Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh, physical therapist and the owner of El Paso Manual Physical Therapy. Our topic today is going to be about knee arthritis. Specifically, we are going to figure out what it is, and what can be done about it.

These are questions we get in the clinic. The time people come in with x-rays, sometimes MRIs, and they have been told, by a doctor or they have read their own X-ray report, and they found out that it says, the dreaded words knee arthritis or osteoarthritis specifically.

But let's talk about what is knee arthritis.

We are going to answer these questions today. What is knee arthritis? How does knee arthritis happen? What types of treatment do people do for knee arthritis? And how much can I improve my knee arthritis? Is it possible to be normal? Let's get going with the first question.

What is arthritis?

Arthritis is actually, it's kind of a misnomer, there are different types of arthritis. The most common by far is osteoarthritis. We are going to assume that that is what we are talking about. I'm not a specialist in other types of arthritis, like rheumatoid arthritis, psoriatic arthritis and there are other types as well. Those are the types of arthritis that you want to see a rheumatologist for. You probably will need to get a different kind of treatment then what we can offer. It's definitely not mainstreams. It's its own specialty.

For the sake of knee arthritis in this podcast episode, we are talking about osteoarthritis. But I'm going to say arthritis a lot, just because I know that's what most people say. They say, “Oh, it's my knee arthritis”. Hardly anybody in the general public says osteoarthritis.

So, what is knee osteoarthritis? Knee arthritis is changes that happens on the surfaces of the joints within the knee. A lot of people don't know this, but your knee actually has three joints in one. It's the connection between the thigh bone, the femur, and the shin bone, the tibia. That's one, and then there is a connection between the kneecap, also known as a patella, and where it interfaces with the femur, the end of the thigh bone. So that's a patellofemoral joint.

Then you have an A joint, off to the side, that people don't typically think about as being part of the knee., but it is. It's called the tibial fibular joint. You have two bones in your lower leg, the tibia and fibula, and they connect in two spots to each other. Down at the ankle is one that makes up the ankle joint and then up at the knee. They connect as well.

In some people, that can be a little problematic, but that's a less seen injury, and for the sake of arthritis, we are going to focus on the kneecap and the femur, the thigh bone, and the tibia, and the femur as well.

Knee arthritis is when the surfaces of the kneecap, the backside of the kneecap, and the surfaces of the thigh bone on the end of the thigh bone, where it's at your knee, and then also on the top of the shin bone. When those surfaces begin to change over time, and when I say time, I'm talking about years, even decades, they change, and they decrease congruency. Meaning, how well they fit together. The surfaces are aligned with cartilage.

Cartilage is important because it's a really smooth tissue, and it eliminates friction. It reduces friction tremendously inside of a joint so that your bones can move on each other without popping, grinding or clicking.

If you have trouble with your cartilage, then it tends to lose its smoothness. It's hydration as well. We'll talk about that in a second, and how easy the joint moves and that's why you might get popping and cracking inside the knee joint. If you have arthritis type problems.

Arthritis is not a disease if you will, it's not like something that you catch like a cold, or an infection. I just want to clear that up, but some people might not know, and I want to just clear that up for them. It's something that happens over time. As we age, and as we use our bodies more. Now I said as we age, but I just want to make it clear that you can be older, you can be elderly, you can be into your 50s, 60s, 70s, 80s, and beyond, and still have fantastic knee health. Despite your x-rays showing that you have arthritis.

Let me say that again. You could have pretty bad looking arthritis on your X-ray. You can be older, and you can still feel great in your knees. I need to say that to you because many people don't associate those things. The proper way to think about arthritis, knee osteoarthritis, is it's a normal part of aging, just like we get gray hairs, and wrinkles on our skin, on the inside of our bodies, our cartilage changes over time in a way that isn't always the best.

The best example that I could give you, if you think about an old vehicle, maybe it's in great condition. For example, I have a neighbor, down the road from me, that collects 1957 Chevy's, I believe it's 57. I'm sure he correct me if you heard this, but he's got three of them, and he keeps them in great shape, but I'd be interested to see under that vehicle. If you poke your head under that car, you probably will see some spots of rust here and there, just because that's what happens to metal over time. Especially metal was used back in the day.

Now that rust is similar to arthritis happening in our body. It may not be detrimental to the function of the vehicle, those vehicles might still run just fine, if there are just spots of dust of rust here and there. It won't affect the structural integrity of the frame of the car, the struts, the shocks, the bolts, everything that builds the car. All the components of the car should operate just fine if you just have some rusty spots here and there.

But think about this, if that rust was so bad that it's starting to cause a hole in pieces of the metal. It's starting to bend because the structural integrity of the metal is being affected, because there is so much rust, then you have a serious problem. Then you may not want to drive around that car. You might be about getting it fixed somehow.

Same thing with arthritis. If the arthritis is so bad inside a knee joint, then it's going to start affecting the ability of that person to walk, to stand, to sleep, to do everyday activities. But if you get a little bit of arthritis on your X-ray, it may not actually be the source of your knee pain, it may just be that, going back to the car example, that you need new tires, or you need an oil change, or that something else needs to be fixed. It may not be the reason why your car is not working, right?

Going back to the knee, a little bit of arthritis may not be the reason why you are hurting, or why you are having any problem. It could be a bunch of other things. It's not a good idea to associate your age with arthritis, and with your ability to improve. I think that's really important for you, because let’s say you are in your 60s or 70s, or older, or even younger, and you have an X-ray and you found the dreaded words in the report knee arthritis or the doctor told you that you are developing knee arthritis. Another thing that people will say the doctors will say is that they have knee degeneration, or degenerative joint disease.

Diseases a misnomer, they actually talk in the medical field about getting rid of that term degenerative joint disease because it leads you to think that it's a disease, like something that you catch, or that there is a medicine for that cures it, and that's not the case. It's just, it's wear and tear, essentially on a knee joint. The cool thing about the body, though, that's different from a car, is that it can heal our bodies, or living tissues where obviously cars are not.

If you put the body in the right environment, if you give it exactly what it needs, it should heal. The predominant thinking in the medical field is, that once you have arthritis, that it only gets worse over time, and that it doesn't heal. If you have pain, especially knee pain from this arthritis, then you are only going to get worse. Some doctors will even go so far as to say that, you might need a knee replacement in five 5 or 10 years, or however many years, because that's what they typically see. They typically will see people that come in for knee problems, and physicians are doing their best, they are  helping them out with injections and medications, and might make recommendations for surgery. That's what they are trained in, and that's what they are specialists in. So, that's how they think to help you out.

Sometimes I even have clients that go to physical therapy, or get other sorts of treatment, and don't get better. I always question what was done? What do they do? Anybody that is therapists, the physician, the surgeon, was it the best thing for your situation? Did they check certain things in your knee that needs to be checked so that you can properly get better? There are all kinds of reasons why a knee can hurt, and arthritis is just one of them.

Let's talk about that, let's answer the question of how does knee arthritis happen? How does it progress? I mentioned the words wear and tear a second ago, and you hear that a lot in the medical field, especially patients that go visit their doctor and get an X-ray. The common way that doctors will explain what's going on in their knee is, they'll say you have wear and tear, and what that tends to mean is that there is cartilage that is thinner than it's supposed to be. So that's where it's worn down, and there might even be spots where there are tears in the cartilage.

Some doctors will mention the words “you have NO cartilage in your knee”. I want to clear that up, a mind picture that people get, whenever they hear these words, that they have no cartilage in my knee. They think that the entire surface of cartilage, on the back of the kneecap, or on the end of the thigh bone is completely gone. That's extreme. I can tell you right now, if you have been told that, that you if you are going to walk, your knee would be locked, you wouldn't be able to bend it, or straighten it out very much at all.

Maybe you do have some loss of motion and some locking here and there, but that could be for a slew of other reasons. Your knee would literally not move at all, it would be like trying to undo a very, very rusty bolt. Like it would be extremely stuck, and if you pry it loose, all this dust would fly out. You might even break the bolt where it's attached to and your knee would not function normally or anywhere near normal.

If you had complete loss of cartilage on any surface of your knee joint. What is more likely to be the case, if you have been told that you don't have cartilage is, that there is a spot on your kneecap, on the back of your kneecap, or on the end of your thigh bone, where the cartilage has worn down enough to go all the way through down to the bone.

Another phrase that doctors will typically use is, it's bone on bone. The knee joint is bone on bone, and they are not talking about the entire surface. We are talking about a single spot, usually in a severe case, where the knee joint is bone on bone, and once people get that, the picture in their mind is that there is no cartilage in there, there is no chance of it coming back. Then they start going down the thinking of I need a knee replacement.

In the root of the problem, what tends to make knee arthritis progress faster than it normally should, because you are going to get it as you age anyway, it may not be painful. But in people that are in their 30s 40s, or 50s, or some people in their 20s, as well, they have some severe knee pain. Usually, it's been going on for a while and you may have gotten x-rays and your cartilage is worn down, and maybe even have a spot that's bone on bone. What has been happening to you more likely than not, the most common thing that I see happen to these people is the mechanics in their joints. In other words, the way that the bones move on each other, has been off for a long time, and it's causing certain surfaces of the joint to rub on each other inappropriately.

It's causing extra friction, extra pressure in those areas where the cartilage is worn down or torn, or it's bone on bone. That's not the way that motion is supposed to happen in your knee. As a result, you have worn it down faster than it should. The good news about this is just like our skin and other tissues in our body. Cartilage can develop scar tissue, and scar tissue isn't a bad thing.

A lot of people get all worked up over having too much scar tissue and, and it being you know, you have to break up scar tissue I hear about that as well. But the reality is that scar tissue, when it's laid appropriately in a tissue, it's about 60 to 70, sometimes even 80 to 90% as strong as the original tissue. That's pretty darn good. In my opinion. That's way better than getting stem cells or PRP injections, where you are looking at possibly regenerating a small percentage of the tissue. I'd rather have scar tissue all day and fix your original root problems so that I'm not going to wear down my scar tissue as well.

How do you generate scar tissue though? Well, in the kneecap, it has to heal slowly over time. In the end of the thigh bone, cartilage just comes on very, very slowly, it heals at one of the slowest rates of all the other tissues in the body. In somebody who has bad mechanics, it has been going on for a long time. They wear down the cartilage.

What I often find if we are talking about the kneecap on the thigh bone, let's talk about the muscles for a second the thigh muscles on the front of your thigh. Those are called quadricep muscles, quads for short. People that have long standing knee arthritis and pain on the front of their knee or deep into the knee. They tend to have very over dominant quad muscles, very strong quad muscles.

I had a client not so long ago that we started seeing for a knee problem and she told me she's been exercising and fit for whole life and she's in her 50s. She is still pretty young to have knee arthritis problem. But she's gotten there because she's been so active, playing sports, going to the gym five days a week and getting on the treadmill running. She's convinced that she needs to stay active and healthy so that she can be healthy into older age, but she's worn through cartilage.

I asked her if she does squats in the gym and other leg exercises. I said when you go do your leg days at the gym, where do you tend to get most sore from, or where do you tend to feel the muscles work the hardest. She said hands down my quads. I have always worked on my quads. I've always been proud of having big quads, big thighs, strong, quad muscles. Then I asked the question, how about the hamstrings? How about the glutes, she said, rarely ever do they get sore, rarely ever do I work them out? I always get on this machine and do this exercise. I do the leg press. I do the squats. I do this. I do that.

I went through deep in detail through every exercise she would regularly do, and she confirmed that she always felt her quads work the most. When I told her what I discovered, I tested everything out in her in her legs to figure out what the root problem of the of the knee arthritis was. I told her you have got some of the most dominant quad muscles I've ever seen. And the evidence is there. From what you are telling me that you have worked out your quad muscles way too much and unknowingly have neglected other muscles that should be in balanced with the quad muscles.

When those quad muscles are as dominant as yours, what happens in the mechanics at the knee joints, those quad muscles all attach to the kneecap. Which causes them to shorten. The stronger the muscle is, the more it shortens just at rest. That's a known fact. So, it puts the kneecap against the end of the thigh bone the femur harder. Without even doing anything, the kneecap will be pressed up against the thigh bone. And that increases the pressures and it doesn't allow the cartilage to recover to rest and be able to regenerate itself and be healthy.

Then when she goes to exercise, when she's not doing any more, we've fixed a lot of things in her. But when she was going to go exercise, she was further strengthening her quads and in further increasing the forces in during the exercise itself. She was getting a lot of grinding, popping clicking in her kneecaps, which was just if you think of the cartilage surfaces, they are just being pressed against each other way too hard.

That's how arthritis happens over time. If you can imagine this woman exercising five days a week, doing things that involve her legs, pressing that cartilage up against itself, way harder than it should, and then doing that over the course of years, over the course of decades. She's in her 50s now, she said she's been active ever since she was in high school, playing high school sports and she never quit.

Occasionally, everybody goes through seasons of life where they might back off on exercise, they gets sick, the holidays come around. In her case, she has two or three kids. So things change in life, but she always came back to exercising. She was pretty consistent with feeding into this muscle imbalance and putting too much pressure on her knee cartilage. She developed knee arthritis.

But how do we undo this? Let's talk about the types of treatment that people do. First, I'm going to go into the types of treatment that are commonly done. What people tend to encounter first, whenever they visit somebody in the medical field. In our opinion, what I think we can do here in our office, I'll pass them a physical therapy to help people for the long term so that this is getting better for months and years, and possibly the rest of your life.

The first thing that people will do at home is use some sort of over the counter pain medication, Tylenol, ibuprofen, or they may rub what's called an analgesic lotion or gel. we are talking Bengay, Biofreeze, Tiger Balm, one of those types of lotions that take away pain.

Both of these things are temporary. They don't make your muscles stronger, they don't fix the way the joints moving, they don't fix the mechanics, which is a root problem for most arthritis problems. It can feel better, it can possibly help you sleep better at night. It may allow you to get through a few days of where you need to be on your feet a lot or use your leg a lot. And that's cool, but it's not a good long-term plan.

The next thing that people will do typically, they'll visit the doctor and the doctor, with best intention, will offer a prescription strength medication, they may offer an injection for the knee as well. Those two things, prescription strength medications and injections, can definitely help the pain but just like with the over the counter stuff, the things that people try at home, they do not help the pain for the long term. It's just short term. It just helps, instead of just a few hours or a day you might get relief for a few weeks, or maybe even a couple of months with another Injection. That might get you through a tough spot.

