What is wear and tear?
Virtually every joint
in the body, of all different shapes and sizes, have the same basic components,
a “sandwich” consisting of bone lined with cartilage and filled with a
lubricant called synovial fluid. This unit is surrounded by a capsule of tough
connective tissue lined by a sensitive layer called the synovium which keeps
the lubricant in place. The cartilage is a dense but rubbery tissue which acts
as a shock absorber, and with the synovial fluid prevents the two bones grinding
against each other.
Wear and tear is
technically known as “degeneration” and it is when the cartilage layer breaks
down. In the early stage this can be a mild roughening of what should be a
smooth surface, to late stage where there is total lack of cartilage in places
and bone on bone contact. This causes varying degrees of pain, a reduction in
the range of movement of the joint, and a characteristic feeling of
“stiffness”, especially first thing in the morning. The muscles surrounding an
affected joint usually become tight and painful and in later stages suffer
wasting. As the body ages it is inevitable that this occurs to some extent, but
the rate of degeneration varies from individual to individual. The exact reason
for this variation is unknown at present, and there is no “cure”, but you can
“slow down the clock”!
The terms
osteoarthritis (OA) and wear and tear are sometimes used interchangeably, and
this is reasonable in some cases. OA can be described as “Primary” when there
is no apparent reason for the onset and “Secondary” where there is an
explanation for the onset. Primary OA in one or more joints is common for
someone e.g. in their 80s and is likely to be due to the degeneration of the
cartilage over time as described above. Primary osteoarthritis in someone e.g. in
their 30s however is far less common. The reason for this occurring is at
present unknown but it is thought to be genetic and it may be hereditary. In
these cases the term “wear and tear” is not sufficient, as there is a disease
process in place. Secondary OA is far more the common type for all age ranges
and can be due to injury sustained to the joint many years previously, injury
to the body at sites distant to the affected joint, or any form of “altered
biomechanics”. The term wear and tear is reasonable in these cases, but there
is usually a reason for it! For example a fracture anywhere in the hip, leg,
ankle or foot shall subtly change the shape or length of the limb and shall
disrupt the ideal distribution of pressure on e.g. the knee cartilage. This
increases friction on the point of maximum pressure and accelerates
degeneration.
To slow down the clock
in all forms of degeneration whether wear and tear or Primary OA, the most
important thing is to keep the cartilage nourished. Unlike other tissues
cartilage doesn’t get its oxygen and nutrients direct from the blood supply but
from the synovial fluid within the joint. This must be swept across the
cartilage surface by the cartilage on the other side and the only way this
occurs is by the natural movement of the joint. Many people are familiar with
the stiffness and ache that occurs in degenerative joints when they haven’t
moved for a while especially first thing in the morning or after a period of
sitting in a chair, and the easing of discomfort they feel with a few minutes
of gentle movement. In the long term, the key to managing degeneration is to
move the joints as regularly as possible (within reason!) and any form of
regular, gentle exercise that you are comfortable doing shall be of benefit.
The worst thing to do is to think that the discomfort you get on initial
movement is somehow causing you more harm (its not) and stop moving altogether.
Although there is no
cure for degeneration, once it has been diagnosed Physiotherapy or Osteopathy
can give you a “boost” in the right direction. With mobilising techniques for
the joints and soft tissue techniques such as massage and stretching for the
muscles we can help the joint reach its full movement and therefore nutrition potential,
reducing the painful symptoms allowing you to better self manage. Maintenance
treatments at regular intervals can also give you a top up when required, but
the most important thing to remember between treatments is…….keep moving!
