Info on Hip OA Requested from any health pros reading

Hi Kerrie,

How did the new gp determine your mineral levels? Did he take a hair sample or run blood tests? I do believe that mineral deficiencies can play a big role in healing and health maintenance, and I'm curious to know if you've looked into how Fe interacts with other minerals? You may want to look it up, but from my research on the effects of minerals I learned Fe and Ca block the uptake of Cu, Zn, and Mg. Here in the US we have an over abundance of Fe in water and food, which comes from the soil. If there is too much Fe, I'm not sure how you would absorb the those other minerals. Did the doctor mention anything about this? 

Holly

copper is 19 (13.0 -25.0). So dr says my zinc and copper should be balanced to ensure absorption of iron...I hope I am translating this correctly. I think my copper levels increased when drinking from copper jug every day...multiple times over a 8 month periodin India. I just read that Indians drink from them only once a day as their diet is lacking copper. Grrrr. 

with vit c and d he suggests I attempt to keep them at the upper end of range. He has given me a referral for 6 weekly blood tests and see him in three months or ring him if concerned.

Um he took blood tests first and then hair samples as we were also looking at allergies as a cause to the ongoing inflamation.

I am most concerned about the inflamation in my body...can any one tell me is CPR level of 7 high or ok, 

with respect ect for this go, he has been attentive and thorough without pushing drugs into me, he does believe the copper levels have played a big part in this episode of inflamation arthritis and once this is controlled I can start looking at full healing. Um in the USA, Canada and Europe there is a product called CH Alpha...have you heard if successful in rebuilding cartridge...we are going to be living in USA later this year....so dr said I should get some. 

Thanks for discussion it is fabulous. Sometimes it is about taking our mind of our bones for a little bit...that helps too ! Have a great day! 

Hi Kerrie,

I've replied to you on another thread.  I just wanted to add that Cipro can play havoc with your mieral levels as it chelates (depletes) your magnesium, iron, zinc  and calcium etc.  I haven't come across high levels of copper before so I'm just off to check up on it!

For some reason, a reason not backed by research, the pros seem to be trained to dash all trace of hope. They go out of their way to browbeat you into accepting their bleak prognosis. 

Research clearly shows that self efficacy is a huge factor in keeping pain levels low, sticking to treatment plans and general overall outcome. If you BELIEVE you can help yourself you'll do so much better than if you believe that a disease is rampaging through your body and that you need medical intervention. 

I honestly think the problem is that traditionally OA was considered to be a disease of the joints. Now it's known that doesn't fit, but rather than go back to the drawing board (which they can't, because the system is set up with surgeons at the helm) they try and fit research findings into their original, flawed model. 

Honestly, muscle imbalance is a hugely positive avenue to explore, but it's also a highly complex one. Regardless of the cause of your symptoms you WILL have muscle imbalances contributing to symptoms so it pays to keep working on discovering and addressing muscle imbalances for the rest of your life. Make it part of your routine. There is every chance that one day you'll discover that you've got nothing left wrong with you! (As happened to me).

My advice is start with self MFR / Trigger point treatment - plenty of freely available info online. This is a quick and easy approach that with most people will do a lot to help manage symptoms. You need to find and fire up those lazy muscles though to get lasting improvements!!

Be careful with yoga. The problem with yoga is you do exercises that cross multiple joints. If there is a tight muscle and a lazy, inactive muscle in the 'chain' that's being stretched you would want the tight muscle to lengthen - in practice that won't happen; it'll stay locked down tight and the lazy muscle that is already over-stretched will stretch more, making the muscle imbalance worse. You need to take a more targeted approach and identify which muscles are weak/lazy and which are tight.  Some starting info on my website here: www.impossible-takes-longer.com - all the info you need to beat this is freely available online, but you need to get to grips with what's wrong so that you know what you're searching for!  Feel free to PM me if you have questions.

Not saying it's certain muscle imbalance is the root cause of your problem, but I would bet everything I own that it's at least a player, and the only way to rule it out as root cause is to treat it and see if you're left with any symptoms. 

Susan,

How did you say your hip OA was diagnosed?  I thought you had said your diagnosis was done with X-rays, MRI or CT?  In my case, I have had several X-rays and an MRI, that show extreme thinning to no cartilage in the glenoid humeral joint. Of course, I had pain after the initial injury occurred, but the images indeed do show cartilage is gone. Also, there is deformity of the humeral head with multiple bone spurs attached. It would  be a natural consequence to have resulting muscle weakness, and instability if pain from cartilage loss and bone spurs causes less movement or favoring to the other shoulder, but that wouldn't seem be the primary cause for pain.

I would be a dream come true if, for example, the muscles were restabilized & I was able to come back to a normal range of motion. However, would restabilizing have an affect to mitigate even pain from pain spurs and bone friction from cartilage loss?  

Mine (initially just hip OA) was diagnosed with a combination of x-ray and physical exam. The non symptomatic hip had the worst degeneration - that never developed any symptoms. That diagnosis was over 10 years ago and research is now showing that for the most part it's pointless to use x-ray to diagnose or even assess how it's progressing as there is simply no correlation between x-ray findings and symptoms. 

My xrays showed degeneration in both hips, severe degeneration in neck and moderate in spine. Shoulders were never x-rayed. At one point I had severe neck pain (a couple of times requiring emergency medical treatment) and no mobility whatsoever - couldn't turn to look behind when driving. Neck is now fine - I can balance on my head! I'm sure the severe degenerative changes are still there; it's likely that they're worse as I stumbled along for another decade with the imbalance that no doubt caused the joint wear! 