Other things people try at home, they get a knee brace. It's a hit and miss where some people swear by it, and say they feel better when they have a knee brace on, other people say they don't. The trouble with the braces is, there are no such thing as a comfortable knee brace. Everybody fights with them, they have to constantly shove them up. Everybody's legs are shaped differently, and no knee brace is truly one size fits all. They might say that on the knee brace, but everybody's just shaped differently, and they fit everybody differently.

The other thing with knee braces is, you ideally don't want to be in it forever. You need to have a plan to fix your knee problems, so you don't have to worry about being in a knee brace forever. You have to have some way to get out of the knee brace.

Other things people try at home is rest it. Which is great because your inflammation will go down. The trouble with that is, once you get back to being active or doing your normal routine, you are going to be grinding those knee joint surfaces again and aggravating the knee arthritis.

In extreme cases of knee arthritis, that joint just doesn't move as good. The joint doesn't bend as well and doesn't straighten as well. We see some elderly clients here in the office where we flat out tell them, you are not going to get much more motion than what you have already. I can work on you here. But maybe you'll get 50% better, maybe 70% better, is a good outcome. But if the knee arthritis is very advanced, then there is no guarantee that it's going to get completely better.

The only way to get beyond, the motion that they currently have, if they are limited, is to look at getting a knee replacement, but that's a whole other process, a whole other story. If you are very elderly, your health has to be taken in consideration as well as your ability to tolerate the recovery.

It's a massive surgery if you think about it, getting a knee replacement, they are literally chopping the end of your thigh off, your thigh bone, and the top of your shin bone, and replacing it, they are putting metal parts in there and other parts. They have to deal with your kneecap as well on the front end, and then they have to reattach everything. So you up and then you have to begin to learn how to use it, and walk on it. The cool thing about it is that surgery has been refined over time and if I had to get one at this point in time, I would be confident getting one.

I think the surgeons out there do a phenomenal job with it. But that's pretty last resort and ideally if you can save your knee from getting to that point, your own natural knee is the best thing you want. I know surgeons will tell you preserve your knee health, try to avoid getting a knee surgery of course but if you have to have it done. It's actually not a bad surgery to get. But ideally, let's avoid it.

Now let's talk about how much is possible to improve knee arthritis. Depending on the severity of it and how much it's limiting you. You may be able to get quite a bit of improvement. If you are thinking about your X ray that you got not too long ago, and they said it was, moderate or severe.

If you were to get an X-ray after doing some treatment, it may not change that much. I think the best scenario you are looking for as far as x-rays improving is that it stays the same, that doesn't get any worse. The changes that happen occur slowly over time. So you are not looking to have a clear X-ray.

What is way more likely to be the case, you feel better and that you can move better. We see that here in the clinic all the time. When I first meet a person here in the clinic, who's coming in to get help with any arthritis problem, after talking to them, figuring out their story, getting all the details that we need, checking them out by hand, feeling their knee joint, looking at muscles, all the stuff that we have to look at, I'll make my recommendation and I'll tell them, hey, realistically, we can get you 90% better, which should be enough to get you back to exercising, and doing certain things that don't aggravate it. You'll have to still baby it at times here and there. But that should be enough to allow you to enjoy your life just fine, and, be with your family, play with your grand kids, be active, be able to travel and be on your feet for a long time and you'll be fine.

In severe cases, then we are telling people, hey, we are looking at a 50% improvement. In those types of patients, usually their doctors have told them that they won't operate on them, that they are high risk. They can't have a knee replacement done. It's this or nothing, pretty much they don't want to be at home stuck taking pain medications all the time. So, they improved tremendously and get a lot of mobility back.

In those people, I'll tell them the realistic expectation of just improving about 50 to 70%. It just depends on how they present exactly. The more important thing for somebody who has severe, far gone arthritis, and they are not going to improve more than 70%. The more important thing for them is keeping their independence.

I had a client last year who was a pretty severe case. He could still walk, he could still drive, and he was in his 80's. He could still do a lot of things on his own. But his arthritis flared up tremendously over the holidays, and he just wasn't as active during the holidays. So that's why it got worse. He had lost his ability to walk on his own. He had to hold on to furniture, and people had to help him out. He was starting to use a walker, he had to use a bunch of different things to help him maintain his balance, because it was so painful for him to stand up and walk after treatment.

He couldn't straight out his knees all the way, he was lacking about 10 to 15 degrees in both knees. We got them maybe down to five degrees, six degrees, I forget the number exactly. But his knees, when straighten out all the way, they were pretty stiff at the end. I told him that's the expectation. We are not looking to have you strain out your knees all the way if you haven't been able to in years and years and years.

But he felt notably better his big concern was he could sleep better. He could stand for longer, he could tolerate getting himself in and out of cars without having so much help. He felt like he could take himself to the bathroom. That was a big deal for him. It's embarrassing to have your family help you out with the bathroom. He also could get himself dressed. That was another thing to get himself showered, he felt more confident being able to move around.

Being able to improve that small percentage, even if you are not looking at getting 100% better, because it's not realistic for you, it can mean the world of a difference, and keep you in a much happier place where you don't have to rely on family seeing you naked, or having to clean you up after using the bathroom. It's a big, emotional component that people can preserve when their knees are healthier.

If you are not in that type of severe situation with your knee arthritis, it's more mild, you can bend and straighten your knee all the way for the most part, maybe just hurts when you bend it all the way or straighten it all the way. You might have some grinding or clicking in there. There are a lot of mechanical improvements we can make. I can't tell you exactly what needs to be done for your knee right here. There are many factors to look at.

To exactly determine what exercises you need to do, what kinds of hands on work you need. It's it really is its own specialty. But we see people all the time, get back to exercising, get back to running, even impactful activities like running and jumping, they can do that. They have got to learn how to move better, and they have got to strengthen in certain areas. That takes some time and coaching, but it is definitely doable. You can definitely get back to being active again. Being able to kneel is a big problem for certain people, get down to the knee or even getting up and down from the floor. That's a big problem that people face too. They have many issues.

Some people that have had knee replacements already continue to have any trouble after the knee replacement, even they tend to not have as much pain because their knee is artificial. They don't have a normal tissue. But people with knee placements have typically not fixed all the underlying root problems that got them the Arthritis to lead to the knee replacement. They still have very overused quads and muscle imbalances and all kinds of issues that that never were fully addressed.

But at least you are feeling better because of the knee replacement. But because they have limitations and how they are able to bend their knee and use your knee, they have trouble kneeling, they have trouble getting up and down from the floor. And that can be improved a lot of these people, because the last thing you want is to lose your mobility as well as to not be able to be independent, not be able to drive, cook your own meals, do all the things that that you won't be able to do on your own at home.

I've had lengthy conversations with elderly clients that come in for knee problems, and they are pretty embarrassed to ask for help from their kids or other family members with doing some things. It's always tough but when you have to do that you need to because it's potentially dangerous if you don't get help. Of course, they think about where it's going to leave later down the line, am I going to put them nursing home? Am I going to have to have somebody move in with me when I've been by myself, or it's just been my spouse and I and I don't want them to have to hurt their back helping me all the time with putting on my socks and shoes, because I can't bend my knee all the way.

There are all kinds of problems that arise from not having healthy knees. If you are listening to this podcast, and you have knee arthritis, and it's not that bad, I strongly encourage you right now to take care of it before it gets too bad. Find out what treatment you need. I definitely recommend talking to somebody who's an expert in preventing surgery, injections and having to rely on pain medications. But take care of it. Don't let it get too far gone where you have to end up talking to somebody that tells you it's only going to get 70% or 80% better. Ideally you want it to be 99% better, even 100% of possible.

So guys, I hope that podcast explanation explains everything about knee arthritis. What it is and what can you do about it. I hope that we've set some expectations about it. Cleared up some myths about what knee arthritis looks like inside of a joint. And I hope that we can share with you all the information that you need to make the best decision about your knee problem.

Visit our website to find more resources on knee problems. We've got a tips guides that you can download for free. You can get them sent to your email right now if you go to www.epmanualphysicaltherapy.com and you'll see our tips guide there that you can download.

If you go to our blog, you'll find tons of helpful videos and blog information on what to do about any problem. If you think that you want to get in touch with us and get started with working on your knee problem with us, we'd love to help you out as well. You can call us at 915-503-1314 to find out more information. But if you are just at home, you just learning right now that’s totally cool. Absorb all the knowledge, do your research, talk to the right people, and make sure that you take care of any problem. Don't wait. Please don't let it get really bad. I hope you have a wonderful day.

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Hey there El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, Physical Therapist, and I'm the owner of El Paso Manual Physical Therapy. I wanted to talk to you today about meniscus tears. We have had lots of clients in the clinic, over the past few weeks coming in with knee problems, and they specifically have meniscus involvement.

Now I'm going to use a bunch of different words, talking about the meniscus. I'll try my best to make sure I delineate the differences between them all. So when I say meniscal involvement, for example, that's just any problem related to the meniscus, because there are different types of ways that the meniscus can get injured, which we'll go into. But just follow me here. In case you are having trouble following all the different terms, don't worry, I'm trying to make this as simple as possible, for people that are not in the medical field and may not understand medical terms.

But I'll have to use a term every now and then just to make sure that I'm communicating clearly. I encourage you to go Google stuff and go look it up type in the word that I'm saying here, but like I said, I'm going to explain it as clearly as possible.

I'm going to tell you everything you need to know about meniscal tears. If you have one right now, you are going to probably find yourself in some of these symptoms I'm going to talk about, as well as some of the issues that are surrounding meniscal tears and treating them.

If you have never learned about a meniscal tear, let me just start with answering the question of what the meniscus is. I get asked this all the time. A meniscus is a chunk of cartilage that sits between your thigh bone and your shin bone. It's in your knee and you have two in each knee, you have a pair in each knee and the pair is differentiated by the inside one, and the outside one. In the medical field that’s called the medial meniscus. That's the inside one, and the lateral meniscus, that's the outside one.

The job of these two chunks of cartilage, in each of your knees, is to cushion the thigh bone on the shinbone, and make sure that movement happens. Normally in the knee, because if you ever look at the structure of the bones in the knee, they don't really sit on each other perfectly well. Well, the meniscus helps to fix that problem, it develops what's called congruency because the meniscus is cup shaped. They allow the end of the thigh bone to settle onto the top of the shin bone, the tibia.

The main job, like I said, is to cushion the femur onto the tibia, the thigh bone onto the shin bone, and of course what's above the thigh bone while the rest of your body your hips, your torso, head and arms. Because it's supposed to cushion it, it acts a lot like a disk in a spine. If you think of your spine or somebody's spine. There are chunks of cartilage between each of the bones in the spine, and their job is to absorb forces and cushion everything else above, and below it and allows certain movement to happen. So that's a meniscus.

The next question I usually get, from people coming in for treatment is, why does the meniscus tear? Why is my meniscus torn? How did it happen? Some people have an accident, maybe playing sports growing up, they were playing soccer or football or volleyball, basketball, one of those and they had a knee injury that went undiagnosed. They got better from it. They never felt like they had to go to the doctor. But they have never quite been the same from that injury there. They tend to avoid exercises that aggravate it. They just been babying it essentially for decades.

You do have some more extreme injuries where we are playing those same sports or something similar or car accidents or other accidents. People blow up their knee, they tear the meniscus, they tear the ACL, or other structures in the knee. They might end up having an operation afterwards because it was a massive injury. Those people can also end up with some meniscal injury later on in life.

There is another group of people that never had a sports injury growing up, never really had any injuries whatsoever. And then they get to middle age, they are in their 50s, 60s, maybe a little older than that, and they start having knee problems. They go to the doctor, get an MRI and find out that they have a meniscal tear. That's always a shocker for them because they are wonder how did they get this? They have never had any knee pain ever. They have never done anything that could have aggravated it, and they chalked it up to old age. They think well, I'm in my 60s now so I'm feeling older and this is what happens to old knees.

But let's talk about what really causes a meniscus tear. Those are just the perceptions that people have, the stories that people give here in the clinic. But when I look at a meniscal problem, somebody that is coming in and they are telling me about their knee problem, the way that the pain presents, I have to differentiate, is it more of an arthritis problem? Is it more of a meniscus problem, a ligament problem or some other cartilage in the knee? Because there is lots of cartilage in the knee.

There are other structures too, that that could be causing knee pain. Certain nerves can cause knee pain. There is actually a nerve that is called the saphenous nerve. It runs on the inside of your leg, and there is a massive branch off the saphenous nerve that lies right on top of the meniscus and could mask meniscus pain for some people. I have to be able to differentiate, is this a saphenous injury or a meniscus injury or is it both, and then decide how to treat that problem so that the person can get back to doing what they want to do.

But in a true injured meniscus, where there is a tear and there are problems with it, the structure of the meniscus is disrupted. A lot of these people can function without any problems. They may not even know that they have a meniscus tear.

Then there are some other people that have knee pain. They go get an MRI, they get checked out, and they are told that they don't have a meniscus tear. When we see them here in the clinic, they have knee pain, obviously, they may even have swelling and other problems that look a lot like a meniscus tear. But what I believe they actually have is an irritated meniscus, which you can't really pick up on an MRI or X-ray too well, and it's confounding for the medical field.

People don't know what to do with these types of patients that have knee pain, that doesn't show anything on any sort of imaging, any sort of MRI or X-ray. The way to think about a meniscus irritation is, just think of your skin, if you scratch your skin, not too hard, but hard enough to get it red, where you leave a red mark. That would be skin irritation. Your skin is just angry because you scratched it. That redness will go away within a few minutes, maybe at most, a few hours, maybe a day at most. It won't take long to recover from that before your skin will look normal again. But if you scratch yourself pretty hard and you break your skin, some blood comes out while you have an injury there, that needs to take some extra time to heal properly, and that's going to take you some more time.

In a true injury on your skin, you have to start the inflammation process, you have to send certain cells to the area, your bloods got to clot, you have to eventually form a scab, under the scab, over time, a scar will form the special cells to do that, that's called proliferation. And then over the course of a week or two, sometimes three, then the scab will fall off and you have a nice new little scar that formed to protect your skin and close it up. Now that's got to happen in just about every single tissue in the body. It just looks different depending on the tissue. That happens on bone, that happens on cartilage, on ligaments, on muscle, but obviously you don't see it because it's under your skin.

