What is Arthritis?

Arthritis and Joint pain are common problems. Many people have been told they have arthritis, but don’t know what that means exactly. Arthritis simply means inflammation in a joint. The -arthr part means joint and the -itis part means inflammation. To begin with, there are many different types of arthritis (plural=arthritides). There are metabolic arthritides such as gout where uric acid builds up to form crystals that damage the joint. There are autoimmune diseases like rheumatoid arthritis that tricks the body into attacking the connective tissue in joints. Joints can also develop arthritis if there is an infection in the joint. However, the most common type of arthritis is osteoarthritis. This is usually what a doctor means when he/she tells you that you have arthritis.

Osteoarthritis is the most common Type of Arthritis

Osteoarthritis (OA) is nicknamed the wear-and-tear disease of the joints. The -osis part indicates degeneration (deterioration, destruction, and dysfunction). Osteoarthritis is the most common cause of arthritis and joint pain. OA is known by many other medical terms such as: Osteoarthrosis, degenerative joint disease, degenerative arthritis, degenerative arthrosis, arthrosis, and spondylosis.

This kind of arthritis & joint pain is the result of excessive and repetitive damage in the form of tension, friction, and compression forces. In turn, the stress causes degeneration of the elements of the joint that keep it moving smoothly. The damage worsens over time. As a result, a person develops stiffness, pain, swelling, and those grinding/clicking/popping noises called “crepitus”. Osteoarthritis is often found along side other problems related to excess physical stress like degenerative disc disease, herniated discs, tendinitis, and bursitis. Each joint in the body is susceptible to OA. However, as you can imagine, it shows up more often in joints that bear more weight and stress.

Causes of Arthritis and Joint Pain

Poor Joint Mechanics

Osteoarthrosis develops due to poor joint mechanics. Every joint in the body is meant to be in a certain position and move a certain way. As the two joint surfaces move relative to one another, they are meant to remain congruent, or flush against each other. Imagine a ball and socket joint. If the ball is not centered in the middle of the joint as it goes through it’s motions, then the ball rides up on one side of the cup grinding and causing excessive friction and stress. This damages the joint and leads to further changes.

Muscle Imbalance

Alterations in the balance of the muscles and/ or ligaments around the joint create a problem. This can be from an injury or a bad habit like improper posture. Muscles are important because they keep a joint centered in the correct position as the joint goes through it’s movement. If the muscles are not balanced, then the joint capsule becomes stretched and altered. These joint capsules are made up of ligaments that connect one bone to another. It is composed of fibrous material that ensures that the bones are held together tightly and keep the bone from sliding too far in any direction.

Ligamentous Changes

If you have ever heard of an ACL tear, then you know that this important ligament keeps the knee from shifting forward. If it is damaged, the knee becomes unstable because there is nothing to keep the motion in check. These ligaments/joint capsules can actually become stretched and warped with repetitive damage. The capsule will be tight and shortened on one side and stretched long on the other. If this happens, the ligaments no longer do their job and the joint rides out of place. A joint out of place experiences an excessive amount of stress and microdamage. If left uncorrected, these types of abnormal joint mechanics will lead to arthritis and joint pain.

How is Osteoarthritis Diagnosed?

Typically a doctor will diagnose you with osteoarthritis by taking an X-ray. Findings on X-ray include:

• Loss of joint space (which indicates erosion and damage to the cartilage).
• Pieces of bone loose in the joint.
• Bone spurs and enlargement of the bone around the joint.
• Alteration of the alignment of the joint.
• Thickening of the bone right next to the joint.
• Deformity of the joint.

Doctors may use the term “bone-on-bone” when it gets bad enough that there is no more cartilage.

Does Aging Cause Arthritis and Joint Pain?

Most important to remember is that arthritis & joint pain is the result of excessive wear and tear. Many of my patients will say something like “Well Doc, I’m just getting old”. My reply is usually to ask if one of their knees is older than the other. Because, if arthritis & joint pain is truly due to age, then why is it that one side is more often effected?

It is true that the older a body is, the more opportunity for damage. The longer we live, the more likely wear and tear will result in arthritis & joint pain. On the other hand, time and old age by itself does not produce osteoarthritis. It is in fact the alteration of the mechanics of the joint that produce this arthritis and joint pain. There has to be a problem with the joint first and foremost. Then this problem finally culminates in osteoarthritis.

