Nicole Belkin, MD
What new treatment or diagnostic technologies get you excited?
Biologic Treatments. Current orthopedic and biomedical engineering researchers are investigating how to harness the body’s natural healing abilities and manipulate them to heal injuries stronger, faster and without scarring. In some cases, we can even fix issues that were previously incurable.
What’s a prevalent myth that you’d like to bust?
“No Pain, No Gain.” Some orthopedic conditions will not get worse or lead to collateral damage with overstressing. However, that’s not always the case! Many conditions can get much worse—and treatment options dwindle and the prognosis diminishes with this neglect. Establish a diagnosis and treatment plan before playing through an injury. Have this conversation with a knowledgeable, trained medical professional—not personal trainers or coaches.
What’s a mistake that patients make that you wish they didn’t?
Don’t wait so long to get checked out! Often, the duration the patient suffers through symptoms before he or she gets medical attention correlates directly with the duration of the treatment needed to extinguish the symptoms. For instance, a patient evaluated after being injured for only 2 weeks can often be successfully treated and symptom-free within 2 weeks. Conversely, if you wait 2 years to be seen, you can expect a much longer duration of treatment to achieve the same level of improvement.
What exercises should I do to maintain healthy joints and bones?
Five types of exercise should be combined for optimal musculoskeletal health: Aerobic and Anaerobic Conditioning, Resistance, Flexibility and Balance Training.
Aerobic exercise is cardiovascular exercise, such as walking briskly or biking at an intensity where you are not breathless, but you’re also unable to carry on a conversation easily. This type of exercise trains your muscle endurance and stimulates blood flow in the joints. Do 40-60 minutes of this type of exercise two to three times per week.
Anaerobic exercise consists of more strenuous cardiovascular exercise, such as running or stair climbing, where you experience some difficulty maintaining easy breathing. This type of exercise trains your muscle speed.
Resistance training, simply put, is moving a weighted object in space. Examples include squatting while holding a weight or pushing a weight overhead. This work trains your muscular strength and stimulates your bones to maintain their density.
Often overlooked, but no less important, are flexibility and balance training. These help to maintain optimal function of all the joints and prevent injury.
I have knee arthritis, but I am not ready for knee replacement. What are the best treatment options?
The intervention with the strongest evidence-based recommendation supporting it is Weight Reduction, which can have a significant effect on knee pain. A 10-pound body weight reduction creates a 40-pound reduction in the forces across the knee, every time you stand up from a seated position or ascend or descend stairs.
Another often overlooked, counter-intuitive treatment involves increasing activity levels and knee flexibility. Many symptoms of knee arthritis arise due to stiffness and loss of range of motion associated with the disease. Studies show that exercise and stretching routines aimed at increasing the knee’s range of motion reduce arthritis symptoms, sometimes enabling patients to delay surgery for years.
Injectable treatments can help as well. These work better than pills, because the medication gets delivered directly to the knee. Many (but not all) commercial insurers cover Viscosupplementation Injections for patients with knee arthritis. Viscosupplements are forms of a protein called Hyaluronic Acid, which healthy knees naturally produce to keep surfaces lubricated and friction free. In an arthritic knee, the naturally produced lubrications are of poor quality. So we inject high quality lubrication into the arthritic knee to decrease friction, and this therapy often decreases pain, increases range of motion and improves function. Unfortunately, insurance companies may soon stop covering this medication, due to its high cost. It’s administered in a series of 3-5 injections or a single large injection. The costs per syringe for the medications dosed as a series range from $100-300 per syringe. The single dose versions range from $400–$1,000 per syringe.
New research shows an alternative to Viscosupplementation called Platelet Rich Plasma may be even more effective at reducing pain and enhancing function.
I hear about growth factor and stem cell injections on TV and in news stories. What are these, and could they help me?
PRP or Platelet Rich Plasma, consists of concentrated anabolic proteins, growth factors and platelets derived for the patient’s whole blood. Researchers believe that concentrating these elements can stimulate healing and calm inflammation in certain circumstances. For instance, tennis elbow—an injury to a tendon in the elbow—can cause significant pain and disability, even after extensive therapies. The tendon tissue often becomes scarred and cannot heal. PRP injected into the site of the scar stimulates healing. These targeted interventions understandably appeal to patients as minimally invasive alternatives to surgery. PRP can also calm the inflammation and decrease the stiffness and pain associated with knee arthritis.
“Stem Cells” are just cells within the body that have the ability to adapt their function and/or to influence the function of neighboring cells. They can be found in the bone marrow, adipose tissue (fat), around blood vessels and in lower concentrations circulating in peripheral blood. These cells can be isolated by harvesting tissue or blood from these sites and then passing it through filters or spinning it in a centrifuge.
For a patient who cannot heal a fracture after 6 months in a cast, we might aspirate blood from the iliac crest (hip bone) and then inject those stem cells into the fracture site to stimulate adequate bone formation to heal the fracture. In the setting of knee arthritis, adipose tissue can be harvested via needle aspiration and filtered to concentrate the stem cells. We then inject them into the knee to stimulate healing of the damaged cartilage.
NewYork-Presbyterian Medical Group Hudson Valley
35 South Riverside Avenue Suite 102A
Croton-on-Hudson, NY 10520
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