Joint Pain and Joint Degeneration: Bone-On-Bone? Do You Need Surgery?

Osteoarthritis (OA), Joint Pain and Joint Degeneration …
Do They Cause Pain and Dysfunction?

“They” say X-rays showing “bone-on-bone” pathology or “arthritic build-ups” are proof of the cause of your joint pain and joint degeneration, and the  need for surgery, or at very least drugs …

BUT IS THAT NECESSARILY TRUE?

It might sometimes be true, but before you make any irreversible or regrettable decisions …

PLEASE READ THE FOLLOWING:

First, It is important to have a better picture of what’s going on.

One thing that’s been reported in medical literature for several decades now is that in MANY CASES, people with LOTS of joint degeneration have NO PAIN. Conversely, many people with NO joint degeneration have LOTS of pain. This well reported fact makes it very difficult to reliably claim that degeneration of the joint surfaces, even completely herniated spinal discs, torn menisci, or missing cartilage, is necessarily the cause of pain.

There are just too many people whom have all of that stuff, yet have NO pain or dysfunction symptoms. Conversely, many people have severe pain and dysfunction, but NO sign of degeneration on their X-rays or MRIs.

If it can be seen on X-ray or MRI that a piece of the joint material is actually pressing against a nerve, then that is possibly the cause of pain. But that is comparatively rare, and in many cases there is NO such evidence, even with a lot of complete degeneration.

… Osteoarthritis (OA) represents one of the most frequently occurring painful conditions. Pain is the major OA symptom, involving both peripheral and central neurological mechanisms. OA pain is initiated from free axonal endings located in the synovium, periosteum bone, and tendons, but not in the cartilage. … 

Osteoarthritis Pain From Surrounding Soft Tissues, NOT Cartilage

REPEAT: NOT in the Cartilage!

The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain, and knee osteoarthritis).

Lorimer Moseley, “Teaching people about pain — why do we keep beating around the bush?Pain Management. 2012.

… Although there are no pain receptors in the cartilage, the origin of the pain is thought to be due to stimulation of the A delta mechanoreceptors and the C polymodal nerve endings in the synovium and surrounding tissues. However, some of the pain experienced in and around the joints is referred pain or sympathetic efferent pain. In addition, there is a poor correlation of clinical symptoms with radiological or imaging appearance. This lack of correlation of clinical evaluation and imaging makes attempts at treatment difficult …

NO Pain Receptors In Cartilage

… Degenerative changes do not constitute a diagnosis because there is little, if any, correlation with pain. … There is no known mechanism whereby degenerative changes can be painful, and the epidemiological evidence shows that they are not. …

Degenerative Joint Disease and Pain Correlation Described

Although there is some evidence of ruptured spinal discs correlating with spinal pain, as we’ll see, and is discussed further below, there are very few or no pain sensitive nerves INSIDE OF  the joints.

Joint Pain and Joint Degeneration just do NOT correlate well at all with aches, pains and dysfunction. Yes, doctors are obviously tempted to point to X-rays of your “degenerated joints” and tell you that’s the cause of your pain or limited range-of-motion.

But if they’ve been keeping up with the medical literature, some of which started coming out back in the 1970s, (!!!) they know it’s NOT a good indicator.

So if the pain sensitive nerves are OUTSIDE of the joint — again, “synovium, periosteum of the bone, and tendons” — and the degenerated joint surfaces cannot compress or otherwise irritate pain sensitive nerves, then how does joint degeneration cause pain?

If it cannot be reliably stated that the joint degeneration is the direct cause of pain, what IS the cause of pain? Is it something else besides the degeneration? … We’ll get to that soon …

Second, It is important to ask the right questions. For example, if you have X-ray or MRI evidence of actual bone-on-bone pressure within the joint in question, you should ask … WHY is that happening in the first place?

WHY is the Joint now “bone-on-bone”? …
WHAT — REALLY — is causing Joint
Pain and Joint Degeneration?

And NO, “old age,” by itself, is not an adequate or intelligent answer. In fact, that answer (“You’re just getting old”) reveals very low levels of understanding of how the body actually works in the long-term of your life. Yet the solution really only requires a minimum level of knowledge of the anatomy and kinesiology of the musculoskeletal system, and some very basic physics. … If you know what to look at.

Anatomy is a description of the shape and location of muscles.

Kinesiology is the description of what happens to bones and other tissues when a muscle contacts or relaxes.

Medical Physiology tells you how the body systems will react to various events and processes.

Basic Physics allows you to see the effects of movements and pressures caused by the muscles acting upon bones & joints. The forces of gravity play a big part in such phenomena.

