Dr. Lin

Can your joints really predict the weather? Are fish oil supplements good for bone health? Albert Lin, MD, Chief of Shoulder Surgery and Associate Chief of Sports Medicine at UPMC weighs in on some old wives tales and lists some simple things you can do to promote joint health.

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– Can your joints really predict the weather? And when is it a sign that your joint pain is something more serious? Hi, I’m Tonia Caruso. Welcome to the UPMC HealthBeat Podcast, and joining us today is Dr. Albert Lin. He’s the chief of shoulder surgery and associate chief of Sports Medicine at UPMC. Doctor, thanks so much for joining us.

– Thanks so much for having me.

– We’re glad you’re here. So much to talk about when it comes to joint health. Is it safe to say, though, that most people don’t think about joint health until there’s a problem?

– Yeah, I think that’s a pretty common thing that can occur. I think a lot of people don’t, really, and it’s like with anything. You often don’t think of things that are a problem until we actually have a problem.

– So we want to start with some wives’ tales that we often hear. And the first about that, we said it in the intro, can your joints really predict the weather? I hear people say, “My knee hurts. It’s going to rain today.” Is that true?

– Well, it depends on what it is. I mean, I think that in certain cases, when you have arthritis, which is basically when you have bone-on-bone wear and tear, there are some occasions when people can really feel something when the weather changes. And I don’t know if it’s the temperature, or the barometer, or the pressure, but sometimes people can feel a little bit of a difference. But does it happen in everyone? I would say no. And there are also people who get fractures, and they have surgery, and the joint’s a little bit different after that. And they sometimes do say, “It feels a little bit different when the weather changes.” So I would say sometimes yes, but not always the case.

– What is your elevator pitch, or what do you say to people about why the joints are so important to the body and such an important health system?

– Of course. I mean, we need our musculoskeletal system to be active, to engage in things like health and exercise, and with all of these other implications, including weight and cardiovascular health. And so your joints are a big part of that, of what keeps us moving. And I think those type of things need to be preserved and taken care of so that we can continue to have a healthy lifestyle.

– The other big question that we have often heard in the past is about your knuckles, and does cracking your knuckles make them bigger? Does cracking your knuckles lead to arthritis?

– So, yeah, obviously that’s around. Everyone has always talked about that. I would say no, it does not make your joints bigger, and it won’t increase your risk for arthritis.

– So, if you’re a parent and your child is cracking their knuckles and you would normally say, “Don’t crack your knuckles. They’re going to get big,” so that’s completely that’s not true.

– That’s definitely an old wives’ tale. I’m actually a knuckle-cracker myself. But no, if you do it, it will not lead to arthritis in the future.

– And any idea why we crack our knuckles?

– I don’t know. I don’t think that anyone knows that. We can do it, but people have all sorts of theories of why we can do this. At the end of the day, I’m not really sure anyone really understands that, or knows it, but it’s not dangerous.

– All right. Well, let’s go to problems, and treating people, and that sort of thing. Do you separate athletes and non-athletes when it comes to joint problems? Is it safe to say that athletes would have more joint problems?

– Yes and no. I mean, I think how you think about it depends a little bit on the scenario. For example, athletes might be more prone to a certain type of injury, and so when you think of it that way, you said, “OK, they’re coming in, they play a certain sport. Maybe this is what’s going on, or they had an acute injury.” These are things that kind of go into your head. Now, a recreational athlete or a non-athlete may in fact do the same type of activities. So they may fall into the same categories of injuries, but they may also come in without an injury, not having played in any sports. And so you might have to kind of tease it out in your mind a little bit about sort of what they’re coming in with. So in some sense, yes, you can think of it differently, but in other senses they may be doing similar activities.

– So if I do absolutely nothing — I don’t run, I’m not a big swimmer, I’m not out in nature a lot, I’m not going to fall traveling through the woods — what is the likelihood of my joint pain? Or what are the causes, then, for joint pain for people?

– Well, I mean, you can split it up into many things. One of them is overactivity, so you can have joint pain. You can be a former athlete having put a lot of mileage on your joints with different types of sports, and that can lead to further things down the road. Or you may be genetically predisposed to having some issues with your joints, even though you haven’t participated in the same level of activities as an athlete. And then there’s all sorts of other things. I think general health, weight, all these things can contribute to joint health, too. And so I think you can still have joint problems, even if you’re a couch potato, for sure.

– Is age going to get us in the end when it comes to joint health?

– In some individuals, yes. We do know in some individuals just from wear and tear of just normal living, you’re just going to put some mileage onto those joints, where a teenager is not going to see the same amount of mileage because they haven’t lived as long. And then you combine that with maybe a genetic predisposition and then maybe prior activity, you combine all those things together, that probably is why older individuals have a little bit more joint health problems than a younger individual.

