Arthritis is the loss of cushion on a joint surface-period. The cushion called articular cartilage is an amazing multi faceted structure that allows us to walk, run, jump, and lift without pain.
Deep to the cushion is bone. If bone is exposed then this causes pain as there are nerve endings in the bone. When bone rubs against bone the joint becomes painful, swollen and stiff. There is no cure for arthritis and treatment is directed towards pain relief.
Diffuse arthritis is not to be confused with a localized chondral defect or a pothole surrounded by healthy tissue. That can be treated with drill holes to stimulate bone marrow healing, placing cartilage plugs or cartilage transplantation.
The treatment plan for arthritis is tailored to the patient. That means treatment is based on the patient’s age, how long they have had symptoms and what other treatments they have tried or had. For an initial diagnosis of arthritis the treatment usually starts with therapy exercises working on range of motion and strengthening. After exercises, medications can be tried like Tylenol®, Advil® or Aleve®. Supplements can also be tried as well as creams and gels. If the pain persists and activity levels are decreasing and x-rays show definite joint narrowing with arthritis, then injections can be entertained.
These are broken up into three different categories:
- Gel (or viscosupplementation)
- PRP (platelet rich plasma)
Cortisone is a tricky substance because it can help pain but if given too many times it can increase arthritis. So used sparingly is reasonable especially if there is already terrible arthritis in the joint. Gel injections are designed to lubricate the joint and decrease the friction between the bones. PRP has been shown to have some anti-inflammatory properties and can be used to treat arthritis, although studies show it works better on tendonitis.
If none of these work then replacement can be considered. Taking knee replacement as an example, recovery is based on range of motion and getting strength back. Typically it takes six weeks to three months to get good strength back.
For the CrossFit athlete with knee arthritis, rehab should be faster because of the increased muscle strength going into surgery. Exercises that can be performed early on in recovery like in two to three weeks would be air dyne, biking or rowing. These should be cautious and gentle with no stress focusing on range of motion and not stressing the tendon repair part of the surgery. Squatting with no weights is reasonable to work on strengthening and range also. Increased resistance and weights will be introduced when tendons are stronger. Now comes the question about running, jumping, and weightlifting.
One of the variables for how long a knee will last is how long the cushion or the polyethylene between the pieces of metal last. If one stresses the knee too greatly, then wear of the knee theoretically would be a factor. The material used is much better than what was used when replacements were invented. However, if these particles break down from wear then the body attacks them and releases cells to digest them called macrophages. These cells in doing so release enzymes which can then cause erosion of the bone. So in fact the bone to metal replacement interface can then loosen. It is for this reason that people should probably not get back to long distance running or jumping from heights. However a study in 2010 looked at high impact activities after knee replacements and found no difference in symptoms or revision for high impact sports versus low impact sports in patients who had knee replacements. Of those who needed a revision were two weightlifters.
The main reason to have a knee replacement is severe pain from arthritis that has not gone away with conservative measures. Studies also have shown that people who have mild arthritis do not fare as well as people who have more involved arthritis. The recovery can be substantial and any surgeon wants to make sure that the arthritis is bad enough and that the x-ray findings correlate with the level of pain. The pain should be everyday and limit functioning like stairs, standing, and walking. Knee replacements should not be performed for mild pain or nuisance pain relieved by other measures.
Knee replacement is a great surgery that allows people who have lost independence and function to regain their lifestyle. One survey asked people to rate their LIVES not their knees when they had severe arthritis on a scale of 0 to 100. The average response came back with a 30. After knee replacements, that number jumped to 90! So it can make a significant difference and allow people to enjoy life and exercise again.
Possible but would have to examine you and see films etc to be sure
I’ve had PRP ,Cortisone, and Depo Medrol (not in that order) in my right knee Still pain. Hard to walk let alone squat at times to even put on my shoes.
Xray today shows basically bone on bone around my patella and where my femur and tibia meet. I was getting good results with cross fit. I’m only 44 so a replacement isn’t in the cards.
Had another shot of cortisone today.
Not sure what other options are. My orthopedic surgeon wasn’t too keen on squats.
Sounds like modifying if you are in that much pain, happy to see you in the office.
You, unfortunately, have gone through a lot of the options. Happy to see you.
