Do You Have Degenerative Arthritis?
Pain, stiffness, and crackling noises are often the first signs of deteriorating joints, as articular cartilage disappears and bone rubs against bone. While there are a variety of causes for this problem, performers may be at particular risk due to the repetitive stress of playing musical instruments, practicing dance steps, and navigating awkward scenery, costumes, and raked stages that can land you in the orchestra pit. Given the progressive nature of this disease, it pays to find out how to protect yourself now. Find out the causes, preventive measures, and treatment for this potentially debilitating disease.
Causes
Mechanical stress appears to be the Big Daddy that causes arthritic joints. Apart from repetitive stress, anatomical deficits, such as a misaligned kneecap or flat hip socket, can place you at considerable risk for serious injuries that set the stage for later arthritis. Likewise, all performers with Benign Joint Hypermobility Syndrome (BJHS) are predisposed to arthritis because of lax ligaments and poor proprioception (See The Dancer’s Way for BJHS criteria). Other major risk factors for degenerative arthritis include a previous history of joint injuries, a genetic predisposition, high body fat, and loss of female hormones.
Prevention
Please don’t ignore physical problems. Anatomical deficits and injuries (past or present) often require a visit to your orthopedist who may prescribe physical therapy exercises and cross conditioning to strengthen muscles and increase a sense of where your body is in space. This preventative approach is equally important if you are hypermobile. Improving one’s posture both sitting and standing can also help prevent the negative consequences of repetitive stress from playing musical instruments. Finally, seeking nutritional help from a registered dietician can reduce excess body fat that appears to be a metabolic factor associated with the onset of arthritis, along with helping to address the loss of female hormones from dieting and menopause.
Diagnosis & Treatment
If you are experiencing stiffness, a sharp ache or a burning sensation around the joint, muscle spasms or fluid buildup, see your orthopedist. A diagnosis of degenerative arthritis is made with a history and physical exam, plus an x-ray. Your doctor will then discuss various treatment options, such as pain management and physical therapy. Be aware that symptoms tend to be most pronounced in the morning and when the weather becomes cold or humid.
In general, arthritic joints respond with improved functioning and less pain to graded, moderate exercises that focus on impairments, but they worsen with intense or prolonged activity. The exception is arthritic hips where manual therapy is more beneficial than exercise. Acupuncture has been shown to provide the most pain relief of all modalities, although the effect is short-term. Analgesics can also relieve pain. Tylenol is preferable to anti-inflammatory medications such as NSAIDS (e.g., Motrin & Advil) since there is less risk of gastrointestinal problems. However, it can have an adverse effect on your liver when combined with alcohol. Orthotics, such as braces and splints, are useful for the upper limbs, whereas insoles are often useful for the foot and ankle. The use of supplements is at best minimal. For example, glucosamine sulfate (not hydrochloride) shows some benefit for early arthritis, although it should be discontinued if no effect is observed after six months. Joint replacements serve as the last resort when the quality of life is impaired.
The bottom line: Degenerative arthritis is not inevitable. Many people who are well into their nineties have healthy joints. Still, given the high rate of mechanical stress in the performing arts, combined with other factors such as a genetic vulnerability, prevention and appropriate treatment is needed.
