It’s a Mechanical Problem, You won’t die from it.

..these were the exact words of an orthopedic surgeon when I consulted with him about total hip replacement surgery as a treatment option for my osteoarthritis.

I have been struggling with lower back problems, hip pain, sometimes sore knees, bunions on both feet for pretty much my entire adult life. The various diagnoses I received obviously come with the territory – 46 years tied to office chairs, typing away on keyboards. Lumbago, sciatica, sacroiliac joint dysfunction, disk prolapse, skew feet, heel spurs, patella dislocation, partial tailbone fracture, and the latest: osteoarthritis of the hip. My body from the waist down is a medical war zone. Surgery had been suggested at various occasions to “fix” some of these defects. I always declined that option because it is somewhat final. Once bones have been sawed off and replaced with metal parts, you can’t go back to the previous state.

X-ray of my hip

As for the surgeon looking at my recent x-rays shook his head and said “Well, as long as you can deal with the pain, there is no rush. Come see me, when you’re ready.” In the meantime we can try pain medication, different injections, physical therapy, crutches, orthopedic insoles, a hip brace…. but eventually you’re going to need surgery, because cartilage doesn’t heal. This image of my hip shows osteoarthritis on both sides, stage 4 “bone-on-bone” with osteophytes on the left, stage 2-3 on the right with potentially some iliopsoas bursitis too. Symptoms include severe pain 24/7, ongoing inflammation, major visible loss of cartilage, greatly reduced range of motion. Accompanied by my usual lower back pain and locked sacroiliac joint – my life is (no, was!) just miserable.

deep squat with bone-on-bone hip OAI do agree with the diagnosis – but I strongly disagree on the treatment plan. Medication, injections, and surgery, all just treat the symptoms. Physical therapy, or braces and insoles, are passive approaches that don’t address the root cause of the problem. To make a point I performed a deep squat (which I can easily get into and back out of) right there in the surgeon’s office and asked, if this was “normal”. The doctor looked a tad puzzled and then said “Perfectly normal, but not in your condition. Doesn’t that hurt?”.

So, where do we go from here? Medical professionals are highly trained specialists. They all specialize in some kind of treatment, and they mean well in most cases. They really can’t “know it all”, especially not for every single individual who presents themselves in their office. Eventually you realize, that you can listen closely to all of them, and combine the bits and pieces of valuable information they all give you (sometimes unknowingly) at one point during the conversation. You personally have to use your own best judgement, though, when it comes to healing (yes, healing, not just treating) your ailments.

If you’re still reading at this point, I’ll give you the current state of my own (non-scientific) research. Be warned, though – I’m not qualified to give any advice. Don’t rely on anything I say, I don’t claim to know better than any doctors, surgeons, physical therapists, osteopaths, chiropractors – or even magic witches.

I believe that the symptoms of osteoarthritis – the wearing down of cartilage, the inflammation and pain, the loss of mobility – are not caused by “normal ageing”, or “overworking” the joint. I am certain (at least in my personal case) that the damage in my lower back and hips was caused by decades of muscle imbalance, muscle weakness, muscle atrophy and “rubbing it wrong” somewhere deep inside by doing too much of the wrong kind of movements and not enough of the right kind. I am also certain that cartilage  – like most cells in the human body – is constantly being worn off on the top and built back from the bottom, as long as there are chondrocytes hiding somewhere in the matrix.

Here’s what I am doing (and have done in the past two months) to heal myself, get back to a painfree, active life and avoid surgery.

Immediate action (for two or three weeks) to stop the constant pain and get rid of inflammation:
Take the maximum allowed dose of some NSAID (like Ibuprofene) for two weeks.
Lie down and put icepacks on the affected joint two or three times a day for about 20 minutes each time.

Ongoing, start as soon as you can:
Take as much load off of the joint as possible by walking with crutches or a walker, and minimize walking at least for the first two or three months.
Take even more load off of the joint by losing weight. One pound down on the scale takes four pounds of pressure off the hip with every step.

Lifelong habits that actually address the cause of osteoarthritis:
Make sure your body has all the tools needed to fight inflammation, heal and regrow cartilage, and maintain muscle mass while eliminating excess body fat.
Proper nutrition for me means plenty of plant-based food, avoiding highly-processed products. Adding some supplements like vitamin D, vitamin C, magnesium.
Intermittent fasting gives the body 16 hours of time to do repairs every day.
Get plenty of sleep.
Hydrate well – drink at least 80 oz. of clean water every day.
Find the right exercises to heal specific muscle imbalances.
Always listen to your body. If it hurts, stop doing it.

Joint Venture 2.0

After over 46 years of working in I.T. as a programmer/analyst it was high time for me to retire. I admit I feel accomplished and exhausted at the same time. The one word that describes my state of affairs would be “enough”. Financially, mentally, and most of all physically, I’ve had enough of it.

About two months ago I went to see an orthopedic doctor just to have him confirm what I sort of guessed already – because I’ve been there before, in 2016. Joint Venture, first edition
For the last two or three years my left hip had been bothering me more and more. It had gotten to the point were I was in pain day and night, couldn’t walk the stairs in our house without dragging my left leg behind, was unable to run if my life depended on it.

severe osteoarthritis left hip The x-ray image of my left hip looked worse than what I remembered from the right side eight years ago. The doctor’s diagnosis sounded like a “death sentence”.

He said in a calm, professional, emotionless voice: “well, as you can see here you have advanced degenerative osteoarthritis, stage four. Bone on bone, almost no cartilage left as far as I can see. You are an excellent candidate for total hip replacement surgery. I’d like to introduce you to a colleague of mine.”

No way! Germany holds the world record in hip replacement surgeries per capita. Statistically 75% of those are performed unnecessarily, or at least prematurely. On top of that 23% of those people come back with the same, or worse, symptoms after just one year. So I said: “no, thanks.” The doctor then suggested different types of injections, and prescription pain medication. My response to that was: “not a good plan either.” At that point the doctor’s face briefly slipped out of the professional pose when he asked “so, what do you expect from me?”

I told him that I was hoping for some advice about what I could do personally to improve my condition. He didn’t have a whole lot to say there, but prescribed six sessions of physical therapy. So I dug out my old notes, and brushed up on my knowledge about bones and cartilage and joints and general self-care. The physical therapy actually helps too, so I’m going to continue that.

On my way out I got one piece of good news from the doctor, though. I had asked, in the light of the terrible condition of my left hip, what was his prognosis for my right side. I had not told him about my adventure there in 2016. Pointing at the fresh x-ray the doctor said: “no, your right side is perfectly fine, no hint of a problem there.”

If you’re having similar ailments, you could go back to my old article. Everything I said there still works:
Fight inflammation first, then build new cartilage. Eat clean, avoid animal sourced food. Don’t drink alcohol, don’t smoke, don’t take drugs. Get enough sleep, hydrate well, exercise daily, keep your weight low and your spirits high.

I had to revise my supplements list, though, adjusting for what’s available in Germany. As always, do your own research, and be advised that I am not a doctor.

General micronutrients one tablespoon daily with breakfast
LaVita

Glucosamine complex take 3 capsules daily, with food
Glukosamine, chondroitin, MSM, and more

Elemental silica two capsules daily
Silizium-3-Komplex

UC-II collagen take one capsule at night, before going to bed
UC-II collagen

Celadrin three capsules daily with water
Celadrin

On top of these essentials, I add several other supplements to my diet that may help with osteoarthritis too.
grass-fed bovine collagen
Fish oil Omega-3
Rosehip powder
L-Lysine