As adults, I am going to venture out and say all of us, at least somewhere in our body, have adhesions or restrictions within a joint capsule. Or two or three. You may not know it. It is normal. Tissues stick together like nobody’s business. This stickiness increases as we age due to changes in fluid and an increase in friction between tissues (such as the fascia and the hyaluronic layer).
During arthritic flares, these adhesions can be made more prevalent by inflammatory chemicals changing the stiffness and quality of the joint capsule.
When the deep ligaments surrounding the joint (the joint capsule) have developed adhesions or stiffness in a specific area, an osteopath or orthopedic manual physical therapist can help identify where that adhesion is, and restore length to specific tissues.
This practice is the basis of a technique called “joint mobilization”. Only two medical disciplines learn and can apply this technique- osteopaths and physical therapists (i.e. what chiropractors do is different).
This technique creates passive accessory motion of the joint (we call this PAJM for short), and can only be done by a skilled and licensed provider above. No pain is involved.
This strategy is analogous to using a foam roller or massage to reduce adhesions in fascial tissue. The adhesions or restrictions in the joint are specifically and mechanically stressed to restore their optimal length.
Though capsular mobility is a very technical treatment we cannot perform for ourselves, we can learn to work with the more superficial facial systems, which in turn assist the overall tension in our system. Cupping and foam rolling our fascia is a wonderful tool to put in our musculoskeletal self-care box. I have a workshop on foam rolling here if you need guidance.
Work these three steps. Have a plan around them. It can be helpful to make a list, make a spreadsheet if you are so inclined, keep all your tools (ice pack, foam roller, ottoman) c lose by so you can reach for them without thinking too much.
Having a Robust Game Plan:
From a practical position, if I was interviewing someone with OA in the clinic and they said to me-
“ I have OA and degeneration but I also have a good plan for it. I work regularly to control inflammation when I get it using P.R.I.C.E and lymphatic drainage. I see a provider monthly (or quarterly) to help with my capsular adhesions. I also check in with a provider quarterly to assess my biomechanics and make changes in my home exercise routine. I avoid flare ups by using the checkbook theory – and making sure I have enough to be able to do what I love.”
I would be able to say "Fantastic. You are taking all the right measures to be proactive and stay ahead of this as best you can." Unfortunately, so much of my convo in the clinic is spent trying to convince folks they need to get involved in their own care. So many of us have relegated our orthopedic health to someone or something outside of our control (a hands on guru, a medication, a surgery). If you have been thinking it is time to get more involved- it is!
And if getting involved sounds like a lot of work- it really is! But nothing rewarding comes without our own sweat equity and courage.
How important is the longevity and use of your musculoskeletal system? How important is the functionality of your right shoulder? Your left knee? Your right thumb? And remember, never underestimate the importance of the big toes!
Once you have tools, I highly recommend writing them down. Collect names of your favorite doctors and providers. Keep a file. If you are excel savvy, make a spread sheet.
Take account of what you are doing for each of these actionable areas:
- Staying on top of your biomechanics (strength and mobility checks included)
- Easing your inflammation on your own
- Providing space in your joint capsule (adhesion reduction)
Think Like a Dentist
Dentistry is a great model for longevity in bony tissues. Dentists have trained us well to get regular cleanings, check-ups and assistance when we need it from the time we are young. My new (and wonderful) dentist recently said to me- " I want to guarantee your teeth until you are 85". Perfect! That is what I want! And that is what I want for each of you as movers- as physical beings.
We all spend a good 10 minutes caring for our teeth daily, on top of a couple of sessions with a dentist each year. Why don’t we treat our skeletal and muscular system with at least as much care?
If you are working with osteoarthritis, please see your MD and work with an orthopedic PT to establish a plan for yourself.
Your plan should be, like 10-20 things you can do, from avoiding certain exercises, to progressing other muscle strength, to learning signs of inflammation and how to treat it yourself.
Happy (game planning and) Moving!