You get used to the idea that after a few years of smashing out the miles – on a bike, on the sports pitch, on the road – or reps in the gym, the wear and tear on joints eventually leads to something going crunch. Most of us tend to push it to the backs of our heads, do a bit of yoga, and then move on. After all, you regret the things you never did more than the ones that knacker your knees, right? But what if you could have your 100-miler and run it too? What if there was a cure for wear and tear itself? Well, in a few years, say these doctors, our prayers might be answered – and if you can’t wait a few years then they have some solutions for right now, too…
Any sport that involves running can be classed as high-impact, and the biggest problem facing those of us with wear and tear to our knees is that cartilage does not have a blood supply. Rack up damage by pounding pavements and the cartilage cannot heal itself, unlike a muscle. So, doctors are refining techniques to take your blood and extract the plasma (which has the best quality cells), then inject it into your knees in order to help the cartilage repair itself (Platelet-Rich Plasma or PRP therapy). This is also done with bone marrow (Bone Marrow Aspirate Concentrate or BMAC therapy), and combined with arthroscopy.
‘These theories have been known for a long time,’ Dr Al-Amin Kassam, orthopaedic surgeon at The Exeter Knee Reconstruction Unit, tells RISING, ‘but the techniques for PRP and BMAC treatments have been improved significantly over the last few years, with better techniques and high-tech equipment to isolate the best cells from your own blood, such as advanced centrifuges.’
‘More and more, we try to repair the meniscus with new equipment, such as suture types, and bone anchors’
Your Shock Absorbers Are The First Line Of Defence
The knee’s own shock absorber, called the meniscus, is a form of cartilage. It helps to protect the cartilage covering the bone, so repairing it is key. ‘In years gone by if someone had a meniscus tear it would be cut out, but more and more we try to repair the meniscus with new equipment, such as suture types, and bone anchors,’ says Dr Kassam.
‘We will often combine the repair with injecting PRP or BMAC, or drill a hole in some of the areas of the bone that are not in contact with the joint. This can help to release some stem cells into the knee which can help to repair the meniscus. Because you are drilling into the bone, which has its own blood supply, you can release some of the good cells from the blood to help heal the meniscus. Repairing it will help maintain normal knee function and prevent wear and tear.’
‘Don’t believe in the old phrase “pain is just weakness leaving the body”’
Don’t Suffer In Silence
While these techniques offer hope for knee-pain sufferers, there is a catch. ‘If you have single isolated areas of cartilage damage, which cause pain when you are active, cartilage regeneration techniques can be used – but these cannot be used for widespread wear and tear,’ says Dr Kassam. ‘Don’t believe in the old phrase “pain is just weakness leaving the body” because if left untreated, these isolated areas could progress to widespread wear and tear which is far harder to treat. Just in the last couple of years we have been using an exciting new technique. With isolated areas of wear and tear we can now remove some cartilage cells and regenerate a layer of cartilage, in the lab, which we can then re-implant over defects, like plugging a hole. This can restore your normal mobility, following rehab. Again, you can’t use this technique once the wear and tear has spread to multiple areas.’
If you’re wondering how to tell when the usual aches and pains associated with exercise have developed into something more serious, then Dr Kassam has a useful yardstick. ‘If you ran today and couldn’t run the next day that is fairly normal. But if the pain is still preventing you from running 10 days later that is not normal and you should report it to your doctor, requesting an MRI scan to assess the cartilage and your meniscus. Red flags include: swelling, instability where the knee feels like it is giving way, and twisting injuries, because there is a higher risk of meniscus tears or ligament injuries.’
The Future Is You
If you’re not suffering knee pain now but are worried about the future, then there are even more exciting fixes on the horizon. ‘Even in just 10 to 15 years, we will be able to print individually-designed 3D material for patients, rather than using artificial ligaments. We will take the patient’s own cells and re-grow the materials needed,’ says Mr Ali Noorani, consultant orthopaedic surgeon at Highgate Private Hospital.
As the medics refine their techniques, the future of joint pain fixes looks like it will even permit us to return to high-impact sports after knee re-builds. ‘Eventually I do believe that patients will be able to return to all activities after reconstructive joint surgery, including running and other impact sports – but for the moment most of us will encourage patients to return to non-impact activities, or at least limit their impact activities,’ Dr Simon Moyes, consultant orthopaedic surgeon at The Wellington Hospital tells RISING.
Of course, the best way to beat injury is to prevent it in the first place and the advice for that isn’t at all futuristic, says Dr Moyes. ‘The best tips for avoiding joint damage are keeping your weight under control, while maintaining your joint flexibility and general muscle strength.’
WHAT NEXT? A key component of a functionally healthy body is correct alignment of your joints. ‘If your alignment is off, you will spread pain to other joints, because each joint has a knock-on effect to the one above or below it,’ says Dr Kassam. He recommends training your core muscles and visiting a physio to assess your running patterns. ‘In training, focus on increasing your movement efficiency rather than speed. Get your technique right and everything else will follow,’ he says.
Something you can do right now is start strengthening your quads. ‘For knee pain, quad strengthening is the single best exercise you can do to prevent injury and improve any pain. It helps improve the tracking of your kneecap and can have a knock-on effect of improving lower leg alignment and function of your hips down to your ankles. An unloaded bar, or bodyweight squat is ideal for focusing on your form and good alignment of the knee.’
Advice is for information only and should not replace medical care or recommendations. Please check with your Doctor before embarking on exercise or nutrition regimes for the first time.