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March 2003 Issue
Osteoarthritis: a very complex equal opportunity problem crippling millions of us.
by Michael Fick
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People who haven’t experienced arthritis can’t appreciate it. Its pain can get so bad almost nothing is worth incurring its wrath. Pants on fire? Let ‘em burn, if getting them off requires using your arthritic fingers. Screeching tires and blaring horn immediately behind you? Let it hit you; it would hurt less than turning your arthritic neck. You start living your whole life finding ways to do everyday things from the office to the bathroom without using any arthritic joints. You’d open your pill bottles with a hammer if you could pick up a hammer, those corny elastic beltless trousers are the only pants you can get on or off, and you get ‘em on and off with your teeth … if your jaw isn’t arthritic.

We may as well joke about our arthritis, because we can’t cure its most common form, osteoarthritis (OA), which is due to mechanical wear and tear rather than biological disease. Our joints, from jaw to toes, are intersections where bones slide over each other on a surface of cartilage. Cartilage starts out as slick and smooth and slippery as silicone on Teflon on wet ice, but when the Teflon – the cartilage – starts to wear thin, the friction increases as though someone threw sand in the joint. When the cartilage wears through in spots and bone starts grating on bone, the pain is so excruciating that almost no activity is worth provoking it.

You will probably get OA; 85% of us do before we reach 70, especially in our hips and knees. It is caused largely by such factors as general joint overuse (a decreasing suspect), certain kinds of overuse (high-impact, twisting games like football and soccer), a genetic predisposition (a major contributing factor, which may allow some people to make early lifestyle decisions), age, and previous joint injuries. Knee OA is very often self-inflicted the same way we cause our own adult-onset diabetes … by obesity.

People who usually work or play hard four hours a day are 7 times more likely (13 times, if obese) to develop knee OA than dedicated couch potatoes. Knees are our primary isolated weight-bearing joints, and obesity tears them up, often to the point of disability and artificial knees … a steep and lasting price to pay for too many calories and too little exercise. Hip OA can be severely crippling, to the point we can’t put on a pair of socks, let alone walk. Hand OA is very common and often runs in families. Spinal OA has driven even obsessed athletes away from their beloved sports; it cripples less driven people even more surely and quickly.

OA wakes you up, preventing sleep but hurting so much you don’t want to get out of bed. The only relief? Get out of bed. Once up, it hurts so much you don’t want to move. The only relief? Move. Even then you can’t possibly work or play. The only relief? Work or play. The most effective way to delay greater pain both short and long term involves pain.

The mantra “No pain, no gain” is appropriate in OA. Rest dries and hardens the damaged cartilage, leaving it more likely to break under impact. Movement lubricates, softens, and toughens it. The only proven way to slow cartilage degradation is motion.

But not just any motion. Running doesn’t cause OA like football can, but it beats up and can break already damaged cartilage. Low-impact exercise often significantly postpones the really crippling phase and may even let you resume normal activity almost pain-free. Swimming, cycling, dancing, and rowing are good for osteoarthritic joints, and strenuous weight-lifting is an excellent way to greatly reduce its symptoms and slow its progress. Stronger muscles help stabilize joints so they move as designed, reducing the damaging and painful bone-on-bone friction that can result from sloppy joint action. An OA joint is a classic and valid application of the Use It or Lose It mantra. Most varieties of exercise help, including strength building, aerobics, range of motion exercise such as stretching or yoga, specific agility exercises, and/or neck and back strength exercises. Of course, your physical therapist should advise, prescribe and train you in these.

If you overdo the exercise until the affected joints start hurting more rather than less, short layoffs, even a splint while you sleep, can help. You’ll have to find your own optimal balances between rest and exercise, cold packs and hot packs, and OTC and prescription drugs. Don’t jump into surgery until all other avenues have been exhausted. Knee and hip replacements usually get patients back on their feet adequately, but arthroscopic knee cleanup surgery for OA has shown to be often ineffective.

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