Four myths about the osteoarthritis that may affect our joints
Osteoarthritis is extremely prevalent in our society. It’s believed to be the most common joint disorder in the United States, affecting tens of millions of adults at any given time. Often referred to as "wear and tear arthritis," osteoarthritis also goes by the medical name degenerative joint disease.
It’s also a very expensive problem. The American Academy of Orthopedic Surgeons reported that the total number of hip and knee replacement surgeries exceeded 1.7 million in 2020, most of which were performed for osteoarthritis.
There are also numerous myths surrounding osteoarthritis. Because it’s such a widespread and costly condition, as the public we should be educated about osteoarthritis as much as possible. Let’s debunk four common myths.
Myth No. 1 – It always hurts
Last month I saw a patient who recalled a consult he had for a hip replacement surgery several years ago. During this visit, the surgeon explained his x-ray findings, which revealed osteoarthritis of his painful hip. In addition to his symptomatic side, the x-ray also showed his other hip. The surgeon looked puzzled and asked him “Are you sure your other hip doesn’t hurt? The arthritis on that side is much worse.” Interestingly, he had never experienced hip pain on that side, nor has he had symptoms there since.
This patient is not alone, and while his story pertained to hip osteoarthritis, the same message applies to osteoarthritis in any joint in the body. It doesn’t always hurt.
Because osteoarthritis is extremely common in the knees, a tremendous amount of research has focused on this area over the past several decades. As a result, we have been enlightened with a couple very interesting facts.
The first is that 50% of people with the radiologic findings of knee osteoarthritis do not have knee pain. The second is that the severity of imaging findings often doesn’t correlate to the severity of pain.
For example, some people may have severe osteoarthritis with very minimal pain or even no pain, and other people may have mild osteoarthritis and be in fairly significant pain.
What this research essentially tells us is that there is a poor correlation between imaging findings and pain in people with osteoarthritis. Because of this, recent guidelines have actually suggested that we shouldn’t use imaging as our primary focus in diagnosing or guiding treatment in osteoarthritis.
Myth No. 2 – It’s caused by an active lifestyle
As stated earlier, osteoarthritis is often referred to as "wear and tear arthritis." What this term unfortunately instills in the minds of the public is that if you lead an active lifestyle, you will pay for it later on with osteoarthritis.
Several months ago, I wrote a column entitled "Does running increase the risk of arthritis?" The column centered around a large review article, which clearly showed that the vast majority of runners have a significantly decreased chance of developing hip and knee osteoarthritis when compared to non-runners.
How could running possibly lead to less "wear and tear" when it produces forces on the lower extremities equal to roughly 2.5 times body weight every time the foot hits the ground?
What many people fail to consider is that the body has a fantastic ability to adapt to the stresses imposed on it. Because of this, the cartilage in a runner’s hips and knees tends to be thicker and stronger than the cartilage in the hips and knees of a non-runner.
Therefore, an active lifestyle is more likely to be an antidote for developing osteoarthritis, rather than a precursor.
Myth No. 3 – It’s bone on bone
This is perhaps the most harmful myth surrounding osteoarthritis.
“Wait a minute” you may be thinking. “I saw my x-ray and it certainly looked like it was bone on bone.”
I believe you, and I have no doubt the joint space was significantly narrowed. But there was a gap between the bones, even if it didn’t appear that way on the x-ray.
If a joint were truly bone on bone, it would be fused. You wouldn’t be able to move it. The fact that you can move your osteoarthritic joint, even if it is very painful, indicates that there is still some joint space left.
Not only is there space, but the joint is lubricated with a liquid called synovial fluid, one of the most slippery substances on earth. In addition, when you look at even the most severe osteoarthritic joints through high level imaging scans, you will be able to see a remainder of cartilage tissue lining the bone on each side of the joint.
The reason why this myth is so catastrophic is because it influences our behavior. For example, if you believe that your joint is ‘bone on bone’, you may think that conservative care won’t have any effect.
This takes us into our last myth.
Myth No. 4 – If severe enough, surgery is the only option
This is an unfortunate misnomer, because regardless of how severe osteoarthritis is, non-surgical routes should be attempted first. While there is always a place for exercise, which can range from gentle range of motion and strengthening to walking and aerobics, there is also a subgroup of osteoarthritis patients who respond especially well to an exercise that is very specific to them.
This exercise is termed directional preference, and refers to a single direction of movement that can significantly improve symptoms, range of motion, and overall function. Directional preference is determined through a specialized movement assessment, and has been shown to be associated with a great prognosis in most patients when they exercise into their preferred direction.
In fact, a very interesting study, "Efficacy of Exercise Intervention as Determined by the McKenzie system of Mechanical Diagnosis and Therapy for Knee Osteoarthritis: A Randomized Controlled Trial," took patients awaiting a knee replacement surgery and assessed them for directional preference.
Directional preference was found in 40% of these patients, even in those with the most severe osteoarthritic changes.
This is important to know, because it can be difficult to determine who will respond to conservative care or not. Many medical providers will look at a patient with advanced osteoarthritis and believe that surgery is their only option.
Now I want to make it clear that this information doesn’t mean your joint pain isn’t due to osteoarthritis, or that you won’t need an operation. Many people still do, and they often benefit tremendously. But we also need to be as educated about osteoarthritis as much as possible, and this means debunking common myths that get in the way.
Dr. Jordan Duncan was born and raised in Kitsap County and graduated from the University of Western States in 2011 with a Doctor of Chiropractic Degree. He practices at Silverdale Sport and Spine. He is one of a small handful of chiropractors in Washington state to be credentialed in the McKenzie Method.
This article originally appeared on Kitsap Sun: Four myths about the osteoarthritis that may affect our joints
