Degeneration of the Knee and Lumbar Joints – What Helps This Condition?

Paul Reller, L.Ac.

A majority of Americans will experience degenerative changes to the knee and/or lumbar joints and discs, many even in their early thirties. With aging, hip degeneration affects at least a third of the population, and is a major factor in the decline of health with aging, as decreased mobility and increased inflammatory stress will be a major contributor to a variety of common health problems with age. A number of factors contribute to degenerative joint and vertebral disk conditions, and understanding these health problems and causative factors helps the patient and Complementary Medicine physician to devise the right individualized protocol to prevent, reverse, or treat the condition. Restoration of healthy joint and disc tissues is possible, and unless these underlying factors are addressed, large studies show that even surgery may not prevent the continuing degeneration. Integrating Complementary Medicine into your health care may be the most important choice in your life to prevent the pain and debility that often accompanies these degenerative conditions.

By 2011, the strategies of modern medicine to treat degenerative joint and spine conditions are proving to be inadequate. Large studies have shown that arthroscopic surgical repair will not prevent the recurrence of degeneration of the joint if underlying chronic inflammatory conditions are not corrected. The medical community responded to this finding by promoting a prosthetic replacement of joints, but by 2011 many of these prosthetics were failing is a short period of time and causing a problematic deposition of metal particles in the tissues. The failures of metal-on-metal hip replacements will generate many billions of dollars in added healthcare costs, time off work, and future nursing care for invalid patients, adding stress to both the patients and their families, and the government, as rising healthcare costs add to government deficits and increased cost of insurance policies. A more comprehensive and holistic approach to joint degeneration is urgently needed.

Joint degeneration is usually referred to as osteoarthritis, but this term does not apply to all degenerative joint conditions. Arthritis means inflammation of the joint, and there are over 100 medical classifications, or types, of arthritis. Osteo is a term referring to bone, and is used also to refer to the bone covering at the joint, or cartilage, as well. Many cases of joint degeneration are more correctly called osteoarthroses. Degeneration of the cartilage may also be due to metabolic concerns, and this would be classified as chondromalacia, sometimes called “softening of the cartilage”, but referring to inadequate metabolic nutrition delivered to the cartilage, or dystrophy, in many cases. The exact causative explanations of joint degeneration are still being debated, and an overview of the scientific understanding on this subject helps the patient and physician to formulate the right individualized treatment protocols to stop tissue degeneration and promote healthy regrowth.

Because of the lack of understanding of the etiopathology of joint degeneration, even the incidence of this problem is not clearly reported, and various medical sources give varying reports of incidence. This is mainly due to the problems with classification of the disease. The Centers for Disease Control in the U.S. report that osteoarthritis is characterized by degeneration of the cartilage and underlying bone within a joint, and is seen in about 14% of the population, and close to 34% of the aging population, but specifies that this is believed to be a very conservative estimate. Females experience osteoarthritic joint degeneration at about a 2-3 to 1 ration over males. The incidence of lumbar disc degeneration is often reported to exceed 50% in the aging population, and even exceed 20% in the young population.

In 2010, with the number of hip replacements performed approaching 200,000 per year and climbing, the number of complaints of adverse events and failure of the metal-on-metal hip replacements alone, which account for over 60,000 of the prosthetics implanted per year, reached over 5000 per year. By the end of 2011, the number of failures of metal-on-metal hip prosthetics mushroomed to a catastrophic number. The New York Times reported in a December 28, 2011 article entitled Common Failure of Hip Implants Bring Big Costs (Harry Meier) that an estimated 500,000 patients had received an all-metal hip replacement prosthetic by 2011, accounting for over a third of the hip replacement prosthetics until alarming reports of failure prompted large recalls and discontinuation of these types of prosthetics. A single type, manufactured by the DePuy division of Johnson and Johnson, was implanted in 40,000 patients in the United States, and recalled in 2010 due to a high rate of failures and adverse risks from metal debris in the surrounding tissues and circulation. The metal debris resulted from both movement of parts against each other and corrosion. In 2011, the Bloomberg report stated that the failure rate of this one type of prosthetic in the United Kingdom reached 49 percent by year six after the first revision. The settlements of these cases involving failed prosthetic joints has generated remarkable financial liability for patients, as hospitals and insurers often settle for a relatively small recompense and pass the remainder of the bills to the patient, according to the New York Times investigation. For patients receiving a direct settlement, liens from the insurers and hospitals often are much larger than the personal settlement, creating enormous economic stress for the patient, who is usually unable to work. The Times article cited a recent study that showed that in the last 5 years, no new artificial hip or knee replacement device introduced to the market was more durable than older devices, and some 30 percent of these “advanced” devices were less durable than older models. An FDA report, however conservative, reveals that the metal flaking and release of metal ions into circulation presents a real risk. Click this link to see the FDA warning: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/MetalonMetalHipImplants/ucm241604.htm.

We have known for some time that there was a big problem with hip replacements, with even a successful prosthetic providing only a short number of years of function. In 2002, an NIH population study by Brigham and Women’s Hospital, Harvard Medical School found that over 37,000 revisions (replacement surgeries) were performed each year in the United States, at the cost of over $31,000 per surgery. Since 2002, this number, and the costs, have grown dramatically. The full recovery time often reaches 6 months, adding the cost of time off work and rehabilitative therapy. Revision replacements have a higher incidences of failure and adverse effects, and a shorter life span of the prosthetic. A third revision is almost never successful, eventually leaving the patient an invalid. While the advances in total hip and knee replacements are remarkable, many intelligent patients are opting for a more conservative course of joint rehabilitation before resorting to this problematic and risky solution. While standard medicine continues to imply that the only options are mild exercise and corticosteroid injections, the research today shows that a treatment protocol integrating acupuncture, electroacupuncture stimulation, herbal and nutrient medicine, direct soft tissue physiotherapy (Tui na), and proper neuromuscular reeducation is able to stimulate functional regrowth of the joint cartilage and surrounding tissues, and reverse osteoarthritis, which accounts for about 94 percent of the cases receiving hip and knee replacements. In addition, recent research has found that specific herbal chemicals may reverse or control rheumatoid arthritis, and may also be combined in a total treatment package with acupuncture, nutrient medicine and physiotherapy.

Degeneration of the Knee joint and cartilage

Degeneration of the knee joint may involve a variety of tissues. In most cases, the cartilage, or tissue covering the bone at the joint, is softened and degenerated, sometimes until parts of the cartilage are almost completely absent. In other cases, the joint meniscus, a fibrocartilaginous structure of the knee joint, with a crescent or horsehoe shape, is degenerated and experiences a number of small tissue tears. The ligaments of the knee, especially the interior ligaments, or cruciates, are also involved in many cases. Ligaments are fibrous tissues connecting and stabilizing two or more bones, cartilages, or other fascial tissues of the joints. While many patients associate tears of the ligaments and meniscus with injury, the majority of these cases do not involve trauma.

