mens health - dr. karim khan › i › pdf › oncallkhan.pdf · karim khan md, phdmd, phd sports...
TRANSCRIPT
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
0
2
4
6
8
10
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?