Knee Injuries, Surgeries, and Vitamin D Status. The knee joint is one of the largest and complex joints. It connects the thigh bone to the shinbone, which has a very important role in:
Supporting the body’s weight
Facilitating movement
Allowing the ability to bend the knee
Because of the complexity of the knee joint, it is highly susceptible to injuries. The most common injuries include tears in the:
Ligaments
Tendons
Cartilage
The kneecap itself can be fractured and/or dislocated.
Tears
Meniscal Tears
The meniscus is the cartilage between the knee joint that absorbs the impact/shock when running, playing sports, yard work, hiking, bicycling, etc. It cushions the joint and maintains stability.
Meniscus tears are common in sports that have a lot of jumping, starting/stopping quickly, changing direction suddenly, like volleyball, basketball, tennis, soccer, football. This is when the meniscus tears. Surgery can be required, depending on the severity/extent of the injury and tear.
Tendon Tears
The patellar tendon works with the knee muscles in the front of the thigh to straighten the leg. Tears in the patellar tendon are common among middle-aged individuals and those that participate in running or jumping sports.
A complete tear is considered a disabling injury that requires surgery for full functional recovery.
Fortunately, most tears are partial and require rest and chiropractic/physical therapy to heal.
Dislocation
Knee dislocations happen when the knee bones shift out of position. This can happen after a fall, car crash, or high-speed impact. It can also be caused by twisting the knee while the foot stays planted. Dislocations require relocation. However, sometimes a dislocated kneecap corrects itself and returns to the proper position. Other cases can require a mild sedative to allow a doctor to relocate the knee. Dislocations generally take around six weeks to fully heal.
Anterior Cruciate Ligament – ACL Injury
The anterior cruciate ligament or ACL is knee tissue that joins the upper and lower leg bones and maintains the knees’ stability. The ACL can be torn if the lower leg over-extends forward or if the leg gets twisted. ACL injuries are common knee injuries and account for around 40% of sports-related injuries. These injuries can range from a small tear in the ligament to a severe injury where the ligament tears completely or gets separated from the bone. Treatment depends on the severity of the injury. Depending on various factors including the severity of the tear, surgery could be required.
Knee Surgery
For most cases, surgery is done using arthroscopytechnology. This procedure uses small incisions to insert a camera and surgical instruments into the joint. Usually, two or three incisions are needed with recovery time being quicker than large incision surgery where the whole knee is opened. Minimally invasive arthroscopic surgery is preferred by sports medicine experts. With this procedure:
There is no need to cut the tendons or muscles
Bleeding is reduced
Small incisions decrease scarring
Recovery time is shorter
However, sometimes a large incision is required for complex surgical techniques. Common knee surgery procedures include:
Arthroscopy Surgery
This method allows the ability to see inside the knee joint. The procedure is often recommended for:
Diagnosis
Minor repairs to ligaments and/or tendons
Cartilage or bone that needs to be removed
Total Knee Replacement
A full knee replacement is known as arthroplasty. When the joint is damaged beyond repair from injury or disease, an implant is placed in the knee joint restoring function. A small amount of cartilage and bone from the shinbone and thigh bone gets removed for perfect placement of the new knee joint.
Revision Knee Replacement
Most knee replacements last around 15 – 20 years. For individuals that have knee replacement early, then a new operation for new implants could be required. Here, the surgeon removes the original prosthesis and replaces it with a new one.
Partial Knee Replacement
Some knee injuries do not require complete replacement. Here, only the worn-out portion of the joint is replaced. As an example, the cartilage that has been lost in an area of the knee can be repaired with a partial replacement.
Vitamin D Status
A study on athletes that underwent ACL surgery looked at their vitamin d status and how it affected their recovery.
The research concluded that vitamin D status had no effect on surgery outcomes.
However, those with the lowest vitamin D status had three times the failure rate than those with higher vitamin D
The average age of the individuals was around twenty-four and were healthy athletes.