Whenever you look at your body, you are pretty much looking at skin everywhere. So, in a meniscus if you have a tear, it is really slow to heal, because cartilage is one of the slowest healing tissues in the body. I think in the meniscus, in my opinion, from my personal experience in treating people with this, this type of problem, it's the absolute second slowest, only second two discs in the spine. Discs in the spine can take a really long time to heal. But the good news about both discs and the meniscus inside the knee, the cartilage in the knee is that it does heal. If you put it in the right environment, you take the proper steps, it can heal. I've seen it happen many times and people are always super happy to reach that point.

The next question that you probably are wondering about, because you are thinking, well, do I have a meniscal problem or is it one of these other things you mentioned, arthritis, that weird saphenous nerve, other types of cartilage in the knee. Let me go the way that a meniscus tear feels in individuals. Whenever we spot them here I can, I can tell you exactly how they present. I categorize these people into three different types, mild, moderate, and severe meniscus tears.

In mild, there might be a little bit of swelling, these people tend to still be active, they get pain. Not every day, it's more so a couple times a week, and it tends to be associated when they are very active. A lot of these people are younger usually, they are in their 40s, sometimes 30s. You see some older people with it too. These are the people that are definitely in better shape and haven't had any injuries, and they tend to get a mild meniscus injury later in life. But they eill be running or playing sports. Being active with families. Some of them just like to go walk their dog and they will push their activity a little too much and that will set off their knee problem.

They will come in saying, I've been walking or jogging for years, and I started to train for this event where I had to do extra and then my knees started to swell up. But I gave it a day or two, the swelling went away, I felt fine again, and then I went back to do that exercise, and my knee swelled up again. And it's just concerning me because I'm getting older, and I want to be able to do this activity. I've never had any problem and I don't want to have to stop doing this exercise because it's keeping me in shape.

That's the typical mild presentation for a torn meniscus, or it could even be a meniscal irritation in these people. In fact, a lot of these people don't get MRIs. It's not that bad for them. Some of them barely get any attention from doctors though. They might go see him for a visit and then get sent straight over to physical therapy. They never actually get an MRI. Which is a good thing in my opinion, because if you have a tear, it leads you down a path that may not be the nicest. Ignorance might be bliss in this in this situation.

Plus, they get better once they come into the clinic and get treatment. They start improving, they don't feel like they need a MRI, or any sort of imaging, because they are happy with the results.

One person in particular, we had a woman in her 50s come in, she's ran for years and years, three, four or five times a week she runs on a treadmill at home. She is not into competition or anything like that. She just runs for her own benefit. She does other exercises as well some aerobics type of exercises. But she started to have knee pain all of a sudden, during and after running. Then she was flared up for a week or two. Nothing that stopped her from doing what she wanted to do. But she had to think twice about getting back on the treadmill because she knew that she would flare up again.

After we address certain things in her hips and her muscles around her legs, we even had to go up into her back, and down into the foot as well. She got back to running and she didn't have any problems at all, it stopped the swelling, we got it back 100%. So that would be a case of a mild meniscus injury. The people that come in at that point, I think are super-duper smart because they are definitely getting ahead of the problem. Ideally don't want to wait until it's more moderate or severe. But I'm going to go into moderate and severe next.

If you find yourself in one of those categories, don't take it the wrong way. Our medical field is just crazy if you have any injuries. We'll talk about it just let's keep going here.

Let's get into the moderate part. If you have a moderate meniscal problem, you think you might have a torn meniscus, the way this is going to present, you are going to definitely have swelling, you are going to definitely have limits on your activity, the problems might present daily. These people to tend to complain about going up and down stairs, usually going downstairs is rougher than going upstairs, and they started having trouble sleeping at night. Because of the knee problem. They also tend to say that mornings are pretty rough. They don't like to wake up and get up out of bed in the morning because those first few steps, getting up out of bed to head over to the bathroom. The knee feels stiff, it doesn't want to move well, it might pop and click a lot. It takes 15 minutes, 20 minutes, and some people closer to an hour to kind of loosen up the knee and kind of get back to normal.

When it's at that point, these people typically have stopped exercising. They are concerned that they are getting unhealthier. They are putting on weight and that's feeding into the knee problem as well. A lot of times they've been seen a doctor already, they might have had some sort of treatment that just didn't work out for them. They might be using a brace or something like that, and we'll talk about what to use, and what not to use here in a second but just bear with me.

If you think that you have a moderate knee meniscal tear, it usually is still salvageable quite a bit, you can usually get in the 90s, as far as percentage improvement, if we are talking, zero to 100%, these people tend to get 95% better, 97% better. They tend to do really, really well, they might just have some very mild limitations that they might not even worry about. Most importantly, they don't need to have a surgery or some sort of invasive procedure, and they can stay healthy the rest of their lives.

Let's talk about a severe meniscal tear. These people will have all the symptoms of the moderate meniscal tear, the ones that just covered, their swelling will tend to be constant. Of course, going up and down stairs is a nightmare for them. They avoid it at all costs. I've had people come in and say I sold my two-story house because I could not go upstairs anymore. And I live in a one-story house now and I avoid stairs at all costs. I always use the elevator the escalator. These people tend to walk with a limp. They have changed their walking pattern over time. Some of them will use a cane, they tend to be older because this has happened over time.

One of the classic symptoms that severe meniscal tear will have is joint locking. What this looks like is their knee will get stuck. They will sit down, or go to get up, and of course you have to bend your knee during that process, and when they are about to transition either into sitting down or getting up, their knee will get stuck. They are sitting down, their knee won't want to bend all the way. Most people, when they sit in a kitchen chair, your knee will bend about 290 degrees, and it'll get stuck at 20 degrees or 30 degrees and they feel like they can't bend it to 90 degrees, it's painful, and it just feels stuck or locked. Usually they can shake it a certain way, kind of wiggle it around, and then it'll make a noise, it'll pop and unlock. Then they can bend their knee just fine.

Then the opposite will happen when they stand up, they will go to stand up and the knee will kind of stay bent. They usually have trouble balancing once they stand up, and they shake their leg around, and move it around, and then it'll pop, and then it'll go straight, and they can walk normal again. By normal i mean they are normal which is painful and with a limp and with swelling and all that. The thing behind this is that there are  a flap of the meniscus that's impeding motion within the joints. That's why these people can shake it loose and twist and turn their knee and it'll move better.

But if it's that bad, you have a severe meniscal problem more than likely. Now, the way that the meniscus will feel in most people, as far as pain, is that they tend to have pain on the inside of their knee. If you were to reach down and you feel your kneecap and then slide your hand towards the inside of your knee, there are  usually some bumpy spots there, depending on how much tissue you havegot, and that's where it tends to hurt for people.

Some people do have pain on the outside of the knee as well, and some people report pain on the back of their knee. There are  something called a baker's cyst that can develop at the back of the knee. When you hear the word cyst people, I think the mind picture that most people get is like a bubble that needs to be taken out or drained. The way I think of this is the joint is just very swollen inside the knee, there are  an active inflammation process happening, and extra fluid is being developed to deal with it.

Sometimes, I think the body is trying to build some cushion inside the knee as well. So, it's generating fluid, and it's a genetic thing. In my opinion, I think some people are just predisposed to react that way to different types of the injuries including a meniscal tear. That Baker cysts is a problem, because they will have trouble bending their knee and it's unsightly for some people. If they get really big, they just get really concerned with it. But the problem needs to be addressed, the meniscus problem needs to be addressed, and usually the baker cysts will reduce or become less of issue.

The medial meniscus, the inside knee meniscus is the one that tends to get affected more often. But you do see the lateral meniscus problem happen to a lot of people as well, and there are  ways to test both here in the clinic. But regardless of which one is affected, the treatment options are typically the same, and we are going to go into all that here in a second. But what you'll see with a meniscus problem is, there are  usually other knee problems happening at the same time. You'll typically see some knee arthritis developing, it's called osteoarthritis. There are usually some cartilage problems in the back of the kneecap, on the front of the femur, the thigh bone, and there could be some ligament problems as well.

There are some major ligaments inside the knee. I'll just go over them really quick. One of the top four are called the ACL, PCL, MCL and LCL. And these are structures that connect the bones to each other and hold the bones together. These four ligaments, their job is to make sure that the thigh bone stays attached to the shin bone. If they get elongated or torn, then that can cause stability problems in the knees. The connection between the two bones won't be as stable as it should be, which can cause the meniscus to get irritated because the meniscus will take some weird forces.

Let's talk about what happens to an untreated meniscus tear. We got lots of clients coming in here, of course they are getting treatment and some of them delay a long time on getting treatment, and the symptoms kind of worsen. And then we have the ones like I was telling you about earlier, where they come in when it's mild, and they haven't had any major limitations yet, and they haven't had a chance with all this other stuff to develop. But what tends to happen in people with untreated meniscus tears, of course, the meniscus problem gets worse over time. They move from mild to moderate to severe, and with all the problems that develop they will progress through arthritis way faster than normal.

About arthritis, arthritis is happening, and everybody constantly think of it as aging just like you get gray hairs and wrinkles on the outside of your body. The thought process osteoarthritis is that you get it on the inside of your body as well, and you age on the inside of your body as well, and it looks like osteoarthritis, so the joints change a bit. You might get different little structural changes in other tissues as well. For some people, they start developing small bone spurs. They start developing the cartilage might thin out, they get spots on their cartilage, the joint surfaces looking even, and it might not actually be painful at all.

In older people, I think, I'll have to dig up the research again, but it's in the 90s. I think once you are over 80 years old, it's like 93% chance that you are going to have some sort of arthritic change, or disc herniation in your back. I haven't seen the research on knees, but the rates go up. Of course, when you are younger, you still have a chance of having all that stuff happening, but it is painless and a lot of people. But if you have a meniscus tear, and you have other issues on top of that, like loose ligaments or cartilage issues in the kneecap, and you havebeen moving inappropriately for a while, you haven't been exercising like you probably should be, because this knee problem is slowing you down. Then it's going to allow for a faster progression.

Just think of it like your overall health. If you don't take care of your health, you are going to probably not live as long as somebody who does take care of their health. Your joints are the same way. If you don't take care of your joints, they are not going to last as long as if you do take care of them. People with meniscus problems in their knee, they tend to eventually develop hip problems. They can develop hip arthritis, they can get pain in the hip joint itself or around the hip joint. They will also get lower back problems. A lot of times we get ankle and foot issues as well. The foot changes the strength in their foot is usually affected and that can cause toe problems like hammer toes, bunions, other issues with the foot that that can be prevented.

Loss of arches in people that leave this untreated for a long time meniscus problem and then the arthritis gets out of hand, they will eventually likely get an knee replacement because the knee problem will continue to get worse. Of course, once they have that locking, like you get in severe meniscal tear that completely changes the mechanics, people really slow down. They don't want to move as much because of the locking and that makes arthritis progress way faster. If years go by, decades go by, then it's just a matter of time before they start getting told by their doctor that they need a knee replacement.

If it's that bad, if they've had joint locking for a long time and in their knee doesn't even move and have all the motion that is supposed to have a knee replacement a fantastic option for those people. The only concern I had is how are you going to move after that. You have to make sure you take care of your leg health, and get your activity back so that you can keep your body healthy, and make sure you don't have to have another knee replacement in a matter of time.

Now we are heading into the final part of this podcast here, we are going to talk about what treatment options there are for a meniscus tear. We will also go through the entire list of things that I see people do, and probably all the options that you are thinking of as well. I'm happy to entertain more if you leave us a comment on this podcast or get in touch with us. Let us know what other options are out there, I want to get a comprehensive list going.

Prior to getting any sort of medical treatment, we often see people trying home remedies.

The top things that people try, which is the easiest one, is just giving it time. They just rest it, they avoid moving a whole lot. They will avoid walking more than they need to, just to rest their knee. This is a very short-term solution, especially if you got an irritated meniscus it's going to feel better with off time. It absolutely will usually feel better because you are not standing on it, you are not putting weight through it, you are not using the meniscus like it's supposed to, so it has a chance to heal.

The problem is, if you haven't fixed the underlying problems that got to the meniscus tear, the meniscus problem in the first place. As soon as you get up to move again and you get active again, because you are feeling better, you are going to flare up again, we see people do that all the time. That's why they have the often symptoms where they say, Well, sometimes it flares up, and then a couple weeks later, I'm okay. Then another two or three months after that, it flares up again, and then it goes away. And then it flares up and it goes away. And eventually after going through this cycle enough times the pain gets worse and it stays more constant, or you don't get as much relief from the rest, because the original root problem hasn't been addressed.

The other things people will try at home, will be over the counter medications. Things like Ibuprofen, Tylenol, and Naproxen. There are a bunch of different medications you can get at the pharmacy over the counter. A lot of people try anti-inflammatory medications. The idea is to reduce the inflammation in the meniscus so that it can help with healing, and it's a pain reliever as well.

This is good for most people in the short term, they do get some relief. But after a while the drugs can become dangerous and this is not a good long-term solution. Ibuprofen is known to affect the lining of stomachs instantly, and for most people they can tolerate it pretty well, but I think the cutoff is six to eight weeks. If you are using ibuprofen consistently around the clock. After six to eight weeks the rate of people having major stomach problems, they get a hole in their stomach lining that spikes tremendously, which can lead to internal bleeding, which for a lot of people, they they need to go to the hospital for that. In some severe cases there is deaths that occur, especially in older populations, which is the people that tend to get these knee problems anyway.

If you are at home right now and you have been taking ibuprofen for a while, I strongly suggest you find an alternative, or take a break, or talk to your doctor about it and see what other options you have. Make sure you start to build a long-term plan to treat this miniscule problem because over the counter pain medication is not a long term plan.

Other things that people try are pain creams, you got your BenGay, Icy Hot, Biofreeze the rub that stuff all over their knee, and that tends to work pretty well in the short term as well. It's a pain reliever, it's not fixing the root problem, which we'll talk about here in a second.

The other the last most common thing that we see is people try knee braces. They will go to the store and buy a sleeve that slides over their foot and ankle and comes all the way up to their knee. These sleeves usually have a little opening for the kneecap to tell you where to line it up and leave some space for the kneecap. Some of these braces will be a little more heavy-duty, where they have metal brackets that are on the inside or the outside of the knee. A lot of people report that they have relief with these knee braces.

