MEN’S HEALTHDr. Karim Khan

Men’s HealthMen’s Health

Knee/Hip painKnee/Hip painBack painBack pain

Bone HealthBone Health

Karim Khan MD, PhDKarim Khan MD, PhD

Sports Physician & Sports Physician & Assistant ProfessorAssistant Professor

UBC Family Practice UBC Family Practice (Sports Medicine)(Sports Medicine)& Allan & Allan McGavinMcGavin

Sports Medicine ClinicSports Medicine Clinic

www.clinicalsportsmedicine.com

OverviewOverview

A. I often have aching knees / hips (6 mins)

B. I have fairly consistent back pain (6m)

C. What about all this talk of osteoporosis in men? (6 minutes)

D. What is the VCHRI doing to help us?

Knee / Hip painKnee / Hip pain

A. I often have aching knees / hips (6 mins)

Arthritis = loss of the smooth shiny Arthritis = loss of the smooth shiny surface (white)surface (white)

Is it osteoarthritis?Is it osteoarthritis?

• Most causes of knee pain are NOT arthritis– Meniscal ‘cartilage’ tear– Patellofemoral pain

• Both can respond to an active program of exercise

Video of knee arthroscopy

Taping of the kneecap & Taping of the kneecap & quad muscle retrainingquad muscle retraining

• Jenny McConnell programme• First described this in 1986• Programme has stood the test of

time and been refined• High-quality RCT was in 2002

(Crossley et al. AJSM)

HalfHalf--squat exercise squat exercise to rehabilitate from knee painto rehabilitate from knee pain

Knee cap tapingKnee cap tapingMedial tiltAnterior tilt

Medial glide Rotation

Parts of physiotherapy treatmentParts of physiotherapy treatment

Tape

Muscle retraining

Hip external rotation

Knee cap mobilisation

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placebo treatment

physiotherapy treatment

VAScmVAScm

VAScmVAScm

baseline final

Average pain

Worst pain

Pain got less!Pain got less!

* p = 0.001 * p = 0.002

0

2

4

6

8

10

baseline

final

Does glucosamine help?Does glucosamine help?

• Very commonly used• Individual response• Clinical trials, in general, not

encouraging• No evidence of benefit from

continued use of glucosamine(Cibere, 2004, VCHRI study)

Is exercise safe or harmful if I have arthritis?Is exercise safe or harmful if I have arthritis?

• Resistance training shown across a number of studies to reduce the pain of knee / hip OA compared with sham exercise or physical inactivity

• Likely due to maintenance of muscle mass• Lubrication of joint• Joints like activity!

OverviewOverview

A. I often have aching knees / hips (6 mins)

B. I have fairly consistent back pain (6m)

C. What about all this talk of osteoporosis in men? (6 minutes)

D. What is the VCHRI doing to help us?

Back painBack pain

Is this a slipped disc?

Will I need surgery?

What other treatments can help?

‘Slipped disc’?‘Slipped disc’?

Graphic coming from Vicky

80% of acute disc injuries settle:

• within 3 months if there is no leg pain

within 6 months if there is leg pain

Practical pointPractical point

Impingement is exacerbated with cervical or thoracic hypomobility which can be treated with physiotherapy mobilisation

Manual mobilisationManual mobilisation

What other treatments can help?What other treatments can help?

• Spinal joint mobilisation (not necessarily ‘manipulation’)

• Effectiveness well proven in high quality trials (Double –Blind Randomized Clinical Trials)

• Original research at Vancouver Coastal, Meena Sran (PT, PhD)

OverviewOverview

A. I often have aching knees / hips (6 mins)

B. I have fairly consistent back pain (6m)

C. What about all this talk of osteoporosis in men? (6 minutes)

D. What is the VCHRI doing to help us?

C. Osteoporosis in menC. Osteoporosis in men

• What is osteoporosis (video)

• What are my chances of getting it?

• What might predispose to it?

• If I have the risk factors what do I do next?

• Are there effective treatments?