Lube it up! We lube our bike chains. We lube our chainsaws. We lube our cars — more often as they get older. So why not lube our joints?
Joints are naturally lubricated with charged sugar molecules called hyaluronic acid and lubricin. These fluids permit the joints to be five times as slick as ice-on-ice. With aging or arthritis, the chemistry of our joints changes, affecting the lubrication, the surfaces and the surrounding tissues. The uncomfortable sensations we, patients and skiers, feel are often caused by joint stiffness.
This stiffness can be decreased by multiple strategies. First, nutrition may matter. The natural supplements glucosamine and chondroitin are the building blocks of the joint lining cartilage matrix. Orally ingesting 1,500 mg to 3,000 mg of glucosamine a day has proved to affect the joint chemistry in positive ways by increasing matrix production, decreasing degradative enzymes that break down cartilage, reducing inflammation and increasing the lubricant hyaluronic acid. (Injections of hyaluronic acid directly into the joint have had mixed results, with some patients doing extraordinarily well and others obtaining no benefit.)
Daily exercise increases blood flow to the joints, strengthens the surrounding muscles and increases testosterone, pheromones and adrenalin — all of which improve one’s sense of well-being and mobility.
Hydration with water — rather than with coffee, soft drinks or alcohol — increases tissue elasticity. Dehydrated tissues are stiff, not stretchy.
Most excitingly, stem cells and growth factors are playing an ever-increasing role in joint health. Stem cells are growth factor engines. They help decrease inflammation, they’re anti-microbial and they stimulate more lubrication production, amongst many other positive attributes. In a newborn, there are 1 in 10,000 stem cells in the bone marrow. Unfortunately, as we age, the number declines to 1 in 2 million in an 80-year-old.
Fortunately, donor stem cells from the amnion layer obtained during C-Sections are plentiful; the growth factors found in the amniotic fluid are two to 50 times higher than those found in most adults’ bloodstreams. We combine these factors with hyaluronic acid to potentiate their effect. When injected into stiff joints, this combination dramatically decreases pain and stiffness in a surprisingly high percentage of our patients. Other than the cost, there have been no known downsides.
At present, the only way to get these stem cells and growth factors into the joint is by injection. But like the vaccines that can now be given by needle-free vapor guns, these therapies may be delivered more easily in the future.
So, will we one day wax our skis and lube our joints before skiing? Someday, if the cost is low enough and the delivery method safe enough, we surely will lube before we slide.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.
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