolenic acid or ALA, which is a type of omega-3 fatty acid. Research from the Journal of Nutritional Biochemistry shows that ALA is a powerful anti-inflammatory nutrient that could reduce cell damage in the body. In addition, a systematic review from the journal Nutrients showed that consuming flaxseed and flaxseed oil, drastically reduces inflammatory markers in the bloodstream. Inflammatory markers are certain proteins that the body releases into the blood during inflammation.
Fruits are naturally sweet, and many offer a substantial dose of antioxidants, fiber, vitamins, minerals and other nutrients. Some have components that may help lower inflammation associated with arthritis and other serious conditions, such as heart disease and stroke.
All fruits have health benefits, but some have more disease-fighting properties than others.
- Berries are among some of the best fruits for arthritis. They are loaded with antioxidants, such ascorbic acid (a form of vitamin C) and anthocyanins and carotenoids, which give berries their deep color. These compounds also help rid the body of free radicals that promote inflammation and help prevent heart disease and certain cancers. Many fruits have powerful antioxidants that reduce inflammation in the body which helps joint pain. Blueberries have flavonoids that turn off the inflammatory response in your body.
- Pineapple contains bromelain, which is shown to relieve joint pain that comes with rheumatoid arthritis and osteoarthritis.
- Tomatoes have the antioxidant lycopene that helps fight inflammation.
- Tart cherries get their dark red color and many of their powerful anti-inflammatory and antioxidant benefits from the flavonoid anthocyanin. Some researchers compare the anti-inflammatory properties of cherries to non-steroidal anti-inflammatory drugs (NSAIDs). Studies, which often use the concentrated juice of Montmorency cherries, have found tart cherries may relieve joint pain in people with osteoarthritis (OA) and lower the risk of flares in those with gout. In addition, recent studies suggest tart cherries may improve the quality and duration of sleep.
- Strawberries are naturally low in sugar and have more vitamin C per serving than an orange. Vitamin C can lower risk for gout, high blood pressure and cholesterol problems. Research has also shown that women who ate 16 or more strawberries a week had lower C-reactive protein (CRP), a measure of body-wide inflammation linked to arthritis flares and heart disease. As with cherries, scientists suspect it is anthocyanin, along with other phytochemicals, that give strawberries their anti-inflammatory and antioxidant health benefits. Strawberries are also a good source of folic acid, which the arthritis medication methotrexate can deplete. People taking methotrexate often need folic acid supplements to help prevent side effects, but eating strawberries is still beneficial.
- Raspberries have among the highest level of vitamin C and anthocyanin. Animal studies have shown extracts from the fruit reduce inflammation and arthritis symptoms. Other research shows that the fruit’s bioactive compounds lower system-wide inflammation and, when a regular part of the diet, help prevent numerous chronic conditions, such as heart disease, stroke and type-2 diabetes.
- Avocados have a high concentration of anti-inflammatory monounsaturated fat. Avocados are also rich in the carotenoid lutein. Unlike most fruits, avocados are a good source of vitamin E, a micronutrient with anti-inflammatory effects. Diets high in these compounds are linked to decreased risk of the joint damage seen in early OA. Studies also show eating avocados daily increases HDL cholesterol and lowers LDL cholesterol. Despite the fruit’s relatively high calorie content, research has found that regular avocado eaters tend to weigh less and have smaller waists. Their high fiber and fat content may help people control cravings.
- Watermelon Studies show that eating watermelon reduces the inflammatory marker CRP. It’s also high in the carotenoid beta-cryptoxanthin, which can reduce the risk of rheumatoid arthritis (RA). It’s also packed with lycopene, an antioxidant that may help protect against certain cancers and lower heart attack risk. One cup has about 40 percent more lycopene than raw tomatoes, the next richest raw food source. Watermelon is also ninety-two percent water, which makes it great for hydration and weight management. One cup of watermelon has about 40 calories – plus about a third of your recommended daily allowance of vitamins A and C.
- Grapes Both white and darker-colored varieties of grapes are a great source of beneficial antioxidants and other polyphenols. Fresh red and black grapes also contain resveratrol, the heart-healthy compound found in red wine that contributes to cardiovascular health by improving the function of blood vessels. Resveratrol is also a potent anti-inflammatory. Studies show this bioactive compound acts on the same cellular targets as NSAIDs. Researchers are studying its potential for improving symptoms of OA, as well as for other chronic diseases linked to aging.
Here’s a guide to some of the vegetables that help keep inflammation low:
- Dark Green Leafy and Cruiferous Vegetables Energy production and other metabolic processes in the body produce harmful byproducts called free radicals. Not only do free radicals damage cells, but they also have been linked to inflammation. Green, leafy vegetables such as broccoli, spinach, Brussels sprouts, kale, Swiss chard and bok choy are packed with antioxidants like vitamins A, C and K, which protect cells from free-radical damage. These foods are also high in bone-preserving calcium.
