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Osteoarthritis and joint related soft tissue injuries

Updated: Jan 13

Life is in motion. You need to be able to move to be able to function and live life to its fullest. There is life in movement. There are so many people who live in pain with osteoarthritis and most believe that nothing can be done about that, apart from anti-inflammatory medications, pain killers and joint replacement surgery.

The NHS says: "There's no cure for osteoarthritis, but the condition does not necessarily get any worse over time. There are a number of treatments to help relieve the symptoms.

The main treatments for the symptoms of osteoarthritis include:

  • lifestyle measures *– such as maintaining a healthy weight and exercising regularly

  • medication *– to relieve your pain

  • supportive therapies* – to help make everyday activities easier

In a few cases, where other treatments have not been helpful, surgery to repair, strengthen or replace damaged joints may also be considered."

While the above is not incorrect, it is very generic and lacking the whys and clues as to what direction one might need to take if they wanted to prevent OA from worsening, ease symptoms and potentially stop the process.

  • *LIFESTYLE MEASURES– such as MAINTAINING HEALTHY WEIGHT: because more weight = more pressure per sq cm on the affected joint surface. More pressure=more wear and tear in the cartilage and eventually changes in the underlying cortical bone. EXERCISING REGULARLY

  • *MEDICATION – to relieve your pain - only a solution temporarily, but sometimes needed to be able to get started on the corrected measures such as targeted exercises which will bring more consistent relief of symptoms .

  • *SUPPORTIVE THERAPIES – to help make everyday activities easier - Articular pumping, will create space, "lubricate" the joint by improving the circulation to the area and improve the fluid mechanics of the joint intrinsically (synovium) and help normalise the joint capsule and surrounding lligaments. Myofascial stretching to normalise the myofascia (unit of muscles +fascial tissue) that have a mechanical impact on the joint, and finally the ELDOA that uses self induced myofascial tension to create a small but significant opening in the joint.

  • POSTURE: it should be added to the above that the pressure per sq cm comes down not only to the superincumbent weight the joint has to bear but the posture of the bones which will effect how the joints surfaces meet e.i. surface contact. Many times with cases of hip OA there is a pelvic torsion where the ilium (affecting the female part of the joint, the cup, the acetabulum) is "stuck" in an "posteriorly rotated" position over the femor (male part of the joint) reducing the surface contact between the two, which results in the above. More weight on less surface area. Or in an "anteriorly rotated" position where increases compression on the joint. This is secondary to micromovement, or lack of it in the sacroiliac joint. Hence it is called a lumbo-pelvic-femoral complex. The pelvic femoral part is what we are concerned when it comes to hip OA but make no mistake, it has its concequence on the lumbar spine as well.

The list should continue with:

  • supportive therapies – to help make everyday activities easier

It should be added that these things will only work successfully if measures are taken in time, but most people are conveniently turn a blind eye to it until it becomes debilitating. Then they are eager to try anything. Although, by then their options are reduced to treatments, which will only help with short term relief (without the physiological changes that could have occurred had they started them earlier), injections and eventually joint replacement surgeries.

What is really OA?

OA is best defined as failed repair of damage that has been caused by excessive mechanical stress on joint tissues resulting from the body's innate mechanisms for repairing the damaged tissues is no longer effective enough in the face of the overwhelming mechanical abnormality and/or load.

In other words it is usually a long process where they body's ability to repair is falling behind the damage caused by the stress placed upon it. The question is; can you tip this balance to slow down, stop and in certain cases even reverse the damage? Well, the answer is yes. It is not a quick fix but with consistent effort, it is possible.

Most don't take it seriously enough when the probability of improvements is high and by the time they do, usually when it is truly debilitating and the options for treatments that can offer a meaningful improvement shrinks to very little if any at all.

Joint and joint related soft tissue injuries; whether it is a sprain or a ligament tear, they are often the precursors of wear and tear injuries that lead to changes in the weight bearing surfaces of the joint leading to osteoarthritis.

So what is our goal here?

1. Treat the injured tissue (fluidic treatment)

2. Create space and improve synovial fluid distribution within the joint

3. Lessen the load on the joint or change the mechanism of loading (offload the injured tissue) e.i. engage more of a joint surface to lessen the load per surface area. This is obviously not doable in all joints and cases.

What does the treatment consist of?

- manual therapy with osteo-articular pumping and fascial normalisation

- postural training to elicit changes to modify the load going through the articulation

- myofascial stretching and analytical strengthening to affect surface contact and load sharing within

- diatery recommendations to control inflammatory responses and weight management, where needed

What is Osteoarticular pumping?

Osteoarticular pumping is part of every treatment but it continues to gain popularity due to its immediate effect on joint range and pain relief. It is extremely useful to treat any acute or chronic inflammation of the joints and its ligaments and is a lifeline in the treatment of osteoarthritis. Whether it is the knee, hip, foot and ankle, elbow, wrist, hands, the spine or the pelvis, OA pumping will set the foundation for effective treatment. It is accurate because it can be targeted to the specific ligament within the joint so if I want to pump the ACL of the knee I can do that without affecting the PCL etc.

In the cases of osteoarthritis it comes hand in hand with the ELDOA™ which are specific joint decompression exercises to create space in targeted joint segment, the exact opposite of what happens during arthritic changes.

The facilitation of the movement of water within the joint complex (synovial fluid, water in the collagen tubes of ligaments, tendons, bursae, and lymph) is the the main goal of osteoarticular pumping. By regulating fluid flow osteoarticular/joint pumping can assist the body in being more efficient in managing the process of acute inflammation. In a chronically painful and tight joint, osteoarticular pumping moves stagnated fluid to improve mobility and functionality. In practice, pumping requires the intrinsic anatomy and mechanics of the structure being treated. It always works along the articular surfaces of the joint in direction of the part of the joint or ligament we want to target, well within the physiologic range of the relating connective tissue. It is a fantastic technique because the therapist isn't forcing the movement on the patient. When doing actively, the patient is asked to move the body part in a certain direction while the therapist simply follows this movement. On cessation of the movement when the joint would naturally return to its starting position, the therapist simply delays this return, or in other words the movement of one bone relative to the other, therefore creating a vacuum effect that encourages synovial fluid flow in the joints and fluid flow in the connective tissue in line with its fibre direction.

In this short clip Guy VOYER DO, demonstrates a passive and active pump for the iliolumbar ligaments.

While pumping is popular with the treatment of the musculoskeletal system, it is usually part of all visceral treatments as well.

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