For many years, it was assumed that “wear and tear” was primarily responsible for these tissues experiencing degeneration. In the knee, there are two areas with cartilage, or bony covering, namely, the cartilage of the primary bones (femur, tibia and fibula), and the cartilage of the moving kneecap (patella). The degeneration of the patellar cartilage is still referred to as “runner‘s knee”, revealing the past prevalent notion that most cases were due to mechanical wearing down of the cartilage. The actual term is chondromalacia patella, implying that insufficient circulation of nutrients is mainly responsible for the degeneration of the patellar cartilage, with wear and tear merely contributing. Degeneration of the cartilage of the primary bones is mainly due to osteoarthritic changes, and this has a more multifactorial cause. A combination of poor tissue nutrient delivery (malacia), improper mechanical stresses, inflammatory dysfunction, and hormonal changes are believed to be the main underlying factors contributing to osteoarthritic degeneration of the cartilage of the primary bones of the knee. Obviously, a thorough and holistic approach to treatment is needed to address these factors, as well as a time intensive and individualized approach. Standard medicine does not deliver this type of treatment approach, but integration of the more cost effective and time intensive treatments in Complementary Medicine could fulfill this need. The specialty of the Traditional Chinese Medicine (TCM) includes physiotherapies (Tui na), herbal and nutrient chemistry, acupuncture and electrical stimulation, and patient instruction in therapeutic regimens and correction of postural mechanics.

In the recent past, standard medicine led the patient’s to believe that arthroscopic surgery would correct problems with degenerative knee joints. More recent evidence suggests that many arthroscopic knee surgeries to repair meniscus tears may be unwarranted, and that the problem will recur due to degenerative arthritic conditions. In a New York Times article in the Health section on December 8, 2008, Dr. David Felson, a professor of medicine and epidemiology at Boston University, explained a study of 991 people ages 50 to 90, some with knee pain and some without, that were examined with multiple MRI scans to determine the frequency and meaning of meniscal tears in the general population. The conclusions, published in the New England Journal of Medicine, were that meniscal tears were just as common in arthritic joints without pain as those that produced pain, and so repairing the joints surgically was not the answer to eliminating the pain. Dr. Felson found that 40% of the general population had meniscus tears at age 60, and there was little correlation between these tears and the pain. He believes that arthritis and chronic inflammatory degeneration are the cause of most knee pain in the aging population, and that conservative care should be utilized to correct this problem. TCM can deliver this conservative care.

Degenerative conditions of the joints occur when normal maintenance of the joint tissues is inadequate to counter mechanical stresses and/or inflammatory diseases. Side effects of medication may also play a significant role, as well as metabolic deficiencies. By the time joint pain becomes debilitating the degenerative process is already advanced. The patient must look at three approaches to this problem: 1) pain relief, 2) identification of the causes and contributors to the tissue degeneration & subsequent correction of these problems, & 3) restoration of healthy tissue and proper response of the inflammatory mechanisms to clear unhealthy tissues and replace them with new healthy growth.

Restoration of the joint tissues depends on concurrent physiotherapy and use of aids to help the body with tissue regeneration. Once the patient learns to correct problems with body mechanics that continue to injure the joint, and corrects other problematic causes of tissue degeneration, such as chronic inflammatory states or diseases, tissue regeneration is possible, even with cartilage. Sometimes arthroscopic surgery is absolutely necessary to clean up dead tissue so that healthy tissue may grow, but the surgical assessment should consider the actual need and benefit realistically, and work in an integrated fashion with other health professionals to achieve regrowth of healthy tissues and take care of problems that contribute to chronic joint inflammation. Post surgical care should include passive mobilizaiton, myofascial release, acupuncture, herbal medicine, and nutrient therapy to aid healthy repair and regrowth of the joint cartilage, ligaments and tendon attachments. Health concerns that contribute to arthritis, or poor inflammatory function, should be addressed holistically.

"Modern medicine is turning to less invasive and more holistic protocols such as prolotherapy, laser surgery and other minimally invasive surgical techniques combined with a comprehensive package of support therapy to promote healthy restoration of the arthritic joint. Health authorities such as the Mayo Clinic state that therapies such as prolotherapy alone will not result in a healthy regrowth of cartilage and joint tissue. This is where the use of Complementary Medicine comes into play."

Prolotherapy is an example of the new attitude taken by the medical community to degenerative joint conditions. In this therapy, also called sclerotherapy, sugar or nutrient solutions are injected repeatedly into the deteriorated or degenerative ligaments, joint capsule soft tissues and tendon attachments to stimulate regrowth of the fascia, or connective tissue. Prolotherapy produces an inflammatory response in these soft tissues to stimulate regrowth, but as the Mayo Clinic reports on their website, prolotherapy alone is not proven to be beneficial. It must be combined with an array of Complementary therapies to achieve success. Utilizing acupuncture, topical herbal medicines, and nutrient medicines, all of which have shown clinical proof of benefit to arthritic joint conditions, along with direct soft tissue physiotherapies, such as TuiNa and myofascial release, the ultimate success with prolotherapy is greatly enhanced. Therapies such as prolotherapy and arthroscopic surgical repair may be utilized by the patient with advanced joint degeneration, but it would be a big mistake to assume that these interventions alone will restore joint health. If the underlying mechanisms that led to joint degeneration are not addressed, the same joint degeneration will recur.

Prolotherapy produces an inflammatory response in the joint tissues to promote healthy growth, and we can understand from this approach the necessity of improving the inflammatory functions in the body. While anti-inflammatory medicines such as ibuprofen and naprosen may relieve pain temporarily, the inhibition of inflammatory processes may result in long term degeneration rather than healthy tissue restoration. Corticosteroid injections, which may promote the inflammatory process and modulate it temporarily, will also cause joint degeneration if repeated too often, and a new clinical trial comparing long-term outcomes of PRP (platelet-rich plasma injection) and corticosteroid injection showed that corticosteroids provided no improvement in long-term outcomes of pain and disability (see NY Times article cited below). Corticosteroids come with considerable health risk when a patient is taking multiple products with synthetic steroids chronically, and synthetic steroids are now found in many prescription and over-the-counter products. The real benefit of corticosteroid injection is a short-term relief of pain that provides a window of opportunity for the patient to utilize an array of conservative treatments to achieve better tissue healing. Complementary and Integrative Medicine provides this array of treatments, combining phyisotherapies with acupuncture, herbal medicine, topical herbs, nutrient medicine, and patient instruction to ahcieve maximum results. Complementary Medicine also utilizes the inflammatory mechanism to do what it is supposed to do, not just create pain, but to repair the tissue. Herbal and nutrient medicine may optimize the inflammatory response to promote the natural tissue healing mechanisms built into the body. For this to work a comprehensive and holistic approach must be taken that insures that your immune response and inflammatory tissue repair works optimally.

