Arthritis is often looked at like a death sentence.
And is the default diagnosis given to people in the absence of any “other” findings.
Let’s try to clear up the confusion and try to talk you off the ledge.
Note: I’m talking osteoarthritis (OA), not rheumatoid arthritis (RA). Although, they are probably more similar than we think.
What is arthritis?
Arthritis is a disease process that affects joints and usually involves the presence of acute or chronic inflammation. It comes with pain (obvious) and
joint degeneration
swelling
decreased range of motion
It is often thought of as “wear and tear” and described as “bone on bone,”
Client stories and research challenges the “wear and tear” concept
Let’s understand what cartilage is first:
Cartilage is the connective tissue that covers the end of bones. Its job is to reduce the friction between the bones and help absorb shock.
There’s 3 types (source)
Hyaline - most common and the one involved in OA
Fibrocartilage - thicker for things like the meniscus or disc in the spine
elastic cartilage - parts that need to move like your ears and voice box
I’m gonna talk mostly about Hyaline cartilage, aka “articular cartilage”
About 90% of articular cartilage is the extra cellular matrix (ECM). The ECM is mostly Type II Collagen and aggrecan (a proteoglycan), and other small amounts of other types of collagen, proteoglycans, and glycoproteins. (source)
Where does it go wrong?
There’s some underlying mechanisms of arthritis that are not fully understand (I.e., I don’t know them), but in a nutshell the ECM’s job is to manage the environment for cartilage repair.
After joint loading, specific processes occur that help to restore that environment (homeostasis). Conceptually no different than when you cut your skin and the body goes through the normal process to heal the cut.
Cartilage doesn’t have its own plumbing system, so the ECM relies on loading/movement as part of the process. Loading the joint pushes all the fluid OUT of the cartilage, and then aggrecan acts like a sponge and brings water back into the joint to restore the shape.
Some thoughts are if the water/fluid is left IN the joint, the environment becomes toxic and the chemical cascade of joint degeneration starts (source)
To summarize this part, damage to the ECM beyond a certain point or damage to the above mentioned process can lead to irreversible damage to the joint, aka
“wear and tear” and “bone on bone”
Like I mentioned above, client stories challenge this notion.
I’ve had several patients doing “pre-hab” for a knee replacement for one knee tell me
“My other knee is actually worse, bone on bone, but this one hurts more.”
This is an overuse thing more than an arthritis thing. They are physically weak (all over) and end up compensating with the “good” leg, overusing it, and leading to pain.
Here’s 2 specific profiles from clients on opposite ends of the spectrum after a knee replacements
“I played college football so my knees are wrecked”
“I’ve never played sports and mostly just sit and do crafting”
This tells you there’s a sweet spot.
How do I know if it’s bad?
So arthritis IS bad when the degenerative joint changes actually cause joint limitations, meaning you have LOST motion in the joint. Some examples are
your knee doesn’t go straight
your hip can’t flex or rotate
your spine motion is limited or there’s narrowing affecting the nerves
This stuff affects your FUNCTION. Hard to walk, sit, bend over when your actual knee, hip, or spine physically cannot do it.
How do I avoid surgery in the future?
So the only cure for advanced OA is surgery, where they have to replace a joint (knee, shoulder) or fuse joints (spine, ankle). You have to weigh the pros and cons of that with your surgeon.
You can always reach out to us if you have concerns, I always think you should exhaust all options before surgery.
Otherwise the normal things
be physically active
be a healthy body weight
have appropriate muscle mass
get good sleep
Based on what we talked about above, joint health is related to managing the fluid in the joint, and you can
Use my client examples above as precautionary tales
The college football player was too hard on his body and the ECM was beyond repair, regardless if the process to repair it worked (it probably didn’t work)
The lady that did crafts NEVER let the process work. No physical activity, so the water in the joints just sat that and created a crappy environment.
How do we flush out the water? Exercise.
So, score one more for the exercise people. If you’re a subscriber you already have our exercise programs.