If you haven't tried a knee brace yet, and you are looking at trying to just get some relief, go for the knee brace that's definitely a way to get off the pain medication, if you havebeen using pain medication for a long time. It still is not going to solve the long-term problem, but I love the knee brace because it's not that dangerous for you to use. It's a safe way to get some instant relief, and most people report a little less swelling, they can sleep a little better at night.

But it only lasts so long because the problem is, knee braces tend to make your muscles weaker. Your body is smart, it can sense stability coming from the outside. The muscles will get lazy and you start to atrophy or lose muscle over time. A knee brace is just a short-term solution, you have to figure out a way to eventually not have to rely on the knee brace.

The other thing about knee braces is their main job, especially the heavy-duty ones, the ones with the brackets, their main job is to stabilize the knee and if you don't have a ligament problem, then it's not going to make a huge difference for your meniscus problem. You might need to get that checked out by an expert to know if you have more of a ligament problem, or meniscus problem, and get proper advice on how to use the knee brace.  Because what I see a lot of people do, that come in where they need brace. I ask them this question I say, well, who gave you the knee brace first of all? Was it just on your own that you got that, or did somebody recommend that you use one? Was it a medical professional? And then what's your long-term plan for this knee brace because, if you are in your 50s or 60s, wearing a knee brace right now, I would not want you to be wearing a knee brace into your 70s and 80s or beyond, you eventually need to get out of that thing, but you need to have a plan.

The last step in your plan cannot be I'm going to be in this knee brace the rest of my life. Those knee braces are uncomfortable, they slide down, they get stinky, you have to wash those things everyday probably, especially in the summertime, and they just don't allow for normal movement. Ideally, you want to be without the knee brace as soon as possible, but you have to get to a point where you can wean yourself off and be able to do your everyday functions without a knee brace.

Okay, let's talk pain medications, prescription strength pain medications. Let's say you have gone to the doctor for this knee problem, they will usually recommend some sort of prescription strength pain medication. There are a ton of different types out there. It depends on which doctor you see, what their specialty is, and what their background is. They will recommend all kinds of pain medications, and these are all short sighted, for the most part, they are just doing their best to help you out with the pain that you are dealing with right now.

Understand that medications do not make your muscles stronger, they do not make your cartilage healthier, or your ligaments healthier, or your meniscus healthier as far as the actual structure. In fact, a lot of these anti-inflammatory medications, they are stopping the first stage in healing. Inflammation is actually a normal thing. That's why our bodies do it. It's the very first stage in healing, and it needs to occur in order for proper healing to happen.

If you are relying on anti-inflammatory medications, like some doctors will prescribe a steroid pack which limits inflammation. It's an anti-inflammatory medication, it is stopping the healing process in your entire body, and that's why they can't give you too much of it, because they know the long term effects of it, but it may provide you some quick relief, which most people are looking for that are visiting the doctor.

That might be a good thing for you, especially if you need to just kind of get through the week or get through the month. Or you don't want to be mean or grumpy with people because of your knee problem because that tends to happen, and you just want people to sleep at night, you are losing a lot of sleep. There are definitely some benefits to using some high-power pain medications, but they cannot be your long-term solution. You cannot rely on those for the long term, you are only going to get worse in your meniscus problem.

The next way the doctors will help out with medications is they will give you injection medication. The most common injection that people get is a cortisone injection into the knee, sometimes they'll do two or three all at once. It just depends on the doctor and how they do it. That is pain medication injected directly into the joints space, or the space where the meniscus is. They tend to be pretty effective in reducing pain. A lot of people have this sensation where they feel instantly better, after the injection site heals, maybe a day or two.

They might need a few days to recover from the injection, but then they feel massive relief. They feel like they can walk again, be active again, do all the things that they want to do. But you have to keep in mind, if you just got an injection, or you have had one not too long ago, or you are going to go get one soon. You have to keep in mind that it is not healing your meniscus. In fact, it's preventing your meniscus from healing. It's just masking the pain and you have got to make a plan to fix this meniscus for the long term so that you are not relying on injections for the long term, or other pain medications.

They will limit you on how many injections you can get per year, especially these cortisone injections. Because the doctors are very aware of the research, insurance companies are very aware of the research. If you get more than three or four per year, I think that's usually the limit. I'm not a physician, I'm a physical therapist, if I'm off, if you are in the medical field, or you know about all these limitations, and you are like, this guy doesn't know what he's talking about. You are probably right. I don't keep up with that part of the medical field. I keep up with my specialty very well.

I'm giving you the information that I hear from doctors and what I learned going through school, and what I keep up with here and there. The laws change, and the best practices change over time, and that's completely normal. But what I hear clients saying is, they limited me to three, they limited me to four. I'm like, good, you shouldn't get more than that because it's going to mess up your meniscus in the long term or other similar structures. So, you cannot rely on those cortisone injections.

Other things that people will get injected is PRP that stands for Platelet Rich Plasma. This is part of the newer, I think they call it functional medicine or it's non-medicinal, and it's supposed to be the natural stuff. They are injecting you with platelet rich plasma, they have to take some blood from you. They put it in a centrifuge, one of those things that spins really fast, and they pull up the plasma from your blood and it's got tons of platelets in it. Which is a sum of certain structures that are in your blood, and they inject that into your knee and the idea is that it helps your knee cartilage heal faster. I've seen mixed results with people getting these. I've heard some people say that it definitely helped out their pain, and then other people say didn't do a thing.

The other thing that people get injected with is, and this is less popular, but it's up and coming are stem cells. You might have done some research because maybe you have a meniscus tear. You have known it for a while. You had an MRI a while back, and maybe you have been dodging surgeons, because they've been wanting to do an operation on you, and you are thinking of alternative solutions. I'm sure stem cells has probably crossed your mind once or twice. It's still controversial, the source of where they get the stem cells is very controversial. I won't go into that. Even the efficacy or the likelihood to be helpful for you, is mixed.

I have had some clients, that said that they had stem cells injected, and said that it made a big difference. And I have had others that said they had it injected, and saw only minor difference, or no difference. It's so new that we don't know much about it. Right now, there isn't much research. Not many people are doing it, and that that's all we know about it right now.

What I can tell you regarding all these injections is, they are not fixing the strength of the muscles, which usually needs to be addressed. They are not dealing with joint mobility, how well the joint moves, the quality of motion, the way that you move overall, the way that you walk and move. But that's something we fix here in physical therapy, which I'll talk more about in a second. There are still a lot of root problems that are not being addressed with these injections, and I think that's why people get mixed results because they get some relief instantly. But they continue to be weak and continue to not move well, and that sets them up to have the pain return. It's not a good long-term solution to the problem.

Okay, two more things. We are to talk surgery next. A lot of people get a surgery to fix their meniscus, they will do a meniscectomy, often a partial meniscectomy, which means that they take out a piece of the meniscus, usually a flap or a torn chunk. The idea is that the tissue is not going to heal, so they cut it out, get it out of the way. Because the assumption is that that is what's causing the pain. But what we know about the meniscus, as far as its ability to generate pain, the outer edges of the meniscus, where tears are less likely to happen. The outer edges are where you have the most nerve endings and where it's likely to be more painful. The inner edges are where you have much fewer nerve endings and that's where the tears tend to happen. It's a little controversial right now doing these partial meniscectomies, because there are actually a few studies coming out of England.

England, they have a national health care system, where it's run by the government, it's socialistic versus here in the US it's capitalistic. But as a result of them being of England being a national health care system, the government is very into figuring out what works and what doesn't, because they want to save costs. So, what they are what they are doing is something called placebo, partial meniscectomy.

What is happening is, they are getting people that have known meniscal injuries, they get them through MRIs, they get their MRIs done, and they find them meniscal tears, and they are putting them into these studies where they split them in half. Half the group goes into where they get normal surgery done. They are the normal partial meniscectomy be done, and then the other group goes into the placebo, partial meniscectomy. Both groups have surgeries. There are  interesting words in the studies, they say they even move the knee the same way in the placebo, they have the same tools, they put them under anesthesia, the same people are there, they take the same amount of time to try to account for every variable possible to make it exactly like a normal surgery. But the one difference is that they do not actually cut the chunk of the meniscus out that they were looking at cutting out.

They leave the torn meniscus alone. Then they close them all up, and after the course of six months, up to a year, what they found was that there was no difference in improvement between both groups. Both groups improved a bit, but not one group improve more than the other. Now they are thinking well, is this meniscus surgery even doing anything? Now they haven't done studies like that in the US, but I think it'll be interesting if they ever do.

For those people that have meniscus surgeries, what I would consider if this surgery even needed? Is that the best place to go? You open yourself up to a bunch of risks possibly, if you ever have a surgery, there is a chance for infection. You have all kinds of risks, and for some people, it is the best thing. I'll even tell some clients that this this is pretty bad, I can't help you with this, you need to go talk to a surgeon, ad I'll be straightforward and honest. But for a lot of cases, coming in a lot of people with meniscus problems, I'd say you know, 9 out of 10. What I'll tell them is I can help you out, and if it's real severe, I'll say well, let's give it a month with treatment., and if you are improving some, maybe you'll be happy with that level of improvement, we'll have a good idea for how much you can improve. Because you might be okay with getting 70% better if that's your max because at least you can walk around and do your normal things. 100% improvement may not be realistic for you, even if you had a surgery, who knows.

If you are out there and you have already had a meniscectomy, a partial meniscectomy, and it didn't improve, and you are one of those cases, unfortunately. Or if you are thinking about getting a meniscus surgery, or you are just learning about this for the first time, and you even know there was a meniscus surgery out there. Let me tell you about the outcomes of this.

A lot of people will improve, they get better, but then over time, they tend to regress, they get worse again. What we know for sure in the research is people that get meniscus surgeries are more likely to have osteoarthritis develop quicker in their knee. I think it's for obvious reasons. There is a chunk of your meniscus missing. So, the knee joint just doesn't move normally again, and it's going to age faster. It's really a short-term solution in my opinion to get a knee surgery, it might be the best decision for you depending on your situation. You have to weigh all those problems with you all those all those risks, all the factors to make the best decision moving forward.

But what the surgery is not fixing. Let's talk about that. Next is your strength, your joint mobility, the way that you move, the how you sit, how you stand. There are a lot of things that we look at here in physical therapy. Here at the clinic, we go into extreme detail about what you are doing, that led up to this meniscus injury. Because that's the question that needs to be answered. If we can fix the problems that led up to this meniscus injury, then you have an excellent shot at recovering for the long term. Even if you have had a surgery, you are going to have a surgery. It allows you to stop using the pain medications. avoid having to get injections. Stop having to worry about your knee all the time, you can get your sleep back, you can be able to go up and down steps just fine.

I'll tell you a story. We recently had a woman who came in for her hip. She actually had a hip surgery that didn't go too well but was having knee problems, and it looked like a moderate meniscus injury. In figuring out what was going on with her hip, and what we found in her was that her glute muscles are very weak. She just was not using them well. And it's counterintuitive because she's got a big butt. You would think she's got lots of glute muscle, and she has some pretty good strength, but she just wasn't using it well, and the strength that she had wasn't enough for the activities that she was doing. She was on her feet quite a bit, walking around every day for her job.

She doesn't have adequate strength to do what she needs to be doing throughout the day. And then she also isn't walking the best, so we had to figure out how to teach her. We taught her how to walk better way to figure out the problems there. We taught her how to strengthen her glutes better, and how to progress and to what level to progress to, and it's been amazing to see the benefits, we are five weeks in, now this week's upcoming is a sixth visit.

She is already sleeping better. She's walking much better. She stopped relying on insoles. She used to get insoles all the time. She feels like she doesn't need them anymore. The number one thing that we talked about recently though was, she's got a two-story home, and she was saying that she has to grab the rails to pull herself up with her arms to take weight off her legs, her hip and her knees. Because it was hurting so much. That was the first visit that I saw her. She flies up those steps now and can go down the steps with little to no pain, and she's still got tons of improvement to make.

This woman is set on getting back into the gym and doing the treadmill, being able to jog, being able to lift weights, and I think she's going to be very capable doing it. We just got to go a little farther and her progress to get to that that level.

So that's the root problem that we are fixing in here, we have got to find out where you are weak, where you are strong, there are usually something called a muscle imbalance happening. Muscles on one side of the body will be relatively strong, and on the other side of the body, they will be relatively weak. That stuff you can't pick up on an MRI. You can't see it on an X-ray, physicians aren’t trained to fix that or even identify it.

I think some doctors will have an idea of that happening, but they are not sure what to do with it because their specialty is medications, surgery, injections, those kinds of things. And that's cool. You need that sometimes. But if you are looking at fixing your movement, your strength, getting that long term, natural cure, because you take that with you, you can only get medication for so long and injections, and you ideally don't want to have more than one surgery. You are going to get one, you want to be going back for surgery all the time, doctors won't even let you do that.

You want to have fixes that you have control over, and that's what we teach here. It's heavy in education. We teach you what to do, and how to do it, when to ramp it up, or when to ramp it down, how to read your body, how to know what's normal, and what's not normal as far as sensations, and what you should be doing. We coach people through that process so that they can get to the point where they feel super confident that they are doing the right things, and that it's only helping their knee and not harming their knee.

There you go, guys. We talked about everything there is about meniscal problems. We covered what it is, what the meniscus is itself. How does a meniscus tear? What does it feel like to have a meniscal injury? We went over the mild, moderate and severe levels of meniscal tears, and what happens to an untreated meniscal tear. Of course, more issues are going to happen up in the hip and down in the foot. Then also the treatment options. We covered everything from what people try at home, and then what you can get done using the medical field, and what's going to help you for the short term, and what's going to help you for the long term. I hope this podcast was helpful for you. If you know of somebody that's got a meniscal injury, please share this with them. I want everybody to have the best information possible so that they can make the best decision about their own health moving forward. And I hope you have a wonderful day. Have a great day. Buh bye.

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Dr. David

Hello El Paso! This is Dr. David, expert physical therapist. I'm the owner of El Paso Manual Physical Therapy. Welcome to the Stay Healthy El Paso Podcast. I've got with me here today Philip Buckler, he is an expert dentist and has, to me worded most clearly, and most succinctly explained things about dentistry, that I never understood.

