Do You Really Understand Osteoarthritis?

Gain insight into osteoarthritis and discover the benefits of Pilates for osteoarthritis prevention in this exclusive conversation with Polestar faculty Brent Anderson PT, PhD, OCS, NCPT, and Beth Kaplanek RN, BSN, NCPT. Watch the #PilatesHour Webinar “Working With Clients With Osteoarthritis” and take your understanding to the next level in our online course “Osteoarthritis of the Hip & Pilates”.

BA:  We’ve been talking about positive movement experiences since the first time we met. How do we create these positive movement experiences? Osteoarthritis (OA) of the lower extremities is the best topic to talk about regarding positive movement experiences. The research all points clearly to this!

BK: As you know, osteoarthritis is the most under-recognized chronic condition out there. The wear and tear are present in almost all individuals on some level, whether you are exemplifying symptoms or not. 

59.4 million Americans have some sort of arthritis and if we look at it globally it’s much bigger. If you take hip, knee, hand, and spine, we’re talking about the fourth largest global disability. 85% of this osteoarthritis is related to the hip and knee.  

There are many different types of arthritis. We are talking specifically about osteoarthritis which tends to be more about wear and tear. But there are definitely some systemic inflammatory conditions that can cause osteoarthritis besides just wear and tear. 

What is Osteoarthritis?

Osteoarthritis is a breaking down of the articular cartilage. Exposed subchondral bone, underneath the articular cartilage, is supposed to slide and glide and move beautifully. It’s also bathed in synovial fluid. The articular cartilage needs this nourishment to stay healthy.  

When you have irritated synovial fluid, in addition, to wear and tear, the breakdown of cartilage creates an inflammatory contusion. We want to work on the things we can do to create an anti-inflammatory environment. This creates the best environment possible to keep that nourishment going properly for the articular cartilage so we have less breakdown. We want to get to a place where we have a little homeostasis. This will hopefully delay and deter the breakdown of the articular cartilage.  

Osteoarthritis today is not only occurring in older people. There is a major increase of individuals between the age of 40 and 55. It is amazing how many more people are suffering from osteoarthritis these days. When it gets severe, it’s a total joint failure. One in two Americans and two in three obese people will likely get knee osteoarthritis. The knees seem to be the leading joint where osteoarthritis is found. 1 in 4 Americans, or about 25 percent of the population, will develop hip osteoarthritis, and it’s very costly. 

Not just costly for the amount of care you need, but costly to the individual. They lose work and time, and can’t make the money they need which also affects their well-being and quality of life. There’s a lot to it, and the pathogenesis of osteoarthritis can get very deep – the chemistry. What we can do is create a beautiful environment to deter or prevent further breakdown. Pilates is great for this!

BA: Something that comes to mind is the importance of students knowing the leading causes of excessive stress to the knee. Especially since the knee is the primary joint where osteoarthritis occurs. I often challenge them with this question:

Where is a place where you have decreased mobility leading to knee wear and tear? 

The answers are lack of ankle mobility, dorsiflexion, hip extension, and deceleration strength in the hip and pelvis. These are some of the leading causes of excessive stress through the knee leading to the loss of congruency. Because the knee is always load-bearing in humans, because we are bi-pedal animals, it takes a lot of the brunt of that wear and tear. If we work backward, how can we improve alignment, congruency, and distribution of force? These are the fundamental components of prevention.  

BK: Yes, lack of hip extension and dorsiflexion are the two biggies. We can also add a lack of thoracic extension and balance on the lateral line of the body to that list. These are the very things we can target in our Pilates programs.

Looking at a 2017 Study from the Journal of Orthopedic and Sports PT, we can see the highlighted reasons that are causing OA. We see that 25% of knee pain is related to obesity. We also see that high BMI has increased overall in males and females ages 15-49 which contributes to the increase in global osteoarthritis. The five major contributors to osteoarthritis are obesity, traumatic injury to the knee, femoral acetabular impingement (FAI), hip dysplasia, and sports injuries.

We see more young people playing sports and see a lot more ACL injuries early on, along with meniscal tears. Both of these can develop into knee osteoarthritis in a person’s lifetime.

The five major contributors to osteoarthritis are obesity, traumatic injury to the knee, femoral acetabular impingement (FAI), hip dysplasia, and sports injuries.

When we get into the hip we’re talking about femoral acetabulum impingement and hip dysplasia. These can have a 10-fold increase in progressing to end-stage hip osteoarthritis within 5-20 years. 

We also see osteoarthritis develop due to high-impact sports like wrestling, distance running, soccer, and weight lifting – these are definitely players as well. Of course, if you are not recovering, rehabbing correctly, maintaining the congruency in the joint, and doing all of the other anti-inflammatory things you need to do, that causes a progression as well. 

BA: A lot of our students answer running when we ask what the causes might be. I want to make it clear that although there is a stereotype out there that running is bad for the knees, humans are designed to run! I will say that jogging may not be as natural human locomotion as others, but walking, running, and sprinting are.

Jogging seems to put an abnormal amount of stress on the knee. Especially if you run with a heel strike, and more if you don’t have the ankle dorsiflexion that you are meant to have. If you visit countries where they still squat a lot, they do not have the same incidence of knee pathologies as elsewhere. These are areas where they are squatting to go to the bathroom, do work, socialize, and rest specifically with the heels down.

Register for our upcoming #PilatesHour Webinar here. Deepen your understanding of osteoarthritis in our online course “Osteoarthritis of the Hip & Pilates” with Polestar Faculty Beth Kaplanek, RN, BSN, NCPT.

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