One type of injection that has been utilized more frequently in recent years for degenerative joints, especially for osteoarthritic knee joints, is hyaluronic acid. A multicenter placebo-controlled trial of the effects of this therapy in France was completed in 2008, and the results indicated that a single injection of hyaluronic acid produced no better results than placebo (see additional information below). Hyaluronic acid is a substance found in normal joint fluid and tissue, and is a major component of synovial fluid, which lubricates and protects the white tissues of the joints. While a single injection of hyaluronic acid proved ineffective, probably because tissue receptors for hyaluronic acid limit the cellular intake from a large dose, repeated topical use of a small amount of hyaluronic acid has proven beneficial for some dry joint tissues, especially if administered with a carrier substance. Research is also progressing on the effects of a small amount of pure hyaluronic acid take sublingually and distributed to receptors via blood circulation. This is just one facet of a comprehensive package of therapy that may be needed to achieve healthy repair and regrowth of the degenerated joint tissues. By studying this article, the patient with joint degeneration can gain understanding of the best therapeutic aids in Complementary Medicine and combine these into an effective package of care.

"No single supplement or herb will work to achieve eventual repair and regrowth of healthy joint tissues when degenerative joint conditions and osteoarthritis or chondromalacia occurs. A package of care includes a combination of research-based medicines along with sensible physiotherapies, correction of body mechanics, and stimulation of both the joint and the systems in the body responsible for tissue maintenance and regrowth."

Joint tissues have no direct significant blood supply, and thus depend upon movement to push fluids in and out of these tissues. The white tissues are the cartilage, meniscus, ligaments and tendons, and these are the tissues that degenerate in the joint. One reason that they degenerate so severely in osteoarthritis is because the bone covering, or periosteum, which does have abundant blood and lymphatic vessels, is absent where cartilage covers the bone at the joint. Instead we normally have layers of cartilage where bone meets bone, and these layers are supplied with nutrients from two directions, the vascularized muscles, and the vascularized bone. When degeneration occurs in the bone and cartilage, spurs or osteophytes, and changes in the bone underlying the cartilage, occur, where this outer bone is converted into a dense smooth ivory-like substance (eburnation), preventing the lower layers of cartilage from getting the necessary blood supply from the richly vascularized bone and also preventing the normal conversion of cartilage into new healthy bone. This basement layer of your cartilage is composed of a type of cartilage cell that creates hyaline and type II collagen. This layer of cartilage near the bone is normally oxygen-rich, from the bone blood supply, and a lack of oxygen accounts for poor hyaline formation. Injection of hyaluronic acid alone will not correct this problem, and only restoration of these cartilage cells that produce hyaline will achieve proper lubrication and decrease of pain. A step-by-step therapeutic approach is necessary to regain the healthy metabolism of lubricating hyaline and formation of new collagen. A combination of passive joint mobilization, stimulation with acupuncture and electrical stimulation, increased blood flow, healthier immune reaction, antioxidant clearing, and tissue nourishment with type II collagen, and perhaps hyaluronic acid included in the comprehensive treatment protocol, is the logical course to increase the success of this therapy.

Collagen type II is the main rebuilding material for both joint tissues and bone, and when a repair and regrowth is stimulated with a package of proper therapy, an enormous amount of this material is needed by the body. Unfortunately, for many patients with degenerative conditions, not enough collagen type II is produced by their cells. The subject of delivery of exogenous collagen type II to the patient has been studied for some time. Initially, it was hoped that glucosamine sulfate and chondroitin could be take orally and provide a better production of collagen type II and joint tissue regrowth. Unfortunately, taking these supplements orally has little effect at the joint because the digestive process breaks down these substances before they reach the joint in the blood circulation. Research at Harvard University has progressed to the completion of two human clinical trials utilizing purified extracts of bioidentical collagen type II from chicken tissues. Methods of extraction, purification, and now encapsulation with an eggshell glycoprotein, has produced a type of collagen type II that can be taken orally and is proven to reach the affected joints. Utilizing a health professional, and dependable professional products such as these, is very important to the success in therapy. When utilizing this research-based nutrient, it would be more effective when the joint is receiving proper physiotherapy and stimulation, when the patient is progressing with targeted stretch and exercise, and when other research-based herbs and supplements are used to promote circulation, tissue repair, and antioxidant clearing. One potent antioxidant is derived from pomegranate, not just the juice, but the inedible parts of the plant also, which contain potent OPCs that have been proven to also modulate the immune response that drives osteoarthritic degeneration, with excess of interleuin-1.

Unhealthy collagen may also be a problem in chronic joint pathologies and degeneration. It has been demonstrated in studies that advanced glycation endproducts (AGEs) may cause oxidative stress and stiffened collagen cross-links that are problematic for both joint tissues and bone. In autoimmune reactions, such as Rheumatoid arthritis, unhealthy collagen may be an important trigger of autoimmune reactivity. The Harvard studies of collagen extracts have proven in clinical human trials that this patented form of collagen supplement significantly replaces unhealthy collagen in both Rheumatoid arthritis and osteoarthritis patients. Decrease of AGEs and AGE receptors may also significantly improve chronic arthritic degeneration. Since the glycation Maillard reactions in collagen and vascular endothelium may occur on protein residues, effective proteolytic enzymes may also be useful in the overall protocol. These problems with AGEs and poor tissue quality are especially suspect in patients with metbolic syndrome (insulin resistance or Diabetes type 2), but are also noted as a physiological problem associated with normal aging. Measurement of increased urinary excretion of key AGEs, such as pentosidine, have been highly associated with osteoporotic vertebral microfractures in studies as well. These bone degenerative conditions may be an important part of the pathology in chronic lumbar joint degeneration and subsequent arthritic conditions.