Of course, I've grown up going to the dentist my whole life. But I love the way that Philip explains things, whenever asked him questions. Full disclosure, he's a patient of mine. He's really close. He's had an awesome experience here at El Paso Manual Physical Therapy, and I wanted to bring him on the podcast, because he has fantastic advice for dental health.

I wanted you guys you listeners, to be able to experience that from Philips. I've got some questions for him, but before we go into that though, Philip, please tell me a bit about yourself. Where are you from, and how did you end up in El Paso?

Philip Buckler

Okay, I'm originally from Oregon. I went to dental school in Michigan. I ended up in El Paso for my job and I fell in love with the city, and also met my wife here. I've lived in El Paso since the end of 2011 actually integrated from dental school in 2010.

Dr. David

Fantastic, awesome! And of course, you've been practicing as a dentist since then.

Philip Buckler

Yes, with a one year add residency, which is kind of an additional year of training beyond dental school.

Dr. David

Awesome. So, you're a super dentist, then…

Philip Buckler

I wouldn't go that far. But the extra training was very beneficial.

Dr. David

Awesome. And your experience, you've treated a variety of ages and specialties. Is that right?

Philip Buckler

Yes, I believe the oldest person that I've seen was 96, I want to say, and the youngest person that I've seen, I've seen a few children as young as a few months old. I'm not a pediatric dentist. Pediatric dentist tells you something that contradicts what you hear for me, go with what the pediatric dentist says with regards to children.

Dr. David

I wanted to pull out of Philip here for you guys. Just some clear up some general health tips. Get clear on a few dental ideas, dental hygiene ideas, and hopefully this is helpful for you listeners at home or wherever you are in the car, at the gym, wherever you're listening to this right now.

One of the most common questions that I hear people talk about is, how many times a day do I need to brush, is it once or twice? Is it after every meal? Should I be impulsive about this? What do you have to say about that? Phil?

Philip Buckler

Well, the answer to that is, for me, it's more comparable to any other area of hygiene. You just need to keep the surfaces clean, a tooth surface that is kept clean, will not develop decay. Unless, there are a large number of other factors present. But good hygiene will cover over a multitude of other potential drawbacks, either genetic or coming from additional treatment like cancer, that sort of thing.

Dr. David

Gotcha. If you had to make a general recommendation, and we have talking a little bit before, as you mentioned about assuming that your genetics aren't that great, so you have to just brush so often.

Philip Buckler

Assuming each surface in your mouth is cleaned at least once every 24 hours each tooth surface is cleaned once every 24 hours, you're good. The standard recommendation is two brushings a day. But if you can get them all in one brushing, or one brushing and flossing, right before bed, so everything's nice and clean before you go to bed. For many people that will be adequate.

The criteria for success will vary from person to person. Because the criteria for success is your teeth are staying in your head, you're not developing periodontal disease and you're not developing decay. If you aren't developing ant new cavities, and your teeth aren’t starting to get loose and fall out, and your dentist tells you that you're not losing bone around your teeth, then whatever level of hygiene you're practicing is adequate, or at least close enough to it for long term sustainability to have your teeth last as long as you do.

Dr. David

So basically, you have to figure out a little trial and error, work with your dentist to get feedback on is what I'm doing enough? Can I back off a bit and be okay still that that's generally how you should proceed?

Philip Buckler

Yeah, many people, if you brush and floss very thoroughly once a night before bed. That's often adequate. My wife, before I met her, she hadn't seen a dentist for seven years, but her teeth are better than mine. And they are clean. I'm jealous. I hope our kids get her teeth. So that just shows the disparity. Some people have to work at it more than others. So again, don't assume that you fall into the easiest portion of the population because that's a good way to lose your teeth. But there is a wide variability.

Dr. David

My wife's the same way. When I met my wife, I had just started flossing regularly because I had the dentist told me I needed flossing. I didn't know how to floss. I finally had a dental hygienist take literally, maybe three minutes, four minutes and showed me how to do it. She taught me about the hug and pull,

Philip Buckler

Using it as a scraper on the inside of the teeth, as it helps to see go back and forth.

Dr. David

It's been a game changer. We taught our kids, but my wife said, when she saw me regularly flossing every day, she said “Really, you floss all the time who does that?” And she put her hands in her hips and said, “I've never had a cavity and I've never floss” and I was like “well I've had a lot of cavities!”

Philip Buckler

Good for her. I'm glad she can get away with it. But most people can't. And for anyone who doesn't like to floss, then in your case, the best form of dental insurance the best gift you can give yourself and it will save you thousands of dollars is a very high-end electric toothbrush. Very high-end Sonicare or an Oral-B. Something that will produce enough agitation inside your mouth against your teeth that will help flush out there in between the teeth.

Now that's the next best thing, and I actually have had people who use those, fool me into thinking they were flossing on a routine basis, which probably doesn't impress my fellow practitioners or any hygienists but I'm sure it's happened occasionally.

They're good products and I don't get any kickback from them. I've used both of them myself. It's just individual preference. Yeah. Other products that help her Water pick super floss. I'm not particularly picky about how my patients get their teeth clean as long as they are clean and they're not developing cavities and they're not they're not losing bone so it looks like the bony support for their teeth will last them through the rest of their lives. A lot of time.

Dr. David

You know about the motorized toothbrushes, what did you call them again?

Philip Buckler

Like a Sonicare or an Oral-B? Those are the two big brands, but there are a lot of other good brands.

Dr. David

I'll never forget, growing up, and I heard you use the same words that I've heard of the dentist say, a high-end toothbrush. And automatically when the dentist said that. I remember telling my mom that I needed a high-end toothbrush and I got the sense of “Oh, we can't afford that it's too high end.” Then when I actually bought my first one, I said that was 40 bucks, relative to a normal toothbrush is maybe 10 times more, or however many times more it is, but those… I got a Sonicare and it has been one of the best investments ever made. It is completely different brushing your teeth, one of those rather than a regular toothbrush.

Philip Buckler

And as long as it prevents at least one cavity, you've more than made your money back. Or if you get one of the $200 toothbrushes, then it might take a couple of cavities prevention. But it's an investment that will repay itself. It's cheaper and more effective than dental insurance.

Dr. David

Oh, yeah. So, we started taking our kids to the dentist, because they are getting bigger, they get more teeth of course, and from the get-go, we didn't want to get them kid’s toothbrushes. Because the brush heads on the Sonicare toothbrushes that we have, are actually kind of small, smaller than the normal toothbrushes, and they fit in my kids mouths better.

Plus, they think it's entertaining to the thing buzzes in their mouth, and they loved it. So, from the get-go, we started having them get used to Sonicare toothbrush, and every time we take them to the dentist, they're like, wow, your kids teeth look great. their gums look great. Just keep doing what you're doing, is what they tell us. I've loved those toothbrushes. I can't go back anymore.

Philip Buckler

Yeah, I'm going to be making sure that each of my kids has a good electric toothbrush. One that runs off double A batteries, does not qualify as a high-end toothbrush. It's more of a gimmick toothbrush better than nothing. Now, don't get me wrong, some people can do everything with a manual toothbrush. I've seen plenty of people who do that, but if you need that extra umpf, it'll really save you time and money, and time and pain in the dental chair.

Dr. David

Oh yea, that's no fun.

Philip Buckler

But dentistry is very friendly these days, relative to how it used to be.

Let's see what else to talk about. Oh, yeah. So generally speaking, I tend to compare people's teeth to the treads on your tires, they will wear down over time thousands of cycles a day. Every day, every year all your life. Your teeth are like anything else mechanical. They are like any other part of your body. They do wear down, they will get sensitive. Some people have problems with their knees, some people don't.

It's the same with people's teeth. A lot of people ask me about jaws clicking, cracking and popping. Again, there's a lot of individual variation on that. I generally say that some people's jaws are more flexible, and others cannot. It's kind of like some people can crack their knuckles or make a habit of doing it.

Again, that's an oversimplification. There's a wide variety of things that go into that. But when your jaw opens, it actually goes through two forms of movement. The first is a purely rotational type of movement for the first half. And then the second half is when you're opening to the full extent. That is what we call a translation movement where the combine all of your mandible is actually moving against the maxilla and physically shifting out of place rather than just rotating to the socket.

To help facilitate that, your body has a disc of cartilage, like it does in many other joints in your body, and occasionally, that disc or curtilage doesn't move optimally, or when you get older. Sometimes it just wears down period. Like arthritis, you can get arthritis in your jaw joint. Oftentimes, that will produce a clicking, cracking, popping sound.

Most of those sounds are not something that needs to be directly addressed, as long as you're chewing comfortably and functioning normally. Oftentimes, it's keeping an eye on it. If it really is messing with your quality of life, there are treatment options, and I'd advise you to see your general dentist and possibly get a referral to a specialist to get that looked at.

Dr. David

Yeah, I think that's good. Just to summarize that in a super concise way, I think the takeaway points from that is, the jaw joints are complicated. It's not just like a hinge joint. There's a bunch of funny movements and then just like you hear about in knees, there's a movable piece of cartilage in there, discs is what they call it, kind of similar in the spine and having compare that to, it's not an exact analogy, but it's very effective.

That disc can be injured, or it can shift in funny ways, or in that can produce clicking sounds. Even can hurt or make the jaw move unevenly. But it basically would fill up here is saying is if it doesn't hurt or isn't affecting, eating or doing anything with your mouth, then not a big thing to worry about, at this point, just monitor it makes sure it's not getting any worse.

Philip Buckler

In general. Yeah. And just kind of like you keep an eye on a knee that tends to pop when you move in a certain way. Same deal with your jaw. There's actually a very in-depth sub specialty of dentists, that and often general dentists will become certified through additional fellowships through this, that specializes in treating disorders of the jaw joint. If it's really messing with your quality of life, that's when you might want to consider seeing one. However, for most people. It's that degree of intervention isn't warranted. It's pretty extreme. But for those people who need it is it can often be very beneficial.

Dr. David

Yep. Super good information. I love this. One of the things that we were talking about, before we started recording here, was about diet and about what you're eating and how that might affect your dental health.

Philip Buckler

Yeah, so when I see someone with good hygiene, who also was developing a bunch of decay, and they don't have anything in their medical history, like radiation therapy, that would decrease their salivary flow, then it's the typical culprit is diet. The way cavities form in your teeth of course, like any other part of your body bacteria likes to live there. It's a nice warm, wet environment. So, bacteria like to live there even more than most places bacteria like to live.

That's why you need to clean it once every 24 hours in order to keep those bacterial colony sizes down. Whenever you put something with calories, or burnable calories in your mouth, the bacteria that are living on your teeth will metabolize that as their waste product, secrete acid, and that acid will not only decrease the pH of your saliva below the point where your minerals start leaching out of your teeth. But of course, they'll also do that in a much more localized focused area on the teeth, which is why you don't want to let any bacterial colonies grow in specific areas on your teeth for any extended period of time.

A lot of areas that people miss, tend to be done by the gum line, especially on the canines and second molars, because those are those areas that people miss. So, don't let plaque buildup back there. But when those areas, those bacteria in those colonies are fed, the pH of your mouth will drop below the mineralization threshold for about 20 minutes according to the classic studies. Every time you take a bite of something with calories, or sip something with sugar, or any other calories, not just sugar, but oatmeal is kind of a Greek culprit that a lot of people don't know about.

That will basically restart that 20-minute timer. So as far as your teeth are concerned, it's usually not how much you eat. It's, in terms of sugar, how often you eat it. If you're nursing an energy drink throughout the day, that's a lot worse for your teeth than say, downing three meals a day, even if they're pure sugar, the rest of your body, your pancreas would object to that much sugar. Your teeth you won't have nearly the problem. So again, it's kind of a moderation thing and unsweetened coffee, unsweetened tea will stay in your teeth. But if you're looking for some kind of an energy buzz or a caffeine buzz, I would suggest developing a taste for unsweetened teas, unsweetened coffees, because well, they'll stain your teeth, but they won't damage them. Caffeine in and of itself doesn't actually lower the pH. of your mouth.

So, it's kind of an indirect effect, but your body actually deals with that because your saliva is super saturated with minerals. When the pH in your mouth is at normal resting pH your teeth will actually absorb minerals, from your saliva, which is good in general. But at the same point in time, once they've absorbed enough minerals, you start to get mineral deposits on your teeth.

It's a very fascinating engineering trade off. You get the deposits on your teeth, but those calculus deposits will irritate your gum tissue. And, of course vector you'd like to live on the calculus deposits because they're much more varied in terms of surface area, and they're harder to clean. So that tends to lead to more gum disease.

The areas of your mouth that are most resistant to decay, also tend to be the most prone to Calculus buildups and bone loss and gum disease. Usually, that's where your salivary glands empty so there's no direct solution. It's only engineering tradeoffs, and it's very interesting, and you can hope that by keeping your teeth clean. Some people with more mineralized saliva just tends to build up more calculus. So, life isn't fair. Some people do need to visit the dentist four times a year, and some people can get away with visiting the dentist one time every seven years. And they're good.

Dr. David

Yea my wife is lucky. I have to go on a regular basis and I'm happy to. I always tell people I will use a Sonicare, I will get a high-end toothbrush, I'll floss, I'll use the water pick whatever it is. I want to go to my grave with good looking teeth.

Philip Buckler

Yeah, and one thing I hear oftentimes, I'm never quite sure how serious people are about this, that they'll just get their teeth taken out and get dentures, and that dentures are way better than nothing. Don't get me wrong, newer dentures that are Implant Supported. I'll be honest, that costs about the price of the new car to get an implant supported set of dentures, but man, they're functional jewelry that's worth it.

If I ever get into a major accident and lose my teeth, I'm going to remortgage my house to get implants supported dentures, because the difference is amazing. But even normal dentures, or even little dentures are still way better than nothing. But they are like prosthesis for your mouth.

You don't get the same kind of function with a denture that you would get with normal teeth, you don't get the same tactile feedback. And it's almost like wearing a custom-made pair of shoes in some ways. Your mouth also changes over the course of your life like the rest of your body. And one of the things that goes on in the case of dentures is that your bone sticks around to support your teeth. When you have no teeth there, the bone will gradually remodel and recede. So, the dentures gradually become loose and fallouts.

Oftentimes, dentures have to be remade, and by oftentimes, I mean once every three to five years and oftentimes more in order to keep them functioning well. And if they don't function well, if they develop sore spots, they're very uncomfortable to wear and they can be normal situations and so there is a learning curve to using them. You don't get the same tactile feedback. But again, they're a lot better than nothing. And if your dentist recommends dentures, it's probably because the health benefits of keeping your teeth in place are now outweighed by the benefits of taking those teeth out.