WHAT Pressurizes Your Joints?

There is one VERY common, and primary reason, to end up with a loss of space, too much pressure on, or degeneration in one or more of your joints. That is, the muscles crossing that joint have chronically over-shortened, and have squeezed much of the water and space out of the joint capsule.

But first, a look at the joint capsule as a whole:

joint capsule with tendons = joint pain and joint degeneration

Notice the VERY thin layer of synovial fluid — mostly water, in light blue — acting as the padding between the layers of cartilage. Also note the soft tissues — tendons, bursa, joint capsule, ligaments — surrounding the joint.

Here’s the joint without the soft tissues:

synovial capsule - joint pain and joint degeneration

It is maintaining that watery space (synovium, holding the synovial fluid and water) between articular surfaces (cartilage), that’s the job of the water within the synovial fluid. Water in incompressible but very mobile. So it’s great at producing the shock absorber effect in your joints without limiting motion.

Here’s an X-ray of the knee joint:

X-ray of knee joint - joint pain and joint degeneration

Loss of water and synovial fluid leads to degeneration and breakdown of the cartilage.

But what increases the pressure in side the joints and forces the water out?


A Look at Muscles Crossing Joints

increased compression of joint leads to joint pain and joint degeneration

Increased Compression of Joint Leads to Joint Degeneration

As you can see in the above illustration, if both muscles of the pair (A and B) are chronically over-shortened, there is NO CHOICE but for the bones and joint surfaces to be pulled closer to each other. The more tension & shortening in those muscles, the closer the bones get to each other. That is basic physics.

This puts increasing amounts of pressure on the joint capsule, containing synovial fluid. This fluid, consisting mostly of water, is the lubricating and shock-absorbing material between the joint surfaces.

Description of Synovial Fluid at Wikipedia

Increasing pressure within the joint capsule increases the physical force of diffusion, which says fluids naturally move from areas of higher pressure toward areas of lower pressure. So as pressure within the capsule increases, the water within, via diffusion, is forced to move outside of the joint, dehydrating the interior of the joint.

As the water, which acts in great part as the “shock absorber” within the joint capsule, diffuses out, there is less water and synovial components to hold joint surfaces apart from each other.

The loss of water also means the synovial materials are dissipating, or is mostly gone. Although usually a gradual, incremental process, when that happens, your joint surfaces will eventually start rubbing against each other, and the friction will start breaking the surfaces down, such as the cartilage on the surfaces of the joints.

Definition & Description of Cartilage at Wikipedia

That directly produces osteoarthritis. You eventually get “bone-on-bone.”

If the increasing pressure from chronic muscle tension is allowed to go on long enough, many of the soft tissues surrounding the joint will start to break down as well.

PREVENTIVE MAINTENANCE would involve keeping the muscles Relaxed, Lengthened & Balanced so they do not apply chronic, excess pressures on the joint capsules and surrounding tissues. THAT is one of the functions of postural yoga or mindful stretching, or what we call Let-Go Yoga.

Is Surgery REALLY Necessary for
Joint Pain and Joint Degeneration?

Well, if the joint surfaces have degenerated, that MIGHT merit some kind of invasive intervention. If you are a professional athlete, or doing some kind of work in which you put extreme pressures, stresses or strains, or velocities, on the joints, that might be warranted.

However, increasing numbers of physicians will say that if you are not in significant pain, and you have adequate range-of-motion to accomplish the normal tasks of your daily life, then surgery is not generally necessary.

The question is, what is the best way to relieve the pain, and regain adequate range-of-motion?

WHAT Is Causing The Pain?

In many, if not most, cases, the cause of the pain is NOT the degenerating cartilage or bone-on-bone contact. In fact, it is well established that there are VERY few “pain sensitive”* nerve endings WITHIN the various joints of the body or spinal discs.

Cartilage does not contain blood vessels (it is avascular) or nerves (it is aneural).

https://en.wikipedia.org/wiki/Cartilage

If there are, by Nature’s Design, NO NERVES (aneural) within cartilage, it CANNOT be the direct source of pain (nociceptive) signals to the CNS and brain. (CNS = central nervous system.)

It is also true that chronically over-contracted muscles will resist lengthening, and will not allow full range-of-motion of the joint. Over-shortened muscles also cannot deliver their full force, nor move across a full distance, even if they are still “fundamentally strong.”

Rather than degenerating hard tissues, this is very often a problem of Active or Passive Insufficiency, described elsewhere on this website.

