[ExI] Rafal's knee nostrum was Re: knees and math

[Rafal Smigrodzki]

On Mon, Jan 24, 2022 at 12:01 PM spike jones via extropy-chat <
extropy-chat at lists.extropy.org> wrote:

>
> So... why do old knees hurt but young knees do not?  What physiological
> change took place?
>
>
### Mitochondrial damage accumulates over time, decreasing
energy-generating capacity, shifting energy generation towards glycolysis,
decreasing reserves needed for maintenance of tissue integrity (in
cartilage it's proteoglycan turnover). Cartilage that is not maintained
becomes brittle, inflammatory response is mounted against the degenerating
tissue matrix and chondrocytes die off, the whole mess irritates
surrounding tissues that have innervation and pain signals are generated.

Cartilage and other non-vascular joint tissues (ligaments, articular
capsule, tendons) are peculiar in that their function is dependent on
mechanically stimulated interstitial fluid circulation. In vascular tissues
all you need is normal blood supply and the needed oxygen and metabolite
movements are achieved through diffusion from and to microvasculature. In
cartilage you need fluctuating mechanical strain to cause a pumping action
on the interstitial fluid, with the tissue acting like a sponge that
squeezes fluid out when compressed and sucks fluid in when decompressed. In
other words, if you fail to apply a moderate amount of pressure briefly and
then release pressure on your joints, multiple times per day, the tissue
becomes deficient in oxygen and nutrients and starts to malfunction. As you
get older the diminished mitochondrial function makes your tissue even more
dependent on this alternating movement, so lack of movement is ever more
destructive, until your joints literally and painfully fall apart.

This is rather tragic, since a lot of people move less as they get older,
in part as a response to pain. Not moving your joints is the worst thing
you can do when they need the oxygen and nutrients for maintenance. This
creates a pernicious positive feedback loop, with pain causing less
movement, which causes less interstitial fluid pumping, which reduces
oxygen delivery, which causes more energy deficit, which causes more rapid
deterioration of the tissue, which causes more inflammation, which causes
more pain, which causes less movement....

The solution is to religiously perform full range of motion repetitive
non-weight bearing brief stretching exercises on all joints that usually
don't get enough exercise, which means shoulder, hip, knee, ankle, and on
foot ligaments. The key parts are "full range of motion" and "repetitive
brief". Partial range of motion without full stretch and sustained
pressures are not effective in the sponge-pumping mechanism. Spine joints
are a bit different matter. You need to do at least 10 - 20 movements per
joint, and they have to be full range of motion, or else there will be
joint parts that don't get enough fluid movement and deteriorate. I do 10
shoulder circumductions in each direction (total 20), 10 flexion/extension,
10 horizontal abduction/adduction (google descriptions of what each
movement means), 10 squats with full flexion of both knees and hips (knees
touch chest and buttocks touch ankles), with transitions to kneeling (with
full dorsal flexion of MTP joints and full flexion of ankle joint), every
day after waking up and preferably once during the day. If you can't squat
or do full range of motion due to weakness or pain, do the leg exercises on
your back or do partial stretching while trying to increase stretch to full
range.

I can attest to the efficacy of the regimen. I had shoulder injuries that
caused rotator cuff pain, and I had the beginnings of hip, knee and foot
pain (plantar fasciitis) a few years ago. All of the symptoms are
completely resolved with exercise but twinges of pain return quickly if I
slack off.

Of course, if your joints are already anatomically destroyed rather than
having just inflammatory changes it may be too late to completely regain
function - but it's never too late to try to salvage what is left. It may
mean working through mild to moderate pain but it's worth it. Note of
caution - if the joints are unstable mechanically or the pain is extreme
and unrelenting, consult a physician with expertise in exercise science.

Rafal
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