Grandmaster Ken MacKenzie - Taekwondo Times

Stretch Yourself
Osteoarthritis causes wearing out of a joint’s cartilage,
either from chronic abuse or from a sudden
trauma that unfavorably affected the joint’s mechanics.
Whether from hardening of the subchondral bone* or
from overloading muscles stabilizing the joint, the end
result is destruction of the articular cartilage, pain and
eventually loss of motion.
You can have osteoarthritis and not know it. The
affected joint may be fairly painless—just less stable
or less mobile than it should, and muscles around it
may be sore often. Or the joint may be painful too.
Destruction of the joint’s cartilage can progress quite
far without pain because the cartilage is not innervated
(has no pain receptors). Joint tissues that are
innervated, and send pain signals when irritated, are
the fibrous connective tissue of the joint’s capsule, the
muscles around the joint, and the bone underneath
the cartilage. So, when the cartilage is worn through,
the bone will hurt. Before that happens, the person
may feel pain in some parts of the joint impinging on
others due to poor muscular control (e.g., impingement
of the shoulder joint), as well as the soreness of
muscles overworked by compensating for poor joint
mechanics. Eventually the person may feel tightness
in the joint caused by increased volume of the joint’s
fluid, which distends the joint’s capsule. Distention of
the joint’s capsule causes inhibition (switching off ) of
muscles controlling the joint, and that leads to their
atrophy.
In any case, the pain is easy to deal with—there is
a multitude of painkilling pills and creams. Killing the
pain alone does nothing to stop the arthritic changes
in the joint, but it may permit arthritis sufferers to do
exercises that slow down or stop the progress of the
disease. What concerns the arthritis sufferers most is
the damage to the joint’s cartilage and the
resulting loss of stability and eventually
mobility of the joint. Yes,
at some stage of cartilage damage
the joint loses stability—
becomes lax—and seems
more mobile (e.g., the knee
may bend too much to the
sides or the front). Later
on though, the joint loses
mobility and eventually, in
the worst case, may become
fused. How does this happen?
While in some spots
the cartilage is worn away,
in some others it grows and
eventually blocks the joint.
This is not visible on
X-rays—not until
the overgrown
cartilage calcifies. Before that happens, both the worn-out
and overgrown cartilage can be revealed by MRI. (X-rays
of arthritic joints show only altered position of bones,
which indicates the amount of change in the cartilage but
does not show the cartilage itself.)
But back to the arthritis sufferers…Knowing that the
cartilage in the affected joint or joints is worn out, most
look for ways to restore it. They eat supplements, apply
creams and ointments, even have medication injected into
the joints. Of the supplements, glucosamine and chondroitin
are shown to do no harm, but there is little proof
of them helping. No cream or ointment can penetrate the
joint’s capsule to bring in the building materials, so the
best they can do is lower the pain and reduce inflammation.
After an injection into the joint’s cavity, the cartilage
may begin to grow, but not so selectively. The undamaged
cartilage, growing in the “wrong places,” will grow even
more—and the joint will be further blocked. This excessive,
uneven growth may have striking results in the knee
joints: Not only will their mobility be reduced but also
the legs may bend drastically, even more than 45 degrees,
either out (bow legs) or in (x-legs), and in the worst cases
one leg out and one leg in. Many people fall for miraculous
medicines, ancient or modern, from shamans or space
labs, that promise to selectively grow the cartilage where
it is damaged (and perhaps eat it away where it is not
needed). There are ways of selectively stimulating growth
of worn-out cartilage and removing the overgrown cartilage—but
these are not simple procedures like injections.
These are surgical procedures: Both the prolotherapy to
stimulate growth of the cartilage and the abrading of the
excessive growth require arthroscopy. They are not very
effective either; after all, people still get their knees and
hips replaced.
So what should you do to restore function of an
arthritic joint? First, stop any exercise or activity that
causes pain and inflammation (pain = damage = inflammation).
If an exercise causes any discomfort in the joint
during or after performing it, then it is not good and has
to go. Second, stop the inflammation. Inflammation damages
all tissues of the joint (cartilage, ligaments, tendons)
and causes atrophy of the muscles stabilizing and controlling
the joint. A long-lasting inflammation can cause
permanent destruction of muscles that cannot be brought
back to life by any means (e.g., fatty atrophy—muscle
fibers dying and being replaced by fat). Inflammation may
be stopped by creams, ointments, or gels such as Voltaren,
prescription anti-inflammatory drugs, and in the worst
cases by cortisol injections. Whatever it takes, the inflammation
has to be stopped for two reasons:
* To stop the damage
* To make the patient realize how it feels to not have the
inflammation.
74 November 2009 / taekwondotimes.com
By Thomas Kurz