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Is Your Pain Really Caused By Arthritis?
Firstly, before I get into full rant mode, an admin point. For the purposes of this article we are talking exclusively about osteoarthritis not any of the spondyloarthopathies (I love using this word, it took me about 2 years to work out how to say it!) which is a very fancy way of categorising a group of auto-immune conditions which attack the joints, usually in the back but can be elsewhere in the body, the most well-known of which is Rheumatoid Arthritis (subject of another Blog perhaps).
So what is osteoarthritis, or more to the point, what have we historically believed it to be in the Physiotherapy world. Most of you will have heard it referred to as wear and tear on the joints. The wearing away of cartilage within joints after years of use and abuse. This wearing away of the joint was thought to be the cause of much pain and when seen on x-ray the frustrated patients are told that there have arthritis and there is nothing that can be done. They may if they’re lucky be given a few traditional Physio exercises that might help.
However, over 10 years in clinical practice we have “cured” many people’s arthritis. So what is going on here? Previously we simply considered that arthritis was over diagnosed – and we still believe it is. But we have helped so many people who have confirmed wear and tear from x-raysto become pain free, surely something else is going on here.
Lets look at this very simplistically. If cartilage’s primary function is to stop bone rubbing on bone within joints then if it wears down over the course of a lifetime is that not just normal function?* Equally if we look at our understanding of the anatomy. Cartilage itself has very few pain receptors (nociceptors in latin!) muscles have loads, and our adipose (fat) layer may have even more sensory cells, if new research is to be believed – see interoception.
In our experience arthritis is usually just a label to explain pain in a joint. Nearly all conditions can be improved if not “cured” completely. So how is that? As we mentioned above most pain comes from structures outside of the joint, namely muscle, ligament and nerve so if we can return these structures to normal using our Progressive Sports Therapy approach we improve sensation in and around the joint.
Moreover, when muscles that act across the joint return to their optimal length, it mechanically unloads the joint, and joint moves more freely and with less pain.
Probably the easiest example of this is the knee. The knee cap simply exists to “improve the mechanical advantage of the quadriceps.” In English – it make the muscles on the front of your thigh stronger. Put simply if those muscles are tight then it compromises the alignment of the knee cap and can lead to pain. When you restore these muscles to their normal length, by understanding and treating the reasons they were tight in the first place, we get an immediate improvement in knee function and a reduction in pain.
There seems to be increasing amounts of evidence to support our views and clinical experience. A recent large cadaver (dead people) study in the US compared peoples’ medical records during their lifetime and then looked at the wear and tear (arthritis) on their joints. There was found to be no correlation between these two measures at all!
This would tie up with what we see on a regular basis. Many of our clients who have been x-rayed to show they have severe wear and tear have little pain. And those who have minimal wear and tear have pain that is off the scale.
So if it’s not wear in tear why do my knees grind and crunch? Now this is a really good question! The honest answer is that we really don’t know. The key things is that grinding and graunchy joints are not an indication of cartilage wear and damage, even if it feels like it!
Another recent piece of research looked into this. It was conducted by two surgeons who were operating on each other. The rumour is that it was carried out under local anaesthetic and were chatting through the whole procedure! It was an open operation on the knee cap and while they were operating they assessed all knee movements and looked specifically at the cartilage. What they found was that there was always at least a 1mm gap between all cartilage surfaces!
Maybe this was due to the fact that the muscles were inhibited during the operation. Maybe when we are conscious and our muscles are held tense maybe this can cause increase pressure on the joint surfaces. But food for thought nonetheless. So then we ask why would the muscles be held tight to affect normal joint function?
Not wanting to sound like a broken record but this is when psychology comes in! Over the years of our lives emotional and physical baggage builds up and we start to hold ourselves tense. It can be sub-consciously protecting and old injury or sub-consciously guarding an old emotional issue or event. This can affect all different muscles for all kinds of reasons, far too detailed to include here.
Lets instead take an example of one of our clients who of course shall remain nameless. The lady in question came to the clinic reporting severe pain in both hips. She had been told by two orthopaedic surgeons that she needs both hips replacing immediately. A little bit more questioning and digging around and we discovered that she had not experienced any pain at all until she had that diagnosis! The brain is a powerful thing. Whatever the mind believes the body perceives.
What was even more interesting is that over the course of the treatment we further identified that the lady was nagged by her mother, in a loving way of course, from a young age, to be careful of her hips or she’ll get arthritis. This lead to a change in her walking posture (she openly says she walks like a T-Rex!) and ultimately that fear of the issue has in many ways lead to the condition coming to the fore.
So how did she fair? Well she was pain free within 4 sessions. Granted her range of movement was still not perfect. But she was moving less like a dinosaur and could go about her everyday tasks pain free. Still think cartilage causes the pain?
Fear is another factor in the amount of pain people feel. At the clinic one of the most common phrases we hear “I’m afraid of making it worse.” It’s safe to say that in all but the tiny minority of conditions (think along the lines of broken back, broken limbs!) the you won’t make things worse. In fact research suggest it’s quite the opposite.
Humans are designed to move. We are not designed to be static. If you put a muscle in short position (adaptive shortening in Physiotherapy speak) it thinks it should stay there and maintains that short position. Picture sitting in a slumped or tense position afraid to move for fear of making things worse. It’s much more sensible to get around and do as much as you can. Give us a shout and we’ll tidy things up for you before they get worse and give you the confidence to do what you want! As you soon as you let the state of your body affect the quality of your life it’s quickly downhill from there.
So if it’s not mechanical wearing that’s the problem, what leads to the cartilage wear and tear? This is the really interesting question. Here’s one idea.
It is widely accepted that with increased stress we do not breath as calmly and therefore as effectively. This leads to a reduction in our oxygen levels in our cells which affects membrane potential and therefore the quality of the cells in our body. This leaves us a bit more acidic than we should be and maybe it is this process which eats away at our cartilage? (This is a very quick summary of a very complex idea we will return to in future Blogs).
So is arthritis as prevalent and incapacitating as we’ve been lead to believe? Our view is a firm no! We’re hopeful the research will continue to catch up with clinical practice.
Should you be worried about arthritis and it’s potential affect on you quality of life? Definite no. Another large piece of research conducted some year s ago now discovered that the most at risk from “wear and tear” were elite athletes and the clinically obese. The rest of us in the middle are usually fine. This may point back to an old mechanical view of arthritis but if we consider the amount of “stress” on these individuals bodies then our newer model still fits quite nicely. I would also question whether the research was done looking at the wear on the joints or reported pain.
So you’re more likely to have “arthritis” if you’re an Olympian or eat too many Olympic Breakfasts! But that doesn’t matter, because even if you are, we can still make you better.
So does arthritis really exist? In our view no. It is usually part of the whole presentation of someone with pain in and around a joint. It is unusual for it to be the major factor in the pain that people feel. In the majority of cases once you simply get everything else working as it should do any joint pain just disappears.
Now we’re not claiming to be Jesus here! And sometimes an operation is the correct way forward. But equally we’ve seen many people who’ve had an operation which has not impacted the symptoms or even made them worse. Why not get it check out first and spare yourself the aggravation. You know where we are and we’d love to help or info@BrightonSportsTherapy.co.uk.