22 years old with possible Osteoarthritis?

My muscles aren't really sore. They just feel strained, but even more so after physical activity.

I like to ride my bike as physical activity and also play basketball and soccer on occasion. When you say that you had to 'pack in' does that mean you stopped completely?

I played golf, which is a long walk, I bought a sit on buggy years ago, but I then came down with gout. It was a tripple whammy. I was in agony every time I went out, even with the buggy. I couldn't walk afterward & as I live on my own, I spent a lot of time in bed through sheer exhaustion. I take a lot of meds which keep it under some measure of control. I have been advised by doctors that swimming is good for me. I can't swim propperly because I can't bend my neck, so it's breast stroke or backstroke. Very, very tiring though. Cycling may be ok too, usually high impact exercises are a no-no. I take a cocktale of painkillers, so try what you can. Ibuprofen, which must be taken with food, or any other propriety pain killer. I also take Tramadol & Gabapentin. I rattle  .

Hi Susan, thanks for your help.

My old chiropractor did an xray and told me that I had pelvic misalignment. It was off by 15 millimetres. I can definitely feel it also. My right leg takes more force and abuse, especially when biking or running. Also, my walking hasn't been as smooth as before.

If you could tell me what you did to fix your problems, that'd be awesome. I really hope this issue can be fixed. I'm at work and feel like crying because of all the anxiety.

Hi David,

Some people have said to you that an xray will confirm whether you have osteoarthritis. I 100% guarantee that it won't! Most people that have x-ray evidence of osteoarthritis (radiographic osteoarthritis) have zero symptoms. If you have a serious muscle imbalance - such as a twisted pelvis - then chances are that will have caused joint wear. The joint wear is a symptom - no the cause. Fix the imbalance and chances are the wear to the joint will never give you any problems. My xrays back in 2006 showed xray evidence of osteoarthritis. Xrays also showed evidence of osteoarthritis in neck and low back. I'm 100% symptom free at age 52 and outperforming most people half my age in sports - so my joints are being well tested!

I had 36 treatments with a chiro with no success. Now you get different types of chiro, that's for sure, but don't assume that a chiro is the best person to help.

If you can work out the exact nature of the twisting of your pelvis, then you can work out exactly what muscles are tight, what are weak etc. That lets you come up with a good plan for getting everything balanced out. Understanding what is happening is the first step.

Others have advised you to get further tests done. There's no harm in doing that just in case.

Try these tests:

Lie flat on your back on the floor, legs together, knees bent, feet flat on floor. Keeping your shoulders in contact with the floor let your knees drop to the right side (let your hips lift of the floor on the left side - so you're rotating your entire pelvis). Repeat on the left side. Was it harder dropping your knees to the floor on one side? Which side?

Do you feel that one leg is longer than the other? Perhaps one knee needs to bend slightly when you stand with your feet side by side? You say your right leg takes more force and abuse - that perhaps that suggests the right leg is longer? If you're pretty sure one leg is longer tell me which one?

If you're not sure about a longer leg then stand in front of a mirror. Is you pelvis hitched up higher on one side? If so, then what side?

Which is your symptomatic leg?

These are crude tests just to get an idea of what's going on. There are more precise tests you can do.

Hi Susan

I just tried the tests you suggested. When standing, biking and running, my right leg seems to be used more. For example, when stanbding up and pedaling on my bike, my right leg seems to straighten more when I need it to have a slight curve.

A lot of the pain is on the right side of my body as well. Right lower back, right groin, right thoracic spine etc. I hope this is the cause. What are some exercises that can solve this issue?

Hi David,

If it's a muscle imbalance causing you problems you need to establish the exact nature of that imbalance. It will take very specific exercises to put things right.

If you tell me the results of the tests I asked you to do that will throw up a few clues. From there I could suggest a couple of exercises and depending on how you got on with them that could get you moving in the right direction and give you a better idea as to whether muscle imbalance really is the cause of your problems.

Hi Susan.

I have tried the three tests that you've outlined. When lying on my back and twisting my hips, it's harder to roll to the right side as opposed to the left. It feels like there is a bump that I have to roll over in order to complete the roatation.

When standing, I notice something wrong with my right leg. The knee is pushing backwards while my left leg has a natural/straight stance

I also had my my parents take a look at my pelvis/hips last night. There's a part on the left side that sticks out more in comparison to the right. I'm not sure which side is right and which is out of whack.,

This sounds very much like you've got a muscle imbalance and it's not the standard type of imbalance that you associate with hip OA. The nature of my twisted pelvis seems to match up very closely to others that have been diagnosed with hip OA. Yours sounds different.

