Angie Brown, Quinnipiac University

Knee injuries are common in athletes, accounting for 41% of all athletic injuries. But knee injuries aren’t limited to competitive athletes. In our everyday lives, an accident or a quick movement in the wrong direction can injure the knee and require medical treatment. A quarter of the adult population worldwide experiences knee pain each year

As a physical therapist and board-certified orthopedic specialist, I help patients of all ages with knee injuries and degenerative conditions.

Your knees have a huge impact on your mobility and overall quality of life, so it’s important to prevent knee problems whenever possible and address pain in these joints with appropriate treatments.

Healthy knees

The knee joint bones consist of the femur, tibia and patella. As in all healthy joints, smooth cartilage covers the surfaces of the bones, forming the joints and allowing for controlled movement.

Muscles, ligaments and tendons further support the knee joint. The anterior cruciate ligament, commonly known as the ACL, and posterior cruciate ligament, or PCL, provide internal stability to the knee. In addition, two tough pieces of fibrocartilage, called menisci, lie inside the joint, providing further stability and shock absorption.

All these structures work together to enable the knee to move smoothly and painlessly throughout everyday movement, whether bending to pick up the family cat or going for a run.

Causes of knee pain

Two major causes of knee pain are acute injury and osteoarthritis.

Ligaments such as the ACL and PCL can be stressed and torn when a shear force occurs between the femur and tibia. ACL injuries often occur when athletes land awkwardly on the knee or quickly pivot on a planted foot. Depending on the severity of the injury, these patients may undergo physical therapy, or they may require surgery for repair or replacement.

PCL injuries are less common. They occur when the tibia experiences a posterior or backward force. This type of injury is common in car accidents when the knee hits the dashboard, or when patients fall forward when walking up stairs.

The menisci can also experience degeneration and tearing from shear and rotary forces, especially during weight-bearing activities. These types of injuries often require rehabilitation through physical therapy or surgery.

Knee pain can also result from injury or overuse of the muscles and tendons surrounding the knee, including the quadriceps, hamstrings and patella tendon.

Both injuries to and overuse of the knee can lead to degenerative changes in the joint surfaces, known as osteoarthritis. Osteoarthritis is a progressive disease that can lead to pain, swelling and stiffness. This disease affects the knees of over 300 million people worldwide, most often those 50 years of age and up. American adults have a 40% chance of developing osteoarthritis that affects their daily lives, with the knee being the most commonly affected joint.

Age is also a factor in knee pain. The structure and function of your joints change as you age. Cartilage starts to break down, your body produces less synovial fluid to lubricate your joints, and muscle strength and flexibility decrease. This can lead to painful, restricted movement in the joint.

Risk factors

There are some risk factors for knee osteoarthritis that you cannot control, such as genetics, age, sex and your history of prior injuries.

Fortunately, there are several risk factors you can control that can predispose you to knee pain and osteoarthritis specifically. The first is excessive weight. Based on studies between 2017 and 2020, nearly 42% of all adult Americans are obese. This obesity is a significant risk factor for diabetes and osteoarthritis and can also play a role in other knee injuries.

A lack of physical activity is another risk, with 1 in 5 U.S. adults reporting that they’re inactive outside of work duties. This can result in less muscular support for the knee and more pressure on the joint itself.

An inflammatory diet also adds to the risk of knee pain from osteoarthritis. Research shows that the average American diet, often high in sugar and fat and low in fiber, can lead to changes to the gut microbiome that contribute to osteoarthritis pain and inflammation.

Preventing knee pain

Increasing physical activity is one of the key elements to preventing knee pain. Often physical therapy intervention for patients with knee osteoarthritis focuses on strengthening the knee to decrease pain and support the joint during movement.

The U.S. Department of Health and Human Services recommends that adults spend at least 150 to 300 minutes per week on moderate-intensity, or 75 to 150 minutes per week on vigorous-intensity aerobic physical activity. These guidelines do not change for adults who already have osteoarthritis, although their exercise may require less weight-bearing activities, such as swimming, biking or walking.