Each of the patients in this study had their vitamin levels measured before the operation and were grouped based on their vitamin D status:
Group 1 vitamin D below 20 ng/mL – considered deficient
Group 2 vitamin D between 20-30 ng/mL – considered low but in a technical range
Group 3 vitamin D above 30 ng/mL – considered sufficient, but not optimal
All were followed for two years with their surgery recovery being measured with two systems.
The Lysholm score, which is a 100 point scoring system that looks at an individual’s knee functions that include:
Mechanical locking
Instability
Pain
Swelling
Stair climbing
Squatting
The WOMAC score is a scoring system that measures:
After 2 years, the Lysholm score and the WOMAC scores were similar.
However, there was a difference in the graft failure rate which was about 6% in group 1 with the lowest vitamin D and around 2% in groups 2 and 3. This shows that the lowest vitamin D status has three times the failure rate compared with those that had increased vitamin D levels. Vitamin D is a known anti-inflammatory with metabolic functions that are documented. Therefore, vitamin D does improve surgical success and recovery in healthy athletes.
Body Composition
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: [email protected]
phone: 915-850-0900
Licensed in Texas & New Mexico
References
Brambilla, Lorenzo, et al. “Outcome of total hip and total knee arthroplasty and vitamin D homeostasis.” British medical bulletin vol. 135,1 (2020): 50-61. doi:10.1093/bmb/ldaa018
European Journal of Orthopedic Surgery and Traumatology, January 2021
Zhang, Hao et al. “Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis.” Annals of nutrition & metabolism vol. 73,2 (2018): 121-130. doi:10.1159/000490670
Smart supplementation along with proper nutrition is one of the biggest factors and plays a large role in an individual’s health. You are what you eat is true. Feeding the body with vital vitamins and minerals promotes growth and healing. Filling up on processed, fatty foods does the opposite. The bones in the spine and throughout the body need nutrients to continue to rebuild and maintain strength throughout life.
A balanced diet rich in:
�Calcium
Vitamin D
Magnesium
This is the best way to nourish the body’s bones and ward off spinal problems, like spinal fractures, and osteoporosis. Inadequate diets or medical issues can create nutritional gaps. This is where vitamins or mineral supplements come in. Supplements are not a cure-all, but they can create a safetyhealth net when taken properly.
Supplement Smart
These supplements for bone health, fill in nutritional gaps. They are not necessary if the key nutrients the body needs from a proper diet are already there. However, individuals use supplements as a replacement for certain foods, this is not how they should be used. Actual food supplies multiple nutrients, along with minerals, and vitamins that are beneficial for health and are not found in supplements.
Taking a Supplement to Strengthen the Spine
The body’s dietary needs change throughout life, so adding supplements as you age or during pregnancy can help maintain health. Calcium and vitamin D requirements vary based on age and sex.When it comes to protecting spine bone health, certain individuals may need supplements to ensure their bodies are processing calcium and vitamin D properly.
This includes:
Individuals who had intestinal bypass procedure
Those with food absorption conditions, like Celiac or Crohn�s disease
People who eat few or no dairy products, like vegans or those that are lactose intolerant
Is a calcium supplement right for you?
The only way to definitively know is by having a conversation with your doctor. Then you can supplement smart.
Supplement Safety
Because nutritional supplements can be purchased over the counter, individuals assume�incorrectly�that they are completely safe. Dietary supplements can interfere with absorption, other supplements, medications, and can be toxic if taken in high doses.
For example:
Calcium and iron supplements can prevent each other from being fully absorbed when taken together. This is true of many minerals, including magnesium, because they get into�absorption�competition with each other and so are best taken separately.
Supplements taken together can cause too much of either one to be absorbed. This is the case with high-dose vitamin D supplements, which can cause too much calcium absorption.
Too much calcium can increase raise the risk of having a heart attack or stroke. Taking more than 1,000-1,200 mg of calcium per day is pointless because the body cannot process that much calcium at once.