So that's good news in the sense that it's unlikely to be OA that's the root cause of your poblems. The bad news is that it sounds like a complex one and I suspect you're going to need help to address it.

For the twisting in your pelvis there are some generic exercises that you can try. Basically, the problem is the weak, lazy muscles. Which is almost certainly the glutes.

Search for :

Clam shell

Side lying leg raise

Prone hip extension

Do these exercises on both side paying particular attention to really feeling those glutes contract. You want to squeeze the glute muscles as hard as you can. Try and find some instructional vidoes on youtube that give you lots of instruction on good form. The problem when you have a muscle imbalance is that you'll almost always do the corrective exercises incorrectly - you need to make a concious effort to do them the right way. Don't expect anything to change overnight but this should do you some good and help stop things getting worse at the very least.

All of these exercises are designed to get the lazy glute muscles working. This will help to stabilise your hips. But it's only a small piece of the puzzle. The issue with your knee bending backwards is something that I have no experience of but it's something that you need to address ASAP.

I think it's very important that you correct these imbalances as left untreated it will eventually damage your joints. If you can afford to see a good private physiotherapist they should be able to help you with this. Depending on where you live it should only cost £30 - £50 for a single appointment. Typicaly you'd need a couple of follow up appointments but even one would give you some useful info. Just get a recommendation for someone local (or use Google to find one) and phone up for an appointment. If all else fails insist that your GP refers you to a NHS physio - but that will take for ever!! I'm assuming you're in the UK - if not things will work differently elsewhere.

I'm more than happy to share everything I know with you to help you get it sorted, but go see a private physiotherapist first and see what they have to say. You need an accurate diagnosis of the muscle imbalance and it's hard to do that for yourself. That's the best way to get things moving in the right direction. I don't think a chiropractor is the right person to deal with this.

Susan,

Thanks for the advice. Is this all you did to correct your issue? I forgot to mention that I sometimes have tingling sensations down my lower legs. Are there any stretches in addition to the strengthening exercises that you showed me?

I don't mean to bother you, but it's really worrying me.

Tingling would be a perfectly normal symptom with something like this. The sciatic nerve runs alongside the piriformis muscle and with that muscle stretched and tight (as it will be) the sciatic nerve can be irritated. That will produce tingling, numbness - and sometimes bad pain. So it's certainly something that is 100% explained by muscle imbalance. I had it all the time.

Your doctor is taking steps to rule out known medical causes so you're doing all the right things.

I had to do a lot more than just those exercises but the thing is you need to have a reliable diagnosis of the muscle imbalance before you can decide exactly what corrective exercises need to be done. From what you've told me I can't build up a clear picture in my mind.

OK, try one more test. Lie flat on your back, knees bent and feet flat on the floor. Push your fingers into your low abdomen one the right side - so down in your pelvis beside the pelvic bone. Lift your right foot a couple of inches off the floor. You should feel the psoas muscle contract under your fingers. If you don't feel it keep trying, moving your fingers around until you've got them in the right place over the muscle. When you've located the psoas muscle try doing the same test on the left side - does the psoas muscle contract as strongly on that side?

Try really hard to give me accurate answers to the test as that will help us figure out what muscles are involved in the muscle imbalance and from there we'll be able to figure out how to put things right.

Just to add - be very cautious about stretching until you know what is going on. Sometimes muscle feel tight because they're already overstretched due to your twisted posture. Stretching can make them worse. More importantly - stretching the wrong muscles at the wrong time can aggrevate nerve irritation (been there, done that!).

If muscles feel tight and sore it's far safer to treat them with myofacial release (google that as there's lots of online info).

Did you also have trouble walking when you had your issues? Whenever I walk, it feels very unnatural. My right foot doesn't plant into the ground and take off as smoothly as my left. I feel a lot of stress on my right leg, especially in the hamstrings and shins.

Yes, in my case I felt a bit like a car with square wheels when I walked!

When you have muscle imbalances that affect the hips then you're invariably going to have some kind of twisting in the pelvis. Which means a left / right imbalance.

The thing that's different about you that I have no experience of his the knee pushing backwards. But that's a common enough imbalance. In actual fact someone else with identical imbalance to me in all other respects only yesterday told me that they had this same issue with knee.

Regardless of what else is going on you 100% guaranteed have a muscle imbalance that is at the very least contributing to your symptoms. That part of it is fixable. Chances are the ONLY thing wrong is a muscle imbalance - it would explain all of your symptoms. But it's always wise to rule out anything that needs medical attention. So you're doing the right thing letting the doc do his tests - just to rule things out.