The agency also recommends that all adults do some form of resistance training at least two or more days a week. Adults with knee osteoarthritis particularly benefit from quadriceps-strengthening exercises, such as straight leg raises.

Treatments for knee pain

Conservative treatment of knee pain includes anti-inflammatory and pain medications and physical therapy.

Medical treatment for knee osteoarthritis may include cortisone injections to decrease inflammation or hyaluronic acid injections, which help lubricate the joint. The relief from these interventions is often temporary, as they do not stop the progression of the disease. But they can delay the need for surgery by one to three years on average, depending on the number of injections.

Physical therapy is generally a longer-lasting treatment option for knee pain. Physical therapy treatment leads to more sustained pain reduction and functional improvements when compared with cortisone injections treatment and some meniscal repairs.

Surgical interventions for knee pain include the repair, replacement or removal of the ACL, PCL, menisci or cartilage. When more conservative approaches fail, patients with osteoarthritis may benefit from a partial or total knee replacement to allow more pain-free movement. In these procedures, one or both sides of the knee joint are replaced by either plastic or metal components. Afterward, patients attend physical therapy to aid in the return of range of motion.

Although there are risks with any surgery, most patients who undergo knee replacement benefit from decreased pain and increased function, with 90% of all replacements lasting more than 15 years. But not all patients are candidates for such surgeries, as a successful outcome depends on the patient’s overall health and well-being.

New treatments on the horizon

New developments for knee osteoarthritis are focused on less invasive therapies. Recently, the U.S. Food and Drug Administration approved a new implant that acts as a shock absorber. This requires a much simpler procedure than a total knee replacement.

Other promising interventions include knee embolization, a procedure in which tiny particles are injected into the arteries near the knee to decrease blood flow to the area and reduce inflammation near the joint. Researchers are also looking into injectable solutions derived from human bodies, such as plasma-rich protein and fat cells, to decrease inflammation and pain from osteoarthritis. Human stem cells and their growth factors also show potential in treating knee osteoarthritis by potentially improving muscle atrophy and repairing cartilage.

Further research is needed on these novel interventions. However, any intervention that holds promise to stop or delay osteoarthritis is certainly encouraging for the millions of people afflicted with this disease.

Angie Brown, Clinical Associate Professor of Physical Therapy, Quinnipiac University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sarguru Subash, Texas A&M University

Millions of people in the U.S. and around the world suffer from urinary tract infections every year. Some groups are especially prone to chronic UTIs, including women, older adults and some veterans.

These infections are typically treated with antibiotics, but overusing these drugs can make the microbes they target become resistant and reduce the medicines’ effectiveness.

To solve this problem of chronic UTIs and antibiotic resistance, we combined our expertise in microbiology and engineering to create a living material that houses a specific strain of beneficial E. coli. Our research shows that the “good” bacteria released from this biomaterial can compete with “bad” bacteria for nutrients and win, dramatically reducing the number of disease-causing microbes.

With further development, we believe this technique could help manage recurring UTIs that do not respond to antibiotics.

Bringing bacteria to the bladder

For the microbes living in people, nutrients are limited their presence varies between different parts of the body. Bacteria have to compete with other microbes and the host to acquire essential nutrients. By taking up available nutrients, beneficial bacteria can stop or slow the growth of harmful bacteria. When harmful bacteria are starved of important nutrients, they aren’t able to reach high enough numbers to cause disease.

Delivering beneficial bacteria to the bladder to prevent UTIs in challenging, though. For one, these helpful bacteria can naturally colonize only in people who are unable to fully empty their bladder, a condition called urinary retention. Even among these patients, how long these bacteria can colonize their bladders varies widely.

Current methods to deliver bacteria to the bladder are invasive and require repeated catheter insertion. Even when bacteria are successfully released into the bladder, urine will flush out these microbes because they cannot stick to the bladder wall.

Biomaterials to treat UTIs

Since beneficial bacteria cannot attach to and survive in the bladder for long, we developed a biomaterial that could slowly release bacteria in the bladder over time.

