OSTEOARTHRITIS What is Osteo Arthritis? The condition that results from Osteoarthritis was once thought to be the simply the result of wear and tear on the cartilage of a joint. Osteoarthritis is now known to be a complex joint deterioration that involves an active disease process. The surface of the joint is damaged and the surrounding bone grows thicker. 'Osteo' means bone and 'arthritis' means joint damage and swelling (inflammation). Other words used to describe osteoarthritis are, 'arthrosis' and 'degenerative joint disease'.

Understanding OsteoarthritisAdding Video to Blog by VideoLightBox.com v1.8

To understand how osteoarthritis develops, you need to know how a normal joint works (see Figure 1). A joint is where two bones meet. Most of our joints are designed to allow the bones to move only in certain directions. For example, the knee joint allows the leg to bend fully but only allows limited movement sideways. The ends of the bones are covered by a thin layer of gristle called cartilage. This cartilage cushions the joint and spreads the forces evenly when you put pressure on the joint. The smooth, slippery cartilage surface also allows the bone ends to move freely.

The knee is the largest joint in the body, and it has extra pieces of gristle (each called a meniscus) between the cartilage layers – these are small rings of cartilage in the shape of washers.

The joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid). This fluid helps nourish the cartilage and keep it slippery. The synovium has a tough outer layer called the capsule which stops the bones moving too much.

The bones are kept firmly in place on both sides of the joint by the ligaments. These are thick, strong bands which run within or just outside the capsule. Together with the capsule, the ligaments prevent the bones moving too much or dislocating.

The tendons are strong guiders that attach the muscles to the bones either side of the joint. They also help to keep the joint in place. When a muscle contracts, it shortens and this pulls the bone and makes the joint move. Figure 2 shows what happens when a normal joint develops osteoarthritis.

When a joint develops osteoarthritis, the cartilage gradually roughens and becomes thin, and the bone underneath thickens. The bone at the edge of the joint grows outwards (this forms osteophytes or bony spurs). The synovium swells slightly and may produce extra fluid, which then makes the joint swell slightly. The capsule and ligaments slowly thicken and contract, as if they were trying to stabilise the joint as it gradually changes shape. Muscles that move the joint may weaken and become thin or wasted.

When we look at osteoarthritic joints under a microscope, we see the joint is trying to repair itself. All the tissues of the joint are more active than normal. For example, new tissue is produced to try to repair the damage, such as the osteophytes. In many cases, especially in small finger joints, the repair is successful. This explains why many people have osteoarthritis but experience few or no problems. However, sometimes the repair cannot compensate for the damage. Osteoarthritis may then seriously affect the joint, making it painful and difficult to move. This occurs particularly in large joints such as the knees and hips.

Osteoarthritis is a slow process that develops over many years. In most cases there are only small changes that affect only part of the joint. Sometimes, though, osteoarthritis can be more severe and extensive, and this is shown in Figure 3. In severe osteoarthritis, the cartilage can become so thin that it no longer covers the thickened bone ends. The bone ends touch and start to wear away. The loss of cartilage, the wearing of bone, and the bony overgrowth at the edges can change the shape of the joint. This forces the bones out of their normal position and causes deformity.

A common complication is where chalky deposits of calcium crystals form in the cartilage (a process called calcification or chondrocalcinosis). These calcium crystals can shake loose from the cartilage, irritate the synovium and cause the joint to become hot, red and swollen.

What are the different types of osteoarthritis?
Osteoarthritis is very variable. There are many different types, affecting different joints (see Figure 4). The knees, hips, hands, spine and big toes are most often affected.

Osteoarthritis of the neck and back
Osteoarthritis of the neck and back is often called spondylosis. X-rays show that it is extremely common, but it often causes no trouble, and what is seen on the x-ray bears little relationship to pain or stiffness in the spine. About half the population gets back pain from time to time, but osteoarthritis is not the most frequent cause of this.

Osteoarthritis of the hip
Osteoarthritis of the hip affects men as much as women and often starts in the 40s, 50s and 60s. It may affect one or both hips. The risk is increased in farmers. Sometimes hip problems at birth or childhood (congenital dislocation or abnormal development such as Perthes' disease) may later lead to osteoarthritis. However, in many people there is no obvious cause. The hip joint is below the groin, and hip pain is usually felt mainly in the front of the groin, but sometimes around the side and front of the thigh, the buttock or down to the knee (so-called radiated pain). In severe osteoarthritis of the hip, the affected leg may get a little shorter due to the bone on either side of the joint being 'crunched up'.

