My husband has osteoporosis due to medication. He also has stage 4 copd. Today, pulling on his sock, he felt a snap in his back. We feel he broke a bone but, with this covid thing going around, are hesitant to go to the ER. I don't know that there is much they can do for him, perhaps a brace or something, but he couldn't undergo surgery due to the copd. He is taking magnesium, potassium, calcium and Vit d3. I will have him start K2 today. Is there anything else he can do? Should we see a dr about this? Exposing him with his lung condition to people at the hospital is something we would rather avoid. Also, it seems that without fail, when dr's treat anything, the treatment doesn't take into account his other conditions and medications and often make things worse. Please make suggestions.
Americans have been taught that they need lots of calcium ..... Adequate calcium absorption and levels of calcium in blood and tissues are of course essential for all children and adults for bones and teeth, and for women who are breast feeding or pregnant. In the U.S. 10 million men and women have osteoporosis... One out of two women and one in eight men breaks a bone due to osteoporosis... However, excess calcium intake may cause muscle spasms, the calcium may appear as unwanted deposits in organs and tissues, such as bone spurs or plaque in the wall of blood vessels or in kidneys, heart, and liver, and it may increase the risk of cancer and cause other symptoms, including migraine headaches, pain, kidney stones, depression, and heart arrhythmia. Americans consume milk and milk products as well as calcium supplements at one of the highest rates in the world. Yet we have one of the highest rates of osteoporosis in the world.
Of course the goal is to have calcium in the right amounts in all tissues. But how much do we need? Despite all that has been written about calcium, it is not at all clear how much calcium humans need. This article will show that the conventional wisdom about calcium, which a number of prominent nutrition authorities reject, is faulty and incomplete, and that optimal health requires a substantial revision of our thinking about calcium.
The conventional wisdom about calcium is embodied in the government guidelines for vitamins, minerals, and other nutrients.... Professors such as Willard Willett, chairman of the Harvard Nutrition Department, T. Colin Campbell, professor emeritus of nutrition at Cornell University, and Marion Nestle, chairman of nutrition at NYU, believe that the [currently recommended] RDAs are too high and are not supported by the evidence.... The calcium proponents have the upper hand right now, with many doctors pushing calcium, and with calcium being added to orange juice and numerous other foods to make it easy for everyone to meet the RDA. The calcium proponents cite many studies in their favor, some of them involving fewer fractures, so it becomes necessary to sort out the apparent conflicts between studies.
The RDA requires that in order to get enough calcium people must consume foods high in calcium, such as milk, yogurt, and cheese, or take calcium supplements. Leafy green vegetables, broccoli, and other foods are also moderately high in calcium, but a person would have to consume such high quantities to meet the RDA that this approach is not at all practical.
Despite all the calcium hype, in this article I will present evidence that in general people who consume about half as much as the RDAs of 1,000 and 1,200 for adults actually have fewer bone fractures and better health than those who follow the RDA, and that high calcium consumption may actually interfere with calcium absorption, result in weaker bones, and cause calcium to be deposited where it is not wanted. I will then present a revolutionary theory that may explain these paradoxical results and why magnesium and/or silicon and a number of other nutrients are just as important for bone formation and preventing fractures as calcium. Finally, I will show that hormone production is very important for calcium balance and bone health, and present a natural approach to improve hormone levels without taking supplemental hormones or drugs. First, let's see what some large scale studies have found.
A recent 12-year study of 77,761 women nurses aged 35 to 59 (the Harvard Nurses Health Study) found that the quartile of American women with high milk intake actually had 45% more hip fractures and 5% more forearm fractures over 12 years from 1980 to 1992 than the quartile with the lowest intake.1 Approximately 98% of the women in the total cohort were white. The quartile with the lowest milk consumption and lowest fracture rate drank ?1glass of milk per week, while the quartile with the highest fracture rate drank ?two glasses per day. Those with the lowest total dietary calcium intake consumed ?450 mg calcium per day, and those with the highest dietary calcium intake consumed >900 mg calcium per day, and had 104% more hip fractures and 8% more forearm fractures than the women consuming ?450 mg dietary calcium per day during the 12 years of the study. (Those who consumed 451-625 mg dietary calcium per day had 102% more hip fractures, and those who consumed 626-900 mg dietary calcium per day had 85% more hip fractures than those who consumed ?450 mg dietary calcium per day. Women who took calcium supplements were excluded from this study. The subjects were all registered nurses and the reporting of milk and food consumption and fractures was deemed to be reliable.)
