６月に読んだ記事で、ブックマークしておいたんですが、ここで感想を書くのを後回しにしていたのを今日思い出したので書いてみますが、気候の良くなってくる春や夏、急に気合いがはいっちゃうのか抜けちゃうのか急に走り出しちゃったりして関節を痛めてしまう人がいますが、その中でも膝関節はわりと直接的に痛みを出します。実は膝はスポーツをする人の中でもナンバーワンの故障箇所。うっかり使いすぎてしまうことが多い部位らしいのです。また、太り過ぎの人や左右の足の長さが違う人も、膝に負担をかけるそう。それで「新しい」民間療法というか、「古い」というかなんというか、そういったレポートの話。でも結構おもしろかったです。
テニスのリンジーダベンポートとか（話は全然違いますが、どうして日本だと「リンゼイ」って書かれるんでしょうか。確かに”A”が入ってますけど、どう聞いてもリンジーですよねぇ）、いつも「氷で冷やす」方法をとってなんとかしているようですね。大変そうです。いつも、試合が終わったら、とか毎日でも、１５分くらい氷漬けにするそうですよ。プロテニス選手って大変ですよね。そして２日おきに熱いお湯につけて血行を良くするらしい。大変だ。そしてお薬を飲んだり、注射したり。いつも華やかにテニスしてますが、そんな辛い努力をしているんだなーと思うと、さらに尊敬しちゃいますね。
うちの学部にもスワンソン教授という有名な教授がいますが、彼はちょうど１年前に膝の手術をしました。手術後６週間はまったく動けない、歩けない状態で、みんな強烈に心配し、それからわりと長い事、びっこをひきながら歩いたり、ゆっくりゆっくり歩いたりして、陰では「ベアリー（スワンソン教授の名前）、手術しない方がよかったんじゃないの？」なんていわれてましたが、なんと、１年経った今では、サクサクサクサクっと歩いていて、奥さんと一緒にジョギングしたり、まるで普通です。そして今日聞いてみたんですが、毎晩のように苦しんでいた膝の痛みが全くないらしい。うちの母も膝を手術したのでいろいろと気になっていたのが、それですっかりと晴れました。お母様、１年経てば嘘みたいに良くなるみたいですよ！
現在、アメリカ政府はそんな膝関節炎などのためのサプリメントなどの効果を調べているらしいです。来年にはその結果が出ると言うことなので、膝に故障がある人はちょっと期待できますよね。それで、今のところ注目されているのが、グルコースアミン、あるいはグルコサミンとして知られるサプリメント。でもそのサプリメント、効果が出るまでに4-6週間かかるわ、毎日1500 mgも飲まなければいけないわで、お手軽ではないわけです。
そしてさらに注目されているのが、しょうが。Gingerolと呼ばれる（そのままですね）しょうがの油分はもともと、カゼにいいとか、船酔いにいいとか言われてますけれども、どうやらそれを飲んだ患者さんの膝関節炎の症状の悪化がとまったというんですね。抗炎症剤のような感じで効くのかもしれないといわれているということです。でも、科学的に証明されたわけではないのでご注意を。なんか、にんにくとかしょうがとかって、いつも、「なんだかいいらしい」って言われがちですよね。しょうがは摂取しすぎると、お腹がいたくなったりする副作用もあるらしいです。
あと面白かったのは、ビタミンCと膝の関節炎の関係。ビタミンCは水溶性のビタミンなので、「撮り過ぎ」ってことはめたにないのですが、膝が痛い人にはあまり良くないかもしれないということなんですよね。面白いです。いわゆる異常発育が問題の場合が多いので、新陳代謝を高めてしまうと逆効果ということなんでしょうか。このあたりまだまだ奥が深そうです。
結論としてここに述べてあるのは、「いきなり春や夏だけ運動をしまくることのないように、一年中なんらかの運動をしておいて、急に膝に負担をかけたり、ケガをしたりしないようにしましょう」ということでした。なんか、栄養学と科学って、いつも思うんですけど、結論にパンチがないんですよね。「バランスよく」とか「適度に」とか、「あーーそんなのわかってるけどできないのよ！」と言いたくなる事ばかり。でもまぁ、それを少なくとも頭に入れておくのが大事なのでしょう。何はともあれ、しょうがの研究、なんだか楽しそうですけれども。
記事は引用しておきます。重要な訂正文があとで出ていたみたいですので、読む方はそれから読んでくださいね。
Novel Remedies for the Aching Knees of Summer
By VICKY LOWRY
Correction Tuesday, July 6, 2004
An article in Science Times last Tuesday about nonsurgical treatments for knee pain misstated a method used in a study of doxycycline as a treatment for osteoarthritis. The drug, an antibiotic, was given by mouth, not injected. The article also misstated a finding of the study about the drug’s effect. The subjects who received it were less likely to report that mild knee pain had worsened; their pain was not reduced. The article also referred incorrectly to the status of doxycycline treatment for knee pain. It is experimental, not yet a practice.
