• 23101 Sherman Place Suite 507 West Hills, CA 91307

  • 818-598-0000

yelp logo Instagram logo Linkedin logo Google plus logo Youtube logo

Too much or too little exercise can harm the knees

How much exercise is a good thing?

Preliminary results of a 4-year study have shown that too much exercise, like too little exercise, can be associated with knee cartilage degradation as seen on MRI. Cartilage degradation is the first step in development of knee osteoarthritis.


In this study, 205 people without knee pain at baseline, who exercised at various intensity levels were followed over 4 years as part of a study at the University of California San Francisco. MRI-based T2 relaxation times were used to assess knee cartilage degradation over time. The preliminary results of this study were presented at the Radiological Society of North America Meeting this year.


MRI findings revealed higher knee cartilage T2 progression in the highest and lowest exercise levels than in the middle exercise levels. High physical activity was defined as one hour of vigorous physical activity, three times or more per week. All people enrolled in the study were at risk for osteoarthritis of the knee based on family history, obesity, or history of injury to the knee.

These results suggest that a moderate level of exercise may be optimal in preserving the cartilage in the knees. Exactly how much exercise this is, is still unclear.


Wilson L. High levels of physical activity are associated with greater cartilage degeneration over a period of 4 years as assessed with T2 relaxation time measurements – 3T MRI data from the Osteoarthritis Initiative. Presented at: Radiological Society of North America Scientific Assembly and Annual Meeting; Nov. 25-30, 2012; Chicago.


Take care of your back! –Prevent back pain

Can we prevent back pain?

The other day I watched a friend carry 2 stacked heavy cases of bottled water out of Trader Joe’s. I gasped: “Are you being unkind to your back?”

Back pain is common. In fact, 80% of us experience some kind of back pain during our lifetime. We don’t have control over some causes of back pain- like inflammation or cancer. However, how we live our lives has a lot to do with how often we get mechanical back pain and how permanent the pain will be.

Common causes of mechanical back pain

  • Muscles- muscle spasm, “unbalanced muscles”, weak muscles
  • Spine- misalignment, arthritis, scoliosis, fractures
  • Disks- degeneration, dessication, herniation, bulging
  • Nerves- impingement, spinal stenosis, “sciatica”

All of us can remember instances where we have been unkind to our back- like carrying that backpack on one shoulder, slouching on the couch while watching TV, or lifting really heavy objects like my friend from Trader Joe’s. Some of what we do causes strain or spasms in our muscles. Trauma, repetitive movements, and excessive pressure can cause arthritis (joint wear-and-tear) of the spine joints and disk herniation. Unlike muscle spasm, arthritis in the back is not reversible. Once the anatomy of the bones and disks has changed, this can put pressure on the nerves the course between them. Pressure on the nerves can cause pain, numbness, tingling, and weakness (one example is sciatica).

Take care of your back!

There are several ways you can prevent back pain and damage to the back structures:

        1.  Proper posture

Sit and stand up straight. Avoid slouching, excessive leaning or hunching over things, or sinking into soft sofas. Did you ever see the movie “My Fair Lady“? In it, professor Higgins teaches a cockney flower girl good posture by having her walk while balancing a book on her head. Pretend you have a book on your head at all times! Besides protecting your back muscles, people with good posture appear more confident. I found good posture tips on this website .

2.  Exercise

Stretching and exercising regularly can help prevent back pain. Strengthening the muscles that support your spine take some of the load off your spine and minimize muscle injury. A Pilates instructor told me that people with strong core muscles (including abdominal muscles) do not suffer back pain. I have to admit this to be true- I have not had any back pain since I stated Pilates 3 years ago.

3.  Avoid heavy lifting

Lighten the load as much as possible. Make a few more trips when unloading your groceries from your car and carry less on each trip. Downsize your suitcase- you will never wear all those clothes on your trip!- consider taking a carry-on instead (also a fee-saving strategy!). Leave your laptop at home/work- instead of carrying it back and forth every day- memory sticks are much lighter. If you just have to lift and carry something heavy, do it properly: 1) Bend at the knee, not the waist; 2) Use your legs and knees to lift up, and keep your spine straight; 3) Keep your back straight while carrying a heavy object. Don’t arch back!

4.  Lose weight

Every extra pound on your body is putting pressure on your back. Imagine walking around with a sandbag on your back- or multiple sandbags. You may not be aware of the weight of the extra pounds because you have acquired them over time, but your spine definitely feels it. Now imagine if you carry the sandbag in the front (ie. you have a belly)- the change in the weight distribution can put further strain on your spine. Weight loss is one of the most effective treatments for chronic low back pain.

