When was the last time you heard someone talk about what started them on their journey towards a ‘dodgy knee’?
Chances are they will be able to pinpoint to an exact period of time when they damaged their knee in some way. Often the story goes like this: “When I was 25, I was skiing downhill and my ski clipped the snow. It sent me tumbling in all sorts of directions during which, my knee felt like it gave way. It was really swollen after that and has never been the same since.”. This is a fairly common story for a lot of the people we see (with a few changes in details of course). The key feature is that at one point in their life the person suffered from some form of traumatic injury that since caused their knee to ‘never feel the same’.
Injury is definitively one of the biggest factors behind the development of OA. However, at MTP Health we like to dig a little deeper than simply chocking everything up to the injury itself. Read on to find out why…
Recent evidence shows that having an injury which will require surgery will increase the risk of developing OA by 4-6X. This means that roughly 30-50% of people who have some form of severe soft tissue injury that causes a disruption to the cartilaginous matrix (e.g. meniscus tear or ligament rupture) will develop OA at some stage in their life. The mechanism behind this is believed to be caused by a phenomenon known as ‘fast loading’. Cartilage absorbs load by distributing fluid effectively throughout the surface in response to the load being applied. This is highly effective for the typical loads that are faced throughout the day (e.g. walking, jumping, landing, running etc.). This load absorption will stimulate constant remodelling of the cartilage, depending on the level the load is applied at (over time our body adapts to the demands it constantly faces).
The problem is that when too great a load is applied too quickly, the cartilaginous matrix becomes disrupted, as it does not have enough time to distribute fluid effectively. This is often the case during severe soft tissue injuries. Common situations where this plays out is in heavy contact sports such as rugby and football, as well as sports where ligament tears are common (e.g. soccer & basketball). This disruption to the matrix isn’t overly problematic initially, however over time (especially when combined with other risk factors for OA such as inflammation, being overweight, joint instability and poor load management) it will lead to osteoarthritic changes.
But once again, this is only part of the story!
A Shift in Behaviour
Because injury is typically associated with every single one of the risk factors that have been mentioned above, we encounter problems when we try to attribute the cause of OA to a singular factor (i.e. Fast loading and a specific injury). What this means is that when people get injured they are more likely to fall into certain behaviour patterns that cause them to be susceptible to developing OA in the future. These behaviours include a cessation of physical activity (leading to the body declining in function) – which was highlighted in part 1. That is why we put the term ‘never feel the same’ in inverted commas in the introduction. It’s because often how a person ‘feels’ about and consequently perceives their condition can have a huge effect on how the condition manifests later in their life.
This component huge for us at MTP Health! All of our programs aim to address the negative behaviour patterns head-on, helping people to realise that they can do everything they have ever wanted and more, despite sustaining serious injury. Because our program combines this form of behaviour changing education with an effective exercise intervention aimed at returning the person to function, we are able to gear the person up toward being able to continue to manage and improve their condition on their own. This is the only way they can ensure they stave off OA for as long as possible. Put simply, education is a huge component to helping people manage their OA and live with the highest quality of life despite having the condition. As such it’s a massive component of our programs. The body of literature has agreed with this stance since 2006.
Empowerment: The Best Solution
Once again, the key remains as empowerment. As soon as we can give people the knowledge and tools about how they can look after their own health for the long term, we can start to eliminate pain and dysfunction altogether. This knowledge has to be experiential in order for the person to fully comprehend what is being presented and how it fits to their situation.
The human body is an adaptive machine that will get better or worse depending on what we do with it. Despite what has happened to someone in the past, along with whatever unfortunate circumstance they encounter in the future, each person has the capacity to change how their body will function.
References (Linked throughout article)