When it comes to addressing joint pain, many individuals don’t get the results they are looking for because their healthcare practitioner failed to address the “complete picture” of their joint health.
In this article you will learn:
- The basics of the four major factors that make a healthy joint
- How these factors play into joint pain
- Why physicians treating joint pain should not follow a cookie cutter approach
- Why different treatment options should be considered when the patient wants to continue an active lifestyle
- Why some people still experience joint pain after they have received some type of treatment
What do you mean stability?
Essentially, a stable joint is resistant to falling apart and has proper function thanks to the surrounding ligaments and muscles. `
Think of ligaments as duct tape that holds the joint together and is responsible for keeping the joint from moving too much out of alignment. Ligament stability requires hairline precision to function properly.
In addition to relying on ligaments, muscles act like thick ropes that hold the joint together and keep the joint precisely aligned with small adjustments through movement. These adjustments require the muscles to fire with microsecond precision to work properly.
If we define a stable joint as one that is sturdy and resistant to injury, then an unstable joint has the potential to suffer more damage during normal movement.
Sub-failure Instability: The silent killer of joint health
The vast majority of people who suffer joint pain started by having a sub-failure instability whose negative effects compound over time.
Sub-failure instability means the surfaces of the joint are not kept in proper alignment during movement. This causes the joint surfaces to constantly hit each other, resulting in rapid wear and tear of the joint compared to one that is completely stable.
There are two types of sub-failure instability, passive instability in which the ligaments are involved and an active instability in which the muscles are involved.
It’s important to note that most sub-failure instability might not be felt by you since they are usually small misaligned movements that happen without your knowledge. Over time, these small amounts of extra motion add up and cause damage to the joint.
Problems with Stability usually lead to issues with Articulation and Symmetry.
What do we mean by articulation?
Articulation is a fancy term for an area where two bones attach for the purpose of motion of a body part. In the stability section we looked at what happens outside the joint, now we are looking at what happens inside the joint or in between the two bones.
The surface of most bones at the joint are lined with a hyaline cartilage, followed by the synovial membrane, and surrounded by the joint capsule and ligaments.
Pain can occur when the cartilage, or other soft tissue depending on the joint, wear down. These tissues act as a type of spacer and shock absorber, so as they degrade pain can start to develop. Pain can also occur when the capsule is distended with fluid, such as an inflammatory arthritis.
Articulation problems are usually the result of one or a combination of the other three factors, but it will lead to further problems in Symmetry.
Why should I care about symmetry?
The vast majority of injuries are a result of poor movement patterns that caused wear and tear to a structure over a long period of time.
An analogy we like to use is a misaligned car with damaged tires. The tires are the result of the misalignment. In the human body, the tires are equivalent to tendons, cartilage, and bone. The cause of the tire damage is due to the misaligned car, which is the equivalent to asymmetry in the body.
What types of asymmetry exist?
Asymmetry can be summed up into two different categories.
Structural asymmetry occurs within the skeletal system and often includes misalignment of the spine and hips. These usually occur from a minor injury or accident, such as falling off your bike when you were a kid but can also be due to major injuries.
One example of a structural misalignment would be a misalignment in the cervical spine, such as a forward head carriage, which can lead to shoulder pain down the road. Over time, the body tries to naturally compensate for structural asymmetry which ends up leading to muscle asymmetry.
Muscle asymmetry occurs when muscles are not properly balanced throughout the body. Examples of this would be differences in muscle strength, length, or activation.
One example would be muscle weakness in one hip that results in knee and/or ankle pain in the same leg.
When asymmetries are involved they can commonly lead to issues in Stability or Articulation.
What do you mean neuromuscular?
Neuromuscular refers to the relationship between the nerves and muscles. As we know, the brain communicates with our body by sending and receiving signals from nerves. When it comes to muscles, the brain will send the signal for the muscle to contract and the muscle responds by contracting.
The problems that can occur here can happen in the nerves, in the muscle, or both.
Our nerves are made up of individual nerve cells that pass signals to and from each other. When nerves get injured, it’s ability to pass these signals from cell to cell become disrupted. This injury also forces the nearby cells to release chemicals that signal the brain of the disruption by causing pain.
In addition to causing pain, we know that nerves control muscles. So when a nerve is injured it can cause problems in the muscle such as the development of trigger points, decrease in strength, and delays in muscle activation leading to asymmetry.
When a neuromuscular problem is involved it usually leads to issues with Symmetry and Articulation.
Putting the Pieces of the Puzzle Together
Katie the Hiker with Knee Pain
Katie is a 50-year-old avid hiker who visited our clinic experiencing right knee pain when she hiked. Her pain began to limit the length and intensity of her hikes.
After doing an examination and proper imaging, we determined that her knee pain was likely coming from moderate arthritis that was caused by asymmetry due to muscle weakness in her right hip.
We discussed that we could treat the direct source of her knee pain with PRP Therapy, which would address the Articulation. After 3 rounds of PRP Therapy, her pain went from a consistent 7/10 pain to a very infrequent 1/10. She was able to return to the hiking routine she had been doing prior to having knee pain.
Katie was extremely happy with the results but we educated her that the problem would likely come back if her hip weakness wasn’t addressed. We referred her to physical therapy to address her hip weakness and within 5 treatments her hip asymmetry was no longer an issue and her knee pain completely resolved.
Katie has been happily hiking better then she was before for a little over 2 years since her initial visit.
You can see here that simply addressing the Articulation would have not given the best result as the pain would have likely come back due to her “alignment” being off which would have worn down the cartilage in the knee further.
Ken the Bodybuilder with Shoulder Pain
Ken is a 35-year-old bodybuilder who visited our clinic experiencing shoulder pain. Prior to visiting our clinic Ken had been to a massage therapist and physical therapist.
Ken was experiencing pain when he raised his arms and lifted weight above his head. He responded positively to massage therapy as it helped him address the tight muscles, aka the Neuromuscular component, around his shoulders. He also had his Asymmetry problem corrected by his physical therapist.
Overall Ken was about 70% better using the massage therapy and physical therapy alone but was unable to lift heavy weight above his head.
After we performed our examination and proper imaging we determined that the problem was coming from an unstable AC joint, from an injury he had endured years ago. We addressed this problem by performing prolotherapy on his AC joint to tighten and stabilize the ligaments around the joint. After 3 treatments he no longer experienced pain when lifting weight overhead and had recovered 100%. .
Ken has continued lifting weights for the last year without any issues.
As you can see in Ken’s case, an old injury caused his AC joint to become unstable. The problem likely compounded over time by having the surrounding muscles compensate throwing off his symmetry which leads to the neuromuscular problem.
These are two real cases that we have seen in our office and demonstrate why simply treating just one component is not always enough if the patient wants to safely return to full activity.