Not only the white tissues of the joint, capsule, ligament and tendon, but also the bone covering, or cartilage will need to repair and regrow. More advanced study of the physiology of this cartilage near the bone has indicated that activated Vitamin D3 hormone, or 24,25-(OH2) D3, is essential to regulation of the healthy calcification of this layer of cartilage. When calcification slows, the cartilage near the bone becomes hypertrophied, or swollen, preventing both circulation to the tissue, as well as inhibiting the growth mechanism of the more surface layers of cartilage. Restoration of this D3 hormone mechanism involves more than just taking Vitamin D. Hormone balance is essential to the Vitamin D3 metabolism. Restoration of healthy hormone balance may thus be needed in certain patients with degenerative cartilage. In the healthy individual, most of our Vitamin D3 cholecalciferol prohormone is generated in our skin with frequent exposure to sunlight for short periods at midday. This cholecalciferol is then transformed, via a number of enzymatic steps, tightly controlled by endocrine feedback regulation, into the activated hormone D3 forms that we need. This occurs mainly in the kidneys. To restore potential D3 deficencies that may be greatly contributing to your degenerative cartilage and joint conditions, a thorough holistic approach is recommended, and professional guidance may be necessary. The book entitled Cartilage, by Brian Keith Hall and Stuart A. Newman thoroughly outlines these findings, and states: ”What distinguishes chondrocytes (cartilage cells) of the growth plate from other chondrocytes would appear to be their ability to respond to environmental regulation by Vitamin D metabolites in a manner not shared by other chondrocytes.“ What this means is that for patients with chronic degenerative cartilage, no matter what the cause, surgical correction and supply with nutrients such as glucosamine and chondroitin will not achieve ultimate goals of restoration without a healthier hormonal support. This type of increased hormonal health can only be achieved with a holistic approach.

A second type of joint degeneration occurs with repetitive wear and tear to the upper layer of cartilage, and this is called chondromalacia, or commonly ’runner's knee‘. In this degenerative condition, the upper layers of cartilage, usually under the patella, degenerate due to poor regrowth when patellar motion wears away the surface of the underlying cartilage. Uneven muscle tension and/or joint subluxation may be the cause of this abnormal abrasion of the patella against the cartilage. Most cases occur in young athletic individuals, especially women, whose wider pelvic structure may create more lateral force on the patella. Masking of the pain with non-steroidal anti-inflammatories and steroid injections may actually contribute to the degeneration because these allow the athlete to continue with harmful activities instead of resting and affecting repair. Using conservative therapies early in the syndrome may be the best advice one could get. After the chondromalacia has become chronic, there are few standard treatment options. Surgical correction has produced very few good outcomes, and often the patient is told that they may have to endure chronic pain until a full knee replacement is justified later in life. The patient wants to hear a more optimistic treatment plan than this. Since our body's tissues constantly regenerate, there is never a reason to believe that with proper treatment protocol, that restoration of healthy cartilage surface cannot by achieved. It only takes work, time, and the care of a knowledgeable Complementary Med physician who combines the various treatment strategies in a logical manner.

Assessing the long term outcomes of total knee prosthetic replacement

Because of the amount of research data in the last decade that has cast a discouraging light on surgical repair of degenerative knee joints when used alone, and the continued reluctance to utilize an integrated conservative approach to healthy restoration of knee joint tissues, many orthopedic specialists have turned to total knee prosthetic replacement as the treatment of choice. Many patients report that the advice given is to wait until the knee is degenerated enough to warrant total knee replacement, since there is no standard therapy that will restore degenerated cartilage and meniscus, especially when there is evidence of arthritic disease. This article presents research that shows that a number of therapeutic protocols are now proven to aid regeneration of cartilage. Patients are also led to believe that the total knee prosthetic replacement will result in a pain free functional state without significant complications. Often times, the long term outcomes presented by the surgeon are overly optimistic. Long term outcome data is still relatively scarce, but the federal government has released some analysis of early long term studies as part of the AHRG (Agency for Healthcare Research and Quality), a mandated part of the U.S. Department of Health and Human Services.

The AHRQ Total Knee Replacement Summary (No. 86) reports that total knee arthroplasty (prosthetic replacement) is now one of the most common orthopaedic procedures performed. The AHRQ states that although previous industry reports were very positive, that “based on conclusions from consensus panels or surveys of health care providers, there is considerable disagreement about the indications for the procedure.” This means that some surgeons may advise a patient to have a total knee prosthetic replacement, while other surgeons may advise that the particular case does not warrant the knee replacement when considering other options, and weighing risks versus benefits. The AHRQ report does report a good rate of success for the procedure, although, when looking closer at the data, there are troubling questions that arise. Since total knee replacement is a relatively new procedure, and the patient wants the knee to perform without problems for the rest of their life, we look to long term study data to help us decide whether the knee replacement will eventually present serious problems. Unfortunately, the AHRQ meta-analysis only considered literature data from standard medical journals up to 2003. Advances in design, and favorable industry reports, have produced a dramatic increase in the number of total knee replacement arthroplasties since 1997. The industry itself still relies on the most favorable study of long term outcome, the 1994 Ranawat study, which reported a 95.6% success at a 14-year follow-up. Dr. Chitranjan Ranawat heads Ranawat Orthopaedics at a hospital in New York that specializes in total arthroplastic surgery, called the Hospital for Special Surgery, and the report is a study of the total knee arthroplasties performed at this prestigious hospital. In many, or most, cases, the knee replacement does not last anywhere near this rosy picture of 14 years. In fact, in 2010, a new type of artificial hip designed to last 15 years or more, was found to fail at an unusually high failure rate after just a few years due to a relatively rapid degeneration of the tissue to which the orthotic attaches. Unlike new drugs, medical implants and devices can be introduced to the market without long-term clinical trials if they resemble a device or implant already approved. To see a New York Times article on this subject, click here: http://www.nytimes.com/2010/12/17/business/17hip.html?_r=1

The AHRQ meta-analysis up to 2003 reports that the median age for total knee arthroplasty was 70 years of age, and 2/3 of the patients in clinical studies were women, with about 1/3 considered obese. About 90% of the participants in the studies had been diagnosed with osteoarthritis. In the studies, 0-56% of the patients receiving the procedure for the first time did not participate to completion of the study. The studies followed patients for between 45 and 67 months (about 4 to 5.5 years). The studies noted that when considering the baseline knees (those not receiving total knee arthroplasty) that the length of follow-up was between 68 to 90 months. The AHRQ panel recommendation, though, suggested a 10 year follow-up, and this is the source of much criticism of industry studies. Of surviving patients, there is a high rate of a need for a second total knee replacement by the sixth or seventh year, and due to degeneration of the tissues surrounding the prosthetic, and the risks of the surgery for patients over 80 years of age, a third total knee replacement is not considered viable as a general guideline. This means that in consideration of total knee arthroplasty, the patient must consider general time of good function and pain relief provided. The patient must also consider that there is a lengthy period of recovery and rehabilitation needed after the first total knee replacement, usually involving considerable pain. Often, the outcomes for this procedure are good after the first year, but by the sixth or seventh year, the prosthetic and attaching tissue are again severely degenerated. The AHRQ study shows that the industry has evaluated this optimal window, and failed to provide data for the time when many, if not most, of these prosthetic procedures fail.

