O.A.W.T.F?

It turns out that, while I am all for non-surgical options, I am more all for understanding the problem and adjusting behavior.

In case you missed it, scientists are working on a less-invasive way of treating osteoarthritis. Instead of getting your joints replaced after years of misloading due to joint instability stemming from muscle weakness, you might be able to get an injection that can alter your body’s response to the aforementioned misloading and save your cartilage.

You can read more here: Osteoarthritis Halted in Mice.

As I have mentioned with frequency enough to make anyone ill (I apologize), the way you move your body leads to particular cellular outcomes. Loading the body — the knee or hip joint, in this case —  in an unnatural way creates an abnormal load, injuring the cartilage and stimulating bone activity beneath.

A little on how it works:

1. Cartilage damage comes with swelling (as you can imagine) which increases the size of the tissue and the pressure within the joint and on the bone.

2. The increase in pressure translates into a new, unique bone load, to which bone adapts.

3. Bone adjusts its shape to deal with the new load, although this new shape is not really compatible for the cartilage above it or suitable for long-term loading.

4. The new bone shape creates micro-cuts into the cartilage like a knife (especially if the loads that damaged the joint in the first place are still occurring) and slowly wears cartilage down and out until you need a joint. Or joint replacement, depending on which state you live in.

I live in Washington state. So, well, you know.

This is a nice drawing from The Human Machine to distract you from that last joke.

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Back to the article: “[Researcher] Cao says degeneration is most frequently initiated by instability in the load-bearing joints of the knee and hip caused by injury or strain, so athletes, overweight people and people whose muscles are weakened by aging are at highest risk of developing {osteoarthritis (OA)}.”

Cool. That’s in line with most OA research.

Then, there’s this part from Cao: “We think that the problem in  OA is not just the cartilage ‘cushion,’ but the bone underneath,” he adds.

Er, I know it’s possibly a semantic issue or that I’m splitting hairs, but I’m taking what he is saying here to mean the bone is the problem and so we need to fix the bone. But didn’t Cao (and the bulk of OA research) say that the precursor to the bone’s reaction to cartilage damage is the misloading of the joint?

It bothers my bio“logic”al self to think that the potential treatments being considered (or funded) would be the creation of a local injection that halts the body’s natural response to trauma.

You see, bone’s ability to beef itself up to new loads is how the bone defends itself from damage. A bone’s robusticity — that is a bone’s necessary size, shape and density (given its environment) is essential. If bone cannot adapt, it will fail. And if bone is allowed to adapt then the cartilage will fail. So am I weird to want to ask the researchers, “Hey, what about the loads?” Am a square to not subscribe to the Robbing Peter to Pay Paul mentality? When did a wholistic approach (let’s save the whole body!) become alternative? How long is an “every part for herself” mentality supposed to last? Is Wall Street running medicine as well? Is this all Ayn Rand’s fault? Was that last reference too obscure? Should I have opted for a nap instead of writing this?

The notion that we would halt the bone from saving itself, to keep the cartilage from being further damaged, which would decrease the bone’s ability to hold up the body — while continuing behaviors that damage the cartilage — is beyond asinine. Kind of like the syntax of that last sentence.

Doesn’t it make more sense to address loading behavior so we get both the right amount of cartilage and the right shape of the bone so they can both do their job? Or is my thinking off somehow?

I liked it better when Science was about understanding Nature, not controlling it.

I also like these books.

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Here’s a longer post on World Wide Osteoarthritis, if you’re interested.

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19 thoughts on “O.A.W.T.F?

  1. My brother-in-law is a surgeon, and I see him about once a year and last night was it. I was asking him about research that I had seen suggesting a rise in autoimmune issues in men who have had vasectomies.

    He explained that like the “blood/brain barrier,” the testes has a barrier too, so theoretically, when you cut through the vas deferens, you can release tissues (i.e. sperm) into the man’s body and the body might realize it as an “attacker” and not part of itself and thus ignite an AI response.

    So this was fascinating and led to a larger discussion wherein he said, “We have to start realizing that we can’t just go in to a body, change the way that it works, or take things out, and expect that there won’t be consequences. Even parts we think of as useless, we are finding out that removing them has consequences.”

    A surgeon said that. And that gave me a wee bit of hope that somewhere, someone out there was considering the impact these interventions are having on the “whole animal.”

      1. Yes, but then each testical has its own barrier as well. I’ve been wanting to do a post about this — may I use your quote and then explain further what a “barrier” is, and how each barrier relates to each other?

  2. Off this subject, but could you address the genu valgus deformity so often seen in obese teens? It was always presented to me as only surgically correctable but I’ve always had the idea that it could be prevented by proper “loading” as you say. While you are at it, what about scoliosis? Again there seems to be nothing inherently wrong with bones or structure, just an improper “pulling” by the musculature resulting in deformity.
    Thank you.

  3. Is Wall Street running medicine? Absolutely. That’s why I’m so grateful for people like you!

  4. Excellent post! And thanks for explaining about the unusual bone growth in osteoarthritis. I had a hip replacement a little over a year ago because the bone growth had made all movement in the hip impossible. I couldn’t understand why the bone had done that. I resisted hip replacement for almost 10 years and many doctors telling me I needed one. I tried so many things to get movement back in the hip, including a lot of PTs pulling on the leg/joint, which caused problems in my spine. Alas, that was all before I found you. Now, after the hip replacement, I have ossification within the muscles of the abductors and/or top of thigh muscles (around where the incision was made, I wanted to say “cut” and it was a cut, a huge one) and the doc said if this ossification fuses with the bone and impedes movement, he’ll just need to go back in there again and deal with it. He said this with impunity! (Is that word used right here? It feels right.)

  5. Great Post.
    What about The bunions?
    I was a ballet dancer And my feet got really deformed. So I Have a big “bunion” That i was told it was moré An Osteoarthritis problem.
    Even though i Have Been trying To work The loads of my feet The excesiv growth of The Bone difficults moré And moré The movement.
    Can you talk about it sometime?
    Thanks

  6. I think your phrase: “the way you move your body leads to particular cellular outcomes.” And in my experience, the Alexander Technique is a particularly effective way to learn how to improve the way you sit, stand and move.

  7. There are so many “tweetables” in this thing. So many sentences i want to use as the facebook link share teaser. but which do i choose? loving on this post.

  8. My husband died at 43 from acute lymphocitic leukemia. He had had a vasectomy in his 30s.

  9. Two things: I’ve been wondering about the astronomical rate of hip replacements in the German-speaking countries, and assuming it had something to do with the amount of bread they eat (lectins and gluten -> gut damage -> AI, that line of thinking) but now I’m wondering if the prevalence of bicycles as transport could be a larger factor. And now I’m freaked out about vasectomies – please someone give me some reliable references to check? We’re talking about The Snip now that the family is complete but it was supposed to simplify things, not kill my husband!
    If I had any notion of mechanics beyond the intuitive, I’m sure I’d like those books too. Got Ancient Bodies, Modern Lives for Christmas, devoured it, felt like a total geek when I realised it was a textbook.

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