A 1994 study of 209 subjects and 207 controls in Sydney, Australia, found that the one-fifth portion (quintile) of men and women over age 65 with the highest milk product consumption, especially at age 20, had approximately double the risk of hip fracture compared to the quintile with the lowest consumption.2 In this study the quintile with the highest milk product consumption consumed about 11.5 units of milk products per week (glass of milk = 1 unit; serving of cheese or milk on cereal = 0.5 units), and the quintile with the lowest milk product consumption consumed one unit per week. The authors cite seven other case control studies of the relationship between calcium and dairy product consumption and the risk of hip fracture, and note that only two of those reported a protective effect of calcium or dairy, one of which was conducted in Hong Kong where the average calcium intake was only 171 mg per day. They also cite D. Mark Hegsted's article concluding that ecologic studies suggest that populations with high calcium intakes (mainly from dairy products) have the highest hip fracture rates.3 Hegsted, who was chairman of nutrition at Harvard, in the same article wrote:
"It seems quite clear that we do not understand the etiology of osteoporosis; the epidemiological data need an explanation, and something is wrong when current explanations are inconsistent with general experience.
"It is dangerous to ignore the epidemiological data. The first rule in formulating public health policy should be the assurance that the recommendations are not detrimental. It will be embarrassing enough if the current calcium hype is simply useless, it will be immeasurably worse if the recommendations are actually detrimental to health."3a
An ecological survey of women in 65 rural Chinese counties was conducted to obtain dietary and lifestyle factors associated with health. The study, published in 1991, found that the mean calcium intake in rural China was only 544 mg/day, about half the RDA in the U.S., while the mean bone fracture rate was only about one-fifth as great as in the United States.4 A related study of 764 women aged 35-75 years in five of these counties in China concluded that higher calcium intake was beneficial in increasing bone mass at skeletal maturity.5 The authors noted that all of the women in three of the five counties consumed no dairy products and therefore consumed amounts of calcium well below even the Chinese standard of 800 mg/day, and virtually all of them over 50 had bone mineral densities (BMD)
"However, the majority of women included in this study appeared to be normal, showing no signs of osteoporosis, such as back pain and dowager's hump, at the time of the survey on the basis of a physical examination. Moreover, ? <4% of these subjects had reported a history of Colle's [wrist] and other fractures suspected to be related to osteoporosis during their lifetime. This fracture rate is very much lower than those reported in studies in Western countries with subjects of the same age range and similar sample size.? Obviously, other factors besides bone mass, such as daily physical activity and chance of fall, may also be very important in understanding this discrepancy in bone fractures."6
The authors also note that the assumption that these Chinese women with low bone density have a high risk of fracture goes against the findings from other studies showing that "incidence rates of hip fracture were much higher in those countries where bone density was usually reported to be high, " and a study by Ross et al.7 that "reported a two-fold lower fracture rate for native Japanese and American-born Japanese than Caucasians, even though Japanese and other Asian people were often reported to have lower bone mass than whites."8 The authors also state:
"In fact, analyses of the prevalence of hip fractures between nations suggest a positive relationship between calcium intake and osteoporosis risk. Osteoporotic fractures appear to be more common in the United States, Britain, and Sweden where calcium intakes are higher than those in other countries."9
In one of the five counties of this study in China consumption of dairy was associated with increased bone mineral density and bone mineral content. Individuals in this subset were members of a nomadic group where vigorous outdoor physical activity (e.g. horseback riding) was more common. However, in this subset consumption of more calcium did not result in fewer fractures. In Part 2 of this article [to appear in the May/June issue of WBJ], I will discuss the importance of outdoor light in hormone production and the formation of strong bones, and the role of exercise, both of which may apply to this subset as well as to women in rural China in general. One of the principal authors of these studies of rural Chinese women, T. Colin Campbell, was raised on a dairy farm in Virginia. For many years he accepted the conventional wisdom that milk consumption produces strong bones, until long experience as a researcher, including 10 years in China, convinced him that the conventional wisdom was mistaken. Dr. Campbell believes that a largely vegetarian diet with relatively low protein consumption is a significant reason why societies that do not consume milk products have a history of many fewer bone fractures. The evidence regarding protein consumption, which I will discuss in Part 2, is complex. However, diets that exclude milk products also have substantially more magnesium, silicon, and potassium relative to calcium, which may be more important than low protein consumption in forming strong bones.
