Arthritis-What exactly is it?

The term arthritis is thrown around a lot at the moment. The important thing to remember is that there are two main types of arthritis with very different causes. Rheumatoid arthritis (RA)  is a painful autoimmune condition in which the immune system will attack healthy areas of the body by mistake and can cause painful swellings and inflammation usually around the joints. If somebody suffers with rheumatoid arthritis it is likely spread through multiple joints and not isolated to one in particular. A lot of people will say it is genetic however genetics will not certainly cause instances of rheumatoid arthritis more so genetically encode the body to have adverse reactions to certain stimuli which can cause RA. If somebody suffers from RA there are a number of things which should be considered including but not limited to endocrine system function, environment, habits, bacterial and viral infections etc. The key understanding here is that the cause is autoimmune and not “biomechanical” or “wear and tear”.

Osteoarthritis (OA) is different in the fact it is more so caused by “ wear and tear”. Unfortunately the narrative has dictated that this is just a “Part of life” or “ because "I'm getting old” when the reality is that a number of people live well into their 80s without ever having major issues with OA. OA will affect the joints and is characterized by degradation of cartilage and grinding pain and sensations usually affecting the knees, hips and lower back facet joints. This type of arthritis is present due to degradation of the health of the joint. Some potential causes can be improper nutrition and overall health, obesity , injury but all of these and the majority of the other risk factors associated with OA have one thing in common which is a change in the movement of the joint. Joints are by their nature designed to be free and flowing. If you think about the way a toddler moves; There is nothing rigid about their movement. It is unorganized, uncoordinated and unsteady. But the joint allows this motion to happen until the proper neuromuscular engrams are encoded with their movements and they can begin to engage their muscles and coordinate bipedal movements and obtain stability. 

What is happening in the joint?

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To put it simply , the tension in the joint and the change in orientation of the bones in the joint has caused a change in the way the joint moves. The space between the bones is narrowed causing friction between the cartilage and can cause degradation. Inflammation in this area can cause inflammatory responses in surrounding tissues of the capsule and synovial membrane which can trigger a further reflex across the joint tensioning it further. Wolff's law will dictate that calcification of this bone may happen and lead to ankylosis and spurs as well calcification of tendinous structures surrounding the joint. 

So what causes the altered joint forces which can degrade a joint?

The obvious start is a previous injury. In a person who has suffered a traumatic event to the joint there will have been an instance of the trauma reflex causing an increased tension across the joint. The body does this as a protective mechanism to prevent any further damage from happening to the joint. In short the muscles will shorten , the fascia tighten and movement be impeded. Other variables then include adhesions in tissues from potential bleeding from the injured site, Trigger point formation in the shortened muscles etc. Any damage which may have happened to the joint can have effects in the way the joint orientates. Now when we apply this to the theory of biotensegrity in which the body moves and is held together by tensional and compressional forces through myokinetic chains of muscles and fascia ; we can see there can be a knock on effect to this. Say a knee has been injured in a collision by an athlete on the field of play. The quadriceps femoris may tension in relation to this impact along with the hamstrings and musculature in the groin which now alters the proprioception in the hip joint. If not properly rehabilitated or restored this altered proprioception in the hip can cause abnormal joint forces i.e the way the femoral head will move within the acetabulum. Over time because now the joint is abnormally positioned ( even if only slightly) this can begin to cause friction within the joint and altered force transmission which can begin to inflame the joint surface as well as the surrounding area. Once inflammation has set in then this can worsen the reflex in the joint and further tighten and alter the joint forces. 

Is a previous injury the only cause of OA? No.

So we examined why a previous injury can alter joint forces by changing the tensional relationship across the joint but many things can change the tensional relationship in the body. Habitual motor patterns can be learned and reinforced with every movement. Think about someone who repeatedly uses one arm more than the other during their working life, maybe a factory worker, tradesperson, dentist or architect; it doesn't really matter. If in your daily life you perform repeated actions with a joint the possibility is there. Think about the 9-5 office worker who plays 5 aside every week; coupling the effects of a hunched over working environment with such an athletic form of cardio can hasten the effects of underlying or brewing incorrect or non optimal forces in the joint. 

Now take someone with foot pathology, someone may have “high” , “fallen” “weak” arches basically all meaning that the foot will not transmit force correctly up through the body when the heel strikes the floor. The Foot is a fascial spring and is designed to be flexible and spring-like . But imagine through years of poor footwear that the arch in the foot has degraded and the force is being unevenly distributed through the body from the ground up, something as simple as an over pronation can internally rotate the tibia and femur and even cause changes into the pelvis which will change the orientation of the joint and over time the same thing can happen.

Something else to consider is ligamentous laxity. If the ligament is lax then the muscles will splint to maintain stability across the joint in an attempt to “tighten” the joint. 

So what are the early signs and how can we approach it ?

The important thing to remember is that anybody has the potential to develop OA and the majority of us will experience some form of joint degradation in life. But to notice early signs and correct postural deficits can drastically change the severity and the onset of chronic inflammation in that joint if addressed. The signs people Generally feel when joint inflammation has set in is 

• Heat.
• Grinding and rubbing.
• Aches after long periods of sitting down.
• Stiffness.
• Reactions to temperature (pressure) changes.
• Fatigue 

To prevent these symptoms from happening it is too simplistic to say everyone should fix their posture and not wear shoes because this is not feasible. Some things to ask yourself are 

• Have I had a previous injury in a joint ?
• Are some areas of my body stiffer than others?
• Do I have aches developing in random areas of my body?
• Do I exercise enough and with a suitable amount of variation?
• Is my posture hunched and bent over or do I stand too tall?
• Do I have lower back pains or muscular and tensional pains in areas of my body?
• Do I regularly get up from my desk and move through ranges of motion?

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While these are ambiguous, all of the above can have a bearing on how the joint sits and functions? Every insult can alter proprioception and posture? Every activity we do can reinforce movement patterns. Improving small aspects of how we move and how we live can have huge implications into the health of our future self.

Osteoarthritis is not limited to ageing people and can strike in younger people also. If you feel you may be suffering with some form of arthritis it is important to get it looked at as soon as possible. Early catching may save someone having the need for a joint replacement surgery.

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