Bone on Bone
Have you ever been told you are “bone on bone,” “filled with arthritis,” or “this is the worst arthritis I have ever seen”? There’s no sugarcoating it; that is scary. The general public perceives only the deep negative connotations that come with the word arthritis. Education surrounding osteoarthritis in the current healthcare model in America leads us to fear and failure. It leads to so many unnecessary surgeries, increased fear avoidance behaviors, and is clearly misunderstood. The goal of this blog is to share a deeper understanding of what arthritis is and share that you are not doomed. You have options.
There are different kinds of arthritis. For the sake of this blog, we are going to focus solely on osteoarthritis as this is one we are all familiar with. Anywhere in the body where we have two bones that come together, we form what is called a joint. Let’s picture the knee. Our femur (big thigh bone) and our tibia (long shin bone) meet and form the knee. At the ends of these bones where the tibia and femur meet, we have cartilage covering the end of the bone. Cartilage is a strong and flexible tissue that acts to give cushion and protection to the end of the bones. The end of our bones, or our “joints” is where our body helps us handle loads and gives us mobility. Over time, the cartilage begins to show signs of age-related changes. That’s osteoarthritis.
Time to drop a bomb on all of you. Arthritis is NORMAL. The analogy often used is arthritis is like wrinkles on the skin. As we get older, our skin ages, and as it ages it begins to wrinkle. Simply put, “arthritis is wrinkles on the inside.” This doesn’t mean our skin is damaged or doomed. We know that and we accept that. Arthritis is no different. After the age of 35, studies show that we begin to form arthritis as our joints begin to age. After age 55, it can be assumed that we have some level of arthritis in our bodies. Studies have shown over and over that it is normal to show arthritic changes on x-ray, but many of these people don’t have pain. Simply put, we need to change our way of thinking that “arthritis = pain.” Arthritis is NORMAL. But being in pain is NOT NORMAL. While I will not argue that arthritis can certainly contribute to pain, much of the pain we experience in our joints is associated with weak muscles and stiffness in the joint.
Study after study continues to show that if we can restore normal joint movement and strength in surrounding muscles, we begin to experience less pain despite arthritis still being on the x-ray. There are a lot of ways we can work to restore this motion and improve strength. Yes, believe it or not, if you are “bone-on-bone” movement remains your best medicine. As we say, “motion is lotion.” This is where Physical Therapy can help. A physical therapist can perform interventions such as joint mobilizations and hands-on techniques to begin to relieve symptoms. With the level of pain reduced, training in the form of strengthening and stretching becomes much more tolerable and in return, your joint becomes more resilient to pain and/or re-injury. Something very simple we can all do on our own to improve pain in the knee or hip is to ride a stationary bike daily. Exercise physiologists recommend 180 minutes of zone 2 cardio a week. (Zone 2 cardio is the level where it becomes more difficult to have a conversation while exercising). That is 25 minutes a day. If you can get access to a stationary bike and ride for 25 minutes a day, you will not only notice dramatic improvements in your knee and/or hip pain but also improve your metabolic health and cardiovascular system among other things. Wow, what a double whammy! If that is too much of a time commitment for you, something as simple as performing a sit-to-stand exercise can be very helpful for your pain. This is the idea of standing from a chair and then sitting back down without plopping and using the armrests. Performing a sit-to-stand 2-3 times a day for 10 reps each time will already have you on a path to a healthier knee or hip if you feel you are someone dealing with the pain associated with arthritis. By performing this exercise, we are activating all the major muscle groups in our body which include the glutes, quads, and hamstrings. If that is not doing the trick for your pain, I highly recommend scheduling an appointment with a physical therapist. I am a firm believer that if there is no traumatic injury that led to the pain, conservative care should be trialed for up to 12 weeks before consulting with a surgeon. After 12 weeks if the pain is not better, trust that your physical therapist will be able to provide you with the proper direction regarding whom to set up a consultation with regarding a joint replacement. Believe it or not, not only are you doing yourself a favor, but you are also doing your orthopedic surgeon a favor by telling them you already attempted 12 weeks of supervised training.
To summarize, we let the word arthritis scare the hell out of us. When we are told we have arthritis we stop moving because of fear of making it worse. When has this ever helped? In fact, I’d be willing to bet the pain only worsened. When dealing with a joint that is showing age-related change, it becomes even more important to prioritize healthy motion and strength. In fact, I will argue that the older you are the more important it is for you to be doing a routine training regimen that includes resistance training and stretching. Having arthritis is normal but being in pain is not normal. When you go to push yourself up from a chair using your arms and then struggle to stand up straight, and then say, “Man, I am getting old. It’s that arthritis” and we normalize it, I now challenge you to say, “This isn’t normal; time to do something about it”.
Thanks for reading!
Dr. Ryan