2004-04-09 / Community

Eye On Physical Therapy

By Tim Rohrs

I often relate the following story to my patients with arthritis of the knees. A few years ago, I would take my 73-year-old mother and my wife shopping at Roosevelt Field Mall on Friday evenings.

I would call my mother and ask her what time did she want to be picked up. On a certain Friday night, she replied that her knees were very bad that day with arthritis and she would not be going to the mall that night. The next week I got the same response. On the third week, I got the same re sponse and decided that I had to intervene. I explained to her that the decisions she was making tonight could negatively impact on her functional status five years from now.

She had fallen into arthritis trap. I explained to her that the more she decides to "take it easy" and "wait until her knees feel better", the weaker and stiffer her knees are going to get. The arthritis does not reverse itself. It will always be there, unless a joint replacement surgery is performed. Again, she will decide to stay off them and continue to add to her weakness and stiffness as well as decrease in her cardio vascular and cardio pulmonary function. Today, it is just a decision to stay home, but where do those decisions lead us? How will she be functioning in five years? At a minimum she will use a cane or walker, or a wheelchair.

Knee pain in the elderly is one of the most common conditions physical therapists must treat, and one of the most debilitating. Knee pain due to Osteo Arthritis causes a sequence of events, which can then restrict day-to-day activities and negatively effect social interactions with others. Pain, stiffness, swelling and weakness are some of the results of arthritis.

The cartilage of the knee is similar in appearance to the cartilage one might see while eating a chicken leg. It is bright white and very shiny. The ability of the cartilage to provide a slick surface is imperative for proper movement. To give an example of how slippery it is, we can compare the coefficient of friction for different things. The coefficient of friction for two solid pieces of ice sliding on one another at 0B0 Celsius is 0.1. The coefficient of friction of cobalt chrome on polyethylene, which is the typical materials used in joint replacement, is 0.01 to 0.05. The coefficient of friction of normal cartilage is 0.005 to 0.02. Clearly, the normal cartilage provides an excellent surface for smooth movement.

As we age, the joint surfaces start to deteriorate and become pitted and worn. As this happens, the friction be comes more, and the surface is less slippery. The body mobilizes the im mune system to clean up the area that gets worn. White blood cells infiltrate the area and literally encapsulate the debris to remove it.

This is the first stage of inflammation, resulting in pain and swelling.

Anyway, my speech had its desired effect: she told me to pick her up in 15 minutes and has not missed a Friday night trip to the mall since.


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