The AHRQ meta-analysis also reports that there is a surgical complication rate within 6 months of surgery of 7.6% of total patients. Anti-coagulant drug therapy was the treatment of choice to prevent deep vein thromboses, despite positive findings for techniques of continuous passive motion and other mechanical means of treatment, which would have a far lower risk of side effects and risks. Failure of the prosthetics over time is expected in many cases, and the number of total knee arthroplasty replacements was high through 2003. The ARHRQ study found that within the five year study time, only about 2% of patients needed a second total knee replacement, but there was insufficient data in the industry studies to assess the number after 5 years, when the first knee replacement is expected to fail. Following the second total knee replacement the AHRQ meta-analysis found that the global knee score (standard measure of pain and function) was about 66 to 80 following this procedure, on average. The AHRQ states that there is no formal basis for translating the size of scores, and that the industry only looks at improvement over pre-operative state, but that a generally accepted rule of thumb is that a score of less than 60 is considered poor, and a score between 60 and 69 represents a fair score (85-100 is considered excellent). The pre-operative scores for these patients ranged from an average of 35.4 to 51.5, indicating that these patients experienced considerable pain and dysfunction. Complications following the second knee replacement in the meta-analysis occurred in 26.3 % of the patients, although only 12.9% of these complications involved the knee, meaning that 13.4% of patients had other health complications after the surgery.

What the AHRQ meta-analysis of knee replacement up to 2003 shows is that within a time frame of 5 years, the surgery is very successful for the 50% of patients studied that did not drop out of the study or die during the study period. No analysis of the percentage of patients needing a second total knee replacement after 5 years was available. Post-operative complications with the first total knee replacement occurred in 7.6% of the knee replacements, with the vast majority involving deep vein thrombosis, which involves considerable risk of stroke or heart attack. Post-operative complications in total with the second total knee replacement occurred in 26.3% of patients, with about half of these health problems occurring in the rest of the body besides the knee. Standard assessment of pain and function showed that the patients generally obtained a poor to good range after the second knee replacement. Study data in the AHRQ meta-analysis was apparently insufficient to rate the actual pain and functional status following the first knee replacement within the first 5 years, but the report states that a “mean effect size” was considered large in magnitude and varied from 1.3 to 3.9 depending on the means of measuring the functional state and duration of followup. Of course, to the general public, this is incomprehensible. The term “mean effect size” refers to an average of the variety of measures of treatment effect, which are combined to calculate treatment success according to a statistical method that is chosen. The British Medical Journal states in its explanation of clinical evidence regarding the use of a mean effect size: “we avoid if possible. Standardized mean differences are very difficult for non-statisticians to interpret and combining heterogenous scales provides statistical accuracy at the expense of clinical intelligibility. We prefer results reported qualitatively to reliance on effect sizes.“ In other words, the AHRQ report does not give the patient much real information to actually assess the pain and functional results of this surgery even within the optimal 5 year life of the prosthetic. To review this AHRQ meta-analysis, click here: http://www.ahrq.gov/clinic/epcsums/kneesum.htm

A 2010 meta-analysis in Europe, conducted by the WHO Collaborating Center for Public Health Aspects of Osteoarticular Diseases at the University of Liege, Belgium, also found that 74 studies met their criteria between 1994 and 2003, but that only 16 focused on total knee arthroplasty exclusively, and that the duration of follow-up ranged from 7 days to 7 years, with the majority describing results at 6-12 months. These small number of studies worldwide reported excellent outcomes within this optimal time frame. No studies were found that gave the patients and physicians data on the outcome past the expected life span of the prosthetics, which is generally accepted to be about 6-7 years with the first knee replacement. The study found that men seemed to benefit more than women, and that when improvement was found to be only modest, the researchers emphasized the role of comorbidities, or other health problems. The success of total knee replacement was found to exceed the success of other knee surgeries of standard procedures, which as mentioned above, did not fair so well in large studies in the long term. No studies are available to compare the success of conservative protocols to the total knee replacement. Apparently, no studies of outcomes after 2003 are available as well.

The patient must make a choice of going through a total knee replacement based upon incomplete and unclear industry study so far. These studies do summarize the procedures as highly successful. Many patients, though, are considering this scenario and exploring ways to utilize conservative care, mainly with Complementary Medicine, to try to reverse joint degeneration, or slow it, to avoid or delay the need for total knee replacement. Another consideration is the integration of conservative therapies after a total knee replacement, which could potentially speed recovery, increase functional imporovement, and prolong the health of the tissues around the prosthetic to delay the time when a second total knee replacement may be needed. If opting for use of Complementary Medicine before the need for the first total knee replacement, a large number of scientific studies now demonstrate proof that various strategies may result in growth of healthy cartilage and joint tissues. When considering a conservative treatment protocol, the patient should look to combine a sensible array of these therapies in a package of care. The choice of just trying one type of therapeutic intervention at a time is a prescription for failure. An intelligent combination of therapies within a protocol is the wise choice, and the patient should try to find the most knowledgable Complementary Medicine physician with an array of treatment skills to deliver this protocol. Combining physiotherapies, such as soft tissue mobilization and myofascial release, with acupuncture, electrical stimulation, evidence-based herbal and nutrient medicines, and patient instruction in self-administered therapies, such as postural and gait correction, and targeted stretch and exercise, is the formula for success.

Trust and Confidence: the need for the patient to take a realistic and objective assessment of the health care industry and influence on government when deciding the course of treatment

There is a history of enormous monetary intervention by the health care industry in both influencing government, and influencing the health care provider and public with treatment recommendations and data. The current health care debate has revealed that the health care industry accounts for over 15% of the entire economy, and could potentially account for up to 30% in the future. Of course, with this amount of profit as a motive, common business sense requires the industry to try to control how this enormous sum of money is spent. Lobbying and political contribution by the health, insurance and pharmaceutical industry accounts for over half the direct campaign donation to congress in 2008, and anaylysts report that a similar figure might be applied to lobbying money spent. Advertising budgets have soared, and the finance committee in the U.S. Senate, leg by Republican Charles Grassley, has uncovered massive amounts of money spent on fraudulent ghost-written scientific studies and payments to researchers and those who control university health research.

As published studies of efficacy in knee surgery emerged, there was a large decrease in the number of surgeries to repair degenerative knee joints. New devices, promising a more natural and “biologic’ approach to surgery, have emerged. In 2009, the FDA admitted that its own former commissioner unduly influenced the fast-track approval of such a device, a biologic meniscus patch, because of intense pressure from three Congressman and one Senator, all whom received significant campaign donations from the company manufacturing this device. The FDA agency director overrode the advice of its science advisors to approve and endorse this surgical device. The story can be read by clicking on the site in additional information at the end of this article.

Both the patient and the surgeon must not be unduly swayed by data and recommendations pushed by the industry, but must make a decision based on the realistic, safest and best course of therapy by analyzing objectively what could realistically work. Hopefully, this article helps the patient and their doctor decide to look into, and try conservative therapies. The course of therapy presented in Complementary Medicine is not simpler, and requires a proactive approach by the patient, but may produce the best long-term outcome for many patients.

