THE MANY CAUSES OF ARTHRITIS
Too many Americans are living with pain. Certainly, there are innumerable reasons for people to experience discomfort from some specific part of the body. But one in particular, affecting far too many Americans, and often inadequately addressed, is the scourge that is chronic joint pain. Unfortunately, far too often, recurring pain from some joint is explained away, completely minimized, by being labeled simply as our old friend “Arthur-Itis.”
A typical scenario: someone in their 'middle-aged’ years begins to experience aching from the knee, a particularly common site. In this scene, the pain becomes more consistent, more frequent, and more intense over the years. If the suffering individual is a male, he’ll simply push through it or take an occasional anti-inflammatory. He won’t let the pain stop him. But they won’t seek out professional care until their spouse grows tired of seeing them limp around.
Medical care in this situation will often consist of a course of anti-inflammatories, at least initially. Although the symptomatic individual will typically obtain some relief, as soon as the medication is discontinued, the pain returns. An unfortunate consequence of this approach, should it be utilized long term, seems to be an alteration in the chemistry of an inflamed joint, changing it from acute inflammation (much easier to treat) to chronic, a more resistant, intractable condition.
Commonly, a course of physical therapy is attempted and may provide some measure of relief. Again, the duration of improvement is frequently inadequate, with a gradual return of pain noted. A corticosteroid injection, the prototypical cortisone, is usually the next recommendation. These drugs are powerful anti-inflammatories, and because the pain is inflammatory in nature, great relief is provided.
Corticosteroids, as most are aware, generally provide only temporary relief. Certainly, an additional injection can be performed, although recurrent administration of corticosteroids causes tissue atrophy. This term refers to a thinning of tissues. One of the structures most affected is the cartilage lining a joint. When this material thins sufficiently, joint motion will cause pain.
At this point, the only viable option for relief in our current healthcare system is knee replacement. To many experts, this indicates a failure of our ability to offer any form of prevention. Modern medicine, as currently constructed, seems unable to intervene in the process of degeneration of a joint. Nearly a million knee replacements are performed annually in the US.
The term ‘arthritis’ is almost always provided as an explanation, although this is not a definitive diagnosis and simply indicates that the joint is inflamed. Never offered is an explanation as to why this particular structure is experiencing chronic degenerative changes, in other words ‘arthritis.’ Very different is a diagnosis of osteoarthritis, psoriatic arthritis, or rheumatoid arthritis. Naturally, many of us have chronic joint pain as the result of some specific traumatic event, an industrial injury or a motor vehicle accident.
Yet many Americans suffer from less significant trauma but on a repetitive basis. For example, many of us have a knee joint being stressed because of its alignment. How well does your knee joint work? How well will it work in 20 years, after five to ten thousand steps a day, day after day, if functioning slightly improperly. This comes under the heading of biomechanics, a term describing the complex motion of innumerable structures that are part of the musculoskeletal system involved with weight bearing and gait.
The field of biomechanics is a relatively new one. Consequently, few healthcare providers received education in the nuances of this specialty. And yet, because of gravity and weight-bearing, this is a vital concern for everyone. After all, being able to stand and walk is an essential component of all quality of life measures.
The knee joint is supported by the foot. How well the foot moves and supports the body, its positioning throughout the gait cycle, has a direct effect on knee function. Many experts claim a majority of knee replacements could have been prevented by addressing their biomechanics and treating abnormalities appropriately before degenerative changes.
Some change in function and alignment from ‘perfect’ does not lead to immediate pain. Early on, we are blessed with the vitality of youth. But we must take into account both aging and that the average individual takes so many steps every day. This is significant trauma when the accumulated results of millions of steps are totaled.
If you or a loved one are suffering from chronic knee pain or an aching joint, an evaluation of your biomechanics may reveal important abnormalities, often benefiting from relatively simple, non-invasive conservative treatments. Many Americans have feet that roll over excessively, termed pronation. Reducing excessive pronation can be remarkably effective in relieving knee pain and also minimizing physical stress to the joint. The connection between foot alignment and knee function, as well as spine health, is direct and should be a vital component of their treatment plan.
Many who are fit with prescription foot supports, typically referred to as foot orthotics, get relief of their foot or ankle pain but also experience obvious improvement in their low back, knee, or hip pain. If it is a structure involved in some way with standing and walking, it can benefit. This subject highlights the importance of the kinetic chain, the forces traveling through the human body while standing in bipedal support, i.e. standing on two feet.
We need to make the connection between an individual’s physical function and their pain, since that is often the root of the problem. Every part of the human body is connected, nothing operates independently . And when it comes to the stresses of bipedal ambulation, gravity is king. Keeping your musculoskeletal system aligned, functioning correctly, will pay big dividends over the course of our lives, as gravity works to, literally, bring you down to earth.