Thus, the American focus on bone density in studies of osteoporosis may be overemphasized because it misses the main point, which is not how to increase bone density, but how to make bones healthier and more resistant to fracture. Increased bone density brought about by high calcium intake may make bones weaker and more susceptible to fracture. This is not to say that bone density is of no importance, as there is a general decline of bone density in adult women after menopause and in men at a somewhat later age, which is associated with an increase in the incidence of bone fractures. However, it is obviously not the most important factor in bone strength. Until scans or other tests are developed that have the capability to measure the strength of bone, it makes sense to give greater weight to studies that measure fracture rates.
The evidence indicating that the current U.S. RDA may be too high appears to relate to other areas of health besides bones and teeth. For example, studies indicate that men with the highest calcium intake had an increased risk of prostate cancer. In one study, men who consumed >600 mg per day of milk products had 32% higher risk of prostate cancer than those consuming ?150 mg per day.10 The increased risk occurred whether the calcium came from food or from supplements alone, indicating that the risk was caused by the increased calcium rather than something else in milk products. The prospective Health Professionals Follow-up Study found that men who consumed >2000 mg of calcium daily had a 4.57 times greater risk of metastatic prostate cancer than those who consumed
I was rushing around a few days ago and caught my pinky toe on the doorframe. After yelling, I collapsed into a chair to regain my breath and evaluate the damage. The toe was cocked out of its normal place and I was sure it was broken. Likely there was soft tissue damage as well. I taped my toe to its neighbor. I kept ice on my toe for the better part of 4 hours. I also kept it elevated. It is typically recommended to keep ice on an injury for 20 minutes out of every 2-4 hours for 48 hours. Because the ice helped the pain so much, I kept it on much more than that. I did keep a towel between the ice pack and my toe so it wouldn't get too cold.
In spite of the ice and elevation, I did develop a good bit of swelling and bruising in my foot. The bruising may have been worse due to taking some aspirin for pain, but I did choose aspirin because Tylenol doesn't help with inflammation and I can't take ibuprofen. I also took some turmeric to reduce inflammation.
At first I only needed a cane to get around, but by later in the day, with increased swelling, I was needing to use crutches. I think the swelling in the foot makes walking as painful as the break itself. And bumping or moving my toe wrong stirred up pain afresh. I continued to use ice intermittently and elevation as much as possible.
By the evening of the second day I had significant bruising. I started to use a tincture I had made on my toe and the surrounding bruising. It was an alcohol tincture of arnica and comfrey. This greatly reduced the bruise overnight. I continue to apply the tincture to my toe and surrounding area several times a day.
Cabbage is used as a wrap for swelling, especially for mastitis. I decided to try it for my toe. Typically, cabbage is used fresh from the refrigerator and bruised with a rolling pin before applying to the area in need. I did this once, but then decided it would conform more to my foot and be more comfortable warm. I took a leaf of cabbage and broke it into a few pieces and placed it in a mug. I poured boiling water over it and left it alone for 15 minutes or longer. Then I strained out the hot water and dried the leaves. When the leaves were a comfortable temperature, I applied them to my foot and covered that with plastic, then used cohesive tape to secure everything. I did this two nights in a row and each morning noticed a significant reduction in swelling. Today is day 5 and I can walk without crutches. I am still keeping my foot up a lot and still applying the tincture. I have the toe taped to its neighbor. Actually I have two bandaids holding the toes together as that turned out to be the most comfortable option.
I have also been using comfrey internally. Comfrey promotes cell regeneration and healing to the bones and joints. Its nickname is “knitbone.” My favorite way to eat comfrey is in a saute. I wash and cut up the leaves and saute them in some coconut oil. I usually use 2-5 leaves of comfrey. When the comfrey is almost finished sautéing, I toss a tablespoon of pine nuts and a small handful of raisins to the sautee. I sprinkle this with some sea salt. I think it is delicious.
A broken toe can take 4-6 weeks to heal. I don't know how long it will be before a shoe is comfortable to wear again. I ordered some flip flop socks because wearing flip flops is easy on the toe but leaves my feet awfully cold here in November.