* Technically speaking, “pain sensitive” nerves are actually called “nociceptive” nerves, because the signal in the nerve does not get translated into an actual “pain sensation” until it arrives in the conscious part of the brain (cerebral cortex). The feeling of pain in your body is actually a projection of your brain, producing sensations that feel as if they are “out there.”

This does NOT mean it’s an illusion or “all in your head.” We are merely describing how modern neuroscience has discovered that the brain & perception actually works. This helps explain phenomena like phantom limb pain, where an amputated limb is still “felt” as if it’s still there.

Ischemia, Hypoxia & Nociception
Reduced Blood Flow, Reduced Oxygen & Pain Sensations

Nociceptors are nerve endings measuring various noxious (bad) irritations in the body, as well as excess levels of chemicals in the blood and tissues.

Additionally, the tension in chronically contracted muscles reduces the amount of blood arriving in the area, producing ischemia (blood deprivation from restricted blood flow).

Definition of Ischemia at Wikipedia

As ischemia increases, less oxygen arrives with the reduced blood flow, producing ischemic hypoxia (oxygen deprivation).

Hypoxia is known by medical research to cause pain. The more hypoxia (less oxygen), the more nociception (pain).

Definition of Hypoxia at Wikipedia

So now, we know that chronically over-contracted muscles can:

  • Reduce or Limit Range of Motion
  • Compress the Joints
  • In the Extreme, the Joint can”Freeze”
  • Dehydrate the Joints
  • Irritate and eventually Erode Joint Surfaces (i.e., cartilage)
  • Cause Aches & Pains

WHAT Is The Solution for Joint
Pain and Joint Degeneration?

If muscles are chronically contracted & shortened, and they are putting offending pressures on the joints, would it not make sense to START with SUBSTANTIALLY REDUCING the chronic and excess tensions in the muscle/tendon units causing those contractions and shortenings in the first place?

If that makes sense to you, why not start by using the available and TOTALLY NON-INVASIVE techniques of getting those muscles to Let-Go of — or RELAX or DE-CONTRACT — their muscular (musculo-fascial) tensions? … Does that NOT make sense?

THEN, if you’ve actually removed the original cause of the joint degeneration, and you still have pain, limited range, stiffness, or other dysfunction, you have a FAR clearer idea of what you’re really and truly dealing with.

(YES, it’s true, there is a more primary cause as to why you’ve accumulated those chronic tensions in the first place, and we’ll get to that on another page. But the direct cause of the joint compression itself is chronic, excess muscle tension, or what I’ve been calling C.E.M.&.N.T.)

THE TECHNIQUES of TENSION RELEASE

My preferred tools, and what I used to relive my own debilitating musculoskeletal problems, were:

  • Physical/Mental Yoga … utilizing Homeopathic Doses of stretch with Long Holds
  • Hands-On, Structural Bodywork Techniques … also of Lower Intensity Pressure with Long Holds
  • BIO-Structural Balancing & Postural Alignment … for determining Which Muscles, and in what Sequence

Dr. John Sarno, M.D., On Excess Muscle Tension

Here is Dr. John Sarno, a medical doctor with a unique yet HIGHLY instructive approach (even if it does not apply to everyone), with a high percentage success rate in reducing or eliminating pain from so-called “structural degeneration” and other apparently physical causes:

ARTICLE & PODCAST on Dr. John Sarno and his approach to resolving all kinds of pain.

 

MORE COMING SOON!

Thanks for Reading about Joint Pain and Joint Degeneration!
David Scott Lynn (DSL*)
* DSL: Your Hi-Touch Up-Link to the Inner-Net
Inner-Net: Your Psycho-Neuro-Musculo-Fascial System

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David Scott Lynn (DSL)

DSL the Yogi at Whole Life Perspectives
Beginning at 13 years of age, DSL's been involved with alternative philosophies & practices most of his life. Becoming a yoga teacher in 1976, then a hands-on bodyworker in 1981, he developed a unique & highly effective form of Yoga / Bodywork / Whole Health Fitness & Therapeutics. … David wrote the chapters on a wholistic philosophy & physiology of bodywork & stretching for the textbook Structural Balancing, published by McGraw-Hill, Inc. in 2010. … He is the author of Simple Steps to Let-Go Yoga, available at: www.letgoyoga.com/simple-steps/ … Several other e-books and e-courses are soon forthcoming at www.letgoyoga.com/dsl-publications/ … David consults with Kyle C. Wright on massage school development at the Schools of Advanced Bodywork at http://kylecwright.com/structural-balancing-a-clinical-approach/co-author-dsl/ .
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