Thursday, March 5, 2015

Understanding Joint Wear & Tear

By Dr. Greg Lusk, DC
Osteoarthritis (OA) is a frequent source of pain and stiffness that brings clients into healthcare offices.  In fact, it is the most common type of arthritis, affecting 1 in 10 Canadian adults.  It occurs when the cartilage that covers and protects bones breaks down and wears away, narrowing the joint and making it less smooth.  Eventually, this may lead to the formation of bone spurs, ligament laxity, and weakening of the muscles around the joint.  It is most common in the weight-bearing joints of the hips, knees, low back, neck, big toes, as well as the fingers and thumbs.
Also known as degenerative joint disease or degenerative disc disease (specifically in reference to OA of the inter-vertebral spaces in the spine), its prevalence increases with age, with a notable increase after age 70.  Other risk factors include a family history of OA, being overweight, or a previous joint injury (e.g. knee ligament injuries).
The diagnosis of OA is made via a combination of a patient's history and symptoms (e.g. morning stiffness lasting 15-20 minutes), physical examination of the joint, and by obtaining an x-ray of the involved area.  It is important to note that x-ray findings and symptoms don't always go hand in hand, where a greater degree of degeneration does not always equal more pain.  As a result, it is important to treat the patient and their unique clinical presentation versus the x-ray findings alone.  This illustrates the complexity involved in the "experience" of pain as structural changes are not the only factor.
When it comes to managing OA the goals of treatment are to control pain and maintain function.  You cannot conservatively reverse the structural changes that are already present but you can work toward slowing its progression and the need for more invasive treatments.
Daily range of motion exercises compete with the progressive stiffness of OA and strengthening exercises are important to maintain muscle tone and active stability around the joint.  Together, these activities serve to improve joint loading patterns to minimize stress on the affected joint(s).  Aerobic exercises are also valuable as they increase energy and assist with weight management.  Furthermore, all forms of exercise have the added benefit of releasing endorphins which have a pain-blocking effect on the nervous system.
Making lifestyle modifications, such as pacing strenuous activities, using assistive devices as needed, and making healthier dietary choices goes a long way.  As stated, excess weight is a risk factor and losing even 10 pounds can create a noticeable change in symptoms.  80-90% of hip and knee replacement patients are either overweight or obese so controlling weight deserves attention.
Manual therapies including soft tissue techniques, joint mobilization and/or manipulation, therapeutic modalities, and acupuncture may assist with decreasing pain and stiffness.  Medications, particularly painkillers and anti-inflammatories, are also commonly used to manage the symptoms of OA.  Each of these approaches should be discussed with a healthcare practitioner so you are informed of the risks and benefits of the therapy.
If your pain and function due to OA is not being successfully managed by the above options, a referral to an orthopaedic surgeon may be necessary to discuss more invasive treatment options, such as joint injections and surgery.
With OA, the concepts of "motion is lotion" and "move it or lose it" hold true.  Seek professional advice if needed to learn your limits and develop a management plan.  This article is for general information purposes only and is not to be taken as professional medical advice.