Are your supplements helping or hurting you? The best way to know is to talk to your doctor whenever you change medication or a supplement program, even when just adding a new vitamin to the mix. An underused resource for supplement advice is a pharmacist. They will know whether the mix of supplements and medicines being taken pose any risk of negative interaction. And a pharmacist can help recommend a trustworthy product.
Supplement Success
Here are a few tips to get the most benefits if you and your doctor think a calcium supplement can help support spinal bone health.
Buy supplements with the USP symbol. This indicates that the supplement has been independently evaluated and certified.
Take your supplement as directed, ideally with a meal.
Take doses no higher than 500-600 mg, no more than 2-3 times a day, for a maximum of 1,000-1,200 mg.
Drink plenty of water as some supplements can cause constipation.
Do not take calcium supplements with a high-fiber meal or laxative. This can interfere with calcium absorption.
Supplements Support Spine Health
Remember that supplements are exactly that supplements. Eating foods rich in calcium, vitamin D, and magnesium is the best way to build/maintain strong healthy spinal bones and prevent debilitating health problems. If you are concerned about your diet, talk with your doctor or a health coach about a smart supplementation regimen to meet your nutritional needs.
The human body needs vitamin D in order to build strong muscles and bones. When the body does not get enough vitamin D, it is not able to absorb calcium effectively. This makes it very important for good bone health. Children who do not get adequate vitamin D develop rickets, a condition that causes weak bones, deformities in the skeleton, and a stooped posture.
What Is Vitamin D?
Most people believe that vitamin D is a vitamin; it isn�t. It is actually a hormone. A vitamin is a nutrient that the human body requires but is unable to produce. This means that it can only be obtained through supplements and food.
However, the body is able to manufacture this vitamin. When the skin is exposed to the appropriate sunlight, the body begins a process that produces vitamin D. It should also be noted that vitamin D plays a part in a strong immune system and can prevent certain chronic diseases in older adults.
There are supplements for people who do not produce enough vitamin D or who do not get adequate amounts in the food that they eat (fish liver oils, certain fish, and egg yolks are good sources). Children and adults typically do not get enough from their foods and activities. People spend a great deal of time indoors with adults at work and children at school. The emergence of digital devices and video games has managed to keep children inside as they engage in these activities.
This vitamin is not measured in milligrams like many other supplements, but in International Units (IU) instead. Research has caused the daily recommended allowance for vitamin D to increase over the years, and the current recommendation is 400 IU. It has been determined that this amount is the most beneficial in promoting healthy bones.
The Role Of The Skeletal System
The skeletal system has several functions. The first and most obvious is that it is the structural support for the body. It also protects vital organs.
For instance, the skull protects the brain and the rib cage protects the lungs and heart. It is also an anchor point for muscle so it helps with mobility. The red bone marrow provides illness fighting white blood cells, as well as red blood cells. Calcium is stored in the marrow, as is phosphorous. Certain minerals and fats are stored in the yellow marrow which is found in the long bones of the body.
How Vitamin D Benefits The Skeletal System
Getting enough vitamin D helps the body absorb calcium which is a bone building mineral. In addition to that task, it also promotes good muscle health.
Stronger muscles can work much more effectively in protecting the muscles and supporting the skeletal system. This can help with joint health as well. Older people who have adequate vitamin D do not fall down as often and people of all ages have fewer broken bones.
Results Of Vitamin D Deficiency
Vitamin D deficiency is a serious condition mainly due to its essential role in the body�s ability to absorb calcium. Muscle weakness and bone pain are two common symptoms, but are typically seen in more severe cases.
A simple blood test can check for vitamin D levels � and it should be checked regularly. Even �minor� cases of low vitamin (those without any symptoms) have been linked to some serious health conditions including:
Increased risk of death due to cardiovascular disease
Vitamin D is generally very accessible. You can get it through foods and sunlight or via a supplement. People who may have some trouble getting adequate amounts are those who have limited exposure to sunlight, fail to consume the necessary levels of the vitamin, and people who have dark skin. If you think that you may have low vitamin D, it is best to talk to your doctor so you can come up with a plan to get your body back in balance.
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