On Injuries from Stadion Publishing Injuries: Treating Worn-Out Joints by Thomas Kurz

Information on this Web page is for educational use only, and is not intended as medical advice.
Every attempt has been made for accuracy, but none is guaranteed.
If you have any serious health concerns, you should always check with your health care practitioner
before treating yourself or others.
Always consult a physician before beginning or changing any fitness program.

Osteoarthritis causes wearing out of a joint's cartilage,
either from chronic abuse or from a sudden trauma that unfavorably
affected the joint's mechanics. Whether from hardening of the subchondral
bone (see Note) or from overloading muscles stabilizing the joint, the end result
is destruction of the articular cartilage, pain, and eventually loss
of motion. (Note: Healthy bone under the cartilage has some give,
so compressive forces acting on the joint are absorbed by both the
cartilage and the bone. When excessively loaded, the bone loses that
give; the cartilage alone has to absorb the pressure, so it breaks
down.)

You can have osteoarthritis and not know it. The affected joint may
be fairly painless—just less stable or less mobile than it should,
and muscles around it may be sore often. Or the joint may be painful
too. Destruction of the joint's cartilage can progress quite far without
pain because the cartilage is not innervated (has no pain receptors).
Joint tissues that are innervated, and send pain signals when irritated,
are the fibrous connective tissue of the joint's capsule, the muscles
around the joint, and the bone underneath the cartilage. So, when
the cartilage is worn through, the bone will hurt. Before that happens,
the person may feel pain in some parts of the joint impinging on others
due to poor muscular control (e.g., impingement of the shoulder
joint), as well as the soreness of muscles overworked by compensating
for poor joint mechanics. Eventually the person may feel tightness
in the joint caused by increased volume of the joint's fluid, which
distends the joint's capsule. Distention of the joint's capsule causes
inhibition (switching off) of muscles controlling the joint, and that
leads to their atrophy.

In any case, the pain is easy to deal with—there is a multitude
of painkilling pills and creams. Killing the pain alone does nothing
to stop the arthritic changes in the joint, but it may permit arthritis
sufferers to do exercises that slow down or stop the progress of the
disease.

What concerns the arthritis sufferers most is the damage to the joint's
cartilage and the resulting loss of stability and eventually mobility
of the joint. Yes, at some stage of cartilage damage the joint loses
stability—becomes lax—and seems more mobile (e.g., the knee
may bend too much to the sides or the front). Later on, though,
the joint loses mobility and eventually, in the worst case, may become
fused. How does this happen? While in some spots the cartilage is
worn away, in some others it grows and eventually blocks the joint.
This is not visible on X-rays—not until the overgrown cartilage
calcifies. Before that happens, both the worn-out and overgrown cartilage
can be revealed by MRI. (X-rays of arthritic joints show only altered
position of bones, which indicates the amount of change in the cartilage
but does not show the cartilage itself.)

But back to the arthritis sufferers. . . . Knowing that the cartilage
in the affected joint or joints is worn out, most look for ways to
restore it. They eat supplements, apply creams and ointments, even
have medication injected into the joints.

Of the supplements, glucosamine and chondroitin are shown to do no
harm, but there is little proof of them helping.

No cream or ointment can penetrate the joint's capsule to bring in
the building materials, so the best they can do is lower the pain
and reduce inflammation.

After an injection into the joint's cavity, the cartilage may begin
to grow, but not so selectively. The undamaged cartilage, growing
in the “wrong places,” will grow even more—and the joint
will be further blocked. This excessive, uneven growth may have striking
results in the knee joints: Not only will their mobility be reduced
but also the legs may bend drastically, even more than 45 degrees,
either out (bow legs) or in (x-legs), and in the worst cases one leg
out and one leg in.

Many fall for miraculous medicines, ancient or most modern, from shamans
or from space labs, that promise to selectively grow the cartilage
where it is damaged (and perhaps eat it away where it is not needed).