In hindsight I wish I had used the comfrey/arnica tincture earlier, but I didn't think about it at first.
I have also used Epsom salt soaks this week, but I am not sure but that the warm soaks are creating more swelling than they are relieving. Perhaps I started them too early (first night) and perhaps it would be better to soak in cool water.
I hope you don't need any of these remedies ever, but if you do, I hope they help you!
~Mama to Many~
Five months ago a friend was repairing his 2-ton trailer when the jockey wheel broke and the draw bar landed on his foot. After two trips to the hospital it was confirmed that he had indeed broken it. They placed his foot in a "boot" and told him to come back in a week as it was too swollen to place in a cast.
He called my husband and I and I told him about comfrey ointment. He was pretty stressed out and desperate as he and his wife had just sold their property and were packing up to leave in a few weeks. He decided to give it a try. He applied the cream three times a day for a week.
When he returned to the hospital he told the doctor he was healed. Of course she didn't believe him until she pressed, twisted and pushed on his foot without him uttering a sound.
She had another look at the x-ray and it definitely showed the broken bone.
Just over a week ago, a young friend had a fall off his motor bike and broke his collar bone. Of course I had to mentioned about the comfrey ointment and relayed the above testimony.
He was pretty excited and the next day, his fiance bought a jar from the chemist and he started to apply it to the area. I saw him two days ago and he said he was able to sleep and could move his arm up, down and around, without pain, whereas before the ends of the bones were touching and causing him great discomfort. He is yet to have his doctor's appointment, but judging by the progress so far, he won't be taking six weeks to heal.
I used a comfrey poultice on my dtrs broken toe and her surgeon said she couldn't believe how fast it healed.
...Comfrey compresses healed not only the deep bruising (in 3 days), resulting from a stubbed, broken toe but also, bone -- after all, the common name for comfrey is "knit bone". Raspberry tea healed my indigestion after I was forced to eat "junk food" for 3 days whilst staying with my husband's cousin.
I fractured my right fifth metacarpal the beginning of this month. I saw the orthopaedist and he set it with a cast. I used a tincture of comfrey acquired from the local healthfood store. I applied with a q-tip under the cast at the site of the fracture once or twice a day. I went back to the doc for my followup visit two weeks and two days after the injury, the doc kept asking, three times, "When did this injury had occur?" He could not believe how fast it had healed, he left the cast off and now I have a soft splint. Now I apply the comfrey tincture on a bandaid and leave it on overnight. I hope to be splint free when I go for my next two week checkup. Not bad for a 58 year old female.
(New Castle, Pa)
You can get around the comfrey problem for internal use as comfrey's active ingredient is allantoin. What you need is to dissolve allantoin, which is not soluble in water. However, it is soluble in DMSO and this can help with fractures. You can mix about 100-5000 mg of allantoin to 2 cc of DMSO. Of course you should add water to 10-20 cc at which you can apply to the skin or drink for internal purposes. It has help some people heal fractures and this is one way to avoid poisonous alkaloids from comfrey. Some people added aloe vera extracts and oil to improve healing.
Dosages for DMSO mixed with comfrey on a per day basis is estimated to be about 10 drops per day based on mixture I mentioned. Please understand that use of DMSO will result in you getting garlic odor. You can reduce this if you halved your dosages or drinking diluted hydrogen peroxide will also help reduce the smell. The reason why it smells garlic is because your body is hungry for oxygen. What it does is it takes out the oxygen component from the DMSO to get DMS. Now if the water you drink is high in hydrogen peroxide (water with not over 0.5% food grade H2O2), then the oxygen will come from H2O2 component more readily, reducing the garlic smell somewhat. Of course you can try MSM which is an DMSO with one more oxygen, this will get rid of the problem and will also help with healing of fractures. Of course, MSM is not as good of solvent for allantoin as DMSO.
I used a comfrey poultice on my granddaughter's arm and it healed so rapidly, the doctor was amazed. My 90 yr old mom just broke her arm and I'm using a comfrey compress. I'm told it will take 3 months or more for it to heal, so we'll see, but I have faith that it will heal much faster!!!
I read "garlic helps to heal fractured bones" - Has someone applied this in factured bone(s)? How, what are the results and how long it takes compared to comfrey salve - Allantoin. Guidelines will be highly appeciated. Thanks and God Bless. Greg.