Thanks a lot Susan, you're really helpful. I appreciate the time and effort that you put into these answers and your website. It's good to know that there's others out there who suffer from the same thing. I really appreciate it.

You're very welcome.

The important thing is not to give up and not to despair! It's unlikely that you'll fix this overnight so keep a cool head and make sure you make good decisions. Once you stop panicking about the unknown the symptoms will bother you a lot less. You'll manage to live with it until you get it sorted. I think there's every reason to believe that you'll sort this.

Within the medical profession very little is understood about muscle imbalance. Amongst private therapists there is tremendous knowledge.

Medical profession is evidence based. They're just starting to catch up re soft-tissue causes of pain and there's very little research to go on. They are light years behind the times. Medical professionals are vital for ruling out other problems. But they are HOPELESS at diagnosis and treatment of soft tissue problems.

In the private sector the problem you have is lack of regulation. Amidst all the fabulous knowledge there are countless scams. It's a minefield.

I'm not saying this to depress you. It's more a heads up - don't believe everything you're told - by doctors or by private physical therapists.

If the doctor can't come up with a very precise diagnosis (and OA is NOT a diagnosis - it's a catch all term to describe unexplained joint pain and dysfunction. If you need me to prove that statement I will) then chase after a treatment for muscle imbalance with a vengeance. You DO have a muscle imbalance. I guarantee it. You just need to make sure there's nothing else going on that needs additional treatment.

You know how to get in touch with me. I'm always happy to help by sharing resources etc if you get stuck.

Thanks. I'm also going to see an Osteopath and a kinesiologist to start off with when I get the chance, just to get second opinions. I have an appoint booked with a sports doctor and a sports chiropractor next week.

Problem is, I live in Canada where these things aren't covered by the government. I'm just waiting to get into school so I can be covered by insurance (January)

Ah - I assumed you were in the UK. Sorry! A physiotherapist is I think called a physical therapist in Canada.

The sports doctor and kinesiologist sound like good choices.

You need to be cautious with osteopaths and chiropractors simply because some of their methods are pretty much disproven. That's not to say they can't do any good and there are some good ones. But there's a lot of dodgy stuff goes on. It's very easy to get conned into paying out a small fortune for treatments that don't work.

When you develop a problem like this you're very vulnerable. It's frightening and you have no knowledge or experience to help you separate good advice from bad. Those more interested in paying their bills and making profits will easily con you into treatments you don't need.

Kinesiology is highly relevant to this kind of thing. And a sports doctor sounds good - not sure what it is, we don't have them here, but people that work with athletes are a much better choice than people that work with little old ladies that never get off the sofa  - much more relevant experience for a case like yours!

Don't commit to any treatment plans without taking time to think first. Go with a view to telling them that you'll call them back re subsequent appointments. Get all the info you can then run it by as many people as possible before making a decision.

 

Did all of your pain and symptoms go away after fixing your pelvic issue?

Yes.

Joints have groups of muscles acting upon them. A muscle imbalance occurs when one of the muscles acting on a joint is stronger than the others. The bones in the joint will be pulled towards the stronger muscle  and that results in incorrect movement and stress and strain to muscles and soft tissue - potentially also joint damage and wear.

To give you an idea of how a muscle imbalance can cause extreme symptoms take a look at the attached image. This shows a skeleton with a very common problem - the sacrum (central bone in the pelvis) is rotated and tilted to one side. This position is actually part of the normal gait cycle. It becomes a problem when it gets 'stuck' in one position.

With the pelvis 'stuck' in this position none of the muscles work as they should. Normal movement is flowing and smooth as the pelvis shifts and rotates to maintain center of gravity. When it can't move normally everything is stiff and awkward. Your whole body has to compensate in order to work around the out of position sacrum. The dysfunction ripples through your whole body.

Some muscles are permenantly tight and shortened; others are over stretched; others become weak and inactive. Tight knots and bands of pain develop in strained muscles, tendonitis and bursitis can form, muscle are more prone to injury, nerves can be irritated and joints can wear (ultimately leading to OA).

It can occur for lots of reasons - it usually doesn't happen until you're older and you've had years to screw up your body through bad habits. But so many factors can contribute to it. There are two schools of thought each of which has supporting evidence:

1. That some muscles in the body are postural and prone to being overactive and tight; others are responsible for movement and prone to being weak and inactive.

2. That muscles adapt to what we do most. Spend too much time in a certain position and that will eventually become the resting position of the muscles.

In practice a bit of both is typically responsible.

Certainly damage and wear to joints could trigger a muscle imbalance (although it's unlikely at your age). But regardless of the root cause of the imalance it needs to be fixed as it will be contributing to symptoms - if not causing all of them.