Joint degeneration of the Lumbar vertebrae

A similar profile of degenerative joint conditions and unnecessary surgeries has been shown in large studies of lumbar spine pathologies. The New York Times article quotes Dr. Michael Modic, chairman of the Neurological Institute at the Cleveland Clinic, who scanned hundreds of study participants with MRI and concluded that as many as 60 percent of healthy adults with no back pain have degenerative conditions in their spines, and that between 20 and 25 percent that receive MRI studies of the lumbar have herniated or bulging discs. Dr. Modic states that one-third of these herniated or bulging discs disappear in six weeks when repeat MRI studies were performed, and about two-thirds disappear in six months. His study found no definitive correlation between worsening disc bulging, resolving disc bulging, and symptoms. He recommended that a person with low back and leg pain should be treated conservatively for at least eight weeks before considering surgery, and that MRI scans should be used as a presurgical tool, and not as a definitive diagnosis suggesting surgical correction.

Unfortunately, we live in a culture that wants a quick fix, and patients usually look at their situation as a choice between one type of therapeutic agent or regimen versus another. This will result in failure in the majority of cases. The successful approach utilizes a variety of agents and therapies to accomplish all 3 of the above goals, namely pain relief, elimination of the causes and contributors to tissue degeneration, and restoration of healthy tissues. By trying to choose a simplistic treatment approach, rather than a comprehensive treatment protocol, the patient is usually prolonging their suffering and at best will only slow the degenerative process. Surgery may be necessary, and may clean up some of the problems with unhealthy tissues, but without a comprehensive treatment plan, degenerative conditions will recur and continue to cause pain down the road.

In many patients, the same vascular pathology that worries them about risk of future cardiovascular problems also contributes to the spinal degenerative condition. In the medical text, Myelopathy, Radiculopathy, and Peripheral Entrapment Syndromes by David Durrant, and Jerome True, the authors state: “Many of the patients that develop degenerative stenosis fall into the same age group at risk for acquiring cardiac and peripheral vascular disease. Some of these individuals may also have a coagulation disorder from disease or from therapeutic intervention (blood thinners). Clinicians who identify cardiac, vertebral, and/or aortic diesase should pay attention to the possibility of a history suggestive of an undiagnosed intermittent myelopathic (spinal cord) presentation.” The arteries run alongside the nerve roots, spinal cord, and supply the needed nutrients to maintain the vertebral discs and lamina. Attention to vascular health should be part of the therapeutic protocol for degenerative lumbar conditions. An interesting area or research that links coagulation problems with fibrin buildup and hardening of both blood vessels and surrounding tissues, especially in the tight capillary beds of joints, is the subject of proteolytic enzymes. Nattokinase and serratiopeptidase are two especially potent proteolytic enzymes now studied to reduce microclotting and fibrous tissue formation. These supplements could significantly benefit the protocol in degenerative lumbar conditions, and perhaps improve vascular health and decrease atherosclerosis.

Much scientific research is devoted to understanding the underlying health problems leading to secondary osteoarthritis, or degenerative joint disease. The National Institutes of Health estimates that 18.2% of the U.S. population will have some form of arthritis or rheumatic condition by 2020. Osteoarthritis is the most common form of arthritis, affecting 12.1% of U.S. adults in 1998, and was the second most common diagnosis in the population. It is estimated that 80% of the aging population will experience secondary osteoarthritis. Research reveals that this slowly developing degenerative condition is likely related to a syndrome of anabolic dominance leading to an eventual catabolic excess. Anabolism is the metabolic construction of complex molecules in our tissue which is balanced with catabolism, the breaking down of complex molecules in the tissues to resupply energy and the building blocks of larger molecules. This process is stimulated and regulated mainly by hormones and the endocrine feedback system. In TCM terminology, this would be referred to as a balance of Yin and Yang, with anabolism being a yang process balanced by the bioavailability of catabolic yin nutrients and energy. When this balance is dysfunctional, a gradual disease process occurs leading eventually to Osteoarthritis.

The anabolic hormones include insulin and insulin-like growth factors, testosterone, estradiol, and growth hormone. When we have problems with hormonal balance and insulin resistance, or relative excess of estrogen from progesterone deficiency, we may develop anabolic dominance. Excess adrenal stress that is chronic may not only stimulate high blood pressure, but excess androgens and testosterone. Testosterone may aromatize to estradiol in our tissues, or to dehydroepiandosterone, and stimulate breast tumors, prostate hypertrophy, and other tissue abnormalities. In a similar way, these hormones play a significant role in tissue repair and maintenance, and imbalances may lead to degenerative arthritic conditions. Insulin resistance and anabolic dominance may lead to metabolic syndrome and inability to lose weight from the midsection, high cholesterol and poor cardiovascular maintenance. Such syndromes of imbalance lead to poor inflammatory regulation and tissue remodeling, and eventually degenerative joint disease is discovered, often too late to fully correct. The smart patient will seek help to prevent these problems be utilizing preventative medicine and TCM. The knowledgeable TCM physician can test for your hormonal profile, look at the circadian rhythms of cortisol imbalance, and gradually correct the Yin and Yang of hormonal imbalances that lead to degenerative disease. TCM may thus be a valuable Complementary Medicine in prevention of osteoarthritis as well as a comprehensive treatment strategy.

Another aspect of lumbar degeneration that has been well studied, but still stymies standard medical practice, is the degeneration of the lumbar discs. This type of degeneration is seen in a sigificant portion of the population even in the 30-40 year old range, and is expected in 60% of the aging population. Degenerative discs may range from mildly bulging to severe disc bulging with extrusions that are relatively large, and include stenosed, or flattened discs. Disc degeneration is not only reversible, but is proven in large studies, cited above, to reverse on its own in a high percentage of patients. MRI studies of degenerative discs can look quite alarming, with extrusions and bulges pressing into the surrounding joint tissues and even against the nerve roots and spinal cord. What is not seen in MRI studies is the fluid nature of many of these bulges and extrusions. Discs that are degenerated may bulge in different directions when body position changes the pressure on the disc, and extrusion may recede with change of body position. On the other hand, spinal disc herniations will usually stay stable no matter what the body position. The exact cause or causes of spinal disc degeneration still eludes science, although many studies do explain the array of factors seen with this pathology. The challenge for the physician and patient is to understand what course of therapeutic protocols will help reverese the disc degeneration and restore healthy disc material.

