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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

June 1998

Osteoarthritis - Part 1

By Rick Allen, DC

"Better health leads to better dancing."

For the past several months, my column has dealt with injuries of the knee. During June and July, I'll broaden the scope with a review of the causes and treatment of osteoarthritis. Osteoarthritis (which I will abbreviate as OA) is a disorder of the joints that is characterized by a deterioration of the cartilage and the formation of new bone at the joint surfaces. OA occurs primarily in the large, weight bearing joints, such as the knee and hip.

[ Diagram of healthy knee ]

In a normal joint, there are smooth linings of articular cartilage covering the ends of the bones, allowing for the smooth gliding motion of the joint. The joint space is also filled with fluid that helps to lubricate the joint (figure 1).

Although the mechanism for the development of OA is poorly understood, there are certain chemical and cellular changes that occur within the joint. These lead to a softening and eventual breakdown of the normal cartilage. Defects develop within the cartilage, and thickening of bone and development of bone spurs occur below the joint surface and around the joint (figure 2).

[ Diagram of knee with osteoarthritis ]

As OA continues, physical changes occur, including pain, swelling crepitus (a grating sound or feeling in the joint), and restriction of motion. Such changes within the joint obviously adversely affect the performance of any athlete, including a dancer.

Although this condition is generally associated with the aging process, it can sometimes develop earlier in a joint that has been subjected to acute trauma or repeated stress. Studies have shown that a joint that has been injured may develop OA. Examples of this would be injury of the knee in football or the repeated pounding of the big toes of ballet dancers. Two other factors which are correlated with OA include increased weight and altered joint mechanics (such as genu varum or knock-knees, improper tracking of the patella or kneecap, and hammer toes creating abnormal forces on the heads of the metatarsals of the foot).

In contrast, it appears that the normal stresses of athletics do not increase the risk of OA. For example, in a 1997 review of the literature, runners more than 60 years old running three hours per week for 12 years show no greater prevalence of OA when matched with non-running controls. (They did demonstrate a very positive, healthy finding: 40% greater bone density of vertebral bodies).

Normal joints are able to withstand the stresses of athletics because the body has a number of protective mechanisms. First, there is a passive mechanism, such as the absorption of shock by the soft tissue in the heel pads and stress by the bones and ligaments. Second, there is a major shock absorbing mechanism in the active, reflex-controlled stretching of the muscles. As joints move, the related muscles stretch under the slight tension; this helps to relieve the joint of the stress.

For many years it was thought that articular cartilage could not regenerate. However, experimental studies in rabbits showed that slow, continuous motion promoted natural repair of injured joints. Today, it is common practice to have continuous passive motion of a joint following surgery to promote natural healing.

While the healing response is less efficient as one ages, we do continue to have the ability to repair articular damage even into our golden years. We need to give our bodies a fighting chance with proper nutrition and restorative rest. I'll give you more on that in the second part of this article.

Until next month, keep on dancing - it provides normal motion which helps keep your joints healthy.

Next article: All too often, we take a pill to relieve for sore muscles and joints. What are the long-term implications of taking ibuprofen and similar anti-inflammatory medications? There are steps you can take to stay healthy and pain-free from osteoarthritis naturally. Let's apply them for your better health.

Future article: I've heard from a few more folks with tales of orthotics. A couple more will provide enough personal experience for a useful article. If you have had experience with orthotics (good, bad or indifferent), I would appreciate hearing from you.

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