Attributing arthritis & joint pain to old age is associated with falsely accepting that there is nothing that can be done about the problem. Thus, some patients do nothing. However, this thinking is erroneous. It may be true that more advanced osteoarthritis is harder to treat, but this does not mean that the problem should be ignored. In the medical world, this mind-set is called “taking on the sick role”. This is essentially giving up and resolving to do nothing. Don’t take on the sick role! If you decide to do nothing, it will continue to get worse. It should be remembered that there are 90 year-olds out there doing triathalons.

Does Surgery Help Arthritis?

Surgery can help some people with advanced arthritis, but they should not expect to be 100% afterwards. It is much better to nip osteoarthritis in the bud rather than let it get so bad that the only realistic solution includes surgical intervention. Once you have a surgery, things will never be the same. The biomechanics in the area will permanently be altered, not to mention the risks inherent to surgery or the recovery time or the expense. 

There are several different types of surgery for more advanced cases of arthritis and joint pain. Major joints can be replaced like: shoulder, knee, hip, etc. The spine and smaller joints have no options for surgical replacement. Some surgeries aim to clean up the joints taking out bone spurs, fragments, or possibly disc material. If the joints of the spine are too far gone, surgeons will often elect to do a fusion using hardware. Fusion surgeries often have poor outcomes.

The goal should be to not let it get to the point of surgery. That old trick knee or a past accident/injury can be the beginning of osteoarthritis, but it doesn’t have to end in full blown arthritis & joint pain. Even if the osteoarthritis is advanced, and even if a surgery needs to be performed, the underlying dysfunction will still persist. What caused the arthritis & joint pain is still there and needs to be corrected, or the problem will continue/reoccur or even spread to other areas. So, you are going to have to address this no matter which way you go. It’s better to correct it before you have to have surgery.

Treating Arthritis and Joint Pain

How do we fix this? Well, it’s not easy–you are going to need an expert (and I’m not talking about a personal trainer). It all comes down to rebalancing that joint: this includes the muscles and the ligaments. The first thing we need to do is get the tension of that joint capsule equal again. We need to stretch the shortened side. This is the side(s) where there is a restriction in the range of motion (ROM). This can be done with Chiropractic care in the form of manipulation aka “the adjustment”. The next thing we need to do is stretch the tightened muscles. This can be done by the Doctor of Chiropractic or by the patient themselves; preferably a combination of the two.

This takes time, but once the ROM has been improved and balanced, it is time to strengthen the correct set of muscles around the joint. If you try to strengthen the muscles first without normalizing the ROM, it is possible that you will be doing more damage by reinforcing the bad pattern. It would be like running after you sprain an ankle. The capsule/ligament fibers shrink up over time if they are not always being stretched out.

Once muscles are correctly stretched and strengthened, the joint will remain centered and give the ligaments a chance to heal. So if the muscle does its job keeping the ROM of the joint in check, then the ligament/capsule has the chance to shorten back up to it’s normal length thereby reestablishing its ability to correctly stabilize the joint.

How long does it Take to Treat Arthritis?

This process takes some time, so it should be viewed as a coordinated effort between the physician and the patient working as a team. Furthermore, both the Chiropractic Physician and patient should be patient, expecting progress to happen slowly over time: especially if the problem has existed for a long time. It is also important to understand that pain is not a good indicator of when the problem has been fixed, but rather by the ROM and balance in the joint.

It typically takes quite a bit of dysfunction and damage to start producing painful symptoms. So when the treatment alleviates the pain, this is only a portion of progress. The joint is still dysfunctional. If the joint does not get properly balanced and stabilized, then the condition will return. This will result in a significant loss of progress. Don’t throw away your time and money. Finish the treatment just the way you would finish out your antibiotic even if you are feeling better.

Where to Get Arthritis and Joint Pain Treatment

If you have arthritis, or a painful or stiff joint that isn’t getting better, or if you have had a recent injury, then please seek out a physician who is a biomechanical expert like a Chiropractor. This is our bread and butter. A Chiropractor treats arthritis & joint pain like a dentist treats tooth decay…it is our main work. If you have any questions, you are welcome to contact our South Tulsa clinic. Consultations with our Chiropractic Physician are always free.