Tuesday, February 14, 2012

Is De-Conditioning More Toxic Than Arthritis?

Dr. Bal Rajagopalan - known as Dr. Raj to his patients and friends – is a double board certified orthopaedic surgeon, who, in his ten years of sub-specializing in hip and knee surgery, has won a wall-full of awards.  Recognized as one of America’s top orthopedists in 2007, 2009, 2010 and 2011, he was named America’s top doctor in 2011 by United Airlines Hemispheres Magazine and featured in the publication Best of LA.  . 

It does not hurt that he is a fanatic about exercise and has bulging muscles and a six-pack usually seen only on movie stars. TV viewers have seen him as a media expert in productions on Spike TV, The Doctors, MSNBC, CBS and FOX and read about him in Newsweek.

So who is this guy?  He is a young man on a mission.  As CEO of the Beverly Hills Orthopaedic Institute Raj sees about 500 patients a month and has performed 4,000 surgical cases, mostly hips and knees, in the past ten years. He is convinced, as he told OTW, that “people are being destroyed by our society.”  The issues are obesity and self-inflicted de-conditioning. . 

The majority of Dr. Raj’s patients are between the ages of 20 and 50, which may reflect the youth-obsessed culture of Southern California.  Twenty years ago, he noted, fast foods had 30% fewer calories, kids played sports out of doors, they walked to school two or more miles – which was a given.   Now he is seeing a whole generation of youth coming into the work force who are de-conditioned. “They have no muscle support for their joints or their backs and they are obese. With their extra weight they are loading their joints and their backs and, when they go to work, they are taking jobs that are desk-bound.  I am seeing more and more young adults in their 20s coming in with injuries and issues – low back pain, knee pain, simply because of the way they have abused their bodies,” he said.

Raj’s concern is focused on two groups.  The first are those he calls “weekend warriors” - individuals who, when they were 20 could perform an exercise.  Now that they are 40, though they have not worked out for the past three years, in their heads they still think of themselves as being athletes – often with disastrous results.

 The second group is the 66% of American children who are overweight.  They are not obese, he notes, but they are overweight and, because of that, “their bodies are unhealthy.”

Raj’s weekend warriors attempt extreme exercise without consulting a physician first, do not bother with a warm-up routine, perform the exercises with improper technique and do not stop when their bodies complain. “Poor training practices, improper equipment and technique, lack of conditioning and insufficient warm-up can land a well-intentioned person in traction,” he says.

What are weekend warriors doing wrong?  Raj says that the simplest thing that most people do wrong when they want to start an exercise regime is they don’t stretch. ”They have not worked out for a week or two weeks. Their muscles are tight. Their tendons are tight. Their blood supply is not around the joints. The exerciser should spend five to ten minutes stretching. It increases blood supply; it increases flexibility of the joints – all of which prevent injury.”

He said that patients also come in with “silly” injuries that happened because of their own negligence. One example, he said, is yoga. “Ten years ago yoga was meant for yogis – people who were interested in meditation, relaxation and stretching.  Now yoga has become a true sport.  We have people who are 50 years old, people who have bulges in the discs of their necks, attempting head stands.  People who have unstable shoulders are trying to do shoulder stands.  Out of shape people assume that because yoga is slow, because it involves slow twitch muscle fibers that they should be able to keep up.”

Raj is a crusader for change. “My task is to help people who are damaging their bodies without realizing it.”  He does not blame the victims, insisting that “it is our society that is creating the problem.”  Society is becoming more and more advanced technologically “but it is destroying us,” he says.  “We have an inactive population, combined with all of these environmentally facts that contribute to the de-conditioning of muscles, increased weight on joints which leads to more and more morbidity.

“Each extra pound of weight is seven pounds of joint reactive force on your knees. So if you are ten pounds overweight that is an extra 70 pounds of force on your joints.  Imagine living to 100 years old (which many will do) and having 50 medical problems that you had struggled with all of your life.  That is going to be horrible.”

No matter ones age, exercise is vital, he says. “Exercise helps maintain range of motion in the joints and stimulates the production of joint lubrication which decreases wear and tear on your joints.”  He advises listening to your body and paying attention to it. “If you have acute pain when you are exercising, your body is telling you something is not right.” He notes that there are two types of pain. One is a work-out pain, which is deep and dull.  That is probably all right. But a sudden, sharp pain indicates that something –probably not good – has happened.

Raj, with his friend gym owner Jack Rosenbaum, has started a health and fitness program for school-age children. “We take kids with issues of self esteem, obesity and secondary pain and mentor them over a period of three months. We tell them that obesity and de-conditioning is not a socio-economic disease.  We take them to the grocery store and \show them foods that are cheaper than McDonalds and much healthier.”  Raj says that “the kids are responding. We are speaking to bigger forums and getting a lot of interest from medical practitioners.”

Raj notes that this will be the first time in history that parents will bury their children due to disease and ill health. Type 2 diabetes in children is at an all time high and children have never been unhealthier than they are right now, he says.  

Raj is enthusiastic about the promise of stem cells. “I think it is an incredible technology and we are coming close to hitting a gold mine with this.”  He is especially interested in the use of stem cells in combination with platelet rich plasma (PRP) which acts as an “igniter” when injected into a joint to promote healing of defects in the cartilage. “There is a degree in which we can make a change with stem cells,” he says.  “But we will not be able to inject stem cells and convert a full arthritic end stage to a normal knee.  That is not going to happen.”   

This crusader was born and reared in Lunenburg, Nova Scotia, a small Atlantic fishing community. Athletic and active in sports he suffered sports related injuries and as a result became acquainted with local orthopedists. “I was one of those kids who was active all the time.  I had a desire to use my hands in a way that I could help people.  When I decided to become a doctor I thought there was no better field than orthopaedics where I could combine my love of sports with the desire to help people.  The nice thing about orthopaedics is we are dealing with people who are basically healthy.  They have issues with a joint or a muscle or a tendon and we have the ability to correct that issue.  There are not many fields in medicine where a doctor can say with 100% confidence that I can correct this issue and get you well.”

Raj is a Fellow of the American Academy of Orthopaedic Surgery is Board Certified by the American Board of Orthopaedic Surgery and certified by the Royal College of Orthopaedic Surgery of Canada.  He and his wife, who is a child psychiatrist at UCLA, have a three-year-old child.

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