– All right. So are there things that we can do to keep our joints healthy?

– Yeah, I think there’s a lot of things you can do to keep the joints healthy. One is to have a certain baseline of activity level that’s healthy. Like low-impact activities, I think are really great for the joints, some level of cardiovascular activity, and then some kind of maintenance strengthening as well.

– So is that walking and weights? What is that? What does that look like?

– So I think cardio-wise, walking. Great activity. Low-impact activities also include things like swimming, things that are not super hard on the joints. Obviously, there are runners out there who love it, and I don’t say that it’s a terrible activity, but that does put mileage on with the high repetitive kind of impact loading. And so if you’re a big-time runner, it’s always good to kind of cross-train to give your joints a little bit of a break. And I think other than the cardio side, I mean, some strengthening stretching. Some type of gym activity, I think, is a good thing. I’m not saying that you have to go to the gym and pump iron, but I think having some kind of weight strengthening is a good thing.

– What about, I see commercials often for fish oil supplements. Do they help joint health?

– Well, I don’t think there’s any conclusive evidence that they do help joint health, but there is not a downside to taking them. This is kind of in the same category as things like glucosamine; you see that advertised as well. All of these things, I think, are supplements that I don’t think are harmful to take. I don’t necessarily think they’re going to make or break your joint health, but I think they’re safe to take.

– Right. What about diet? What are the best things we should be eating, and what are the things that we should be avoiding?

– Yeah. I mean, I think this is a great question. I think it’s always great to have a balanced diet. You have too much of something is always not good. In terms of people say, “OK, protein,” but if you eat all protein, that’s not going to be a great thing. So I think a balanced diet is important. I think something high on protein, low on fat. You have some carbohydrates in there, but not excessive amounts. So something that kind of keeps it balanced is going to be the best diet to just kind of keep your overall health.

– Diet soda. As an ortho guy, what do you say about diet soda?

– Oh, man, so diet soda. I mean, I know what the appeal is. The appeal is no calories and so on and so forth, but I think there’s a lot of downsides to diet sodas. You have a lot of artificial ingredients in there, things that artificially sweeten that taste like sugar, but aren’t. But in the long term, they’re probably not great in massive quantities. And I think the air in these carbonated drinks, they tend to actually expand your stomach. And so what happens is your stomach expanded, and while you’re not getting calories from the drink, you actually might end up being more hungry because you now have a little bit of more dilated space.

– Does it rob important nutrients from the bones? Or is that a wives’ tale, too?

– I think yes, in the sense that if you drink too much of this, this is not going to replace any type of real nutrients that you’re going to get from whole foods and whole grains and protein. And so you drink an excessive amount, it’s certainly not great for your overall health and certainly not great for your bone health as well.

– What’s the best thing you can drink for your bone health?

– I think some dairy products are —

– So milk does do the body good?

– It does. Because milk has the calcium and the vitamin D, and those types of things can help build bone health. Now, is it great to drink gallons and gallons of milk every day? Probably not, but again, it has the nutrients in there that is overall good for bone health. Chocolate milk, if the actual milk itself is not tasty for the individual, is OK, too.

– All right. So when someone has pain, when is it time to see a doctor?

– Yeah, so I think many different scenarios here. I think one is if you have an acute injury. Something happened, you fell, you reached up and grabbed something, or you twisted your ankle, and it’s not the same as it was before. You have a loss of function, a dramatic change in function, definitely need to see somebody to assess that. If it’s affecting your quality of life significantly and you can’t perform simple what we call ADLs, activities of daily living: I can’t put my shirt on, I can’t wash my hair, I can’t do these things that many of us would just take for granted that we’re able to do. If that’s occurring in a frequent manner, something is probably wrong. You might need to see somebody for that. And I think overall, there’s been a sustained period of time when something is just not going away. Let’s say you didn’t have an injury, but pain just suddenly came on. You’ve waited a little bit of time, maybe a week, two weeks, it’s really not getting better. You should see somebody to just get it assessed.

– And how has treatment evolved over the years? I mean, when someone comes to see you, is it automatically it’s surgery, or therapy? What’s sort of the process?

– Yeah, I think that has evolved significantly, and I think part of the reason it’s evolved is because our ability to diagnose problems is so much better now. We can get advanced imaging studies, even basic x-rays, MRI, CT scan, all these things help us kind of complete the picture. And I think that there’s never kind of a one-size-fits-all, and nothing kind of always fits in the cookie-cutter shape. And so patients will come in, and yeah, physical therapy may be the right thing for a certain person, but it may not be the right treatment for another, and maybe they would be best treated with surgery. And so I think our ability to diagnose problems is significantly greater now than it ever has been in the past many decades. And so being able to use that information along with the patient’s history and exam, I think those are the things that are really improved significantly over the last several years.

