IMMOBILISATION ARTHRITIS

Cartilage Nutrition

IMMOBILISATION ARTHRITIS is what sets in when joints are robbed of movement - for whatever reason. My first conscious experience of it was some twenty-five years when I was consulted my a young man with low back pain caused by a very odd gait - he was unable to bend his right knee. Five years previously he was shot in the upper thigh with a high calibre rifle in the (then) Rhodesian War. The femur shattered, his whole leg - foot to hip - was immobilised in a plastar cast for over a year. At the end of that year he was unable to bend his knee even slightly, and never regained the movement. Starved of nutrition from the normal effect of joint fluids swilling about in the knee, the cartilage rapidly, and irreversibly, degenerated.

That in effect is what happens in the spine when much smaller facet (and disc) joints become fixated.

Cervical Spine degeneration.

The condition started insidiously in 2004. There was no known cause, and no trauma is recalled. There was (and is) no pain in the neck. She did complain of stiffness in the neck, however.

A tentative diagnosis of MS was made in 2006 by a neurologist. Parkinsons medication eased the pain sufficiently for her to sleep at night, but had abhorrent side effects. Nothing else helped.

For the purposes of this page on Immobilisation Arthritis, orthopaedic and neurologic details will be omitted.

Notice the relatively minor degenerative changes in the first and third X-rays taken in 2006. The radiological report states: There is slight loss of C5-C6 disc space. The spinal canal has sufficient depth, and the formina are all normal.

Notice the severe changes that have occured in only three and a half years. I have only shown the right oblique, but the left is almost identical.

The ins and outs of this case have not yet been satisfactorily settled. The MRI does not give clear cut signs of cord impression causing long tract signs in her feet. The absence of obvious TMJ symptology leaves the numbness in the face unexplained. She does also have an upper cervical fixation, perhaps effecting the sensory nucleus of V in the upper neck. The association of TMJ and upper cervical subluxations is of course legendary.

I'll add to this case history as it unfolds.

ANKLE JOINT PAIN

Here we can see exactly the same pathological process occurring in the calcaneo-cuboid joint. ANKLE JOINT PAIN ...

SUBLUXATIONS

Chiropractic Subluxation

It is this loss of movement that causes Immobilisation Arthritis.

Medical Subluxation

Is it any wonder that confusion reigns? In the Chiropractic model, mobilisation and manipulation (or an adjustment, as I still call it) is the treatment of choice. In the Medical model, it's strictly contraindicated.

RECEPTORS

Mechano-receptors (aka Proprio-receptors)

Interestingly, in the dorsal horn of the spinal cord they have an INHIBITORY effect on information relayed from Nociceptors.

Noci-receptors

In particular, chemosensitive nociceptors carry information about noxious stimuli to a nerve root, for example, that is being bathed in the toxic byproducts of joint cartilage nutritiion. Normally such wastes would be dispersed, but in hypo-mobile joints, such wastes accumulate causing a noxious effect on the capsule, hyaline cartilage and adjacent nerves.

Cell degeneration has been demonstrated within thirteen hours (in white mice) of artificial joint fixation. These degredation products set up an inflammatory cycle further adding to the dorsal horn bombardment by nociceptors.

DOUBLE WAMMY

Initially, this is a silent process. There is no pain, that comes later.

Worse, this increased nociceptor activity has been shown to have a cascading effect on the autonomic system, and general health.

Histologically ...

Okazaki et al (JRheum 2003)

Okazaki and his fellow researchers confirming the existence of Immobilisation Arthritis found that:

1. There is demonstratable proteoglycan loss within one week of the onset of joint hypomobility.

2. Hyaline cartilage changes can be measured within one day of joint fixation.

Notice here that, once they hyaline cartilage covering of the bone has been breached - in this case by the butcher's saw - fluids in the joint have immediate access to the underlying bone. That's what sets up inflammation, and the cysts that form within arthritic bone.

Lumbar spine degeneration

Nucleus pulposis

The nucleus pulposis has a very high metabolic rate, but no blood supply. It lives only 'because of movement' (Mooney, Spine 1987), movement being the nutritional pump that drives nutrients, oxygen and waste products in and out of the disc. Without movement the water-binding property of the proteogycans in the nucleus is lost as the cells, starved of nutrients, begin to degenerate as Immobilisation Arthritis sets in.

Worse, waste products and intracellular fluids released as the cells degenerate are trapped within the fixated disc, setting up an inflammatory reaction, and a "chemical radiculitis".

It is the water bound by the proteoglycans in the nucleus that pressurises the disc, keeping the vertebral bodies apart. When it is lost, the disc (as seen in MRI) is lost and it loses its bright white colour. Eventually it's bone on bone.




Facet hyaline cartilage

However another effect occurs: Loss of disc height places an increased load on the facet joints. Further, altered biomechanics places further strain on the facet joints and ligaments. The net result? Facet degeneration.

Click on the pic below for more about core chiropractic: HYALINE CARTILAGE ...

OBESITY and SMOKING

Arthritis, smoking and obesity are all first cousins. Kissing cousins, that close. The reasons are complex, firstly because of chemical changes in the body as the large fat deposits start to act as glands producing noxious chemicals, but also simply because the increased weight on the joints. Smoking starves joints of their required oxygen. Result: degeneration joint disease.

See someone using a walker. Nine out of ten are obese, and because of the arthritis in hips, knees or feet... OBESITY and ARTHRITIS. Read more ...