The spinal disc is composed of hard annular rings surrounding a soft fluid center, with the endplates of the disc, on the top and bottom, composed of a type of cartilage, and pressed agaist the vertebral joint cartilage, or bone covering. Most of the nutrients that pass into the inner layers of the annular rings, and the inner gel-like pulposa, comes from the vertebral bone cartilage, and this cartilage, which is the bone covering, gets its nutrient chemicals largely from the blood vessels in the vertebral bones. When the cartilage of the vertebrae degenerates, the supply of nutrient chemicals to the disc endplates, and thus to the inner disc, is greatly diminished. Therapy that restores vertebral cartilage, decreases mechanical pressure on the vertebrae and discs, increases circulation, and decreases chronic inflammation, will help restore the vertebral discs. This process is similar to the restoration of the degenerative knee joint.

Utilizing Complementary and Integrative Medicine in the treatment of degenerative joint pathologies

Achieving pain relief with medication does not mean that the degenerative condition is resolved, and when the patient focuses only on pain relief as a measure of success, this success is usually temporary. Dependence on pain relieving medication can be very harmful to the health and create other serious problems, such as stomach and gastrointestinal problems, and cardiovascular inflammation. A whole treatment protocol, directed by a competent physician, utilizing physiotherapy, patient instruction, acupuncture, herbal prescription, dietary supplements and changes, and correction of postural mechanics is effective, especially when the physician, who is a Licensed Acupuncturist, identifies contributing health problems and addresses these as well. The ultimate benefits of this comprehensive approach are many, and the patient will emerge with not only pain relief, but lasting tissue health, a healthier daily routine, and decreased risk of serious health problems related to aging.

Popular supplements and herbs are frequently advertised with exaggerated claims and give the patients false hope. Prescription of herbal formulas and nutriceuticals by a Complementary Physician with a Medical License and education in herbal medicine, and utilizing professional products, will be much more effective. Along with the proper herbal formulas, acupuncture and physiotherapy, there are a variety of specific herbs and supplements of use. These products are usually helpful but are not a cure by themselves, and quality varies considerably between products due to the lack of regulation by the FDA. Professional products insure quality control, and these are available only to the Licensed herbalist. Here are the facts on some of the popular therapeutic aids available to the public:

Oral Glucosamine supplement: studies show that oral glucosamine had no effect of increasing glycosaminoglycan content when the cartilage was normal, but had some mild beneficial effect if the cartilage was in a rebuilding phase. Rebuilding cartilage has a much increased demand for glucosamine. Studies show that rates of collagen repair in the cartilage & meniscus were not affected by the amounts of oral glucosamine or injected glucosamine. These studies point to the fact that the patient must improve the body’s response to tissue repair in order to utilize the glucosamine supplement, and then this supplement will be effective. Thus, oral glucosamine, or glucosamine delivered locally to the tissue, in the form of topical agents or injections, will benefit only as part of a program that improves the overall tissue repair response. In patients that have no rebuilding of cartilage or meniscus, the glucosamine supplement is a waste of money. When the patient utilizes a complete conservative care treatment plan with passive soft tissue mobilization, gentle breaking up of tissue adhesions, and various stimulation techniques, the cartilage goes into a rebuilding phase, and the glucosamine is utilized fully (refer to PubMed PMID: 12355498)

Cartilage extracts with Matrix Proteins: sharks cartilage and bovine cartilage extracts have been available for some years, and are the principal sources for many chondroitin sulphate supplements. In many cases of degenerative joint problems, these have been ineffective. Studies that looked at patients with autoimmune cartilage diseases such as Rheumatoid Arthritis and Polymyalgia Rheumatica showed that these supplements could be useful to modify the course of the disease. The studies showed little effect in cases where the degeneration or joint inflammation was induced by medication side effect. The effectiveness of the cartilage protein extracts was linked to the immune stimulation of proteoglycan synthesis, and thus, concurrent use of immune stimulants or modifiers that enhanced interleukin or other cytotoxic immune response could greatly improve the effect. Once again, alone, these supplements may not benefit, but integrated logically into a treatment plan, they may have dramatic results for the right patients.

Collagen extracts and antioxidants: when the joint is receiving physiotherapy, with gentle breaking of chronic adhesions and improved circulation, there is a great need for large amounts of collagen in joint tissue repair. Studies show that the tissues may need up to 80 times the normal supply of collagen. Along with this nutrient material, antioxidants are required to help with clearing of dead tissues and debris. I use Health Concerns Collagenex 2 to supply usable collagen type 2 (glucosamine, chondroitin etc.) derived from compatible tissue extracts from the chicken, and delivered in a patented encapsulation discovered by many years of research at Harvard Medical College. The concurrent use of a potent tissue antioxidant supplement is also recommended, such as pomegranate extract. I also utilize a topical herbal cream that delivers glucosamine and chrondroitin with the carriers MSM and emu oil, so that these nutrients can get to the tissues directly. When used within the course of physiotherapy, this combination can benefit tissue repair greatly.

Maca and Cat's Claw: studies have shown significant benefit for cartilage repair with the use of these herbs. Of course, cartilage cells, or chondrocytes, will not regrow until manually stimulated. Studies have also shown that chondrocytes will regrow when the tissue is stimulated with gentle cross-fiber massage, or if this is not possible, with passive joint mobilization techniques and electrical stimulation. Studies showed enhanced mRNA (insulin like growth factor) expression and production in human chondrocytes when joint mobilization was utilized, and certain herbal chemicals have shown efficacy in promoting insulin like growth factor as well./p>

Gotu Kola: this herb has also demonstrated significant benefit in regrowth of joint tissues and cartilage. Chemicals act on collagen formation, anti-inflammatory activity, and antioxidant clearing. Amino acids and triterpenoids in Gotu Kola are considered to be essential to tissue healing. If there is a problem with varicosities or veinous insufficiency, combine this with Butcher's broom and Stone Root (Formula V).

Amino acids: certain amino acids are essential for repair of soft tissue such as ligament and tendons. L-Arginine, L-Lysine, L-Leusine and L-isoleucine are all effective, and should be combined with Vitamin B6 to increase utilization. The olympic swimmer Dara Torres claimed that an amino acid formula was extremely helpful in healing her tissues and helping her get to another Olympic tournament at age 41.

Manganese or Manganese SOD: manganese deficiency has been shown to be a significant factor in many cases of degenerative cartilage. Manganese deficiency results in the poor utilization of chondroitin, glucosamine and other mucopolysaccharides in the normal repair and maintenance of cartilage. Manganese SOD (super oxide dismutase) is a combination of a potent antioxidant with manganese, and thus may aid cartilage repair even more. Manganese is more commonly available in essential mineral supplements, some of which contain other nutrients beneficial to cartilage repair, such as Vitamin K (phytonadione), calcium hydroxyapatite, zinc monomethionine, and boron (Vitamin Research is a good professional source: Advanced Essential Minerals or Optimum D). Manganese SOD, or superoxide dismutase, is now difficult to find as a supplement. Concurrent use of a manganese supplement with an SOD source, such as dried barley sprouts, is recommended. Current research shows that angiotensin II, a protein that chronically stimulates higher blood pressure with adrenal hypertension, may both create more superoxide radicals and inhibit SOD in tissues. Treating adrenal stress syndrome may also be indirectly helpful for the healthy maintenance of degenerative tissues.