5.  Stop smoking!

Studies have shown that smoking is a risk factor for developing back pain. It is thought that the damage caused by smoking on the blood vessels supplying the discs and joints may be responsible for the back pain. In addition, smoking has been correlated with osteoporosis, which weakens the bone structure and makes one prone to vertebral fracture.


Herbal and natural supplements for arthritis

Not infrequently, once I have explained the diagnosis of arthritis, its manifestations and treatment options, a patient will ask me “what herbal or natural supplements can I use to help my condition?  Although not heavily emphasized in Western medicine, there have been several studies on the effects of herbal and natural supplements for arthritis pain. So I decided to make a comprehensive review of what has been proven to work.

 Things to consider

First, let me start by making a couple of points about natural supplements in general:

  • Just because something is “natural” it does not mean it is harmless. Read carefully about potential side effects.
  • Natural remedies are not regulated by the FDA, so their composition may be variable and their claims may be untrue. (see blog on Reumofan)
  • The ingredients in some herbal supplements are the same as those found in FDA-approved drugs
  • The supplements may interfere with your other medications, so please review them with your doctor
  • They may help with mild arthritis, but chances are you may need stronger drugs if your arthritis is severe!
  • Herbal supplements may not be safe in pregnancy or breastfeeding

Herbal and natural supplements for arthritis:


Where is comes from

What it claims to do


Potential side effects

Glucosamine Sulfate

Derived from the shells of shellfish

Reduce osteoarthritis pain and slow progression. Lubricates joints


-people with shellfish allergy may be allergic

-may interact with blood thinners

-can increase blood sugar

-can increase cholesterol

Chondroitin Sulfate

Usually from bovine trachea or pork by-products

Reduce osteoarthritis pain and slow progression

800-1200 mg/day, usually with Glucosamine

-remote possibility of mad cow disease if contaminated

-may cause blood thinning

-use with caution if sulfa allergy

-diarrhea, constipation

Omega-3 fatty acids

Found in fish oil (salmon and tuna), Canola oil

Decrease joint inflammation and pain

1-4 grams


-may have a fishy taste

-can increase risk of bleeding

-may contain high levels of mercury

-can cause gout flare

-gas, diarrhea, bloating



A natural hormone produced by the adrenal glands

Reduce disease flare in lupus and perhaps rheumatoid arthritis

10-25 mg/day

-acne, facial hair, menstrual irregularities

-abdominal upset

-may worsen liver function

-contraindicated in prostate cancer and uterine fibroids

S-adenosylmethionine (SAMe)

Naturally occurring chemical in the body.

Sold as a drug in Europe

Reduce pain and stiffness from osteoarthritis, fibromyalgia,  rebuild cartilage, help depression

400mg twice per day


-avoid if bipolar disorder

-nausea, vomiting, diarrhea, headache

Borage oil

From Borage plant seed

Anti-inflammatory and anti-thrombotic properties


-increased risk of bleeding

-liver damage

-bloating, upset stomach



From turmeric plant root

Reduce joint pain and inflammation

0.5-2 g/day

(capsule or spice)

-can thin the blood

-stomach upset

-contraindicated in people with gallstones (causes flares)


From ginger plant root

Reduce joint pain and inflammation, helps circulation in Raynaud’s, also motion sickness

30-500 g

Any form

-can interfere with Coumadin (warfarin)

-can increase bleeding risk

-contraindicated in people with gallstones

-considered safe by the FDA

Green tea extract

Concentrated from green tea

Anti-oxidant effects, help RA and Sjogren Syndrome

Capsule, liquid extracts

-liver inflammation

-insomnia (it has caffeine)


From Arnica flower

Help muscle aches, sprains, bruises, joint pain

Topical cream or ointment

-should not be taken by mouth without medical supervision

-skin irritation, eczema

Avocado soybean unsaponifiables

Made from avocado and soybean oils

Slow breakdown of cartilage


-upset stomach

Cat’s claw

From the bark of an Amazon vine

Anti-inflammatory properties (mild)

250-1000 mg/day

-can lower blood pressure

-nausea, headache, dizziness


From the bark of the Boswellia tree in India

Reduce inflammation and pain in RA and OA

100-250 mg/day

-stomachache, diarrhea

-skin rash

Evening primrose oil

From the evening primrose seed

Contains gamma- lineloid acid (GLA)

Reduce arthritis pain


-increased bleeding risk

-may cause seizures

-may interact with medications

-nausea, diarrhea, headache

Black current oil

From black current seeds



Insufficient data



Decrease joint pain and inflammation


Conflicting data in clinical studies

Thunder god vine


Helps symptoms of rheumatoid arthritis


Severe side effects including:

-temporary infertility in men, amenorrhea (lack of periods) in women, decreased bone density, suppressed immune system.

-Some parts of the plant are poisonous and can cause death.