Our biomaterial is composed of living E. coli embedded in a matrix structure made of gel. It resembles a piece of jelly about 500 times smaller than a drop of water and can release bacteria for up to two weeks in the bladder. By delivering the bacteria via biomaterial, we overcome the need for the bacteria to attach to the bladder to persist in the organ.

We tested our biomaterial by placing it in human urine in petri dishes and exposing it to bacterial pathogens that cause UTIs. Our results showed that when mixed in a 50:50 ratio, the E. coli outcompeted the UTI-causing bacteria by increasing to around 85% of the total population. When we added more E. coli than UTI-causing bacteria, which is what we envision for future development and testing, the proportion of E. coli increased to over 99% of the population, essentially wiping out the UTI-causing bacteria. Moreoever, the biomaterial continued releasing E. coli for up to two weeks in human urine.

Our findings suggest that E.coli could stick around and survive in the bladder for extended periods of time and successfully decrease the growth of many types of bacteria that cause UTIs.

Improving biomaterials

Our findings show that E. coli can not only control harmful bacteria it’s closely related to but also a broad range of disease-causing bacteria in humans and animals. This means scientists might not need to identify different types of beneficial bacteria to control each pathogen – and there are many – that can cause a UTI.

Our team is currently evaluating how effectively our biomaterial can cure UTIs in mice. We are also working to identify the specific nutrients that beneficial and harmful bacteria compete over and what factors may help beneficial bacteria win. We could add these nutrients to our biomaterial to be released or withheld.

This research is still at an early stage, and clinical uses are not in development yet, so if it does reach patients it will be well in the future. We hope that our technology could be refined and applied to control other bacterial infections and some cancers caused by bacteria.

Sarguru Subash, Assistant Professor of Veterinary Pathobiology, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pamela L. Geller, University of Miami

When I started my research on the Samuel George Morton Cranial Collection, a librarian leaned over my laptop one day to share some lore. “Legend has it,” she said, “John James Audubon really collected the skulls Morton claimed as his own.” Her voice was lowered so as not to disturb the other scholars in the hushed archive.

As my work progressed, I uncovered no evidence to substantiate her whispered claim. Audubon had collected human skulls, several of which he then passed on to Morton. But birds and ornithology remained Audubon’s passion.

Nevertheless, the librarian’s offhanded comment has proven useful – a touchstone of sorts that continues to remind me of the controversy and confusion long surrounding the Morton Collection.

Morton was a physician and naturalist who lived in Philadelphia from 1799 until the end of his life in 1851. A lecture he delivered to aspiring doctors at the Philadelphia Association for Medical Instruction outlined the reasons for his cranial compulsion:

“I commenced the study of Ethnology in 1830; in which year, having occasion to deliver an introductory lecture on Anatomy, it occurred to me to illustrate the difference in the form of the skull as seen in the five great races of men … When I sought the materials for my proposed lecture, I found to my surprise that they could be neither bought nor borrowed.”

He would go on to acquire almost 1,000 human skulls.

Morton used these skulls to advance an understanding of racial differences as natural, easily categorizable and able to be ranked. Big-brained “Caucasians,” he argued in the 1839 publication “Crania Americana,” were far superior to small-skulled American Indians and even smaller-skulled Black Africans. Many subsequent scholars have since thoroughly debunked his ideas.

Certainly, condemnation of Morton as a scientific racist is warranted. But I find this take represents the man as a caricature, his conclusions as foregone. It provides little insight into his life and the complicated, interesting times in which he lived, as I detail in my book “Becoming Object: The Sociopolitics of the Samuel George Morton Cranial Collection.”

My research demonstrates that studies of skulls and diseases undertaken by Morton and his medical and scientific colleagues contributed to an understanding of U.S. citizenship that valued whiteness, Christianity and heroic masculinity defined by violence. It is an exclusionary idea of what it means to be American that persists today.

Yet, at the same time, the collection is an unintended testament to the diversity of the U.S. population during a tumultuous moment in the nation’s history.

Men of science and medicine

As a bioarchaeologist who has studied the Morton Collection for many years, I have sought to better understand the social, political and ideological circumstances that led to its creation. From my work – analyzing archival sources including letters, laws, maps and medical treatises, as well as the skulls themselves – I’ve learned that, over a lifetime, Morton fostered a professional network that had far-reaching tentacles.

