The progression from Joint Instability to Osteoarthritis and Degenerative joint disease
In this article Ross Hauser MD will explain the non-surgical advantages treatment of Degenerative Joint Disease or as it is better known – osteoarthritis. Also discussed is the crucial role of ligament damage (ligament laxity) and joint instability that leads to the advancing of the degenerative joint condition.
Degenerative joint disease (DJD) is a painful condition that results in the deterioration of the cartilage tissues that support the weight-bearing joints in the body. Once the cartilage is thinned or lost, the constant grinding of bones against each other causes pain and stiffness around the joint. Abnormal and excess bone formations (bone spurs) grow from the damaged bones, causing further pain and stiffness. These are the classic signs of joint instability.
The importance of treating ligament injury in chronic joint instability cannot be overstated
It is important to note that, although associated with old age,osteoarthritis and degenerative joint disease are not simply a result of the aging process, nor are they a result of general wear and tear on joints.
Osteoarthritis and degenerative joint disease almost always begin as a ligament weakness resulting from injury.
Ligament laxity (a stretched, loose ligament) is an often overlooked but extremely important cause of chronic body pain in the degenerative condition.
The importance of treating ligament injury in joint instability cannot be overstated. Left untreated, or mistreated in many cases, ligament damage leads to further degeneration of the joint. Research has shown that laxity in the bone/ligament insertion (i.e., ligament laxity) leads to subchondral bone changes (bone destruction) that leads to cartilage changes which in turn leads to osteoarthritis.1 In other words: If the ligaments become weak and untreated, it will lead to breakdown of cartilage, bone on bone, and a recommendation to joint replacement.
The above described process is not well understood in medicine. In one of the more recent papers on the true origins of knee osteoarthritis researchers made these observations:2
- According to these researchers, thanks to new MRI techniques and arthroscopic surgery we have a better understanding of how knee osteoarthritis begins. For my opinion on these statements I invite the reader to review these articles on our website: Is My MRI Accurate? and Arthroscopic Knee Surgery for Osteoarthritis. In these articles you will find my comments on personal observations of misguided treatments based on MRI and unnecessary knee surgeries that accelerated the joint degeneration.
- In their defense, the researchers of the above cited paper had this to say: “The significance of MRI findings such as cartilage defects, bone marrow lesions, synovial inflammation/effusions and meniscal tears in patients without radiographic signs of osteoarthritis is not fully understood. Nevertheless, early joint tissue changes are associated with symptoms and, in some cases, with progression of disease.”2 ibid
Twenty years ago, an article published in Gerontology disagreed with the notion that wear and tear is the origin of osteoarthritis and conducted a literary review to prove that osteoarthritis starts with ligament damage. Reviewing numerous research articles, the authors conclude that subchondral bone (the bone just beneath cartilage) changes precede any cartilage change associated with osteoarthritis.
These bone changes are due to a loss of tension on bone at the ligament/bone insertion. In other words, ligament laxity causes bone changes that in turn cause cartilage change and damage. This idea appears again and again in the literature and this article – ligament laxity causes joint instability and degenerative joint disease.
When discussing knee osteoarthritis, the authors point to the importance of joint stability in the development of osteoarthritis.
“It should be remembered that the knee joint functions as an organ with every tissue contributing to its mechanical stability. Ligaments, subchondral bone, meniscus and joint capsule all subserve the need for stability. . . the earliest change appears to be at the ligament-bone insertions site. However, we propose that it is a change in the ligament that leads to an alteration in the tension on the bone at the bone-insertion site which precipitates bone remodeling (injury to subchondral bone) [emphasis added].”3
Taking account of the progression of osteoarthritis, it becomes clear that the ligament integrity or lack of integrity is what needs to be treated to prevent further joint destruction and this applies to all joints:
“The health and integrity of the overlying articular cartilage depends on the mechanical properties of its bony bed. Ligament injury precedes the subchondral bone changes and these changes occur before articular cartilage degeneration. ‘The proposed reversal of the current concepts of the aetiology of osteoarthritis from cartilage to bone and ligament suggests that research and therapeutic strategies could be effectively redirected.”3
That was twenty years ago and still pain management medicine continues to search for drugs, devices and surgical procedures to eliminate the chronic pain associated with osteoarthritis and degenerative joint disease and then fesses up that this is still not a fully understood science.
Ligament regeneration and repair – Progression of degenerative joint disease addressed by comprehensive Prolotherapy
As mentioned above in the more recent paper: The standard osteoarthritis treatment involve symptom management such as nonsteroidal anti-inflammatory medications, cortisone shots and even surgery to provide pain relief. Cortisone and other steroid shots have adverse affects on bone, cartilage and soft tissue healing, this has been well documented.
Since osteoarthritis begins with ligament damage it would make sense to treat the ligaments early.
Understanding ligament damage
- A ligament is damaged through overuse or trauma, such as a sports injury or an accident.
- Because of the ligament’s poor blood supply, it does not heal (unlike muscles, which have a good blood supply and heal quite easily).
- Over time, the injured ligament weakens, like a stretched rubber band that has lost its elasticity.
- Since ligaments function as joint stabilizers, the injured ligament is no longer capable of doing its job.
- As a result, the muscles must compensate. They begin to ache and spasm and, eventually, the joint or vertebra in the area begins to compensate as well.
- Overgrowth of bone occurs to help stabilize the injured ligament, which leads to arthritis, and a whole new level of pain and disability.
Stem Cells and Prolotherapy for degenerative joint disease and Instability
This downward spiral of pain can be halted and reversed only by stimulating healing at the source—the ligament. The only proven procedure that stimulates this kind of healing is Prolotherapy.
Recently we published our findings on Stem Cell Therapy, as part of a comprehensive Prolotherapy program for advanced arthritis. In this paper we were able to describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (stem cells from a patient’s own bone marrow), into osteoarthritic joints in combination with simple dextrose Prolotherapy. Seven patients with hip, knee or ankle osteoarthritis received two to seven treatments over a period of two to twelve months. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. Learn more about stem cell therapy for osteoarthritis and Prolotherapy at pages on our website.
In my opinion and documented by scores of medical papers, Prolotherapy is the safest and most effective treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. The inflammation causes the blood supply to dramatically increase in the ligament, alerting the body that healing needs to take place. In the simplest terms, Prolotherapy stimulates healing.
Furthermore, Prolotherapy offers the most curative results in treating osteoarthritis and degenerative joint disease bone repair. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What’s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent
1 Bailey AJ, Mansell JP. Do subchondral bone changes exacerbate or preceded articular cartilage destruction in osteoarthritis of the elderly? Gerontology 1997;43:296-304.
2. Favero M, Ramonda R, Goldring MB, Goldring SR, Punzi L. Early knee osteoarthritis. RMD Open. 2015 Aug 15;1(Suppl 1):e000062. doi: 10.1136/rmdopen-2015-000062. eCollection 2015.
3. Bailey AJ, Mansell JP. Do subchondral bone changes exacerbate or precede articular cartilage destruction in osteoarthritis of the elderly? Gerontology 1997; 43:296-304.