Proteolytic enzymes: Serratiopeptidase and Seaprose-S are two researched enzymes that help clear the rebuilding tissues and are proven to aid in both cartilage repair and decrease in chronic joint pain with a long course of use. Nattokinase is another heavily researched proteolytic enzyme that is becoming popular. A study (cited below) by the Pritzker School of Medicine of the University of Chicago, found in 1975 that enzyme treatment was an important factor in the responsiveness of cartilage cells, or chondrocytes, to stimulate greater production of chondrointin sulfate proteoglygan, or aggrecan.

Hyaluronic acid: while hyaluronic acid (HLA) is utilized in injections for treatment of degenerated cartilage and joint tissues, these single injections are found to be of questionable value. HLA is a chemical in our cells that helps with cell hydration. A molecule of HLA may attract up to 1000 times its volume in water. Our cells create more HLA receptors when there is a problem with cell hydration, and HLA in circulation is proven to attach to receptors to help restore the hydration of dry cells. Dry cartilage cells are a primary problem in cartilage degeneration, and chondroitin sulfate produced by these cells also helps to retain water in the cartilage cells, or chondrocytes. Use of an HLA serum may supply needed hydration to these cells.

Pomegranate extract with seed oil and polyphenol antioxidants enhanced by fermentation: a study by the Case Western Reserve University School of Medicine, published in the September 2005 issue of the Journal of Nutrition, demonstates that a properly prepared concentrated extract of pomegranate exherts significant antioxidant and anti-inflammatory properties, such as the inhibition of interleukin 1b, which plays a key role in cartilage degeneration in osteoarthritis. Polyphenols in whole pomegranate extract include anthocyanins, catechins, and punicalagins (a source of ellagic acid), which are now well studied and proven to be highly effective in many disease states other than tissue degeneration as well, such as cardiovascular disease, atherosclerosis, and cancer prevention. Use of this supplement will help to decrease the rate of cartilage degeneration, as well as speed growth of new healthy tissues by clearing oxidant radicals.

Boron and Vitamin D3: boron along with activated vitamin D3 hormone may increase cartilage formation. Boron helps regulate calcium metabolism and helps activate estrogen and vitamin D3, as well, preventing tissue calcification and aiding tissue repair. Food sources of boron include dates, raisins, prunes, almonds, hazelnuts and honey. Like many individuals, you may be deficient in activated vitamin D3, which is a hormone activated by exposure to sunlight on circulating D3. A simple blood stick test is available to determine D3 deficiency. Daily exposure to sunlight on the face and arms for 10 minutes insures activation, and so a midday walk in the sun is helpful. Exposure through glass in the car or office is not effective. You might take a cholecalciferol D3 supplement as well as chelated boron supplement combined with amino acids to aid utilization. Current study on boron supplementation is insufficient to definitively confirm that boron supplementation will treat arthritic conditons. Vitamin D3 is not really a vitamin, but rather a prohormone. D3 cholecalciferol is created daily in your body by exposure to sunlight, health cholesterol metabolism, and minimally from food sources. This cholecalciferol goes to the kidney to produce hormone D3. Two types of D3 hormone are known to science, and recent research has found that one isomer is integral to cartilage remodeling, regulating the basement membrane of the cartilage near the bone, and may be responsible for successful cartilage remodeling and repair. Since D3 hormone is tightly regulated in your body, not only supplementation with cholecalciferol and increased midday sun exposure is recommended, but also treatment to correct hormonal imbalances and improve the functions of the kidney and liver metabolism. Studies show that a high percentage of the population is deficient in D3. Utilize a holistic medical regimen to best advantage when taking these supplements. Deficiency of Vitamin D3 hormone is very widespread now in the United States, and could lead to a hormonal deficiency that affects the D3 hormone that regulates cartilage remodeling. Supplements with both D3 and boron are available. Coral 3X by Vitamin Research contains 1200IU cholecalciferol (Vitamin D3) plus 4mg of boron, with ascorbic acid (Vitamin C), calcium and a balanced array of minerals from coral, including magnesium, all of which may benefit joint tissue repair.

Information Resources

1. NY Times Health article on recent evidence supporting conservative care with meniscus tears http://www.nytimes.com/2008/12/09/health/09scan.html?partner=rss
2. Environmental Health Perspectives gives a peer-reviewed in depth analysis of the benefits of boron supplement at http://www.ehponline.org/members/1994/Suppl-7/newnham-full.html
3. An initial human clinical trial of purified extract from chicken cartilage showed that this supplement of Collagen type II of bioidentical form can reach the affected joint and both a decrease in autoimmune destruction and repair of the joint: http://chickencartilage.com/harvardstudy/
4. Serratiopeptidase is clearly explained at http://www.purebodysolutions.com/Merchant2/graphics/00000001/PDF/serratiopeptidase.pdf
5. Hyaluronic acid injections are not the same as prolotherapy; a large randomized trial in France was completed in 2008 and showed no benefits: http://www3.interscience.wiley.com/journal/122220639/abstract?CRETRY=1&SRETRY=0
6. A 2009 article in the New York Times outlines current research that shows that platelet-rich plasma injections found in rigorous study to provide no better healing than saline injections, and that steroid injections provide temporary benefit, but do not change long-term outcomes of pain and disability. : http://www.nytimes.com/2010/01/13/health/13tendon.html?ref=health
7. A 2001 study by the Univerisidad Nacional in Lima, Peru, demonstrate that Cat's Claw, or other species of Uncaria, had proven beneficial effects on human study participants with osteoarthritis of the knee, both reducing pain and with antioxidant and anti-inflammatory mechanisms, especially the inhibition of TNFalpha: http://www.ncbi.nlm.nih.gov/pubmed/11603848
8. A 2009 NY Times article reveals manipulation of FDA approval of new biologic surgical devices: http://www.nytimes.com/2009/09/25/health/policy/25knee.html
9. A study in Japan, published in the Journal of Bone and Mineral Metabolism, found that AGEs (advanced glycation endproducts) were highly associated with osteoporotic vertebral microfractures in a large study of aging women: http://www.springerlink.com/content/3058213826n8404j/
10. A 1975 study at the Pritzker School of Medicine at the University of Chicago found that enzyme therapy was an essential cofactor of stimulation of increased chondroitin sulfate proteoglycan production by cartilage cells, or chondrocytes: http://informahealthcare.com/doi/abs/10.3109/03008207509152169

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.