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Alleviating Arthritis Pain and Discomfort: Human joints are unique ecosystems that are designed to last a lifetime of movement. Unlike a mechanical joint, which breaks down frequently, a human joint offers a self-lubricating, frictionless environment with the exquisite ability to sense itself (a kinesthetic sense). Amazingly, even large, repetitive forces -- such as those in marathon running -- do not automatically damage joints.1 By the year 2020, however, approximately 60 million Americans will be afflicted with some form of arthritis.2 A population-based survey of individuals with chronic medical conditions reveals that those suffering from arthritis experience the most restriction of mobility.3 The socioeconomic and psychological impact of physical immobility is enormous. In addition, long-term immobility negatively affects all bodily systems. Many support groups and management techniques exist to help persons cope with arthritis. However, for these persons, coping mechanisms are not the answer in their quest to improve the quality of their lives. Their desire for more pervasive and permanent improvements in their health status make them vulnerable to market scams that profess to "cure" the disease. One of the most important attitudinal advances in the last decade in the treatment of arthritis is that passive therapies are considered of limited use. Active approaches to self care have proven more beneficial.4 While exercise programs proliferate, no standardized exercise parameters exist that ensure joint protection and healing. While water exercise is undoubtedly beneficial, clients can't always exercise in water, and need to find ways to gain ease, lightness, and support by "unweighting" the body on land. Finally, arthritis sufferers want positive approaches to living -- not just exercise. Arthritis is a general term for many rheumatological diseases. The most common manifestations of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). While the "cause" of arthritis is multifactorial, mechanical and neuromuscular factors are thought to play a significant role in the progression and severity of symptoms. In OA particularly, inflammation (the "itis" part of arthritis) follows joint destruction brought about by harmful movement mechanics.5 These harmful mechanical factors include bony malalignment and the loss of timely and appropriate muscular contractions that cushion joints in movement. Over time, this loss of shock absorption leads to abnormal pressure on joint surface areas and subsequent joint trauma, inflammation, and joint degeneration.6 Insidiously, clinical signs of arthritis can remain subclinical for decades, perhaps showing up only as activity-related knee-pain. By the time x-rays reveal degenerative joint signs, the disease is well-advanced.7 Clients with arthritis are often unaware that they are moving in an injurious manner, demonstrating poor movement qualities. One movement quality implicated in joint breakdown is heavy weight bearing, in which the person moves too forcefully, quickly, and heavily for his muscles to contract in time to cushion the shock of weightbearing.8 Every one can recognize from a distance a person who walks with this pattern -- the person whose heels you hear pounding the floor with every step. This person might go on to develop knee osteoarthritis with persistence of this injurious movement pattern. How do we correct (repattern) such harmful movements? We can educate clients to identify and sense these injurious movements and to move with greater ease and support. This requires retraining their kinesthetic sense, that which allows them to feel how they are moving within their bodies and in the environment. Additionally, it requires retraining the brain to sense, interpret, and utilize new sensory input. Recently, researchers have suggested that a normal kinesthetic sense plays a strategic role in maintaining joint health .9 A distorted kinesthesia disrupts normal joint function (both within the joint and within the neuromuscular control of the joint).10 It can lead to untimely and unbalanced muscleforce production which places the joints at risk for trauma. One area of intervention showing clinical success is the philosophy of retraining harmful movement habits linked to arthritic conditions. These approaches to improving movement call for active, conscious awareness by the person as they move, and have been shown to be effective in preserving joint health. The Alexander Technique is one approach that helps a person find greater balance, ease, and freedom of movement. Through an active process of sensory awareness in simple everyday activities -- standing, sitting, walking -- the Alexander Technique helps retrain injurious neuromuscular patterns, such as the type of heavy movement pattern mentioned earlier. The Alexander Technique teacher cues clients through light touch and directed movement to release patterns of poor coordination and alignment. The Alexander Technique has an extraordinary history and a reputation of integrity and excellence. Its roots go back 100 years, further back than physical therapy. As an active intervention, it is a painless and noninvasive method of retraining dysfunctional movement patterns that jeopardize joint health. The Alexander Technique can help a patient in ways frequently neglected by traditional exercise programs. For the person with arthritis, both the choice of activity and how it is accomplished are important. Proper movement helps transform a painful activity into a pleasurable one. Using the principles of the Alexander Technique, a person can learn how to cary out any physical activity with greater ease and efficiency. Observed clinical benefits of learning the Alexander Technique include:
References
For a review of the pathomechanical factors of osteoarthritis, read:
This is an article from PhysicalTherapy.org |