You may be able to guess why I'm having trouble nailing advice on this one just using Google! I just read about comfrey and can't believe I forgot that one for my herbal bag of tricks. With a deeper fracture like this, do you just heat it up a bit more and leave it on a bit longer?
Anyway, main concern (due to lots of misdiagnosing, I really think the fracture occurred following a should have been simple (and wasn't) ventral hernia repair last January. Surgery itself was OK, just have had very bad pain and a limp ever since (pain over the iliopsoas, which I think make sense in light of the location of the fracture). Because of misdiagnosis ("something in the hip, " "osteoarthritis" "let's just try cortisone") I've actually been in PT plus hiking and biking over the summer. Not a prime candidate for oodles of osteoporosis, but am getting a bone density scan.
Anyway, my specific problem is my husband and I are happily married and are trying to avoid the celibacy thing (this is 9 months, after all) but are looking for tips to avoid further injury to the area. Please, does anyone have any suggestions? Positions? If it hurts, don't do it? Limit actual intercourse to some number of minutes. (Probably some of you ladies would be envious, but he can go on at length without peaking, but many, many minutes even with my leg supported does start to make the involved area painful).
Collateral damage: had rotator cuff surgery on both sides 2 years ago. Crutches provoked rotator cuff pain that was worse than the fracture. Have since found the spring-loaded dealies, but a lot of the damage was already done (thinking comfrey might be a help there as well).
Sorry if this frankness makes anyone on the list uncomfortable, but this has not been a subject I've been able to find any info about (plus I'm being treated in a university setting so feel like I'm getting care management by the Keystone Kops. ) Ted and anyone else, dig in!
Blessing to all. I started taking MSM for my fracture foot, which it did not help. BUT it has my knee joints and elbows. I tried the apple cider vinegar also.
Use Silica for fast healing of bones, fractures and breaks...
Quick bone healing in elderly lady.
Several years ago I had occasion to advise a woman in her 70s about calcium absorption. She was formerly a professional dancer and teacher of dance. I had not seen her for some time until I saw her in March 1998 at a meeting where she was in a wheelchair. When I asked what happened she told me that four months before that she had been in a bad auto accident causing multiple fractures of her right tibia (shin bone) just below the knee. She was still in a wheelchair because according to her doctor her fractures were healing very slowly or not at all, and she found it extremely painful and difficult to move her leg and she could not put any weight on it.
I asked if she was taking supplemental calcium, and she said she had been taking about 1,000 to 1,200 mg per day. I advised her to cut down to no more than 400 mg of calcium per day and to take at least as much magnesium. I asked if she was taking horsetail, an herbal (plant) source of silica. She said she had not heard of horsetail, and was not taking any silica supplement. I suggested that she begin taking horsetail, as it is high in an easily absorbed form of silica (Ionic forms of mineral silica are also absorbable), and low in calcium, and is available inexpensively through health food stores and pharmacies. I advised her to take about six capsules daily with meals, as recommended on the bottle (about 2,640 mg of horsetail per day). I explained to her briefly why that might be helpful, and how it might also reduce the pain in her tibia.
I talked to her a week later and asked how she was doing. She said for the past week her recovery was like "a miracle every day"; that her tibia was rapidly improving, the pain was less, she was finally gaining mobility, and she was able to start putting weight on her right leg by standing. She told me that she had followed my advice and bought some horsetail the day I talked to her and had taken it daily for the past week as recommended, and that she had also cut her calcium intake down to about 400 mg per day, and was taking 400 mg of magnesium per day. She continued this regimen.
Within about two weeks she was out of her wheelchair and walking short distances using a walker, and she continued to make rapid improvement. Five weeks later she was walking with the aid of only a four-pronged cane, and six weeks later she was walking without assistance and got a car and began driving again. She said her doctors told her that her x-rays showed rapid healing of her bone after the time she started taking the horsetail and magnesium, and reduced her calcium intake. In contrast to her despair about her condition when I first talked to her, she was in a very positive mood each time I talked to her after she changed her regimen.
- Reduce calcium supplement to less than 400mg per day
- Take 400mg of magnesium malate per day (plus mag oil topically would be very good)
- Take 2,640mg+ of Horsetail per day for high SILICA content.
Complete wrist fracture healing in 5 weeks?