It's complicated and therefore difficult to put right. Mainstreem medicine is pretty clueless about this but the theory is supported by research and is well accepted and tried and tested. Essentially the normal resting position of each muscle needs to be restored. Fortunately our bodies tend to have set patterns to the way in which imbalances occur so that simplifies the diagnostic and treatment process. It isn't easy to fix these things but there is no good reason (other than it being difficult) for you not to obtain a complete cure. Persistence is the key! The most important thing is to get an accurate diagnosis of your precise imbalance.

 

Right, this makes sense and hopefully the professionals who examine me will be able to diagnose it correctly as I'll be persistent and constantly reminding them of what you said.

It makes sense though... My pain seems to be more muscular than bone related. In the back, the pain is off to the right side, not so much in my spine and when bending, I sometimes get a wince of pain in my right lower back. My leg pains seem to be strains. Actually right now, I'm dealing with groin pain on my right side... It feels a bit swollen. I don't really experience any of the bad knee pain others talk about. However, I'll notice a bit of pain that lasts for a second or two when I climb the stairs for example. My knees are more weak than anything.. It's weird because I have pretty muscular quads, but justl ast week the areas around my knees (lower quads) have been feeling weak and I've been getting an annoying tingling sensation in my legs. Also sometimes when I get up, my knee joint or groin or upper back will make a cracking sound like when you crack your knuckles.

Day by day it seems less like OA and more like something else... Maybe a pinched nerve or something to do with the lower back. It's truly a shame though. Two years ago when I was covered under my parents insurance I should have gone further with this issue. My chiropractor made the comment about the misalingment and my other physio/chiropractor told me that it was most likely a MUSCLE IMBALANCE . I was given a heel lift in my orthotics but not much more.

 

Also, do you have any sources for your info? I don't mean to discredit you or anything as all of what you're saying makes perfect sense.

Also, I couldn't complete the last test you gave me because I couldn't locate my psoas muscle, Lol.

For more info on muscle imbalances google for Janda, sahrmann. It's well understood and well researched. However, as with everything, not every last details is backed by a scientific research study - so there's always disagreement between different camps over detail. The basics though are well understood and widely accepted.

Have a little search into 'trigger points' and myofascial release (pretty much the same thing). One cause of pain is tight bands or knots that form in the muscles and connective tissue. The exact mechanism isn't yet understood but it is known that this is a cause of pain and restriction in muscles and it's treated simply by applying self massage. That pain in your back could be a trigger point in the QL muscle (google it). Trigger points can cause weakness - so it could explain the weakness you're feeling in your knees. Trigger points can cause tingling sensations.

Nerve irritation could also cause the tingling.

In addition, when you're freaking out (as you have been!) your mind can amplify normal sensations and turn them into pain. To illustrate that, prior to getting my OA diagnosis I was heavily involved in martial arts. I was always sore from training but it didn't have any negative connotations - it was part and parcel of a sport that I enjoyed and I never classed it as pain. The moment I was told I had OA every sensation was experienced as pain. All that changed was my beliefs.

You will need to fight to get appropriate help with this. There is plenty of good knowledge out there but it's always hard to find suitably experienced people locally.  It's worth educating yourself. The good news is that if all else fails it's something that you can treat for yourself. It's not rocket science - the tricky thing is figuring out precisely what's wrong and how to do corrective exercise to put it right.

Start experimenting with trigger point treatment / myofascial release now - it won't do any harm and info is freely available online. It's a good way to start learning more about what is wrong with you and you can get some instant relief of symptoms. At least start reading about it!

Will do... I know I've been worrying a lot. I guess I have to just wait and see and not fret about things I cannot control.

I also suffer from anxiety and depression which makes this even worse. My pain and anxiety was worse a couple years ago (when the pain started), so I guess I've made some improvements both mentally and physically.

I hope you are right Susan and again, thanks for your help. I hope you'll be here in the future if I need any further advice... I'm going to keep updating this thread as I get results and such from doctors

 

You can always contact me privately via my website if I miss your posts here.

It's interesting that you say the pain started when your anxiety was at it's worse. That's perhaps no coincidence. I know that I'd had muscle imbalances for years but I had no symptoms at all despite being extremely active. My hip siezed up during a time of intense stress due to the death of both my parents. I have a strong suspicion that it's connected. Stress causes the muscles to tighten up and that can be enough to turn a non-symptomatic muscle imbalance into a big problem!

Good luck, and contact me any time if there's anything I can do to help. I know what it's like to be on your own with no help & support over something like this!