Osteoarthritis (OA) is the most common diagnosis that can affect any joint, but most often in the knees, hips, spine, small joint of the hand. Hallmark symptoms of osteoarthritis pain and stiffness of the joint. It is considered a degenerative disorder that results from the breakdown of the cartilage that provides the smooth surface of the joint for motion and acts as a cushion. This disease affects about 27 million Americans. Causes and risk factors for developing osteoarthritis are genetics, obesity, and overuse. 1
The pathophysiology link between obesity and osteoarthritis is related to both the direct excess of mechanical loads on the cartilage, but also the adipose tissue releasing leptin. In both scenarios, there ends up being an increase in inflammation, which helps to drive the tissue breakdown. 2 To describe this further, I often discuss with patients the “coin analogy.”
Let’s say the coin is osteoarthritis pain. On one side you have a mechanical inflammatory response related to things like injury, overuse, genetic (i.e. malformed joint), lack of movement (sedentary lifestyle, not moving through full range of motion of joints to allow lubrication) or obesity (increased joint forces). On the other side of the coin you have a systemic inflammatory responses related to adipose tissue effect (adipocytes produce inflammatory adipokines) 2, blood sugar dysregulation (diabetes or Metabolic Syndrome all related to poor dietary habits high in sugar and nutrient deficient foods), chronic gastrointestinal disruptors (like dysbiosis or microbiome imbalance) and systemic infection (bacterial or viral).
The case for osteoarthritis being called diabetes of the joint is linked primarily to the systemic inflammatory condition. Much like diabetes being associated with irregular blood sugar regulation and poor nutritional choices, so does osteoarthritis. As we will see later, osteoarthritis is multi-factorial, but there is a significant risk associated with systemic inflammatory process and the development of osteoarthritis.
Whether you come at the osteoarthritis pain from the local inflammatory pathway and/or systemic inflammatory pathway, you still have osteoarthritis and pain. The two inflammatory pathways are not mutually exclusive. For example, your systemic inflammatory condition like Metabolic Syndrome (as described in an earlier post) can lead to a disruption of the joint, which thereby begins the mechanical inflammatory response with abnormal joint movement. You can see the vicious cycle begin.
Diagnostic criteria include a physical exam of the painful joint assessing range of motion and strength. Xrays may be warranted to assess the joint space and integrity. Further testing like an MRI may be ordered to further evaluate the soft tissue surrounding the joint as well as the cartilage and labral integrity of the joint if appropriate.
One of the most common treatments for osteoarthritis is Non-Steroidal Anti-Inflammatories (NSAIDs), which may only hold a partial and temporary relief to the symptom of pain, but does not change the trajectory of the disease process or the health of the joint. They may even disrupt the supportive soft tissue of the joint. 3Additionally, NSAIDs and other anti-inflammatory medications have many side-effects including gastrointestinal upset.
So how do you manage, improve and maybe even decrease your personal risk of osteoarthritis?
In keeping with SOAR’s principles; Eat well, Move well, Sleep well, Soar On, we will try to cover the items in each category to remove, replace, in order to restore joint health and even delay progression.
Let’s start by addressing the nutritional components that drive systemic inflammation that contribute to a degradation of joint health. Systemic inflammatory dietary contributors (directly or indirectly) to poor joint health are:
What is more amazing, is the natural and whole food components that mitigate and even improve systemic inflammation. Here are a list of things that reduce systemic inflammation and thereby potentially decrease the pain and even improve joint health:
Pretty amazing that some very simple, whole food items carry a very large impact on your systemic inflammatory response that indirectly and directly will improve your joint health.
Remove. Replace. Restore.
Remove refined sugar, refined vegetable oils and food like substances.
Replace with whole fruits and vegetables along with wild fish and grass fed meats for an anti-inflammatory impact.
Restore a normal inflammatory response.
There are a few critical components to keeping the mechanical inflammation in check. My top recommendations to maintain joint health mechanically are:
Keeping the joint moving, even if osteoarthritis has already started will keep it lubricated. Once the degenerative process has been initiated, it can be halted with healthy movement. It is important to listen to the pain, but not to avoid movement because of the pain. The mechanical movement is important to keeping the joint nourished.
If you find your self struggling to get moving either before osteoarthritis or after the diagnosis, a movement specialist can help you along.
Remove. Replace. Restore
Remove stagnancy and fear of pain from osteoarthritis
Replace with gentle movement of the joint through its full range of motion. Initiate an exercise program and daily movement to keep the muscles strong.
Restore joint health.
The importance of sleep cannot be overstated as a means to recovery and repair, especially recovery from a mechanical injury to the joint. Your sleep-wake cycle is governed by your circadian rhythm regulated by the sun. Yet, did you realize that even the health of your joints and risk of osteoarthritis is also affected by disruption of your circadian rhythm?
Disruption of your circadian rhythm especially chronically appears to have osteoarthritis like pathological changes in the mouse joint while eating a high fat diet. 62 Alternating the light- dark cycle mimicking shift work disrupted the circadian rhythm producing proteoglycan loss involved in cartilage homeostasis.
In today’s world, even without shift work, we disrupt our own circadian rhythm by looking at screens (computer, ipad, phone, TV), heavy lighting when it is dark out, and evening staying up late in addition to eating the Standard American Diet. This sets us up for a host of diseases, now to include osteoarthritis.
How do you avoid disruption of the circadian rhythm?
Remove. Replace. Restore.
Remove screens from the bedroom and 1-2 hours before bed.
Replace regular bedtime in a dark, cool room. Get sunshine during the day. Eat a healthy vitamin rich diet.
Restore a normal circadian rhythm and healthy joints.
This principle is the most flexible of connection and purpose. For the sake of Osteoarthritis and joint health, this primarily indicates the need to connect to your joints. Listen. And if you can find a group of people who care to keep their joints healthy, then spend time with this group.
Connecting to people with similar goals is a great way to keep on track. Those with similar conditions can also be a great resource to share information.
Move your body on purpose; with a pet or a friend.
Remove. Replace. Restore.
Remove isolation and doing it alone.
Replace with connection to a group, a person, or pet to help keep you on track. Seek help from a professional if you get stuck.
Restore joint health.
If we return to our “coin” we can see that taking control over the things you can control you just may decrease your risk of developing osteoarthritis, and improve your condition using four simple steps.
Eat well. Move well. Sleep well. Soar On….even with osteoarthritis
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Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.
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