Arthritis

The Self Fulfilling Prophesy

Joint Pain

The major problem with joint pain is that you cannot feel it. This is true of all joint pain but is so counter intuitive when you have a pain that is keeping you awake at night, how have I got the gall to try to convince you that there is no pain?

Well let’s start with the hip joint as it is a big one and I have a drawing that shows it nicely; not at all accurately but quite clearly.Hip-1

As you can see the joint is surrounded by a capsule and inside that the cartilage covers the ends of the thigh bone and the inside of the socket. So the cartilage absorbs all the rubbing and is lubricated by a nice fluid that comes out of the inside lining of the capsule. No blood vessels come through the capsule so the ‘synovial’ fluid has to transport all the nutrients needed to lubricate and regenerate the cartilage and carry away any and all old or damaged molecules of cartilage

The fluid washing against the inner surface of the capsule dumps this rubbish into the lymphatic system. So this kind of second hand nutritional supply and waste removal system is not as efficient at healing the tissues as a good blood supply and direct flow away in the lymph would be but it does work, if slowly.

None of which explains why I claim you feel no pain from the joint, well there are no nerves inside the capsule either; not a single one penetrates the capsule so however much damage is done to the cartilage you will feel nothing until you damage the bone. Bones have lots of nerves and they will report high levels of pain from small amounts of damage. Bones are only damaged where the cartilage is either worn right through or has detached and exposed the bone beneath.

If a small section of the capsule gets caught into the joint as in the next picture, the consequences can be far reaching, because as you can see in the fourth picture a few muscle fibres get caught as well.Hip-2n

In this way the first pains you feel are in the soft tissues outside the joint, the muscles have lots of nerves as do bursae even the ligaments and tendons have some and when the problems spread to them you get pain and this is often months after the inflammation started in the joint.

Bursae; well they’re fluid filled sacks that are tucked behind points where tendons may be rubbed in order to prevent things being damaged and becoming inflamed. There are lots of bursae around all the joints and if bursae become inflamed, they’re extremely painful. Tendons are the gristle that joins a muscle to the bone and ligaments are thicker parts of the capsule.

In the bottom picture you get an idea of the complexity of the situation as this represents less than a third of the muscles, only one of probable two dozen bursae and shows how the nerves make their way through this mass of soft tissues, but none of the connective tissue is shown. So mostly the pains you feel start as being an indeterminate ache that moves around a bit as different soft tissues outside the joint become inflamed or muscles spasm due to the joint capsule being trapped. But no pain from inside the joint until the damage is severe.

Knee-4eThis same system operates all over the body as here with a knee.

The inflammation has spread to muscles and bursae and each of these will be hurting from time to time.

Internal inflammation causing pain in the muscles and bursae around it but no pain within until there is damage to the bones. But when the bones start rubbing together the pain will be intense.

Here another example, a shoulder which is more complex as some muscles’ tendons actually penetrate the capsule and they have become inflamed and stuck to their sheaths so in this case they may take an external inflammation and spread it into the capsule and damage the cartilage lining of the joint in that way. You can see how close this is to a bursae so that is liable to become inflamed.

The problem here has already spread to the ribs, the joint [bottom left] between the cartilage and bone of which has become misaligned [subluxed] and the muscles and other tissues around that are inflamed.Frozen Shoulder8

But worst of all the nerves coming past are in imminent danger of inflaming as well. That of course would be agony all down the arm. All of these problems can occur in almost any joint in the body.

Now the really bad news is that before joints become agonising, even before they become achy, the internal painless inflammation sticks solid every night when you don’t move it for hours. The capsule is stuck down on the cartilage covering the bone and the opposing cartilage surfaces are stuck fast together.

Then you wake and move, first pushing yourself up to sitting using that achy shoulder, putting on socks which requires a full range of movement in hip, knee, shoulder and back, even standing putting weight through the leg, instantly ripping the tissues apart which, if only you could feel it, is something that would be so painful you’d never do that again. But you feel nothing so you start your day with a severely inflamed joint day after day.

In the first seconds of moving for the day you have done more damage than can heal in one day. Gradually this will get worse and worse.

There is quite a good example from everyday life that equates to this. With a nut that has rusted solid to its bolt first you spray the W.D.40 into it then with small movements you work the nut loose, back and forth until it undoes; if you just swing off it the bolt will sheer.

To avoid this first apply an anti inflammatory spray, lotion or cream on going to bed to reduce the overnight adhesion.

Next you need to carefully mobilise the joint before you leave your bed, even before you sit up and even if that’s in the middle of the night.

Start by clenching the muscles around the joint compressing the capsule and pumping the fluid inside it deep between the surfaces. Squeeze and release, squeeze and release several times.

Then, very gently at first, with lots of tiny then small movements, working that synovial fluid into the depths of the joint and lubricate it by rolling the bone in its socket then slowly increasing the range of movement gradually until you have a full range of rolling movement. Now lift the limb a little and drop it back again increasing the height a little every time, until you have a full range of lifting movement.

Once you have worked up to a full range of movement and not before, you can sit or stand up and put weight through it. In this way you avoid tearing surfaces apart that are stuck fast together.

Some changes of routine may be helpful, clean socks on going to bed rather than in the morning or dressing gown and slippers until after breakfast to avoid the huge range needed for putting on socks and shoes.

Make sure you wear PJ’s or a tea shirt to avoid waking with a shoulder that has been outside the bedclothes half the night as a cold shoulder joint will be even more firmly stuck down.

The aim in the first seconds of moving for the day is to do less damage than can heal in one day. Gradually this can get better and better. It will take months even so as the poor supply of nutrition and waste removal means slow healing. .

And why was this all a Self Fullfilling Prophesy? Well as the ache starts near the joint we decide that since we are getting older this has to be arthritis and do nothing about it. In due course it then becomes Arthritic.

Of course this has not dealt with the cause of the internal inflammation and for that you will need to Visit Your Therapist, Preferably Me