Published: June 29, 2004
Correction appended
The start of summer is a busy time for Dr. Robert S. Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical Center in Manhattan. That is when his waiting room swells with patients who want to see him about their knees.
“The complaints of knee pain are directly proportional to the change in seasons,” Dr. Gotlin said. “People run more in the spring and summer, and the pain usually comes from upping the mileage. It’s hard not to overdo it when the weather is so nice.”
Knee pain, Dr. Gotlin added, “is catching up to back pain as the No. 1 physical disability seen by sports medicine physicians.”
Overdoing it, as Dr. Gotlin put it, is a major cause of sore knees and can lead to osteoarthritis. Knee pain can also result from torn ligaments, supporting excess weight and mechanical problems like having one leg shorter than the other or misalignment of the knee.
In the most severe cases, surgery may be necessary. But in recent years, more non-surgical treatments have become available, including new drugs that can be injected*, applied topically or taken as pills.
The first course of action for a sore knee, experts say, is to turn to familiar home remedies for sports injuries, including ice, heat and over-the-counter anti-inflammatory medications like ibuprofen to reduce swelling and control pain. Doctors often recommend icing the knee in several short sessions at a time for the first 24 to 48 hours.
“I tell my patients to ice twice a day, for five minutes at a time, five minutes on, five minutes off, for a total of 15 minutes with the ice on,” Dr. Gotlin said, adding that a bag of frozen peas can cover the knee or an icepack can be placed on a thin sheet of fabric to avoid freezing the skin.
After two days, patients can try heat, preferably moist heat like a hot-water bottle or a warm soaking in the tub, to relax tissues and increase blood flow.
If the pain does not go away in a few weeks, then it is probably time to see a doctor, who may prescribe stronger drugs, nonsteroidal anti-inflammatory medications like Vioxx, Bextra or Celebrex to reduce swelling quickly.
Vioxx and its pharmaceutical cousins are not the only pills that runners and other active people use for pain. In the last 10 years, glucosamine and chondroitin, two substances that occur naturally in the body and are sold as nutritional supplements, often combined in one tablet, have gone from being largely ignored to being widely recommended for treating osteoarthritis of the knee. Unlike traditional anti-inflammatory medications, glucosamine and chondroitin are thought to work against osteoarthritis by decreasing the rate of cartilage destruction involved in the disease and possibly increasing the formation of new cartilage.
The federal government is financing a major study on the effectiveness of the supplements, to be completed in 2005. A variety of other, smaller trials have found positive results, and anecdotal accounts of their ability to relieve arthritic pain abound.
“Dogs don’t lie,” said Dr. William Cabot, an orthopedic surgeon in Atlanta. “My friend had a golden retriever with arthritis. Homer couldn’t even get up off the floor. At the end of several months of taking glucosamine, he was jumping up on the bed. That tells me it works.”
One drawback to glucosamine-chondroitin combinations is that they take a while to have an effect, at least four to six weeks of taking up to 1,500 milligrams a day, Dr. Cabot said. “That’s why a lot of people just stop using it,” he added.
