The Go-Go dancer’s knee


While thinking about joint pains, there is an old orthopedic surgeon’s joke which goes: “What’s a nice joint like you doing in a girl like this?”  However our joints certainly give us lots of problems, especially as we get older.

The joints to give us the most worries are knees, ankles, fingers, shoulders and hips in around that order.  All of them are joints you use and need frequently.

For many of the joints it is a simple case of wearing them out.  This is especially so with the weight bearing joints as the knees, ankles and hips.  In the perfect body scenario, your joints are designed to last you about 80 years, hold your bottom off the ground for 80 years and move smoothly for 80 years.  Overload these joints and they wear out quicker. Consequently, if they have become knackered by the time you are 55 then you have another 25 years of aching joints to look forward to. Of course, the quickest way to wear out your poor old joints is to be overweight.

In the past week I have had a couple of people come to see me to ask about their pains.  However, this is not surprising, as pain is often the presenting symptom for many illnesses and physical conditions.  For example, the symptom of a fractured rib is pain on deep breathing, coughing or sudden movement.

In fact, our skeletons are responsible for many of our pains.  Fractures and degenerative conditions such as osteoarthritis are certainly high in the list of likely suspects.  Gout, which produces an arthritis in the joint in the big toe gives exquisite pain – just ask anyone who has had it!

Is it not possible to be pain-free, in today’s Android world?  Unfortunately, the chemicals that are strong enough to mask the pain are also strong enough to render your brain inoperative when taken over a long period.

I do also realize that there are times when you want “temporary” respite from pain.  The footballer with a fractured finger can have local anesthetic injected into the fracture so that he can do the two 45 minutes halves plus injury time and penalty shootout.  That’s it.  Not tablets for the next three weeks!

So why do we have “pain”?  Pain is actually inbuilt into our systems for an important purpose.  Damage control!  Pain is what stops us damaging our bodies even further than they are damaged already.  Let’s go back to the broken rib scenario.  Most fractured ribs are “cracks” along the long axis of the bone, not a complete break right through, so that the ends are flapping around in the breeze.  The pain stops the unfortunate person from doing too much and breaking it totally right through.  Pain has a protective influence.  With the person who has joint pains or gout, the purpose of the pain is to stop further damage to an already “crumbling” joint or one filled with sharp crystals.  Pain makes you rest it, so that it can heal.  When you stop to think about it, pain is good for us.

However, there are also chronic pain situations, and these are harder to deal with.  Particularly when the pain is coming from a permanently damaged skeleton, or from a condition we cannot “cure”.  This is where pain management comes in, and it is a fairly skillful region of medicine, let me assure you.  Practitioners in this have to really understand what the patient is going through.  What happens is that we (or you) have to maximize an ability of the body’s nervous system known as “attenuation”.  This is where the nervous system receives so much pain stimuli that eventually the pain receptors “give up” through the overuse.  However, getting to that stage is a long and painful road itself.

Chemical assistance is needed, but it is not just a case of taking big dose analgesics.  In actual fact, much of the work in this area is with taking agents to slow down nerve transmission and other agents such as anti-inflammatories, which work with pain killers to make them more potent at a lower dose (so the brain doesn’t get mussed up)!  It’s not easy.