He had plenty of help amassing the collection of skulls that bears his name.

The physician connected with medical colleagues – many of whom, like him, received degrees from the University of Pennsylvania – gentleman planters, enslavers, naturalists, amateur paleontologists, foreign diplomats and military officers. Occupational differences aside, they were mostly white, Christian men of some financial means.

Their interactions took place during a pivotal moment in American history, the interlude between the nation’s revolutionary consolidation and its violent civil unraveling.

Throughout this stretch of time, Morton and his colleagues catalyzed biomedical interventions and scientific standards to more effectively treat patients. They set in motion public health initiatives during epidemics. They established hospitals and medical schools. And they did so in the service of the nation.

Not all lives were seen as worthy of these men’s care, however. Men of science and medicine may have fostered life for many, but they also let others die. In “Becoming Object,” I track how they represented certain populations as biologically inferior; diseases were tied to nonwhite people, female anatomy was pathologized, and poverty was presumed inherited.

From person to specimen

Such representations made it easier for Morton and his colleagues to regulate these groups’ bodies, rationalize their deaths and collect their skulls with casual cruelty from almshouse dissecting tables, looted cemeteries and body-strewn battlefields. That is, a sizable portion of the skulls in Morton’s collections were not culled from ancient graves but belonged to those of the recently alive.

It is no coincidence that Morton began his scientific research in earnest the same year Andrew Jackson signed the Indian Removal Act of 1830. Men of science and medicine benefited from the expansionist policies, violent martial conflicts and Native displacement that underpinned Manifest Destiny.

The collection reveals these acts of nation-building as necropolitical strategies – techniques used by sovereign powers to destroy or erase certain, often already vulnerable, populations from the national consciousness. These skulls attest to precarious existences, untimely deaths and trauma experienced from cradle to beyond the grave.

In the specific case of Native Americans, skeletal analysis testifies to the violent effects of U.S. military campaigns and forced removal. Native skulls that Morton labeled “warriors” have evidence of unhealed fractures and gunshot wounds. Children’s skulls bear the marks of compromised health; such pathology and their young ages at death are evidence of long-standing malnutrition, poverty and deprivation or stress.

To effectively transform subjects into objects – human beings into specimens – collected crania were ensconced in the institutional spaces of medical school lecture halls and museum storage cabinets.

There, Morton first numbered them sequentially. These numbers along with information about race, sex, age, “idiocy” or “criminality,” cranial capacity and provenance were inked on skulls and written in catalogs. Very rarely was the person’s name recorded. If used as teaching tools, Morton drilled holes to hang the skulls for display and notated them with the names of skeletal elements and features.

As dehumanizing as this process was, the Morton Collection does contain evidence of resilience and heterogeneous lives. There are traces of people with mixed-race backgrounds such as Black Indians. Several people may have also bent gender to navigate dire conditions or in keeping with social norms, such as native Beloved Women, who were active in warfare and political life.

What these bones mean today

As anthropologists now recognize, it is through the repatriation of the remains of the people in the Morton Collection to their descendants, among other types of reparations, that current practitioners may begin to atone for the sins of intellectual forebears. Indeed, all institutions housing legacy collections must contend with this issue.

There are other, valuable lessons – about diversity and suffering – that the Morton Collection has to impart in today’s interesting times.

The collection demonstrates that the American body politic has always been a diverse one, despite efforts of erasure by men like Morton and his colleagues. Piecing together the stories of past, disenfranchised lives – and acknowledging the silences that have made it difficult to flesh them out – counters past white nationalism and xenophobia and their current resurgence.

The collection, I believe, also urges the repudiation of violence, casual cruelty and opportunism as admirable attributes of masculinity. Valorizing men who embody these qualities has never served America well. Particularly in the mid-1800s, when Morton amassed skulls, it led to a nation divided and hardened to suffering, an unfathomable death count and the increasing fragility of democracy.

Pamela L. Geller, Associate Professor of Anthropology, University of Miami

This article is republished from The Conversation under a Creative Commons license. Read the original article.