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The Carousel of Joint Degeneration: Osteoarthritis Part 1



Terms:


hypertrophy: growth of tissue

atrophy: diminishment of tissue

pathology: etiology (cause and origin) as well as nature of a disease process

aneural: without nerve supply

avascular: without blood supply



The process of osteoarthritis is multi-factorial and cyclical in nature. This is both a bummer and extremely good news.

It’s why we haven’t found a pill or injection that works to control the cycle of degeneration, and why we likely never will. Working with osteoarthritis requires a multi- faceted approach- movement, diet and nutrition, lifestyle and educational changes. Let’s flush out some of the education concepts so we can learn to work with our arthritic changes more autonomously.


Multifactorial Vs. Genetics

Please note that genetic markers play a part in the development of osteoarthritis (OA)- but the amount of involvement seems minimal and is not well understood. (The exception here is the people born with hip dysplasia). We have many more lifestyle choices that affect the development of OA.


When I hear people say, “my mom had a bunion, my grandma had a bunion and I have a bunion” I am struck by the lack of connection with the true multifactorial nature of the disease. Similar to cardiovascualr disease, OA can have genetic predispositions, and also similar to cardiovascular disease, you can really influence the disease process through your own behaviors and beliefs.

Recall that how we move (how we stand, how we walk) is socialized- we learn to move and speak like our parents and siblings and family because they are our social network. It is time to move away from blaming bunions on genetics, to understanding how to control the biomechanics of your own body.


When thinking about arthritis, it is important to keep in mind the different types of arthritis, and their different causes:


- Gout: caused systemically by excess uric acid within the body, along with genetic propensity

- Autoimmune Mediated Arthritis: Rheumatoid arthritis, lupus, psoriatic arthritis, juvenile idiopathic arthritis. These conditions are caused by an autoimmune issue of not totally understood origin

- Osteoarthritis (OA): due to mechanical stressors on the joint that change the structure of a joint over time (wearing thin cartilage, stiffening joint capsule and causing hypertrophy of bone).


Be clear, what most of us have and what I’ll be exploring is related to osteoarthritis specifically.


Please think of mechanical stressors are physical forces- think back to your days in physics- forces acting on your joints such as compression created by gravity or caused by muscular contraction, forces created by the ground as it interacts with your feet and rotational and shearing forces created by our movement.

Osteoarthritis is like a Carousel:

Every pathology (disease process) we see has a certain nature or flavor to it. A bone fracture is like falling off a cliff- you are fine one moment, and the next you are in a cast, immobilized. You have a slow climb back to recovery, and then at a certain point, you are mostly “normal” again.


It is easy when you are not familiar with pathology to think of disease like a light switch- either you have it or you don’t.

Osteoarthritis is like a carousel. It is cyclical in nature. In this way, it is more like cardiovascular disease or Type II diabetes. You may have flares when your sugar or blood pressure is out of control, but you can bring it back under your control through behaviors and actions you take.

Though you may not be 100% in control of getting on the cycle of arthritis in the first place (because of past injuries or movement predispositions) you can control the speed with which the cycle goes, and how long you stay in it.


Within the lifetime of say, a knee joint, someone with OA may experience 100s or even 1000s of arthritic degenerative cycles before the joint surface becomes so degraded that a surgeon recommends a joint replacement.


Movement Extremes (Behavior and Belief) Seem to Exacerbate OA:

In the clinic, I see two types of folks who develop osteoarthritis most often:


1) People who have moved a lot in their life and have not spent time improving their biomechanics (understanding the forces they are subjecting their bodies to as they move)

2) People who have done very little movement in their lifetime- or who only move in a certain way, in a specific direction.