The View from Sports Center: Uncle Arthur

"Maybe today will be different. Maybe today my hip won't hurt." But as you roll over to rise from another restless night's sleep, the hip pain comes in waves. Stiff, sore and aching, it feels like a headache. The first few steps look like you are just learning how to walk. You gingerly make your way to the bathroom anxious for the soothing warmth of a gentle showering rain. As the warm water caresses your body, the pain and stiffness begin to fade. You feel younger with each passing minute. When you finish, you can finally walk and face the rest of your day. But, you already know that tomorrow will be no different from today and you dread it. You are 49 years old and feel like you're 75.

Nearly 70% of people in the United States between the ages of 45 and 74 will have radiologic evidence of hip osteoarthritis or as my Dad called it "Uncle Arthur". The disease process actually begins many years before it reveals itself on an x-ray. The first sign is a dull ache in the hip region after sitting or lying for a period of time. Early morning stiffness sometimes accompanied by pain lasts less than thirty minutes and is relieved with movement or a warm shower. It is at this stage that osteoarthritis is most capable of rebuilding yet most people have no idea. They are plagued by a nagging stiffness and pain and tell themselves "it will go away". Just what Uncle Arthur wants. Denial.

Cartilage has properties which make it very different from other tissues in the body. It has no blood or nerve supply. The only way it can speak to you is through other tissues such as the lining of your joint (synovial lining) or the outer layer of your bone (periosteum). Healthy cartilage is a stiff, slippery tissue which both protects your joint from every day impact forces and provides a nearly friction free surface. It is slicker than a skate on ice. The impact protection comes from corraling water molecules into small groups and binding them together creating a cushion similar to taking a large piece of foam and wrapping rope around it from all directions. The foam compresses and pushes out against the rope making itself stiffer. The rope is a matrix of containment. You could place the foam on the floor and step on it and it would hold your weight. Diseased or injured cartilage is like wrapping the foam with a scotch tape. When you step on it, a piece of the tape breaks allowing the foam to pooch out through the matrix. If you were to jump on the foam, you might burst all of the tape.

The first messages from your cartilage that it needs help are faint and unclear except to the person trained in "cartilagese" - the foreign language of cartilage. As the matrix falters, more force is transferred into the surrounding tissues. The water leaks out of the matrix and the joint surface softens. Your hip feels stiff due to the gelling of cellular layers and the loss of the fluid. As you move your hip the synovial fluid bathes the joint surface restoring some of its thickness and the sense of stiffness subsides. As your joint worsens, the stiffness lasts longer and you have more pain.

Changing the health of cartilage is possible. But, you need three things. The first two come together. Load and motion. But, you must know how much force your body can withstand and not hurt. As I mentioned in a prior View (When Can I Run Again?), at SportsCenter, we use a Variable Incline Plane to determine the maximum force level of a single leg squat to a 90 degree knee angle. This should be a pain free movement and well controlled. If, for example, you weigh 200 lbs and your pain free squat force is 60 lbs, then you should avoid exposing your leg to forces which exceed 60 lbs. (Hmm. So, does that mean I need crutches? Possibly so. It will depend on what your day to day situation demands.) The best motion for hip osteoarthritis is squatting. One of your drills will be squatting at a load level equal to no more than 20% of your maximum. In this case, that would mean 12 lbs. of force. You will perform these light load squats at least 30 minutes per day. The more the better.

Thirdly, you need certain nutrients and supplements to maximize the effect of the load and motion. The most important are water and chondroitin sulfate with glucosamine. Hydration is key because cartilage needs water to improve its stiffness. Most people are under hydrated. You need at least 2 liters of water per day and more if you weight over 200lbs. Chondroitin sulfate is sold over the counter and assists not only in reducing the symptoms associated with osteoarthritis but also in helping it rebuild itself (see http://www.drtheo.com for suggestions on brands and for research information regarding chondroitin sulfate).

The sooner you begin to make choices to improve your joint health, the longer your joints will last and the younger you will feel. Listen to the messages of stiffness and pain. Feed your cartilage with the nutrients it needs by moving with a controlled load. It is your only way to a healthier joint.

Make today count.

Doug Kelsey
Author. Teacher. Therapist.