With a look of resignation my patient explains that their family doc told them their knee pain was arthritis and they could only manage it with anti-inflammatory meds and eventually surgery. I asked them, as I ask many patients, “what do you think arthritis actually is?”. Most patients look at me, somewhat perplexed, and give a variety of answers hovering around the idea of joint damage. In the most simplistic terms osteoarthritis is excess wear and tear on a joint, it’s not congenital, auto-immune, infectious or most importantly it is not an uncontrollable condition. For the average person (average meaning without major trauma, surgery etc) it’s the result of their sports, work and day to day activities compounded over their lifetime. Excess wear and tear.
Patients actual xrays with subtle loss of space between her femur and tibia. Thicker white lines on the joints surface of the femur and tibia.
Luckily this patients had been referred for knee xrays, so we took a look at her films together. I showed the patient the space between the bones in her knees and where I’d look to see bony indicators of degenerative change. We could both appreciate that the changes were subtle. We read the report together, “signs of early arthritic change” was the key line in the two sentence report on otherwise normal knees. So I asked another question “do you think arthritis is still the only reason you might have knee pain”. With a little more optimism she started to question the original diagnosis. For the sake of comparison the image on the right shows moderate to severe osteoarthritis.
This is more significant arthritic change. There is an obvious difference when comparing to our “arthritic” patient.
Let’s look back at that simple definition, osteoarthritis is the result of excess wear and tear. Excess wear and tear is often the result of poor joint movement. Maybe the balance of leg/hip strength, flexibility and coordination has forced or allowed her knee to move poorly and now painfully. Maybe she wasn’t feeling the pain of worn cartilage but the pain of stressful movement.
What’s the point?
Worn cartilage and arthritis feels very much out of our control. Strength, flexibility and movement is something we can control, work on and ultimately improve. Arthritis is an effect of poor joint movement. If you feel like throwing in the towel because you’ve been told or think you have arthritis it might be time to reconsider your understanding of this process. Take charge by truly understanding the source of your pain, not just the symptoms. Invest time moving your body and getting stronger.
