Q&A: Inflammation; Sore Knees

Q. I hear much about how damaging inflammation is for the body. Can you tell me  more about this potentially dangerous condition? Can I prevent inflammation?

A. There are two types of inflammation, acute and chronic. Acute refers to a short-lived, immediate bodily reaction to harm or injury; for example, if you stub your toe, it becomes swollen and your body increases blood flow to the site to promote healing.

Chronic inflammation, however, is low-grade, long-lasting (months, even years) and has damaging effects, as is seen in rheumatoid arthritis, an inflammatory disease. Frequently, people are not aware they have chronic inflammation because it occurs gradually.

Obesity, diabetes, high blood pressure, and stress also can cause inflammation. Ongoing stress causes your body to release a hormone, cortisol, which stimulates increased glucose release, inhibits insulin production, and narrows arteries, which raises blood pressure, leading to increased risk of cardiovascular disease and diabetes.

Ways to counter or inhibit inflammation include diet and physical activity: Eat a diet high in a wide variety of antioxidant-rich fruits and vegetables, whole grains, and omega-3 fatty acids (fish), and avoid refined starches, sugars, saturated and trans fats. Try to engage in low- to moderate-intensity exercise at least 30 minutes a day (a brisk walk qualifies).

You can have a blood test for a substance called C-reactive protein (CRP), a marker of chronic inflammation, to determine if you have heightened levels of inflammation; there is also a high-sensitivity CRP test that can detect low levels of the protein in people who do not exhibit other signs or symptoms. If you think you may be at risk, ask your doctor if you can be tested, or include a CRP test when you have your annual bloodwork done.

Q. My husband keeps complaining about sore knees. Could he have osteoarthritis? Or are there other possible causes? And, what’s the best remedy? He’s in his late 60s and still very active playing tennis and golf.

A. There are several causes of sore knees, the most common of which is too much sitting—but since your husband is active in tennis and golf, that probably doesn’t apply to him. He could be in the early stages of osteoarthritis (OA). OA wears down the knee cartilage and occurs over time. The knee joint’s synovial fluid, a natural lubricant that contains hyaluronic acid, depletes with age, losing effectiveness, which leads to pain, inflammation, and reduced mobility.

First-line treatment includes specific exercises, weight loss, and lifestyle changes; if this doesn’t suffice, wearing a knee brace and taking nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections may mitigate the pain. If these measures don’t work, injections of hyaluronic acid have met with success. Patients report the benefit lasts for several months after an injection; the body begins making more of its own hyaluronic acid after treatment. The shot is administered in a doctor’s office—usually an orthopaedic surgeon or sports medicine physician.

Another cause your husband should be aware of: His hip flexors may have become tight, causing the hamstrings to become tight, which then causes an unnatural knee extension and flexion when walking, and may lead to knee pain. Several stretching exercises, such as  a standing hip flexor stretch (see below) and a supine hip flexor stretch can help strengthen and stretch the flexors. Ask your husband to try them for a couple of weeks and see if they help.

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