Recently, I received a wonderful question on The Injury Corner — a Facebook group I moderate that provides advice and guidance for anyone dealing with chronic pain and injury.
A podiatrist has told me that I have arthritis in my big toe. It’s painful to fully flex it and it’s throwing off my gait, which as many of you know, is foundational to proper function. He didn’t have any suggestions for correcting it other than giving it space (said I’m too young for surgery as that surgery is so debilitating). Any suggestions here for either alleviating it or working around it?
I love this question because it touches upon something I hear frequently. “I am in pain because I have arthritis.” This is a statement that I do not fully agree with–primarily because it sounds an awful lot like “It’s because I’m getting old!” — which I write about here.
There are two main reasons I disagree with the commonly held belief that arthritis = pain.
1. The Failure Prescription
2. Arthritis is a symptom, not the problem
The Failure Prescription
I’ve borrowed this phrase, “The Failure Prescription,” from one of my mentors, Dr. Kathy Dooley. Most people, when told they have arthritis, assume there is nothing they can do about the pain, other than treat it with drugs, topical pain relievers, injections, and/or surgery. This is not a treatment prescription to thrive–it is a prescription to fail. In the case of a failure prescription, there is little strategy for change, help, healing, recovery, and most importantly…hope. A failure prescription suggests that pain is just the way life is supposed to be and there is nothing to be done about it.
I don’t believe in failure prescriptions. Call me an idealist, but I believe there is always hope for some sort of meaningful change. As a Movement Therapist and a life changer, I do not write prescriptions to fail. Instead I offer hope.
Degenerative Arthritis = Symptom, not problem
Just as I’ve written before about pain being our body’s way of alerting us to an underlying problem, so arthritis is a marker of a larger issue. The underlying problem responsible for both the arthritic condition and the pain is simply how well, or not, you move.
In my experience, osteoarthritis and pain are both caused by dysfunctional movement patterns and are primarily related to gait — i.e. the way you walk and run. In the world of movement therapy, gait is huge. It is the movement pattern used most frequently and with the longest duration of any other movement pattern in a human being’s life. From the moment we are born, every movement made prepares us for walking upright. Once a person does begin to walk, every movement thereafter is built upon this gait foundation.
If you have inefficient movement anywhere in your body, it will show up in your walking gait. When this inefficient movement is assessed, corrected, and cleared from your gait by a skilled movement therapist, you will see greater efficiency and quality return to other movements. The positive side effect of this type of therapy? With healthier, higher quality movement you will experience less wear and tear on the joints and more importantly, less pain.
There are two main types of arthritis, osteoarthritis and rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease that can cause inflammation of joint tissue. As a Movement Therapist, I do not work with autoimmune disorders, as they are outside my zone of expertise. For the purpose of this discussion, I will be specifically addressing osteoarthritis.
Osteoarthritis or degenerative arthritis is the most common form of arthritis. Osteoarthritis is the degeneration of the bone and cartilage caused by “wear and tear” of a joint, and is generally blamed for pain and stiffness in the knees, hands, hips, and back.
It is helpful to note that arthritis is not always symptomatic with pain. Many people have arthritis with no pain at all. In fact, “up to 60% of people with radiographic knee osteoarthritis may not complain of pain.” For example, I have degenerative arthritis in my surgically-repaired right knee. The degeneration can be seen in x-rays, but I don’t experience arthritic pain in my knee.
Also, just because pain is present and arthritis is present, doesn’t mean that arthritis is to be blamed. There is a correlation between the two, but that doesn’t always equate to causation. This is an important distinction to make. If a symptom is diagnosed as the problem, you will waste time, money, and frustration chasing relief for something that doesn’t resolve your pain. Your pain and injury can become further aggravated if invasive interventions such as injections, orthotics, and surgery are used to treat the symptom (arthritis) and not the problem (how you move).
Let me reiterate: arthritis is not the problem. How a person diagnosed with arthritis moves is the problem.
This is the primary reason I recommend exhausting all non-invasive options prior to undergoing surgery or other invasive procedures. I frequently hear from clients who’ve gone through 1, 2, 3, or more surgeries–and yet their pain hasn’t improved. Prior to seeing me, many of these people had unnecessarily resigned themselves to a life of chronic pain. Thankfully they continued looking for help and are now not only able to move with less pain, but are also returning to the activities they love. Here is an example of a woman who was able to recover from eight years of painful “arthritis”.