A common spice could turn out to offer quicker relief, but its effectiveness is not yet proven. Ginger, whose active ingredient is an oil called gingerol, has been used to treat the common cold and motion sickness. In a recent study conducted by researchers from Miami Veterans Affairs Medical Center and the University of Miami, patients with osteoarthritis of the knee who took ginger extract had a noticeable reduction of knee pain on standing, as well as an increase in knee function.
“Ginger works in a similar fashion to traditional anti-inflammatory medication like ibuprofen by decreasing the production of inflammatory substances like prostaglandins,” said Dr. Cabot, a member of the committee on complementary and alternative medicine of the American Academy of Orthopaedic Surgeons.
But some scientists have said the study’s results are not definitive. In addition, ginger is not without side effects. “It can cause bleeding from the stomach, and can cause stomach upset, if you take enough of it,” Dr. Cabot warned.
Taking too much vitamin C may not be good for people with knee pain, experts say. A study published this month in the Journal Arthritis and Rheumatism by researchers at Duke found that prolonged use of high doses of vitamin C seemed to make knee osteoarthritis worse in guinea pigs. The animals exposed to the highest doses of vitamin C over an eight-month period had more severe arthritis than those exposed to low or medium doses, the investigators reported.
In some cases, more aggressive approaches to knee pain, including surgery, may be necessary. Many doctors are now injecting knees with hyaluronic acid, a thick fluid that the body manufactures in the joints and that can be extracted from a rooster’s comb. Hyaluronate injections, first used in the 1970’s to treat post-traumatic arthritis in race horses, were approved for use in humans by the Food and Drug Administration in 1997. They have shown promise for lubricating the knee joint and soothing pain. (The injections are also used to reduce wrinkles on the face).
Dr. Kevin Plancher, an orthopedic surgeon with offices in Manhattan and Greenwich, Conn., said the shots “play a definite role in my practice.”
The injections can also be given after surgery.
While scientists are not exactly sure why hyaluronic acid seems to work – it may reduce inflammation or have an analgesic effect – the benefits from a single shot can last up to six months, Dr. Plancher said.
Another new practice, injecting a common antibiotic not yet approved for use in the knee, may not only reduce pain but may halt cartilage loss in osteoarthritis. In a study of 431 women, ages 45 to 64, all of whom had osteoarthritis in one knee at the start of the trial, half the participants were injected twice a day with doxycycline, a prescription medicine used to treat infections. At the end of the 30-month trial, the researchers found, X-rays showed a significant slowing of cartilage loss in the women who received doxycycline. The study was presented last fall at the meeting of the American College of Rheumatology.
“Many of the medicines used to treat osteoarthritis – nonsteroidal anti-inflammatory drugs like Vioxx and Celebrex – deal with the symptoms, not with the basic pathology of the joints,” said Dr. Kenneth Brandt, the study’s principal investigator and a professor of medicine and of orthopedic surgery at Indiana University School of Medicine.
Some topical painkillers also show promise for treating osteoarthritis. Celadrin, a cream containing cetylated fatty acids, eased pain and improved knee function and mobility in patients with osteoarthritis, according to a recent study published in The Journal of Rheumatology. The benefits appeared as quickly as 30 minutes after the cream was applied, the researchers reported.
“Every patient in the study who used the compound got some level of relief,” said Dr. William Kraemer, the study’s lead author, who is a professor of kinesiology at the University of Connecticut in Storrs.
In another study, an analgesic patch containing lidocaine provided significant pain relief, according to the subjects who wore the patch over the most painful area of one or both knees for two weeks. “It produces an analgesic effect without numbing the skin,” said Dr. Joseph Gimbel, medical director of the Arizona Research Center in Phoenix and one of the study’s principal investigators.
The patch, currently approved for use in treating shingles pain, is expected to receive F.D.A. approval as a treatment for knee pain within two years, Dr. Gimbel said.
In the meantime, for runners on the verge of overdoing it, maintaining a regular stretching and strengthening program throughout the year may be the best protection for knees, experts say.