Broccoli and other cruciferous vegetables (Brussels sprouts, cabbage, bok choy and cauliflower) all have a natural compound called sulforaphane. Research on mice shows sulforaphane blocks the inflammatory process and might slow cartilage damage. And there’s some evidence diets high in cruciferous vegetables could prevent Rheumatoid Arthritis from developing in the first place.
- Sweet Potatoes, Carrots, Red Peppers and Squash These brightly orange and red-hued vegetables get their distinctive color from carotenoids like beta-cryptoxanthin. Plant pigments also supply sweet potatoes, carrots, squash and red peppers with antioxidants. Some research suggests eating more foods rich in beta-cryptoxanthin could reduce your risk of developing inflammation.
- Red and Green Peppers Peppers, no matter what their color or whether they’re mild or hot, are a good source of vitamin C, which preserves bone, and may protect cartilage cells. Getting less than the recommended 75 mg vitamin C for women and 90 mg for men daily may increase risk for osteoarthritis of the knee. Just a half-cup of red bell pepper gives you a full day’s supply.
- Onions, Garlic, Leeks and Shallots These vegetables are all members of the allium family, which are rich in a type of antioxidant called quercetin. Researchers are investigating quercetin’s potential ability to relieve inflammation. Alliums also contain a compound called diallyl disulphine, which may reduce the enzymes that damage cartilage.
- Olives Though technically a fruit and not found in the produce aisle, olives and olive oil can be potent inflammation fighters. Extra-virgin olive oil contains the compound oleocanthal, a natural anti-inflammatory agent that has properties similar to the ibuprofen.
Pinto beans, chickpeas, black beans, soybeans, and lentils all include anthocyanins, a flavonoid that helps reduce inflammation in your body. Beans and lentils also provide a great source of essential minerals, fiber, and protein.
Oils such as peanut oil, vegetable oil, and sunflower oil can increase inflammation levels. Olive oil, however, is an excellent substitute for salad dressings or cooking. It’s a healthy fat and packed with inflammation-fighting Omega-3s.
Dark chocolate is delicious and great for joint paint because cocoa contains antioxidants that counteract inflammation. The key is to choose chocolate with a high percentage of cocoa and to indulge in moderation.
Along with knowing which foods to add to your diet for healthier joints, it’s also vital to know what to avoid. Certain foods can increase inflammation in your body and joint pain. Inflammatory foods you should limit or steer clear of include:
- Processed foods
- Fried foods
- Oils high in Omega-6 fatty acids or saturated fats
- Sugar and refined carbohydrates
How to Buy
Buy fresh produce at your co-op, preferably fresh and locally grown and always organic.
Buy organic seeds and nuts in bulk either at your local co-op or online at nuts.com.
Buy beans in bulk or in cans. When buying canned beans, look for those with no or less sodium. The salt added during cooking adds up.
Hu chocolate is Paleo, Vegan, Organic, with no dairy, no soy, no emulsifiers, no soy lecithin, no gluten, no refined sugar, no cane sugar, and no sugar alcohols. And, it is delicious!
How to Store
Seeds, nuts, legumes, sweet potatoes, tomatoes and onions can be stored on your counter or pantry out of sunlight.
Greens and fruits should be stored in your refrigerator.
How to Cook
Almost as important as which vegetables you choose is how you cook them. Steaming is preferable to boiling because it preserves the nutrients in the vegetables. Don’t use a lot of water, because vitamins and antioxidants might leach out in the water. Also, don’t overcook them. Keep vegetables a little bit al dente to hold in the vitamins and minerals.
Eat fruit as fresh as possible. Overripe fruits may be still good to eat or easily convert into smoothie, juice or used as an ingredient such as in banana bread. Eating an over-ripe fruit such as a banana does not mean that you are putting more sugars into your body as the total amount of carbohydrates in the fruit does not increase after harvesting.
1/4 of a cup of seeds or nuts is a serving. For nut butters and seed spreads, it is two tablespoons.
Jessica Hoffman/ Choosing Chia
- 2 cups lacinato kale, shredded
- 2 cups spinach, chopped
- 1/2 cup red cabbage, shreded
- 1 cup quinoa, cooked
- 1/2 cup broccoli florrets
- 1 pepper, chopped (a mix of red and yellow peppers)
- 1/2 green apple, cut into cubes
- 1/3 cup pomegranate seeds (frozen are easies – they are quick to thaw)
- 1/4 cup toasted slivered almond
- 2 tbsp hemp seed
- 1 tbsp chia seeds
Maple Dijon Dressing
- 1/4 cup olive oil
- 3 tbsp lemon juice
- 2 tbsp maple syrup
- 2 tbsp dijon mustard
- pinch of cayenne
- salt & pepper to taste
- Mix all the salad ingredients together in a large bowl.
- Mix the salad dressing ingredients together in a mason jar or in a cup until well combined. Taste the dressing and adjust seasoning if needed.
- Pour as much dressing as you like onto the salad and toss everything together.
Buy organic when you can to make sure your fruits and vegetables are not sprayed with any pesticides.
If you want to have leftover salad for later, put some aside and store in the fridge before adding the salad dressing.