Another example is an eighty-one-year-old woman who fell and fractured her wrist in July 2000. Two months later it was not healing well, so in September I advised her to take supplemental horsetail. She took two capsules of the herb three times per day for a week, then one capsule three times per day. Five weeks later her doctors reported that her x-rays showed complete healing.
Every one of the approximately six persons with similar problems to whom I have given the same advice to take horsetail and in some cases to take magnesium and reduce calcium intake has experienced the same rapid healing of bone fractures after a long period of very slow healing or no healing. In one case the orthopedist treating the patient used the word "miracle" to describe the sudden appearance of rapid healing that began after the patient started taking horsetail, as confirmed by her x-rays. That patient was a 24-year-old woman with a congenital estrogen deficiency whose badly fractured tibia had not healed at all in the two months before she started taking the horsetail. Her estrogen deficiency caused scoliosis when she was a teenager for which she had a steel rod placed in her back
In several of these anecdotal reports we have additional scientific support because four of the women served as their own controls - that is, they had an actual prior experience of healing very slowly or not at all, as well as experiencing significant pain before starting to take horsetail, and thereafter they experienced rapid healing and cessation of pain (I had not advised them to expect the pain to go away).
What is remarkable about these anecdotes is that in each case they match the results of controlled scientific tests of the effects of vegetal silica (horsetail) in healing broken bones of animals - that is, rapid healing of bone in those given horsetail, but very slow healing in those given calcium.
Silica heals bones
In studies on silica and bone formation by Dr. Louis Kervran, the femurs of rats were broken. X-rays show very rapid healing effects of horsetail(high in silica) on the broken bones just 10 and 17 days after the break, and the very slow rate of healing in control rats who received only calcium. In the rats receiving horsetail, after just 17 days (10 days in one rat) the area where the bone was broken was completely healed and actually more solid than the rest of the bone, whereas in those receiving calcium the healing was just beginning. (Sociologist and anthropologist Wolf-Dieter Storl PhD comments this experiment saying, Horsetail tea is more effective for people with brittle bones than milk.)
(Ten Mile, Tn)
(Athens - Greece)
I served in the military and as a result of my training have been suffering bilateral stress fractures in my shins. It has been two years of going to the doctors who are unable to pinpoint the source(s) of my pain. They have given me peroxicam(sp?) to help with the pain which kind of works. I was wondering if anyone has/had a similar injury and what you did for the pain and to help the healing process. The doctors think I am crazy and tell me I should not be feeling any pain according to the x-rays, and I would love to tell them differently. Along with this pain it is troublesome to work a full 8 hour day without being completely wiped out 6 hours into it. Being on my feet daily is out of the question for now. It seems time it helping but I was wondering if anyone had any ideas what to do to help with the pain. Please advise. Thank you!
It is called MSM because its chemical name is methylsulfonylmethane. This is a first cousin of sulphur & is related to DMSO also. MSM is a natural substance found in the body, but apparently is another of those things that have declined in our super fertilized agriculture which has a habit of depleting our foods of many of those nutrients that used to be found in adequate amounts in our foods.You can google MSM or the chemical name & learn more about it. I have loved the results ever since I realized how effective it was. I got a number of people interested & they started taking it and found just as great as I told them it was. A lot of those had some post traumatic arthritis. My nephew was unable to get his hands above his head (fractured wrists years ago from motocycle accidents). He started taking it l0 or 15 years ago and still is. He's probably giving some to his horses & dog also. A coworker told me that her husband's back gave him less trouble after starting it. He had fractured his back in a car wreck several years before & was very painful after that. When The ladder I was did a backward flip 2 years, ER xrays said nothing broke, MRI done 2 days later said I had a slight impaction fracture of the distal femur, tibial plateau fracture, and totally unattached AC ligament in the left knee. With a hinged knee brace, a pair of crutches and the race horse dose of MSM daily, I breezed through recovery with only 2 Orudis kt (NSAID) pills for pain. Knee is painless unless I do something like I did approx. a year later. In preventing myself from falling with a big box of books in my arms, I had to do what I wasn't supposed to - I had to pivot on the left knee and without an ACL, you can't swivel or pivot on the injured knee. I think it was my hamstring muscle I got on that one - unfortunately MSM didn't help that much on that one. Other than not being able to pivot or swivel on that knee, the only other restriction I have is to continue to wear the knee brace when waling on uneven ground, so when I go hiking through the woods, I wear it and very thankful that I have it.