“Don’t wait until summer to start running more,” Dr. Gotlin said. “Working out year-round is the best preparation for when it comes time to pick up the pace. You’ll be more physically fit and have less chance of injury.”
By VICKY LOWRY
Correction Tuesday, July 6, 2004
An article in Science Times last Tuesday about nonsurgical treatments for knee pain misstated a method used in a study of doxycycline as a treatment for osteoarthritis. The drug, an antibiotic, was given by mouth, not injected. The article also misstated a finding of the study about the drug’s effect. The subjects who received it were less likely to report that mild knee pain had worsened; their pain was not reduced. The article also referred incorrectly to the status of doxycycline treatment for knee pain. It is experimental, not yet a practice.
Published: June 29, 2004
Correction appended
The start of summer is a busy time for Dr. Robert S. Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical Center in Manhattan. That is when his waiting room swells with patients who want to see him about their knees.
“The complaints of knee pain are directly proportional to the change in seasons,” Dr. Gotlin said. “People run more in the spring and summer, and the pain usually comes from upping the mileage. It’s hard not to overdo it when the weather is so nice.”
Knee pain, Dr. Gotlin added, “is catching up to back pain as the No. 1 physical disability seen by sports medicine physicians.”
Overdoing it, as Dr. Gotlin put it, is a major cause of sore knees and can lead to osteoarthritis. Knee pain can also result from torn ligaments, supporting excess weight and mechanical problems like having one leg shorter than the other or misalignment of the knee.
In the most severe cases, surgery may be necessary. But in recent years, more non-surgical treatments have become available, including new drugs that can be injected*, applied topically or taken as pills.
The first course of action for a sore knee, experts say, is to turn to familiar home remedies for sports injuries, including ice, heat and over-the-counter anti-inflammatory medications like ibuprofen to reduce swelling and control pain. Doctors often recommend icing the knee in several short sessions at a time for the first 24 to 48 hours.
“I tell my patients to ice twice a day, for five minutes at a time, five minutes on, five minutes off, for a total of 15 minutes with the ice on,” Dr. Gotlin said, adding that a bag of frozen peas can cover the knee or an icepack can be placed on a thin sheet of fabric to avoid freezing the skin.
After two days, patients can try heat, preferably moist heat like a hot-water bottle or a warm soaking in the tub, to relax tissues and increase blood flow.
If the pain does not go away in a few weeks, then it is probably time to see a doctor, who may prescribe stronger drugs, nonsteroidal anti-inflammatory medications like Vioxx, Bextra or Celebrex to reduce swelling quickly.
Vioxx and its pharmaceutical cousins are not the only pills that runners and other active people use for pain. In the last 10 years, glucosamine and chondroitin, two substances that occur naturally in the body and are sold as nutritional supplements, often combined in one tablet, have gone from being largely ignored to being widely recommended for treating osteoarthritis of the knee. Unlike traditional anti-inflammatory medications, glucosamine and chondroitin are thought to work against osteoarthritis by decreasing the rate of cartilage destruction involved in the disease and possibly increasing the formation of new cartilage.
The federal government is financing a major study on the effectiveness of the supplements, to be completed in 2005. A variety of other, smaller trials have found positive results, and anecdotal accounts of their ability to relieve arthritic pain abound.
“Dogs don’t lie,” said Dr. William Cabot, an orthopedic surgeon in Atlanta. “My friend had a golden retriever with arthritis. Homer couldn’t even get up off the floor. At the end of several months of taking glucosamine, he was jumping up on the bed. That tells me it works.”
One drawback to glucosamine-chondroitin combinations is that they take a while to have an effect, at least four to six weeks of taking up to 1,500 milligrams a day, Dr. Cabot said. “That’s why a lot of people just stop using it,” he added.
A common spice could turn out to offer quicker relief, but its effectiveness is not yet proven. Ginger, whose active ingredient is an oil called gingerol, has been used to treat the common cold and motion sickness. In a recent study conducted by researchers from Miami Veterans Affairs Medical Center and the University of Miami, patients with osteoarthritis of the knee who took ginger extract had a noticeable reduction of knee pain on standing, as well as an increase in knee function.
