I am guilty of perpetuating a long term belief that osteoarthritis (OA) is caused by excessive “wear & tear” of one’s joints. It made sense in the past. Patients diagnosed with OA had common presentations such as joint pain, swelling, and/or stiffness; and the majority of cases were older individuals and the arthritic joints were interfering with the patient’s physical activities. In the more involved cases, joint replacement was inevitable (which btw, for end-stage arthritic joints is a modern medical miracle and a technology not to be disregarded). The “wear & tear” story made sense because the older we get and the more we use our joints, the more they will “degenerate”, right?
If it were true, then why is it that not everyone over the age of 50 needs a knee replacement? And why is it that not everyone is diagnosed with osteoarthritis as they age?
Perhaps there are other variables involved that affect the progression of OA and the presentation of symptoms. Inflammation appears to play a significant role where in general, it is a process to repair damage throughout the body. Issues can arise when inflammation hangs around longer than is necessary. When there is injury to a joint, inflammation happens and its prolonged presence is what contributes to an accelerated degeneration of the joint soft tissues over time. There is another factor when there is excessive systemic and/or localized inflammation that may affect the joint soft tissues as well. Cases of obesity (high amounts of fat tissue promotes increased levels of inflammatory biomarkers), poor diet, and poor lifestyle habits such as lack of exercise, smoking, poor sleep, poor hydration, and a poor recovery capacity are all possible contributing factors to excessive inflammatory states.
But what if one didn’t sustain a joint injury and still has OA?
There was research by Harrison et al from 1953 that has been gaining some ground the past several years regarding to what is called the Unused Arc Theory, which says that the areas of joint surfaces that get the most use (“wear & tear”) are actually the healthiest aspects of the joint and it is the less used aspects of the joint that contribute to joint soft tissue degeneration. This is literally a case of “use it, or lose it”. The less used aspects of the joint are not conditioned to handle load and when they do, in a case of too much too soon, they tend to “break down” easier and thus stimulating the inflammatory process in the body’s effort to repair it.
Compression: And yet, another perspective for osteoarthritis.
If you have ever seen an x-ray of an osteoarthritic joint, what you will see is a decreased space between joint surfaces. When muscles around a joint are chronically “tight” or have above average levels of hypertonicity, there is a tendency for the muscles to pull the two bones of a joint closer together. This is compression. Compression provides stability and a platform in which force can be produced. Excessive compression affords too much stability, sacrificing the joint’s capacity to move and absorb forces. The key is to find strategies so that the body’s nervous system disengages its need for more global compression throughout the body. Perhaps this is why massage therapy or chiropractic adjustments can give temporary relief for Patients with osteoarthritis. And perhaps what can give a more sustainable relief is re-training the body how to move with greater variability without the need for excessive compression states of the involved osteoarthritic joints (Hint: Individualized exercise).
In summary, perhaps osteoarthritis is more than just a “wear & tear” situation of the joints. Perhaps its causes and thus, progression, are related to the process of inflammation, the “Unused Arc” theory (“Use it or Lose it”), and states of excessive compression for one’s posture and movement profiling. And I am guessing that perhaps addressing one’s diet, nutrition, and life style habits, along with enhancing one’s movement variability through postural therapy and training may help individuals with diagnoses related to osteoarthritis.