Because when teeth get loose enough to the point where you can't clean them, or the bacterial colonies get big enough, your mouth is very resilient, and it has an excellent blood flow and can bring far more white blood cells to the site than almost any other part of your body. But at the same point in time, that bacterial load does still play stress on your body. So eventually, if a tooth gets loose enough, the question isn't going to come out. But is it going to come out on your terms or its terms and are you going to have to get it out when you have a chronic infection that's losing puss…

I'm sorry, I don't mean to gross everyone out. but I've seen cases, so generally a controlled plant removal of teeth followed by the delivery of a prepared denture or followed by multiple impressions to make a denture for your mouth as it is, once it finishes its healing remodeling process is a much better alternative to letting things go on their own.

That being said, again, there's compromises and tradeoffs. Everyone has to decide for themselves, as an individual where they're at. And of course, there's costs for dental treatment, you just have to make the best judgment call you can about how you're functioning with the teeth that you have.

Now, if you if you ever have to look into that situation, or you're ever faced with that choice, see where your teeth are at now, versus where you would be with dentures, and just kind of make that call and decide when that would be right for you. That will vary from case to case. I see my role as a dentist to give people the information they need to make the informed decision that's right for them, rather than necessarily dictating to the decision to them.

Oftentimes people ask me what the best option is. In that case, I look at their teeth and I'm like, well, if your teeth are my teeth, here's what I did. But oftentimes there's plenty of good options. There's a joke that if you go to 10 different dentists you will get 10 different treatment plans.

That's not because dentists are blind, it's just because there are multiple ways to approach a problem. And a lot of these teeth problems are not just medical, but they're also mechanical. And there's multiple ways to get to the right solution. Dentists are individuals in terms of what works best in their hands, it's the same thing that you would run into in terms of a surgeon who recommends a particular procedure that they're very good at, which is where you get the Doctor of Dental Surgery degree or a different approach.

If you're in doubt and you're contemplating a course of dental treatment, whether it's expensive or invasive, or just because you want to educate yourself, one of the best investments that you can make is to get a second opinion. Once you find a good dentist, stick with them, and there's a lot of good dentists in El Paso. The El Paso district dental society actually does have a large number of good people that I know quite a few. And there's a lot of excellent dentists in El Paso. And that number is growing.

Dr. David

This is awesome Philip, this has been phenomenal information. I feel like we cover the whole gamut. We talked about kids a bit. We talked about, what you should be doing normally. And then we even went into end of life, dental hygiene, talking about the dentures and all that stuff.

Philip Buckler

Yeah, thank you for your time. I know I can get long winded on this, and there's so much more that could be said, and people are keeping their teeth longer. It's just great. What's going on dentistry as far as the advances that are being made even just every year.

Dr. David

Yeah. That's awesome. It's very exciting. Well, thank you so much for your time, Philip. I really appreciate it. Hey, everybody, for those of you listening right now, go on to the platform that you heard this podcast on, whether that's Apple platform, the Google platform, Android, wherever you're going listening to this.

If you want to get more health information just like Phillip said, so that you're in the best position to make the best decision about your health. Educate yourself and hit subscribe so that you get notified about when we put out more information so that you can learn more about how to stay healthy in El Paso. Thank you so much, and we'll talk soon. Bye. Thank you.

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Dr. David

Hey, everyone, my name is Dr. David Middaugh. Welcome to the Stay Healthy El Paso Podcast. I've got a good friend of mine here, Tony Stafford. Tony Stafford is a client of ours. He came in for a little issue that people in their 20s and 30s tend to deal with, and it's a relatively quick problem to solve, and he's doing fantastic at this point.

He's nearly at the end of his care with us. But the reason I want to bring him in is because he's not in his 20s or 30s. He's actually in his mid-80s, 84 to be precise. He'll tell you more about himself in just a second here, but I wanted to bring him on because he's got some awesome advice on how to keep healthy into your 80s. So welcome onto the show, Tony. Tell us a bit about yourself. Tony, where are you from?

Tony Stafford

I'm from North Carolina, originally, little town outside of Charlotte called Belmont. I went to Wake Forest University and graduated in 1957. After I graduated from Wake Forest, I was drafted into the army and spent my first year in Fort Meade, Maryland. Then I was shipped to Fort Bliss, and that's how I ended up in El Paso. When I got here, I discovered that there was a little college here by the name of Texas Western college, so I checked it out and started taking some night classes at Texas Western college. And met a girl Of course, and when I got out of the army, I stayed in El Paso to finish my master's at Texas Western. After I got my master's from Texas Western, I went to LSU for my Doctorate, and I was not coming back to El Paso, but Texas Western called me and said, Hey, we'd love to have you as a doctoral candidate. So, I told my wife, I said, we'll go back there for about a year or two, till I finish my dissertation, then we'll be out of there. 55 years later, I'm still here because I love El Paso. I'm here by choice.

Dr. David

Fantastic. Yeah. So, you said there that you went through all this education. You ended up moving away from El Paso for a while to go to LSU, to do your doctorate. And would you mind sharing what your doctorate is in which are you studying?

Tony Stafford

Yeah, my specialty is English and American literature. My dissertation was on Shakespeare.  At University of Texas El Paso now I'm in the English department, and I teach a variety classes. My specialty is dramatic literature, and additionally, Shakespeare, a British playwright, American playwrights, but I can teach it all.

Dr. David

that's awesome. Sounds like you'd be a fun professor to have as a student.

Tony Stafford

I love teaching. I put a lot of energy into it, and It keeps you young.

Dr. David

Oh, yeah. And you can tell with your personality and disposition. Well, let's get into some of the health tips that I think that you've got, that our listeners need to hear. So, first off, just getting motivated is a big deal. So, for you what are two or three motivating factors for you to stay healthy?

Tony Stafford

Well, that's pretty easy. I hate being sick, and I love feeling healthy. So, to me that's a powerful motivating factor. I don't like being overweight. So, I like to watch my diet and workout and a little bit of vanity. I don't want to get fat and ugly, it I don't have to yet. But staying healthy is what's important to me, and I noticed it’s something you have to work at. It doesn't come free. The law of the universities says use it or lose it.

Dr. David

It's so true. I love that. That's fantastic that that motivates you. I know for me specifically. I don't want to have to get bigger clothes. I don't have to go up in the size of my pants or my shirts or anything like that.

Tony Stafford

It's called vanity also.

Dr. David

Yep. It's a bit of vanity for sure.

Tony Stafford

That is also about health.

Dr. David

Oh, yeah. You just feel tremendously better. A little bit of my whole story. I won't take much time at all, but I used to be very obese when I was a kid. I kind of grew up like that. But once I lost a lot of weight. I was stunned at how good I felt, and I never knew that I could feel like that, because I was so used to feeling the way that I felt when I was really overweight.

Tony Stafford

You just feel lethargic and low energy. And that's not a good feeling.

Dr. David

So, what have you tried and found that has not worked for you to keep healthy?

Tony Stafford

That's a hard question to answer because everything I've tried so far seems to be working. I tried bicycling, but then I discovered the streets of El Paso are rather dangerous. I had several friends who were killed on bicycle. Including Beto. O'Rourke's father who was killed on a bicycle. I tried swimming, swimming wasn't for me. But I played football in high school and junior college, and you have to run a lot to stay in shape. And I found out that I really enjoyed running just for the sake of it. But bicycling didn't work. Swimming didn't Work. And eating steaks and hamburgers didn't work. So, I had to eliminate those things.

Dr. David

So, does that mean that you're not eating meat right now? Are you eating chicken or fish? Or what's your diet look like, how is that contributing to your health?

Tony Stafford

Vegetarian all the way. I started off on this kick about three and a half years ago, and I was going to try to be vegan. That's very, very strict. And you can't have cheese which I love, and eggs which I have one egg a week. But so, I slipped back to the Fed classification of vegetarian but no poultry, no ham, and I love pork chops. But you know, when you get into a vegetarian diet, and you learn all kinds of delicious dishes, you discover after a while you don't really miss meat. I don't miss it at all. Not even tempted. A few bacon crumbles on my salad maybe when I go out to eat, but that's about it.

Dr. David

Wow. Yeah, that's fantastic. For me, I was a pretty heavy on meat, especially back when the Paleo Diet was a big kick, and I know a lot of people are on the keto diet. If you're listening right now and you're very carnivorous, or you're following one of these, paleo, keto, or there's a bunch of other diets out there. I think what Tony has developed, I've had other conversations with him about health and for myself too, is you kind of have to figure out what works best for you, and your genetics and your health. And maybe meat is a part of that.

Tony Stafford

I would say, if you're going to eat meat, you should have small pieces. Sparingly and of course, poultry is not as fattening, or doesn't contain as much fat as beef, or pork does. So that might be an alternative for some people. I know my son's a big Health Nut also, and they eat mostly Turkey, which is pretty close to almost no fat.

Dr. David

Yeah, it's pretty lean. Especially the breast. So just to sum it up there, you found that exercise wise, cycling was not your thing because of safety. Swimming didn't really take too,

Tony Stafford

even though I was a lifeguard when I was in college. I was a sinker. Swimming is very difficult. So, I gave up swimming. And I found my niche was running.

Dr. David

Yeah, we'll talk more about that right now on the next question. The other things that didn't work out for you too well was eating meat, especially you said pork and beef me. I'm glad that you found that out. For those of you listening I'm looking at Tony, I'm describing he's probably going to blush right now, but he said he's 84 but he does not look like a year pass 54. He looks fantastic. I mean if you look at his skin, he's got excellent color. I've worked on him, hands on wise, and he just feels sturdy and strong, not frail at all. Someone in their 80s it's not uncommon to see them as somebody that if you if you shove them or nudge them accidentally, they might fall over. Tony looks like he'll shove you and nudge you and knock you over. He's a tough, sturdy guy. He's in fantastic health so it's evident. That's why I wanted to bring him on the podcast today.

Tony Stafford

One of the essentials in life is good blood flow. Through your skin, through your muscles, for your heart, for your lunges for everything. Good blood flow. Lots of oxygen. I think that keeps you young.

Dr. David

Definitely, and mind wise, something that I think maybe you're picking up on is, Tony's a sharp guy and he's into reading, and keeping up to date with things. He's feeding his brain, exercising his brain quite a bit as well.

Tony Stafford

Crossword puzzles, I exercise my brain. The law of the universe use it or lose it.

Dr. David

Yep. Fantastic. So, let's go on to the next question here. Tony, what are three or more things, if you've got more, that you attribute to your current successful health?

Tony Stafford

Well, it may be a little repetitive, but I run every day. I'm in a phase out program right now. So, I'm not teaching this semester, so I have that luxury of being able to run every day. I may take one day off a week. But running is one of the secrets from me. I run pretty long distances anywhere from 30 to 50 minutes every time I go out, and I try to keep a pretty good pace.

I think running is absolutely in my life for me is essential. I love running and when I'm running, I'm breathing deeply and looking at the blue skies and just enjoying the exercise and feeling my body in good health, and it's that, in itself is very stimulating.

The running is one thing. The other course is the vegetarian diet. For me, that works very well, and I don't get into a medical history, but every time I have a checkup, I blow my doctor socks off because he can't believe my cholesterol and my heartbeat and all my vitals condition, they're in. Yeah, again, vigorous exercise, and then a healthy diet.

The other thing is attitude. A lot of people get 60 or so, and they go around talking about how old they are, and they make themselves old. I do not see myself as old. I see myself as young. Maybe that's kind of stupid on my part, but, but I think the brain has so much effect on the body. For me, we know the relationship between brain and body and having the right attitude, and a youthful attitude and enjoying things in life.

I am a scholar. But I'm not often the library all day long, doing research. I have a good balance in my life. I mean, I go to football games and basketball games, and dining with my lady friend, and just staying involved in life and enjoying good things, enjoying good movies, enjoying good play, enjoying good concerts. Those things. attitude is the third thing I would mention here. Running, diet, and attitude my summation for that.

Dr. David

That's super good. That's spot on. Just to highlight each point that you're saying there. With the running specifically, I love that you found that out for yourself, and for me as an expert physical therapist, and I will never forget one conversation I had with a woman. It's been two years now, who came in, she was in her 50s very petite shaped. In other words, she had a small waist, big hips and she was short. And she told me it's been on my bucket list to run a half marathon. Yet she was seeing me because her knee and her hip are killing her from running just a couple miles, and she's talking about she was having to ice her knee.

I had been working with her for a little while already, and I had been pushing her to do strength training. Now she did phenomenal. With the strength training, nothing hurt her. She was actually good at it, and she enjoyed it. So, I had this conversation with her. I said, “look, you're genetically built to lift weights like that. That's what your body is built to be good at, running a half marathon you're just not cut out for.” I think there's something to that. That's why you see, Kenyans and Ethiopians win the Boston Marathon, there's a certain body type that's built.

Tony Stafford

They're very small. UTEP has a number of Kenyans, and I see them around campus and they're tiny guys, they probably weigh 135 or 140, something like that.

Dr. David

They're lightweight and you're looking at your build, I could see why you would tolerate running as much as you do. Because I'm sure there's listeners out there saying oh my gosh, every time I run my knees kill me or my feet kill me or something hurts and, and so I would consider that you know, what have you done exercise wise that you've enjoyed that hasn't been harmful to you? And what have you done that has hurt and don't dismiss it as I'm not just I'm just not an Exercise person. It's not for me. There's got to be something out there something that you enjoy

Tony Stafford

Bicycle, a stationary bike or something like that. One of the questions I always get asked David is, well don't your joints hurt from running so much? Of course, I don't do marathons. That's beyond my scope. But I do run every day. Those distances I mentioned. Yeah, but people always ask me well don't your joints hurt. I've never had any joint problem. And the thing is, I think everybody should hear this.

First you want to buy very good shoes and make sure they're plenty cushion. And then I buy a couple of extra inserts in my soles so that my shoe has lots of padding in it because there is some pounding that takes place which I which jogging and running. But I think if you have that cushion there, I think it really eliminates the trauma to your joints that way. So, I would say make sure you have some good shoes and put extra Doctor Sholls inserts in for extra padding. That's what I do.

