Quite often, we see patient who have been told their pain and problems are “normal” for their age. One of the most common “normal” findings we see at our office is arthritis. There are two main types of arthritis: osteoarthritis and rheumatoid arthritis. The vast majority of people who have arthritis have osteoarthritis. Osteoarthritis is also known as DJD or degenerative joint disease.
DJD can affect any joint in your body. The most commonly affected joints that experience DJD are:
It is possible for other joints in the body to experience degenerative changes but the four listed above are the most commonly affected by degenerative changes. Unfortunately, degenerative changes are NEVER normal. They may be quite common but they are never normal and indicate the presence of a problem. For joints in the spine, the degenerative changes are most commonly found in the cervical (neck) and lumbar (lower back) spine. The degenerative changes can be lumped in to four basic groups:
- Phase 1
- Phase 2
- Phase 3
- Phase 4
Phase 1 Degeneration
Phase 1 degenerative occur first and involve the soft tissue structures in the spine, muscles, tendons and ligaments which also include intervertebral discs. The intervertebral discs provide shock absorption and play a role in the position of the spine. Due to abnormal positioning of the body, increased loads are transmitted through the body. Your body will compensate, tightening certain muscles and thickening tendons to cope with the increase in loading forces caused by the abnormal position of your body (joints and spine). Phase 1 degenerative changes are mostly reversible and you won’t always feel pain when this is occurring in your body. As you might have guessed, the further your spine and joints are from a neutral, normal position, the quicker the degenerative processes are expected to occur.
Phase 2 Degeneration
Phase 2 degeneration involves both soft tissue changes and hard tissue (bony) changes. The muscles and ligaments continue to tighten. Adhesions from overuse are now becoming thickened and could be considered scar tissue at this point. The trigger points which occurred originally and could be worked out are now a permanent feature and don’t ever seem to go away. Pain will become more frequent and possibly more intense. Your body “realizes” the muscles are no longer enough to keep your body stable and your body starts to remodel the shape of the bones meeting at your joints to accommodate the abnormal forces. After a long enough period of time, these changes are characterized by sharp, jagged edges called bone spurs. These bone spurs can occur in any of the joints previously mentioned: hip, knees, spine and shoulder. Once the spurs occur, it is not possible to get rid of them and your ability to recover and return to normal will be reduced. Phase 2 degeneration means you’re now going to have to work harder to avoid frequent and severe pain AND further progression of your problem.
Phase 3 Degeneration
Phase three degeneration follows Phase 2 and means the cartilage in the joint is gone and the joint is nearly always, bone on bone. There will be no shock absorption and the bones will just grind on each other as the joint moves through its normal range of motion. The bony spurs which have formed in Phase 2 continue to progress and spurs on opposing sides of the joint will start to “grow together.” Patients are not always in chronic pain anymore because the nerves which report pain from the joint start shutting down as the body recognizes there is a problem and will “down regulate” the pain sensitivity in the area so the body can function as close to normal as possible.
Phase 4 Degeneration
There is Phase 4 degeneration, as mentioned above. For the purposes of our discussion, we don’t deal with Phase 4 because people who are unlucky enough to have Phase 4 degeneration are typically referred to a surgeon. It’s always best to find these types of problems BEFORE they have progressed to a point where surgery becomes an option
Part of our exam process involves any necessary x-rays. X-ray analysis is a valuable tool when staging the level of degeneration in your body. They can also help determine what is causing the degeneration in your body. Our office uses proprietary software called to perform an analysis. Your x-rays will be imported into this software and then digitized. After digitization, your films will be compared with normal positions. The areas of your body that deviate from neutral tend to be related to areas of increased degenerative change and even pain. By identifying these areas, a cohesive plan to correct the imbalances can be developed to get rid of any pain you are experiencing and to allow the body to progress towards a more neutral normal position. This analysis technique is so effective; it is even possible to identify areas that will cause problems down the road, even if you’ve never experienced pain in those areas at any time.
The x-ray analysis will also allow us to prioritize which area of your body should be corrected first. The area of pain doesn’t necessarily mean it’s the area with the problem so a thorough evaluation process is always necessary even if it’s “just” neck pain, back pain or knee pain. You can never tell what’s happening in there unless you look under the hood.
The x-ray analysis will also allow us to figure out which exercises are most appropriate for your recovery AND which exercises you will be able to do on a regular basis after your treatment plan has been completed and you want to keep your body moving in the right direction.
As far as osteoarthritis being “normal” for your age, it’s actually a function of how far the body is out of position and will only be present when your body is breaking down. Failing to correct joint systems which are compromised will mean your body is much more likely to degenerate and that you are more likely to experience pain in some form. You have probably figured out by now that the presence of DJD is NOT normal and if you’re feeling an ache or pain that has become more frequent or severe, you should get checked immediately. Pain, which is intermittent or comes and goes but always returns to the same place on your body is also a significant problem and must be checked.
The other important component of your exam is a kinetic chain evaluation. The kinetic chain evaluation, described in our blog post about runner’s knee, helps tie the specific symptoms and problems you experience to areas of your body where your joints are compromised and compensating.
As you already know, many degenerative changes cannot be undone. So, getting the problems identified and corrected as quickly as possible will give you the best chance for a long-term, lasting recovery. The longer you wait to fix your problem, the harder it will be to get it corrected. If you let the degeneration progress as far as Phase 4, it will be highly unlikely we will have any avenues to help you and surgery will likely be the only option available. Getting checked early enough is the most important thing you can do to be certain you don’t lose your ability to exercise (run, walk, etc.) as you age. It should also be mentioned all offices do not have the ability to digitize and analyze your x-rays. So, if you are having pain/ problems be certain you select a healthcare professional who is able to perform an effective examination of both your soft tissues and hard (spine) tissues.
If you currently have aches and pains or “just” have an ache or pain that is intermittent and not present all the time, it’s best to get checked. Better safe than sorry. Muscular problems generally heal within 4-6 weeks, if your problem has been present longer than that, it’s not normal and it needs attention. It is NOT something that occurs with normal aging. It may be common as part of the aging process but it’s definitely not normal.
Call us today, get yourself checked and see what you can do to put yourself AHEAD of the curve. Don’t get old before your time!