Arthritis Physiotherapy Treatment: Can Physio Help Arthritis?

Does Cartilage Cause Arthritis Pain?

If cartilage’s primary function is protect the joint is it not normal that it would wear over time over the course of our life? Cartilage itself has very few pain receptors. Muscles have loads. Our adipose (fat) layer may have even more sensory cells if new interoception ideas are to be believed.

If we look at the facts of physiology it would suggest that the most nociceptors (pain receptors) lie in the joint capsule (the bit that keeps the lubrication in the joints), ligaments, bones and their wrappers (periosteum), fat and around the blood vessels serving the joint. Not the cartilage itself.

Also, excitingly, there’s a lot we can do to influence joint capsules and ligaments as they are entirely continuous with muscles. Cartilage is harder, but not impossible, to influence.

In our experience arthritis is usually just a label to explain pain in a joint. Nearly all conditions can be improved if not ‘cured’ so how could that be if all the pain is coming from the cartilage which can’t feel pain in and of itself.

You could say inflammation and there would be an element of truth in that. When we are more inflammatory we do feel more pain. There are many reasons why we might be a bit more inflammatory. Perhaps cartilage wear is one. But we’re also more inflammatory with increased stress levels, poor diet, excess alcohol intake. All of which we have the ability to influence.

Equally arthritis is not thought to be inflammatory. N.B. Very important note here is that for the purpose of this article I refer to arthritis as a short version of osteoarthritis. Not rheumatoid arthritis which is very inflammatory. That said, the same principles apply regarding causes of increased inflammation above and the same principles we talk about here can help rheumatoid arthritis. Just not to the same level.

The pain from arthritis is thought to come from the structures outside the joint we mentioned above – the joint capsules, muscles, ligaments, nerves and associated fascia (connective tissue). If we can optimise how these structures function using whole body physiotherapy techniques then we will normally see an improvement in the pain felt around the joint.

Probably the easiest example of this is the knee. The knee cap simply exists to “improve the mechanical advantage of the quadriceps.” In plain 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 often see an immediate reduction in pain.

What Does The Physiotherapy Arthritis Research Say?

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 might explain why clients with confirmed arthritis can have anything from severe pain to no pain at all.

The fabulously titled Yet More Evidence That Osteoarthritis Is Not A Cartilage Disease suggests that the ligaments around the joint are a more effective predictor of the pain than cartilage wear. Backing up the point we made above.

Do You Believe Arthritis Is The Problem?

This is where the psychology of pain 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 an old injury or sub-consciously guarding a trapped emotion, issue or event.

Let’s take an anonymous example of one of our clients 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 as a child 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 significantly contributed to the problem.

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. We see this quite consistently with later stages of arthritis – usually the pain is relatively easy to ease or remove. Mobility can be trickier. Perhaps severe cartilage wear and tear in some ways limits movement in the joint?

What Can Physiotherapy Arthritis Treatment Do For You?

So what can physiotherapy for arthritis do for you? Well hopefully quite a lot. We work with our clients to find out what their current abilities are and look to progress them to claw back that all important quality of life.

We discuss how to progress levels of activities gradually using knowledge of adaptation to find the right pace for each individual person. Always working towards what their ultimate goal is.

Then there’s the more technical bit. Why does this person in front of us feel pain in that area? This has to be completely unique for everyone. We look to unravel why there is more load, or sensitivity, in the joint that you feel pain.

Let’s expand further on our knee example from above. This is a little technical (hopefully not too much so) so let’s use a picture first to set up the explanation. Below is our version of the Anatomy Trains deep front line.

We spoke about tight quadriceps but why are they tight? Possibly from inactive hip flexors (psoas and iliacus). This maybe from sitting too much.

It could be from the fear of the pain in the knee. Or both. It could from an old sub-conscious limp from an old injury which was fine to a point but when your stress levels increased or you started using it more you started feeling it more. Initially you may have pushed through the pain which increased the sensitivity but no you feel unable to too fearful to do so.

It may be that you are using you inner thigh muscles (adductors) more to compensate for sub-optimal function in the hip flexors. These muscles are directly linked to the knee joint capsule. Seeing as the joint capsule is thought to be the main cause of pain in joint issues then we often see correcting this patterns very helpful indeed.

Another further possible reason as to why releasing hip flexors can be so affective for knee pain is summarised nicely by our picture below of the path of the femoral nerve. You can see that the nerve that gives sensation in and around the knee originates within the hip flexors. Perhaps this is why releasing the hip flexors can help knee joint pain so much.

The example above is for the knee for two reasons. One, it’s the most common joint we see affecting by arthritis and wear and tear. Two, it’s an easy one to explain with the pictures I have available. But similar principles apply no matter which joint we’re trying optimise.

Not everyone may be lucky enough to afford an individual physiotherapy treatment for arthritis so here’s some things you can do to start to help yourself.

What Can You Do To Help Your Arthritis?

1. Move

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. If your pain starts to build at a certain point keep going to that point. Most people will gradually be able to go further. If your pain is bad to start with but gets better as you get going find out what distance is best so you don’t feel worse after and equally it doesn’t make it harder to get going again next time.

2. Don’t Fear Making It Worse

We often say at the clinic the only thing that makes conditions worse if the fear of making them worse! Fear makes us more tense which increases sensitisation throughout the body, especially the joint you have problems with. Try to walk as relaxed as you can even if you do feel pain. Try not to tense in expectation of the pain and remember to breathe. One of our mantras is that pain is not damage. Just because it hurts doesn’t mean you are making it worse. It’s important to remember this. Hopefully the complexity of this article will help you understand that the pain that you feel isn’t necessarily coming from where you feel it.

3. Be Less Inflammatory

As we mentioned above inflammation is thought to be a strong factor not only in joint pain but any pain throughout the body. There are many things we can do to affect our background inflammation levels. Reduce alcohol levels. Improve our diets – there are some diets specifically designed to reduce inflammation. Working at better managing our stress levels will also reduce our background inflammation. Do what you know works well for you to relax and do more of it. More on that below.

4. Do Impact Exercise

This may sound counter intuitive if we’re still thinking arthritis is a caused by wear on cartilage. Indeed if you are in significant pain I would strongly urge you to seek professional guidance before increasing your impact exercises but this research here concluded that ‘Progressively implemented high-impact and exercise gives favourable effects on knee cartilage quality and physical function in mild knee osteo-arthritis.’

5. Lose Weight

When we do our treatments at the clinic we are looking to optimise load through the joints. A simpler way of doing this than what we do is to lose some weight as this piece of Australian research concludes.

6. Well Being

Look after ourselves better. Are we taking to time out to look after ourselves and truly relax? Or are we running, or limping, from one life stress to the next. The modern world is busy. Most of us are guilty of neglecting our own needs and prioritising others. When we’re in pain it’s important to redress that balance. Here’s some more well-being ideas of how best to squeeze that downtime in.

Conclusion On Arthritis Physiotherapy Treatment

Hopefully the above has given you ideas and inspiration of what you can do about the pain in your joints that your fear, or have been told, is arthritis. We’ve seen so many people move on from a restricted lifestyle caused by joint pain. We’d love you to be another one.

It’s important to note that in some cases an operation is absolutely the right way forward but we urge people to try all available options before going under the knife. If you’d like to speak to us regarding your joint pain please give us a call on call us on 01273 921831 or email info@BrightonSportsTherapy.co.uk. and we’ll be happy to talk through your specific condition and how it might be helped.