Dr. David

I agree hundred percent. I think investing in your footwear is a big deal. I've been running myself in the past, and I've noticed a difference when I the palest level running shoes versus the running store running shoes are the top brands. You definitely pay for what you get when it comes to running shoes.

The other point that you brought up, on the three things that that attribute to your health, was nutrition, your diet. I love how when I've heard you talk about your diet, it's very disciplined and you don't seem stressed out about it. You don't seem worried about it. I see some people that bring up how they wish they could have this food, or that food that they can't have because they're on their diet. But the resolve that I have seen you is incredible to me that this is just the way that they eat, I enjoy it.

Tony Stafford

This may be hard for a lot of people. They love food, which is very easily to understand, and some people can't do without food, and they can't get enough of it. That becomes the problems. I've tried to minimize the importance of food. I love vegetables, and I have fruits and nuts and vegetables and pastas, and all kinds of wonderful things with lots of good sauces and everything else. But I don't make food that I'm not living from meal to meal.

Some people are, and for some people is a recreation, and or pastime or a way to feed their own happiness. But you don't need to make food so important. Yes, it's vital, to be able to have the nourishment to live on, but you mustn't get it out of perspective as to just how the role it plays in your life. I have friends for whom food is extremely important. They spend all their time reading cookbooks and trimming up all these fantastic dishes. Can't quite go there. I have to be reading a good book.

Dr. David

I think that's connected to the third point, which is your attitude, your mindset towards your health and nutrition. I can tell you, my background, I grew up with food being probably the most important thing when it comes to get together,

Tony Stafford

My culture was the same way. I was a southern boy. And food is really important to Southerners. Fried chicken and all those things.

Dr. David

I've taken the angle of I just need sustenance, I need this to be good., and it needs to give me the energy that I need to make me feel good. I don't want to fall asleep because it had.

Tony Stafford

I think when you eat a little bit, you enjoy it more. When you reach the point where you're eating, you're already full and you just keep on eating, and it really gets to be painful and kind of nauseated.

Dr. David

I love that. Those are excellent health tips, and I think really foundational for everybody, it's awesome that you're doing that. Let's move on to the next question here. So what health advice do you have for listeners that are in their 30s 40s and 50s? The people that might be working right now, they might have a family to care for at home, because you were there at one point, it looks like you were just there.

Otherwise, I mean, age wise, they're busy, they're dealing with day to day constant things or they're spending the time working all day and so, finding time to exercise and cook and do all that stuff is stressful. What advice would you have for them?

Tony Stafford

Well, I know when you're young and you have a family, and lots of obligation, it is extremely difficult. I don't make light of that. My son is just turned 40 and he has three little ones. But he carves out time somehow. Even if he has to get up at 4:30 in the morning to go ride. He carves out a little bit of Time. If his wife ever complains, he says to her, would you rather be I'd be hanging out at bars.

I'm not preaching, and I sympathize with you when you have lots of obligations and a full-time job, and a family, and all those things going on. But you just have to set aside a little bit of time to take care of yourself. Otherwise you won't be around for your family very long. And I think if they know you're doing it for them, they'll appreciate it and be supportive.

I understand the challenge completely. My son has been known to jog in the middle of the night before dawn, all these times, yes, he's a marathoner. He is in a different category. He's got to be committed. He works out he lifts weights and everything. So, it can be done. It just takes a little bit of discipline.

First, make it important. Secondly, be determined that you're going to do this. And then considering your family's needs and their schedules, carve out a little time for yourself to do that. Otherwise family life will devour everything and that's important too. But you got to take care of yourself. Also, you won't be around for long for your family.

Dr. David

So true. Yeah, you're doing it for them. If I could put in my two cents, I'm currently in my 30s right now, and I've got three small children, and of course working and my wife's working and we're in the same boat. So, I'm like your son, I'm the guy waking up showing up at the gym at 4am 4:30 in the morning, trying to get 40 minutes of weightlifting in.

On Monday, I went for a run in the dark at about 4:30am as well. In certain spots where the streetlights were very good. I had my phone, so I flip on the flashlight. Yeah, I'm on a familiar path though, so I can know what to expect.

But just a concern that might come up for listeners out there that my wife deals with. Because I get home from my run and she says, Well, I'm glad you ran. I wish I could do that. I'm the lady and running at five o'clock in the morning, doesn't sound very appealing to me. Because you never know. The safety of all that stuff is questionable for a woman. And so, I completely get that.

Tony Stafford

I understand her frustration, because for my son is that his wife manages some city gyms. So, she's in the gym all day long, and she gets her workouts in while she's at work. And she’s teaching aerobics classes and all those things. They don't have much tension when it comes to that, but I can understand your wife’s frustration.

Dr. David

Oh, yeah. She manages though, we make it a point to get the kids to exercise as well. We bought a jogger. stroller and on the weekends, we'll all go run together and jog. Yeah, we'll go to the park, have the kids play in the park where we take turns running around.

Tony Stafford

There's nothing wrong with a nice good steady walk. You don't have to be running all the time, and you and your family can all walk with you. Just tell them keep up the pace a little bit. And they need the exercise also.

Dr. David

And one more piece that I think listeners will appreciate, is the idea of life ebbs and flows, but staying in your zone. So, for instance, the holidays might come around, the December holidays that everybody's on break. For me, my kids were off during that time. So, my schedules changed. I was comfortable with saying, you know what, I've worked out well enough. I can take a couple weeks off. Maybe get some workouts in, here and there with the kids. But as soon as life gets back to normal, the holidays are over, back on my schedule, and that's okay.

Tony Stafford

There's nothing wrong with taking a Break.

Dr. David

Yeah. So, taking breaks, I think is okay. The key is getting disciplined enough to come back onto the normal healthy schedule. So, we got one more question here before we're out of time. Now we talked about people in the 30s 40s and 50s. What health advice do you have for somebody in their 60s 70s 80s and beyond? Or somebody who was about to retire, maybe has already retired, and they're looking to stay healthy? What advice you have for them?

Tony Stafford

Of course, it depends on what their lifestyle has been like. Many people at that age are very sedentary. It's like, use it or lose it. If you just sit down, once you're retired or in your old age, because you're tired a lot, it gets worse. You have to force yourself to get out of the easy chair and out from in front of the TV set. And because you're following the line of least resistance just to plop down in a chair, have lots of snacks and watch TV. If you do that every day, you're not going to last long.

Staying active is really important. If someone can't start off running and that kind of thing. But you can take walks, and I would say, also have interests in addition to the physical and the dietary considerations that we talked about attitude, but also have some interest. I read every day. I of course, I'm an English professor. So, I love writing, and just finished my third novel. But go to art galleries, go to concerts, find a really interesting hobby, something that you're good at. All of us have a special talent. And many times, we follow our economic needs and go into jobs and whatever because we have to, but at some point, you have to ask yourself, what do I really enjoy doing? What am I kind of good at got a knack for?

People's hobbies often bring them a lot of satisfaction. So, having interest and getting out of the house, going to movies, plays, concerts, that kind of thing. But having interest is important for people. I mean, I've seen people have the attitude, oh, I'm this age and I'm no damn good anymore and I'm worthless and, and they just make it worse for themselves by just kind of resigning and not having a positive attitude.

I sound like Norman Vincent Peale, but as we said before, the relationship between the mind and the body is a powerful one. The mind can affect incredibly powerfully the body. Having interest and having a good attitude, and having some activity, it doesn't have to be running.

That's what I would say to people, you have to start off very slowly. It should be something you look forward to every day. When you are getting out of bed in the morning, what is it in your day that you're really looking forward to? And I've known people who just said, I'm not looking forward to anything. And I don't care if I die now or not. I'm like, Hey, man, there's a lot to be lived yet. And so just enjoy the sunshine and the rain and everything, just enjoy life. That would be my advice. Not that I'm a counselor or anything. I'm just speaking from my own experience.

Dr. David

I love it. I hear, throughout the past year even, we've had clients that are older, and we've seen them lose a spouse who's relatively devastating. Talking with him through that and being able to see how they cope with it and then realize their purpose in life beyond where they're at, and beyond losing the spouse has been amazing.

For me personally, as a youngster, relative to somebody at that age, I look at you and how I learned a lot from you, and I see it as I have so much to learn from all these people that are older than me. So, I need them in my life. And I think it's important for somebody who's getting older in their years to realize how they can contribute to the generations.

Tony Stafford

Go to senior citizens cities, centers, meet somebody new. Don’t give up!

Dr. David

Yeah.

Tony Stafford

So, I would say that … where was I going with this…. I told you the story before. My mother had a sister, my aunt Ruby, and she was married to my father's cousin, Uncle Brady, and they worked very hard all their lives. They made a decent amount of money, had real estate holdings, and so they were comfortable. But when they retired, they stayed in bed all day. They ate in bed, they read the newspaper in bed, they watch TV in bed, and I'm telling you within a year's time, they totally deteriorate. Both of them became very senile and demented. Why? Because they just weren't using their body and their mind anymore. Now, and I just watched it. I was flabbergasted to see how quickly they deteriorated from just doing nothing. So, you don't want to stay in bed all day. You want to have activities and that kind of thing.

Dr. David

Yeah, great advice. This has been a wonderful bit of advice. I think our listeners are going to benefit a lot from this. Thank you so much, Tony. Appreciate it.

Tony Stafford

My pleasure

Dr. David

Well, guys, for those of you listening, if you want to hear more podcasts, you can visit the website, www.stayhealthyelpaso.com, please subscribe to our podcast on the platform that you're listening on, whether it's Apple or Google or Android, any of you were on all the platforms, just so that you can get updates about future podcasts coming out. And I hope that you are staying healthy out there. So, have a wonderful day. Bye bye.

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Dr. David

Hey there. I'm Dr. David, welcome to the show. I've got a great guest here, friend of mine. His name is Dr. Angel Garcia. He's a physician here in El Paso, sports medicine specialist. One of the best in the southwest. Certainly, the best in El Paso and I let him tell you more about all that. But I just want to welcome you to the show. Thank you for listening, and welcome on here. Dr. Garcia. How are you?

Dr. Garcia

Good. Thanks for having me.

Dr. David

Yeah, absolutely. We sure appreciate it.

Dr. Garcia

So, my name is Angel Garcia, was born in Puerto Rico moved to El Paso when I was about five years old. Been here since then. Went to Bel Air High School, part of the health magnet there, first graduating class. After Bel Air, went to Baylor for my undergrad, got my degree in psychology. And then from there I went to San Antonio for Med School, Medical University of Texas Health Science Center, San Antonio for medical school.

Graduated there, came back home for residency at Texas Tech in Family Medicine, and then after completing the residency in family medicine, stayed at Texas Tech for a fellowship in sports medicine, to better serve the patient population that I was interested in treating.

What drew me to family medicine was more of the… being able to see the whole family, treating the whole family, but I really love the musculoskeletal system working with athletes, and dealing with those type of issues and trying to provide a different perspective then what was provided by surgeons.

Not that, you know, surgery has its place, but for the vast majority of problems can be solved without surgery. And I was wanting to be able to help my patients more. So, I decided to do the sports medicine fellowship at Texas Tech.

Dr. David

That's awesome. Were you one of the first classes there at Texas Tech because they are pretty new?

Dr. Garcia

For sports medicine. We were the first class for sports medicine at Texas Tech. They had, you know, different program throughout the state. But my wife and I really want to stay here in El Paso with family.

Dr. David

Cool, cool, awesome. I love El Paso. So, you've got your own company here and let's just where we're at right now we're recording from Dr. Garcia's office. So, tell me about your company, what's the name and where's it at?

Dr. Garcia

So, yeah, when I left residency and fellowship, I really wanted to just kind of go out on my own, you know, not working for the man. So, we opened up a clinic El Paso Center for Family Sports Medicine. Initially we were at another location on Lee Trevino. But we recently just moved, we got a new building, trying to expand our services. So now we're on George Dieter and physicians, right next to diagnostic outpatient imaging and across the street from foundations hospital. So, it's a pretty cool location. So far, people are really liking the new building.

Dr. David

I know, I just got a tour when I walked in and is swanky looking. I mean I think of just modern. The floors are just beautiful, everything is, it smells like that new car smell.

Dr. Garcia

Still breaking it in, still moving in. But slowly but surely. Yeah.

Dr. David

So, I don’t know if you mentioned, but when did you start your practice?

Dr. Garcia

So, we've been in practice, I’ve been in practice for about seven years now, outside of residency and fellowship, but if you take that into account that has been about 10 years.

Dr. David

Nice, awesome. And then you mentioned that you did the fellowship and the residency and all that. Just so that people understand the difference, because I don't think the general population understands. I think they think you go to medical school, you become a physician, and residency and fellowship kind of just loses meaning after that. Could you explain a little bit more about what that means?

Dr. Garcia

So medical school, everyone kind of receives like the same kind of groundwork knowledge for general medicine. Then you had to start picking what specialty you're wanting to go into. So, whether you want to do dermatology, ophthalmology, or you know disorders of the eye, or if you want to focus on skin, if you want to become a surgeon, if you want to become a heart specialist, then those require more training than just what's in medical school.

Once you graduate medical school, you can become a general practitioner, but you're not necessarily a specialist of in of any sort. So, OBGYN had to do a residency in OBGYN. Cardiologists have to go to fellowship to study the specifics of the heart. So, after medical school, you have this kind of groundwork that you have to build on, and then depending on what specialty you're wanting to do, that's the fellowship or residency that you go into. Residencies can vary from three to seven years. Family Medicine is a three-year residency. Most of the primary care residency are two years. So, pediatrics is also three years, psychiatrists two years the surgical subspecialties can be anywhere from four to five years.

Dr. David

So, what's the difference between a residency and a fellowship?

Dr. Garcia

So, residency is your primary specialty, so internal medicine, psychiatry, pediatrics, family medicine.  Fellowship is when you want to take an aspect of that, and sub specialize. So, you get further training in the heart. Your further training in the GI tract. You get special training and different surgical procedures.

In my case, we got more training in the muscle skeletal system, more common sports type injuries, management of those injuries. Just dealing in more specifics on a smaller area, that you can become more specialized in, as opposed to this broad topic of, Family Medicine, where you have tons of medical elements that you study. The fellowship focuses on one of those, and you go into that a lot more in depth.

Dr. David

So, you're, that's like super specialist. My understanding is, it's like the most specialized that you can get in a specific body area or subject within the medical field.

