Targeting Arthritis Pain: A Joint-by-Joint Guide to Relief (Arthritis Part 4)
In this series, we've redefined osteoarthritis (OA), explored the engines of inflammation and biomechanics that drive it, and built an action plan of conservative treatments. Now, it's time to get specific.
While the underlying disease process is similar throughout the body, the unique anatomy and function of each joint demand a tailored approach. A strategy that works for a knee may not be the right one for a shoulder. Understanding these differences is the key to unlocking targeted, effective relief.
The Spine: Breaking the Degeneration Loop
In the context of the spine, "Degenerative Disc Disease" is arthritis. It’s often driven by repetitive mechanical stress, such as combining compression with flexion (bending forward) or rotating off-center. This creates a vicious cycle we call the Discogenic Pain Loop:
Shear forces lead to tiny tears in the outer part of the disc (the annulus), triggering an inflammatory response.
This inflammation causes the disc material itself to degrade and break down (catabolism).
The degraded disc leads to segmental hypermobility, otherwise known as instability.
This instability allows for more shearing forces on the disc, and the painful loop begins again.
The Spine Strategy: The goal is to break this cycle by enhancing core stability to protect against excessive shear forces and by coaching movement patterns that avoid repetitive end-range stress on the discs and joints.
The Hip: A Story of Mobility and Impingement
Hip OA is often linked to abnormal joint morphology, such as Femoroacetabular Impingement (FAI). A critical factor is a lack of hip mobility, especially internal rotation. In fact, restricted hip rotation is a known risk factor for other injuries, like ACL tears, highlighting its importance for overall lower body health.
The hip’s fibrocartilage, the labrum, acts as a gasket to create uniform pressure distribution. When a tear occurs, this seal is compromised, leading to abnormal loading and accelerated OA. This isn't just a hip issue; FAI patients often display abnormal kinematics in their low back and pelvis, which must also be addressed.
The Hip Strategy: Improve hip mobility (especially internal rotation), strengthen the supporting musculature, and assess and correct any contributing dysfunctions in the lumbar spine and pelvis.
The Knee: It’s Not Just About the Cartilage
Knee OA is a complex interaction between multiple tissues.
The Meniscus: This fibrocartilage structure is a key shock absorber. Meniscal injuries fundamentally change joint contact mechanics, leading to increased cartilage strain and OA progression. A successful meniscus repair can significantly reduce the long-term risk of developing OA.
Inflammation: The specific pattern of a meniscal tear can influence the type of inflammatory response in the joint. Furthermore, irritation of other soft tissues, like Hoffa’s fat pad located below the kneecap, can be a predictor of knee inflammation (synovitis).
This brings us to a common question: Is running bad for arthritic knees? The answer is nuanced. While running causes temporary changes in healthy joints, they are generally reversible. For those already diagnosed with OA, the ability to continue running is often linked to having good knee extension. They may simply need more recovery time between runs. For those who have undergone a total knee replacement, only about 12% return to running.
The Knee Strategy: Focus on preserving meniscal health, controlling synovitis using the strategies from Part 3, and optimizing the mechanics of the entire lower limb to ensure proper loading through the joint.
The Hand and Shoulder: Unique Structures, Unique Needs
The Hand
Why it's vulnerable: Unlike the hip or knee, the small joints of the hand lack shock-absorbing fibrocartilage, making them highly susceptible to mechanical stress. These small joints also concentrate force, contributing to wear.
The Hand Strategy: The focus is on conservative care like splinting, joint protection education, and targeted hand exercises to maintain function. Topical NSAIDs can be very effective for symptom relief. Simple isometric exercises, like squeezing a grip ring for holds of 30 seconds or more, can help maintain strength.
The Shoulder
Common culprits: Shoulder OA is often associated with the degeneration of the labrum, scapular dyskinesis (improper shoulder blade movement), and a loss of internal rotation (GIRD).
The Shoulder Strategy: Treatment must involve strengthening the entire rotator cuff complex. It's also crucial to identify and correct movement faults in the shoulder blade and thoracic spine to take stress off the main ball-and-socket joint.
Coming Up Next: In our final post, Part 5, we’ll bring everything together. We will briefly touch on higher-level medical interventions and discuss the importance of co-managing your condition with a trusted healthcare team to build a truly comprehensive and effective long-term plan.
Is your joint pain holding you back? A specific diagnosis is the first step toward a targeted solution. Contact our office today to schedule a detailed assessment and find out what’s really driving your pain.