There are ways of selectively stimulating growth of worn-out cartilage
and removing the overgrown cartilage—but these are not simple
procedures like injections. These are surgical procedures: Both the
prolotherapy to stimulate growth of the cartilage and the abrading
of the excessive growth require arthroscopy. They are not very effective
either; after all, people still get their knees and hips replaced.

So what should you do to restore function of an arthritic joint?

First, stop any exercise or activity that causes pain and inflammation
(pain = damage = inflammation). If an exercise causes any discomfort
in the joint during or after performing it, then it is not good and
has to go.

Second, stop the inflammation. Inflammation damages all tissues of
the joint (cartilage, ligaments, tendons) and causes atrophy of the
muscles stabilizing and controlling the joint. A long-lasting inflammation
can cause permanent destruction of muscles that cannot be brought
back to life by any means (e.g., fatty atrophy—muscle fibers
dying and being replaced by fat).

Inflammation may be stopped by creams, ointments, or gels such as
Voltaren, prescription anti-inflammatory drugs, and in the worst cases
by cortisol injections. Whatever it takes, the inflammation has to
be stopped for two reasons:

• To stop the damage
• To make the patient realize how it feels to not have the inflammation

Some arthritis sufferers recognize a big flare-up but not a low-level,
continuous inflammation. They think that what they feel is normal
and keep on exercising and damaging the joint. After a successful
anti-inflammatory treatment, they realize how the joint should feel
when it is not inflamed, so they can monitor their activity using
that feeling.

Third, restore proper joint mechanics as much as possible. Without
doing this the joint will be damaged again, the cycle of damage-inflammation-damage
will return, and the joint will be lost. Only after restoring the
proper joint mechanics can it be safe to exercise it.

The most effective methods of restoring proper joint mechanics are
those based on specific manual tests of the joint's function (actually
of muscles controlling the joint) that reveal the cause of dysfunction
and at the same time suggest a treatment. The treatment is done immediately
after each test, and then the muscles are tested again to see if they
control the joint correctly. The procedure is repeated within one
treatment session until the best possible result is obtained. (Often
several treatment sessions are needed to get the desired result—because
old habits are hard to break and the patient's neuromuscular system
tends to slip back into the old ways.) This is how dysfunctional joints
and other injuries are treated by specialists of Applied Kinesiology,
Active Release Techniques, Muscle Activation Techniques, and Sports
Chiropractic. To learn more about those specialties, visit websites
of their governing bodies:

International College of Applied Kinesiology at www.icak.com

Active Release Techniques at www.activerelease.com

Muscle Activation Techniques at www.muscleactivation.com/main.html

American Chiropractic Board of Sports Physicians at www.acbsp.com

A general comment: If you had a serious sudden injury, or are rehabbing
after a surgery, it is best if the MAT specialist you see is also
a physical therapist. Anybody can take MAT courses, but physical therapists
(and surgeons too, obviously) understand all implications of an injury.
They know properties of damaged tissues, regularities of healing,
and what can go wrong.

Sign up to be notified of new articles on injuries and training as soon as they are posted! (Your email address is safe with us. It won't be sold or given to any other company.)

Survey of interest on sports injury prevention and rehab

Information on the injury prevention, diagnosis, and treatment provided on this site is for educational use only, and is not intended as medical advice. Every attempt has been made for accuracy, but none is guaranteed. If you have any serious health concerns, you should always check with your health care practitioner before treating yourself or others.

Stadion Publishing Home | What's New at Stadion | Questions & Answers on Training | The Athlete's Bookshelf | What Others Say About Our Titles | Contact Stadion Publishing
Register to be notified of free information and new products

© 2010 by Stadion Publishing Co., Inc. All Rights Reserved. This internet site is protected by copyright. Any distribution or duplication of any of its content (text or images) without written permission from Stadion Publishing Co., Inc. is prohibited by law.