Osteoarthritis of the knee
Osteoarthritis of the knee is more common in women than men and it usually affects both knees. It causes most problems in the late 50s, 60s and 70s. Being overweight and having nodal osteoarthritis increase the risk of osteoarthritis of the knee in women. A previous sporting injury or operation (such as a cartilage being removed) are more common risks in men and may cause osteoarthritis of just one knee. Sometimes there is no obvious cause. Any pain is usually felt at the front and sides of the knee. In severe cases, the knees may become rather bent and bowed (as in Figure 5).

Osteoarthritis of the hip
Osteoarthritis of the hip affects men as much as women and often starts in the 40s, 50s and 60s. It may affect one or both hips. The risk is increased in farmers. Sometimes hip problems at birth or childhood (congenital dislocation or abnormal development such as Perthes' disease) may later lead to osteoarthritis. However, in many people there is no obvious cause. The hip joint is below the groin, and hip pain is usually felt mainly in the front of the groin, but sometimes around the side and front of the thigh, the buttock or down to the knee (so-called radiated pain). In severe osteoarthritis of the hip, the affected leg may get a little shorter due to the bone on either side of the joint being 'crunched up'.

Osteoarthritis of the hands
Osteoarthritis of the hands usually occurs as part of nodal osteoarthritis. This mainly affects women, and often starts in the 40s and 50s, around the time of the menopause ('the change'). Most often it affects the base of the thumb and the joints at the end of the fingers. At times these joints become red, swollen and tender, especially when the condition first appears.

Gradually, over several years, firm knobbly swellings form on the back of the joints (see Figure 6). These are called Heberden's nodes after the English physician, William Heberden, who first described them. Once the Heberden's nodes are fully formed, pain and tenderness often improve. However, the base joint of the thumb may continue as a persistent problem. Although the fingers are knobbly and sometimes slightly bent, they work well and rarely cause long-term problems. However, having nodal osteoarthritis in middle age means you are more likely to develop osteoarthritis of the knee, and occasionally a few other joints, as you get into your 60s and 70s. This is why it is sometimes called 'generalised' (widespread) osteoarthritis. Nodal osteoarthritis is mainly related to genes that are inherited and so it runs in families.

Osteoarthritis of the foot
Osteoarthritis of the foot generally affects the joint at the base of the big toe. Eventually the toe may become stiff (hallux rigidus), which makes walking difficult, or bent (hallux valgus), which can lead to painful bunions (see Figure 7).

Osteoarthritis with crystals Chalky deposits of calcium crystals can form in the cartilage in joints (a process called calcification or chondrocalcinosis). This calcification mainly occurs in the knee joint, especially in older people. It shows on the x-ray, and the crystals can be identified in synovial fluid which has been removed from the knee through a needle. Because most of the crystals are made of calcium pyrophosphate, this form of osteoarthritis with crystals is often called pyrophosphate arthritis (or chronic pyrophosphate arthritis). It tends to be more severe and to progress more rapidly than osteoarthritis without crystals. Also, the crystals can cause occasional attacks of very painful swelling (pseudogout, or acute pyrophosphate arthritis).

Treatment of Osteoarthritis
Treatment is mainly aimed at the relief of the symptoms described above. Most often the following Osteoarthritis treatments are use: Glucosamine, Chondroitin, Sulfate Supplements, Pain and anti-inflamatory medication to treat pain associated with Osteoarthritis. Massage is very soothing and relaxing for most sufferers, little and often seems to be the key.

When using our therapy on a regular basis many of our clients have reported sustained symptomatic relief from this and many other health ailments.

Client reported benefits for Osteoarthritis include:

• Reduced pain levels by relaxing associated muscle tissue.
• Increased mobility and range of movement.
• Decreased Fluid Retention.

Medical research on the benefits of Massage for Arthritis:
Clients with arthritis were massaged by their 15 minutes a day for 30 days (and a control group engaged in relaxation therapy). The client's anxiety and stress hormone (cortisol) levels were immediately decreased by the massage, and over the 30-day period their pain decreased on self-reports, parent reports, and their physician’s reports. Field, T., Hernandez-Reif, M., Seligman, S., Krasnegor, J. & Sunshine, W. (1997). Arthritis: Benefits from massage therapy. Journal of Pediatric Psychology, 22, 607-617.

To read more about our therapy click here or to learn more about the general benefits of massage therapy click here

To see if you can receive similar or possibly even better results why not take us up on our offer of a free in-home demonstration.

Remember you have nothing to lose but your pain and just like many of our current clients in the years to come you could be reporting back to us your improved quality of life.