“Ginger works in a similar fashion to traditional anti-inflammatory medication like ibuprofen by decreasing the production of inflammatory substances like prostaglandins,” said Dr. Cabot, a member of the committee on complementary and alternative medicine of the American Academy of Orthopaedic Surgeons.
But some scientists have said the study’s results are not definitive. In addition, ginger is not without side effects. “It can cause bleeding from the stomach, and can cause stomach upset, if you take enough of it,” Dr. Cabot warned.
Taking too much vitamin C may not be good for people with knee pain, experts say. A study published this month in the Journal Arthritis and Rheumatism by researchers at Duke found that prolonged use of high doses of vitamin C seemed to make knee osteoarthritis worse in guinea pigs. The animals exposed to the highest doses of vitamin C over an eight-month period had more severe arthritis than those exposed to low or medium doses, the investigators reported.
In some cases, more aggressive approaches to knee pain, including surgery, may be necessary. Many doctors are now injecting knees with hyaluronic acid, a thick fluid that the body manufactures in the joints and that can be extracted from a rooster’s comb. Hyaluronate injections, first used in the 1970’s to treat post-traumatic arthritis in race horses, were approved for use in humans by the Food and Drug Administration in 1997. They have shown promise for lubricating the knee joint and soothing pain. (The injections are also used to reduce wrinkles on the face).
Dr. Kevin Plancher, an orthopedic surgeon with offices in Manhattan and Greenwich, Conn., said the shots “play a definite role in my practice.”
The injections can also be given after surgery.
While scientists are not exactly sure why hyaluronic acid seems to work – it may reduce inflammation or have an analgesic effect – the benefits from a single shot can last up to six months, Dr. Plancher said.
Another new practice, injecting a common antibiotic not yet approved for use in the knee, may not only reduce pain but may halt cartilage loss in osteoarthritis. In a study of 431 women, ages 45 to 64, all of whom had osteoarthritis in one knee at the start of the trial, half the participants were injected twice a day with doxycycline, a prescription medicine used to treat infections. At the end of the 30-month trial, the researchers found, X-rays showed a significant slowing of cartilage loss in the women who received doxycycline. The study was presented last fall at the meeting of the American College of Rheumatology.
“Many of the medicines used to treat osteoarthritis – nonsteroidal anti-inflammatory drugs like Vioxx and Celebrex – deal with the symptoms, not with the basic pathology of the joints,” said Dr. Kenneth Brandt, the study’s principal investigator and a professor of medicine and of orthopedic surgery at Indiana University School of Medicine.
Some topical painkillers also show promise for treating osteoarthritis. Celadrin, a cream containing cetylated fatty acids, eased pain and improved knee function and mobility in patients with osteoarthritis, according to a recent study published in The Journal of Rheumatology. The benefits appeared as quickly as 30 minutes after the cream was applied, the researchers reported.
“Every patient in the study who used the compound got some level of relief,” said Dr. William Kraemer, the study’s lead author, who is a professor of kinesiology at the University of Connecticut in Storrs.
In another study, an analgesic patch containing lidocaine provided significant pain relief, according to the subjects who wore the patch over the most painful area of one or both knees for two weeks. “It produces an analgesic effect without numbing the skin,” said Dr. Joseph Gimbel, medical director of the Arizona Research Center in Phoenix and one of the study’s principal investigators.
The patch, currently approved for use in treating shingles pain, is expected to receive F.D.A. approval as a treatment for knee pain within two years, Dr. Gimbel said.
In the meantime, for runners on the verge of overdoing it, maintaining a regular stretching and strengthening program throughout the year may be the best protection for knees, experts say.
“Don’t wait until summer to start running more,” Dr. Gotlin said. “Working out year-round is the best preparation for when it comes time to pick up the pace. You’ll be more physically fit and have less chance of injury.”