– Right. When we talk about evolution, technology is really changing the game, too.

– Absolutely.

– And talk a little bit about everything that’s going on now to help you in your work.

– Yeah, so I specialize in shoulder surgery, and some of the things that really are in the forefront in the next, I think, 10 years. I think you’re going to see a lot of this, things with 3D printing. If I have to do a joint replacement, being able to really physically see what the patient’s specific anatomy looks like and have that available before I go into, let’s say doing a joint replacement. Or things like artificial intelligence and virtual reality, we literally put a goggle on, and you go into the OR, and you can kind of match a hologram image of what we’re trying to accomplish onto the patient’s anatomy. And having that help you, guide you in the OR in terms of, how you want to to do the surgery. I think all of these things, and I don’t think these are specific to shoulder surgery. I just am more familiar with it, obviously, because it’s my expertise and my field. But all of these things, I think, are on the forefront of spine surgery, sports surgery, or anything you can really think of in orthopaedics. And I think these things combined with the research to see if it improves outcomes, I think, is going to explode, I think, over the next 10 years.

– Wow, and how long have you been using this now?

– So I’ve been using things like 3D planning, 3D printing, now over the last three to four years. pretty routinely. And things like virtual reality, or mixed augmented reality, those types of things we’re just starting to do now. And so it’s been a really exciting time. There’s really going to be some great, great innovations in the next couple of years.

– And so when you tell your patients, “I’m using 3D printer

– Yeah.

– “to help with you,” what’s sort of the reaction there?

– They’re always amazed. The best thing is being able to show them these models that we have. We make custom guides as well. So I tell them, “Listen, we know we’re going to do this surgery. We’re going to set you up for image, and we’re going to use that image to virtually do your surgery on the computer, and then we’re going to make a guide specifically for your shoulder.” So that’s something I routinely have been doing for joint replacements now, for the last three years, I would say.

– Wow.

– And then that’s just going to be taking a step further, I think, in the next couple of years where we say, “OK, we’re going to now have an implant specifically, potentially designed, or 3D-printed for this patient. We’re going to have these goggles that we can really see what we were planning to do, and just superimpose that onto the patient’s anatomy while we’re doing the surgery.” I mean, this is almost like sci-fi that I used to watch when I was a kid, but it’s coming.

– That’s amazing. And how long down the road do you think there would be comprehensive research results? How long do you need

– Yeah.

– to, like, say to the rest of the world,

– Sure.

– “See, this works. This is the standard of practice now.”

– Yeah, and that’s a great question because obviously, technology is always exciting, it’s expensive. And you’re right: In order to know whether it works, you’ve got to track outcomes, and you have to make sure that there is long-term follow-up. So usually, in order for these type of technologies to be implemented and to say, “OK, they are safe and they actually improve outcomes,” you need years and years of research and I would say probably a good 10 years of outcomes to really know, is this the right thing we’re doing? Is it cost-effective? Is it improving outcome? Is it decreasing complications? All those things, and that’s one of the great things about UPMC as well. We do so much research. We like to track outcomes, and so we definitely are on the forefront of a lot of this research. And I think we’ll know for sure in about 10, 15 years, whether this technology is the right thing.

– Wow. Two last questions: You always have to ask an ortho guy, what sports do you play?

– Well, when I was in high school, I used to play lacrosse. That was a big sport for me. I did some track and field as well. And now, since I’m old, I go to the gym. So I try to go to the gym three times a week, do cardio, do a little lifting, do a little stretching as well. So I think all of those things, I try to maintain my own joint health.

– And last question: What do you like most about your job?

– So many things. I mean, the most satisfying part about my job is that in orthopaedics, it’s usually an issue with quality of life. People have quality-of-life problems. They can’t get through their day because they have certain issues. And one of the most satisfying things is being able to take somebody from that state and then restoring their quality of life, whether it’s pain, restoring function, getting them back into sports. And really, that’s not just with operations. Although it’s always great to see something broken, you fix it, and people get better, but also with non-operative treatment, physical therapy, injections, and really the best part is seeing improvement in quality of life. And really, that’s really what got me into orthopaedics to begin with. And it still drives me today.

– Well, Dr. Albert Lin, thank you so much for your time today. Some good information, and we all learned some things.

– Thanks so much for having me.

– My pleasure. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

About UPMC Orthopaedic Care

As a national leader in advanced orthopaedic care, UPMC treats a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. Whether you have bone, muscle, or joint pain, we provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. As leaders in research and clinical trials with cutting-edge tools and techniques, UPMC Presbyterian Shadyside appears on U.S. News & World Report’s rankings of the top hospitals in the country for orthopaedics.