Dr. Garcia

Right. And that's where the fellowship comes in. Some people will do multiple fellowships to get specialize in very minutiae. So, like the eye doctor can become a specialist of the retina. So, there are different things like that. Orthopedic surgeons who will become specialists in just the hand. So, that's the point of fellowship. It is just to focus on one or two areas and expand your knowledge on that as supposed to just kind of generally brush.

Dr. David

So, we are going to get into our topic of the day, one of the favorite things for you to talk about is shoulder problems. And, you know, it's definitely a commonly injured body part for people in sports. So, tell us about shoulder problems, what got you interested in that?

Dr. Garcia

So, it's basically what got me interested in sports medicine in general is just trying to deal with, you know, common ailments that athletes, and I use the term athlete loosely, you know, you don't have to be a professional athlete or anything like that to have shoulder pain.

Dr. David

Be like a weekend warrior.

Dr. Garcia

Weekend warrior, you know, or even just recreational. Just dealing with aches that I myself had, you know, I had a shoulder injury a few years back when I fell and dislocated my shoulder. You never realize how important the body part is until it hurts. So, helping people deal with shoulder issues is something that I enjoy just as my general sports medicine practice and trying to provide a non-invasive or non-surgical approach to something that can be pretty debilitating. And try to approach it from a vantage point that is just not isolated to the shoulder, but like the whole body in general.

Sometimes people will have neck pain that presents in the shoulder. Or they could have the elbow that is the cause of their shoulder pain. So, it's not just the shoulder that you have to look at. You have to look at the whole individual. And sometimes when you go to, you know, other specialists and tell them you have shoulder pain, they don't necessarily evaluate the other things that could be masking as shoulder pain, and people go undiagnosed, or misdiagnosed for several years. So that's one of the things of why I was wanting to get into that so that I can help patients get to the right diagnosis. And the right treatment sooner.

Dr. David

Yeah. That's awesome. That's so cool. And so, how long have you been focusing on people with shoulder problems? I mean, was that been your whole career pretty much it was an after the fellowship more so?

Dr. Garcia

More so after the fellowship. I didn't do as much during my family medicine residency. But the little I did do was what sparked my interest to do the fellowship. So, in my fellowship, and then the time since then, so for the past seven, eight years, have been really, really focusing on shoulder issues.

Dr. David

Now you said that you help people out with avoiding surgery or alternatives to surgery more. So is what he said. What are some of the common problems with shoulders that you see like some of the more specific diagnoses?

Dr. Garcia

So, the most common would be, you know, rotator cuff injuries. That's, that's kind of a catch all phrase, sometimes, but that's, you know, definitely the most common shoulder problem that that we see. And rotator cuff issues don't necessarily have to be caused by any, you know, real significant injury or trauma. Someone could just reach for something really quickly or, awkwardly rotate their arm a certain way and they develop inflammation of the rotator cuff or a sprain.

Not all rotator cuff issues are necessarily tearing that require surgery, a lot of times it's a muscle strain or inflammation of a muscle that just needs the right type of treatment. Most of the time that treatment consists a lot of going someone like you and getting physical therapy.

Sometimes, when I tell my patients it's a simple fix, but it's not a quick fix. The exercises aren't very elaborate, you don't have to have a lot of weights or a fancy gym because people always say, “Well, I don't have time to go to the gym.” Well, you don’t have to go to the gym, you can learn about some of these exercises, you can just use your door jamb for exercising the muscles of the rotator cuff. But the key is arriving at that right diagnosis. So that the appropriate treatment can be applied.

Dr. David

And one of the other diagnoses that I commonly see, related to rotator cuff tears, and the way that I look at the body, it's more of a spectrum and on the lower end of the spectrum of rotator cuff tears like the extreme end, on the other end would be like nerve impingement. So, there's something wrong with the ball and socket joint. Do you get a lot of those people as well?

Dr. Garcia

Yeah, it's definitely a spectrum. It's the impingement, I think, is one of the more overlooked. And the reason why is because, a lot of the studies that we use, or a lot of the diagnostic studies that people use nowadays, don't involve, unfortunately, the physical exam.

So, x-ray, a lot of people will focus on X-ray when people have shoulder pain and like, “Whoa, you have nothing.” Meaning that yeah, there's not a break. You may have a little bit of arthritis, but the X-ray is normal. Until the patient's like, “Well, why do I have this pain?”

Well, one you know, muscle doesn't show up on X ray. Second, test that is commonly used is the MRI. The MRI is great for looking at tears. It's great for looking at signs of inflammation. Maybe some calcifications in the tendon that cause irritation. But it doesn't allow for you to examine the muscle in movement. And impingement is one of those things where movement is what triggers the symptoms.

So yeah, the MRI may come back negative, because impingement you're holding still in an MRI, you can't move. So, there's no way to, appropriately diagnose impingement using MRI. So, impingement is more of a clinical diagnosis in terms of certain exams that you do within the visit that trigger that symptom.

That's one of the things that, sports medicine specialists learn in fellowship are those provocative tests to elicit that symptom, that can't necessarily be visualized with the most common modalities that we have.

Dr. David

Yeah, that's exactly I wanted to ask you next is, what are you doing? You specifically as a sports medicine shoulder specialist, what are you doing that's different than, say a general doctor, like what kind of knowledge, or hands on test do you do that they wouldn't necessarily know to do?

Dr. Garcia

In family medicine, when I was doing my residency. The basic exam that I got was, do they have full range of motion of the shoulder, or are they tender to a particular spot. For impingement, and other shoulder issues, there's a slew of tests that can be done to test the rotator cuff.

There's one is called the job's maneuver where you know, you're putting pressure on the arm and external rotation pushing kind of up towards your head. The other one that's called for impingement is the nearest test so you kind of put your thumb facing down and then you kind of elevate your arm close to your ears. So near to the ear.

Hopkins test is another test that checks for impingement where it's kind of like you hold your arm out in front of you, bend your elbow and just kind of rotate your arm down towards the floor, as you move across your body.

So, there's different tests that specialists have been trained to do that that weren't part of my, my residency training. And a lot of times you got to use multiple tests to isolate the issue, because the longer an issue goes on, other muscles start to get affected, they start to ache and can give you a false positive on some test and kind of lead you to another direction when it's all coming from the impingement.

It's just that it's gone on for so long that the other muscles around it are irritated because they're having to pick up the slack. So, it's a combination of all those tests. Sometimes I'll do an ultrasound. So that's one of the few, or I think the only one, that you can actually visualize the impingement because you're actually visualizing the muscle and then you move the joint, and then you can see the impingement on ultrasound. So that's, that's another modality that we can use.

Dr. David

Wow. That's awesome. What type of symptoms should people be looking for when they have a shoulder problem? When should they decide to come and see you versus waiting and seeing if it'll pass?

Dr. Garcia

That's a great question because you know, everyone's going to have aches and pains. It's part of life. You tweak muscles here and there. When it starts affecting your activities of daily living, if you're having trouble getting dressed, or putting on your shirt, women having issues striking the bra, reaching for a cup in the cupboards, or doorknobs.

When it's affecting your activities of daily living, and the symptoms have been going on for about a week or two. Most muscle strains heal within a week or two timeframes. But if it's severe pain, if it's pain that's keeping you up at night. If there's any significant weakness or neurological issues, numbness, tingling, burning, then I would definitely come in sooner.

But if it's just a pain to the shoulder, without significant reduction in your daily living, you know that 7 to 10-day window is usually good enough for most muscle strains to kind of go away. But if it's persisting past that, that definitely seeing someone would be beneficial.

Dr. David

Yeah, one of the common ones that I hear about all the time is picking up the full pot of coffee, to pour their coffee people always say “Gosh, that kills me every morning! That’s how I know my problem still hasn't gone away!”

Dr. Garcia

It could be something as simple as that. I've had one person that couldn't get their toothpaste on because they would have to reach up into the medicine cabinet to get it. Just that motion of moving their arm up the few degrees was killer.

Dr. David

Oh, cooking is another one, like chopping up a lot of vegetables or you know, whatever it is they're chopping, that force repetitive, I hear a lot of people complain about that.

Dr. Garcia

Yeah, that too. The people who are able to enjoy their golf, they are finely attuned to when their swing goes awry because of the shoulders bothering them.

Dr. David

Yep. And in the sports world, people lifting weights, all the time run into shoulder problems. Especially with like doing overhead exercises or anything with any shoulder specific exercises. Bench-press, I hear about all the time.

Dr. Garcia

So, for people who are who are on the more athletic side, do more performance. Being akin to your body is key. If there's a gradual loss of weakness on one side to the other, that wasn't there before. In someone who trains a lot needs to be dealt with soon, because those slight weaknesses can actually be a sign of pre-significant muscle damage and someone who's very well built.

So, someone who has that, or notices that you should be seen pretty quickly. For those who are wanting to work out form is key. You can be doing the right exercise, but if your form is not right, you are going to hurt yourself.

Dr. David

I see that all the time. I agree 100%. So, do you have any other helpful information that you want to share with people in El Paso about shoulder problems, that they may not otherwise know? Like, it's not common knowledge or something that unique that you end up telling patients a lot.

Dr. Garcia

What I tell patients in particularly, because I'm a huge believer in diet and exercise. And a lot of people think that one day they have to go to the gym or have a lot of fancy equipment to do the exercises. But in terms of the shoulder, they are very basic, simple exercises that for the actual intrinsic rotator cuff muscles don't require a whole lot of heavy weights or machines. It's, it's mostly a lot of range of motion and an appropriate range of motion.

Just because you go to the, and I get this a lot for people when I try to refer them for physical therapy is like, “Why, I go to the gym three, four times a day. I'm already doing exercise.” Yeah, you're doing exercises but you're doing exercises one for more of a general kind of well-being of the body, and usually more geared towards muscle building or muscle toning.

The exercises for shoulder injury, or any musculoskeletal injury are more geared to taking away the inflammation, or muscle strain from the smaller intrinsic muscles that oftentimes get overlooked when you're going to the gym.  Curling or bench pressing, that are focused more on the larger muscle groups.

Physical Therapy is something that focuses on the intrinsic muscles, that helps stabilize the joints better, that don't necessarily make you look, it doesn't add to the curb appeal. But it just helps mitigate the pain by assuring more proper alignment of the muscles and joints.

Dr. David

Yeah. I always have people that, whenever I talk to them about working on their rotator cuff muscle, I tell them this, you'll feel somewhat of a burn but it's not going to be like if you go work out your biceps are triceps, and then you never going to have the muscle burn where you look in the mirror and flex and rise like, look at this rotator cuff back here. It's just popping out like that.

Dr. Garcia

Because people go to the gym to focus on muscle building or improving their physique. The exercises for rotator cuff, the emphasis is not on improving the physique. It's on improving your pain, which will down the line allow you to improve your physique by letting you do the exercises that you're more wanting to do. But these exercises are needed to help prevent injury when you're doing those other more strenuous, heavy lifting exercises.

Dr. David

For the rotator cuff muscles, just to talk about that a little bit because that's a super common problem area for a lot of shoulder problems. There's four of them. We don't have to go to the names you can certainly Google them, but they all pull in different directions. They help to connect the ball on to the socket in the shoulder joint. And so, as a physical therapist, finding the exact direction in motion, that is the weakness or that is the main problem area or knowing which rotator cuff tendon is injured is also part of the problem. When we talk about doing shoulder exercises, rotator cuff exercises, it's not always like the same one that's going to help every person.

Dr. Garcia

Right? Because with their being the four major muscles that make up the rotator cuff, not everyone's going to be injured in the same muscle. And like you said, each muscle has their own action. One of the muscles rotate your arm outside, and another one rotate inside, another one lifted above your head. And then depending on what degree you're in, multiple muscles are working at the same time to give you that same benefit.

So that's what we talked about, when we talked about what exams to do for shoulder pain. Evaluation is trying to isolate that muscle in a particular movement or test that elicits that symptom.

The same exercises don't work for everybody, because not everybody injures the same rotator cuff muscle. Even though we dump it in the catch all phrase of rotator cuff injury. But rotator cuff injury can be a slew of different things. Because there are the four major muscles and then you have all those other smaller intrinsic muscles or ligaments that that can be injured.

Dr. David

Biceps tendon, I always hear about that.

Dr. Garcia

I see that bicep tendon is pretty common. You got ligaments that are combined but hold the humerus, and the shoulder together, are really small ligaments that that can be a cause of posterior shoulder pain, or pain on the backside of the shoulder that aren't necessarily muscle related. It's a ligament that attaches or holds two joints together. So yeah, every rotator cuff injury is different and therefore needs a different set of exercises to work through.

Dr. Garcia

Yeah, yeah. Cool. Well, this has been great. Talk about the shoulder today. So, do you have anything else that you think you want to share with El Pasoans about shoulder problems, or your company, or just in general about anything else you help us with?

Dr. Garcia

So, I mean, we're here, like I said, on the corner of Georgia Dieter and Physicians 11851 Physicians Dr. to help you with any sports medicine or musculoskeletal injuries. We also offer a vast array of other things, to general found medicine issues. So, we see anywhere from kids to adults.

For people who do a lot of working out trying to lose weight. We offer a weight management, education and help with weight management in terms of medication and diet, nutrition counseling.  For people who have problem areas that they want to get rid of love handles or things like that. We have some aesthetic procedures that we offer SculpSure is a non-invasive way to lose the fat in those problem areas that aren't responding to diet and exercise.

It's not a substitute for diet and exercise. It's just for people who had those polar bears that they just can't get rid of that we can give you that added assistance with the with the SculpSure.

Dr. David

Amen to the problem areas. I know very well about that. Well cool. So, if someone El Paso wants to learn more about your clinic, Dr. Garcia, or even maybe make an appointment. What's the best way for them to get in touch with you?

Dr. Garcia

They can call us here at the clinic, 915-493-6646. We have a Facebook page and they can just search El Paso Center For Family Sports Medicine. They can reach out to us on our website, and they can actually book through our website at www.elpasocenterfamilyandsportsmed.com. There's a link there that you can actually book online if for whatever reason you're trying to book an appointment after hours or over the weekend. So those are the main ways to get a hold of us.

Dr. David

Awesome! Great information today. Thank you so much for taking the time to talk with us really appreciate it. I think El Pasoans are going to benefit from this, time and time again as this podcast is available.

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