I have been diagnosed with a “pothole” in the cartilage of my right knee. I’ve had a few injections over the past few years but the last one doesn’t seem to help. I go to CrossFit classes 4 times a week. The knee problem is preventing me from doing squats and lunges. My orthopedic doctor that is doing the injections told me to quit don’t squats and lunges. Unacceptable. The research I have done seems to indicate that the pothole will just get worse with time. I’m not interested in a future knee replacement or any other serious knee issues that limits me. I read about possible surgical interventions that could help. What would be your suggestion for someone in my situation? Thank you.
Speaking not to your knee but in general pothole treatment depends on surrounding areas, i.e. is there arthritis in other areas. Treatments can be gel injections, PRP injections for anti-inflammatory properties, microfracture, cartilage plugs, or transplantation
Hi Doc Sean. I’ve been CrossFitting for over 4 years and just had my 2nd scope for right-lateral-meniscus. Original injury was 20+ years ago from soccer. I’m fully recovered from my surgery and back to lifting with some moderation of movements and weight levels to avoid shear on the knee joint. I think it’s going well, although I’m “aware” of the joint with every step. Thanks for the description of the progression. I’m going to try the viscosupplementation as a next step but giving myself 3-6 months to fully heal first.
Hello Sean –
I am wondering if you have used or what your experience is with stem cell injections/therapy for treating arthritis and meniscus damage. I have both issues and have gone through PRP and physical therapy to try and correct issues with pain and joint stiffness with not much improvement. There is limited information out there on stem cell but what I can find seems very positive. Your thoughts? Also is meniscus transplantation some that I should explore? Have you had much luck with it?
My history is that I had an ACL and meniscus repair back in 1992 and don’t have much meniscus left in my knee. I had it scoped and cleaned out again last year and the surgeon said there is moderate arthritis and that the ACL didn’t look great but my knee is still stable. I’m a competitive Crossfit masters athlete and 44 years old.
Thanks in advance!
Hi, Stem Cells are being touted as more than what they can do in my opinion. They can have an anti-inflammatory effect. but as far as regrowing cartilage that is debatable. Be careful with what you read on the internet. Meniscal transplants also not as effective as we were hoping for.
Hello Sean, have you ever come across glenoid dysplasia? I have it in both shoulders, and arthritis that has stopped me.moving my right arm. Have bailed on CF and tried neuropathic medicine, cortisone, nerve blocks, physio. I’m 36 so no one wants to operate on me for a reverse shoulder replacement but looking for any advice
Matt that is a tough thing to have at an early age. Shoulder replacements don’t last as long as hip or knee replacements.
Hi Sean – My question is related to the best treatment option in your opinion to return to CrossFit activities for a chondral defect in the trochlea area of my right knee (about 1 cm by 2 cm in size). Also, if you can recommend a specialist in the Southern California area that would be great. Thanks and keep the great work!
conservativemanagement is the best option but if it comes to surgery possibilities include microfracture, OATS procedure, cartilage transplantation
His name is Michael Emery at Indiana University
Thanks…CF + arthritis is me! CF has delayed inevitable surgery…significantly so. On another note, any thoughts about kids and lifting. I have a 12.5 yr old who is a beast. He’s hungry to move iron. Shall I delay him? Or green light. Of course I’ll keep the wts low and teach perfect form. Thanks for your work!!!da
Low weights and strength training has benefits for young people. Don’t push the amount and listen to him if he is complaining of soreness
Michael Emery is the sports medicine cardiologist at Indiana University
I saw your article in The Crossfit Journal about doctors that lift. You mentioned to someone that commented that you knew a cardiologist in Indiana that lifts. I was wondering who that doctor is. Here is a little of my story behind that inquiry. My son is a Hodgkins Lymphoma survivor. He had is chemo treatments almost 8 years ago at the age of 7. Fast forward to a healthy 15 year old swimmer and golfer. He is becoming interested in getting bigger, stronger and faster. He had a port for his chemo treatments. We were told by his pediatric oncologist that he should never lift heavy and especially “max out”. Too much stress on his heart was the reason given. I would NEVER want to do anything to harm my child, just wondering if the heart (muscle) would be strengthened with some lifting. Been hoping to find cardiologist that also understood lifting weights. Thank you for your time.