A great article was recently published in the British Medical Journal about how practitioners and patients should view osteoarthritis.
Certainly when I went through colleague we were taught that osteoarthritis is degeneration of the cartilage, it was irreversible and leads to pain and dysfunction. In short many medical, physiotherapy and chiropractic schools taught us that osteoarthritis was disease of cartilage.
But there a few problems with model. Firstly more and more studies are coming out that show that the correlation between the decree of tissue damage shown in your joint cartilage correlates very poorly ( if at all sometimes ! ) with the amount of pain and dysfunction a patient has.
Secondly in focusing just on the cartilage we are ignoring the degeneration of bones, muscles and ligaments that can often cause much more pain and dysfunction. This focus just on cartilage explains why many studies are not find a great benefit with supplements or even stem cells. We are only fixing one small link in the chain even IF we can repair it and even IF it makes a difference anyway.
In short cartilage degeneration may be the symptom of the problem not the cause !
The authors conclude that ” In considering disease-modifying treatment for osteoarthritis, it makes more sense, in our opinion, to direct attention to the correction of the underlying mechanical abnormality than to the development of pharmacological or biological agents. Even if the biological agents should show the potential in vitro, or in relatively short-term in vivo studies in animal models, to grow new cartilage or retard the breakdown of damaged cartilage, that cartilage will exist in the same unfavourable mechanical environment that affected the joint in the first place “
In other words it makes sense to address faulty bio mechanics that puts stress on joints past what we can handle ( and that’s usually sudden high impact force ) than it does to focus on trying to diagnosis a treat a disease by focusing just on one tissue.
Fortunately manual therapists such as Chiropractors, physiotherapists and Osteopaths are well trained to assess and correct faulty bio mechanical chains and it may be well worth doing so to reduce stress on the components of joint.
It’s worth a read in full and it’s open source