UNDERSTANDING OUR “WEAR ZONES”

By Vincent Hanneken, PT/Owner

Hello and welcome to our osteoarthritis (OA) or another way to say it is Degenerative Joint Disease issue of our newsletter. This is a condition nearly everyone to some degree is going to experience. The question is how will they address it? The data below provides some understanding of where we are now as a country regarding the use of surgery to address the end stage of arthritis. And, we have several articles to help you understand how graded exercise helps to stimulate the mechanism whereby cartilage can recover better from the stress of activity. 

When comparing the USA to Canada, countries that have similar demographic and economic situations, the US does about 50% more TKAs than Canada per 100,000. And not so unsurprising, the projection is for this number to significantly grow by 2040 for TKAs in the US. Total hip replacement (THA) in 2023 amounted to over 760,000, and lower back surgeries for laminectomies and/or fusion numbered 500,000. Shoulder surgeries for rotator cuff repair was nearly 500,000 and cervical surgeries for relieving nerve compression was around 135,000/yr. 

It is amazing we have the technology to help people whose joints are so degenerated a replacement is needed to sustain their quality of life; however, the projected number of these surgeries is going to grow at an even faster rate than the past 25 years.   Between 2000 and 2019, the estimated annual volume of THAs increased by 177% and that of TKA increased by 156% on average.  Based on this data, it’s not hard to draw a conclusion that the US has a major problem with arthritis and how it is handling this disorder.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9974080

It is clear based on these stats that the human body has common “wear zones” and we can see from the frequency and type of surgeries what areas of the body are vulnerable to degenerative joint changes.

Cartilage is the tissue that overlies our joint surface and is vulnerable to wearing down and creating a bone-to-bone condition which is called degenerative joint disease or OA. Knees are number one for surgery, followed by hips, lower back, shoulders and then the cervical spine and from treating many patients in therapy this pattern seems accurate. 

This data on surgeries and joint replacements indicates quite clearly where our vulnerable areas are in our body.

The question becomes what could we do to reduce the stress in these “wear zones” and help lower our chances of becoming an eventual candidate for surgery to replace a worn-out joint. 

The optimal condition is for our joints to age at the same rate or even slower than our chronological age; yes, I am 65 but the doctor says my joints on x-ray looks like I am 50. Wow, how could we improve our odds to hearing that from our physician?  In our country, the opposite condition is occurring more and more as the statistics mentioned earlier indicate. A common denominator to many arthritic joints is that restrictions and poor muscle control over the joint are insidiously occurring over time to wear the cartilage faster than it can repair itself.

It may not be recognized by someone, but our bodies are in a perpetual dynamic between forces that are causing the body to breakdown and our immune system’s potential to repair and manage this breakdown to sustain health. These wear zones are places where the repair cycle is not keeping up with the breakdown due to the concentration of stress.  

From a physical therapist point of view, if those wear zones were managed early in the stress cycle and the patient is educated on how to care for their unique vulnerable areas, their ability to keep their rate of healing ahead of breakdown would be improved.

A PT’s exam can help identify why stress is concentrating over a joint causing pain and inflammation.  

Their exam can look at the system of movement, called the kinetic chain, to see where the weak and tight links are which are causing stress on a knee, hip or lower back. 

A PT is really the only professional who assesses a patient as a system of movement which is how the body functions. In so doing, they can get an understanding how to treat the involved area and reduce stress to the joint that is not keeping up with the repair cycle. It is a strong fact that the earlier in the degenerative process you take action to treat an area to alter the rate of breakdown back to favor the repair cycle, the easier and more successful the process is. 

The rest of this issue is devoted to helping you understand the role of cartilage in your joints and how correct exercise can improve the ability of our cartilage to take stress and not suffer. 

It is sometimes surprising to a patient to come to understand that exercise can be therapeutic and healing to a joint when it seemed that activity caused it to get sore in the first place. Over utilizing rest is not the answer or nor is the excessive use of anti-inflammatory drugs. Neither assist with improving the integrity of the cartilage.

I would encourage you to read on to get a better understanding of how graded pressure with prescribed exercises can help a joint recover to perform better during your day. With being more proactive before the joint is fully worn out, one can improve their chances that a total joint replacement is not waiting for them as they move into their 6^th decade or later. 

To healthy joints, 

Vincent Hanneken, PT