Mobility & Stability
For healthy efficient movement to happen you need both mobility and stability throughout the body. Mobility is simply the ability to move freely. It is the wide range of movement your body is capable of performing. The greater the range, the greater the mobility. Defining stability can be a bit trickier.
I used to think that stability meant rigidity. But as I’ve learned from another great mentor of mine, Gary Ward of Anatomy in Motion (AiM), with human movement, there is no such thing as rigidity. We are always moving, constantly passing back and forth through a state of being neutral. In this context, “neutral” is just a moment in time between two opposing extremes. For example: try standing still, and feel yourself sway back and forth and side to side. Now try to prevent this swaying. Notice that the more you try to prevent the movement, the harder it becomes and the more you actually move? In our natural state of constant motion, it’s impossible to completely still movement in/of the living human body.
With this in mind, stability does not mean rigidity. Rather, stability is dynamic–it is the braking mechanism of motion. Imagine stability like the brakes of a car: it is the ability to decelerate joint movement against gravity to prevent excess or unsafe motion.
At first, it may appear that mobility and stability are antagonistic to each other, fighting and at odds with one another. But in reality they are not. When your body is moving well, mobility and stability work like two beautifully choreographed dancers: giving and taking in perfect balance, neither one more dominant nor important than the other. Mobility and stability working in tandem allow graceful, precision movements through wide ranges of motion to take place.
Then where is the breakdown?
When injury enters into the body, movement becomes inefficient. What used to be perceived as a safe movement become unsafe. When this happens, the body will sacrifice mobility for greater stability. In an attempt to protect, the body creates excess stability either in the soft tissue, such as tightening up a muscle, or in the skeletal structure through joint compression. Joint compression can lead to arthritis.
In the example from The Injury Corner referenced above, I would expect that the joint of the big toe is compressed similarly to this picture. Compression is an excellent stabilization strategy for your body to protect itself from harm; it’s like an internal bracing system, similar to wrapping a sprained ankle or knee. If a joint is unstable due to muscle weakness or inhibition–stemming either from an injury or repetitive poor movement–the joint can compress, making itself rigid and stable. Some of the range of motion of the joint is lost, but the compression allows for continued movement.
Generally one joint goes into a stabilization strategy to protect movement within itself or for another joint above or below it that may be hypermobile and unstable. To prevent further injury and keep the body moving, your nervous system locks down the joint, preventing too much load on an unstable structure. Note that the stiffness or rigidity at this particular joint is a bracing strategy that allows dynamic mobility and stability to take place in the rest of the body. (A rather important strategy since movement is key to survival!)
This joint compression then occurs with each step taken–and when a joint compresses, it squeezes out nourishing and lubricating synovial fluid. As a result, the joint no longer tracks smoothly or efficiently, surrounding tissue can become inflamed, cartilaginous tissues become brittle, and the overall structure of the joint itself will experience greater wear and tear.
It is this excess stress of joint compression that is the cause of pain in arthritis sufferers. It is this lack of nourishment and joint health that is the underlying cause of osteoarthritis. Arthritis is not the cause of the pain, it’s a symptom.
Poor movement quality is thus the underlying problem that created both symptoms of arthritis and pain. Healthy efficient movement is The Healing Prescription, and it is possible. In contrast to The Failure Prescription, arthritis can instead present the opportunity for hope–a call to alter your movement patterns in a way that can fundamentally change your life for the better.
To do this, you will need help from someone who specializes in movement therapy. For optimum results, I recommend seeking out a highly skilled movement therapist specifically trained and experienced in assessing muscle function, joint compression, and gait mechanics (i.e. the way you run/walk). Ask around, interview several therapists, get multiple opinions, be picky, and ultimately choose the person who best addresses your needs and goals.
The Healing Prescription
With a different “diagnosis,” there comes a new “prescription.” If the problem is caused by a dysfunctional movement, then it can be resolved by correcting the dysfunctional movement patterns and replacing them with healthy, efficient, pain-free movement. A skilled movement therapist can help you learn ways to move better. Better movement = less joint compression. Less joint compression = less symptoms of both arthritis and pain.
You have the ability to heal. By shifting your perception of arthritis, it is possible to see that it is not a prescription to fail. This is your prescription to thrive.