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 your physician before undergoing any treatment.

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, either excessive or chronic, 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 injections of cortisol or corticosteroids. 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 in 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 icak.com

Active Release Techniques at activerelease.com

Muscle Activation Techniques at muscleactivation.com

American Chiropractic Board of Sports Physicians at 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.

Recommended reading:
Joints in Trouble: Self-Treatment