In the UK, it's now recommended that x-rays / MRI's aren't used in people aged over 45. People do still seem to be given definite OA diagnosis (strictly speaking, they shouldn't be), but more recent guidelines are recommending that it's more of a 'provisional' diagnosis subject to change. The reality is that there is no test for OA - it is just a catch all term to describe 'unexplained joint pain'.  Also, NICE point out that OA isn't a single disease, but a collection of diseases each with different prognosis and characteristics. 

If you doubt what i'm saying I'm very happy to post more info and links to research etc. I realise that that's not the information that's typically handed out to patients, but it's what the current guidelines say. 

Why do you assume that your pain is caused by friction from cartilage loss and bone spurs? Research indicates that it's simply not possible to tell from x-ray. As I've mentioned, research shows no correlation between symptoms and degenerative changes on film; some people have badly degenerated joints and NO symptoms; others have joints that look fine on film but bad symptoms. Recommendation nowadays is that there's no point in using x-rays to establish severity of the condition. The only reason they're recommended now is to rule out other conditions. 

It would be impossible for anyone to guarantee that, if you got muscle balance corrected, that you'd be symptom free. HOWEVER, the converse is also true - it's possible that ALL symptoms are down to muscle imbalance. Muscle imbalance WILL cause abnormal joint wear; It's also likely that a diseased joint WILL cause muscle imbalance.

Regardless of the root cause of the pain, treating muscle imbalances will surely help. Chances are that it's causing at least some of your symptoms. Why assume the incurable rather than the curable when the ideal treatment is identical - treat the muscle imbalance for the best possible outcome! 

I had severe pain in both shoulders a few years back - left shoulder in particular. I had hardly any range of motion and even the slightest movement was painful. Because I already had a hip OA diagnosis OA was assumed to be the cause of shoulder pain too. A physio told me "Move things around at home so you don't have to reach overhead. It's not as if you want to be swinging from the chandeliers at your age!".  Well, he was wrong. A few years on I can do handstands, walking on my hands, pullups - including extreme variations - maximum pullups in a single day is 670 (on video if you want proof!).

Muscle imbalance causes pain identical to that described by people awaiting joint surgery. 

In this study - "Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging." Goolgle for it as if I add a link it will be held back for moderation - 42 symptom free patients were given MRI's (50 shoulders in total). Almost all the over 30's had evidence of arthritis but no symptoms. 

"Forty-one (82%) of 50 shoulders had abnormalities consistent with arthritis on MRI. Patients were divided into two groups according to age: those older than 30 years and those 30 years old or younger. In the 30-and-under age group, 68% of the shoulders had arthritic changes, whereas in the over-30 age group, 93% had arthritic changes."

" In the UK, it's now recommended that x-rays / MRI's aren't used in people aged over 45"

Why?

I agree that x-rays should not be definitive in determining anything, as I mentioned in my post about diagnostics and how disturbed was by the "top" surgeon who gave me a diagnosis with only an x-ray and nothing else. No physical exam or other tests. I did ask him for an MRI because if it was a high resolution machine it would show the detail on soft tissue that a x-ray couldn't. I don't at all doubt what you're saying, and I wish it was the case with me. After my injury, a CT scan clearly showed a labral tear which explained the source of 5 month pain which prior to that was mystery. Unfortunately, knowing what I know now I should never have had the surgery and used alternate methods for healing. 

In my case, there is good reason to relate the source of pain to the arthritis because I (and everyone else in the room) can hear the bones rubbing together, and prior to the injury I had no history of shoulder pain. That's not to say that anytime we hear our joints or bones making a noise or we see significant cartilage thinning, we feel pain, but in may case the exact instance I hear the rubbing noise I feel very sssharp pain.  Also, my left shoulder was imaged and it shows some thinning but there is still cartilage, and I have little to no pain there.

Sometimes images (if they are clear) do correlate with the nature of an injury or disease - sometimes they don't. In the US, MRI's are used no matter what the patient's age, but there just too many machines that are outdated and low resolution and may not give enough information.  

Even taking account of what you say - I wouldn't be too quick to assume the joint to be the source.

For example, when you have a muscle imbalance around a joint, the bones in that joint will be pulled towards the stronger/tighter muscles. In other words, the joint is pulled out of normal alignment. So, even if your grinding noises ARE coming from bone spurs catching, if you restored correct muscle balance the joints would correctly align and there could well be plenty of space for joints to move freely without rubbing or bone spurs catching. 

The arthritic shoulder is in theory far less likely to become symptomatic than say, the hip because the shoulder capsule has a great deal of slack. The hip capsule is tight and any bone spurs etc are more likely to catch and rub. I used to get all sorts of crunching and clicking from my hip - mostly I think due to tendons catching and snapping over bone. Shoulders should be a lot more accommodating. 

As I say - impossible to say for sure either way as research shows totally trashed joints can be symptom free and perfect joints can have terrible symptoms! Either way, treating the imbalances can only help. 

Because research shows no correlation between x-ray / mri findings and symptoms. Most people with radiographic OA are symptom free so you can't conclude that just because someone has radiographic OA it is the cause of their symptoms. 

Research also shows that regardless of whether you get x-rays / mri, the outcome is the same - it doesn't improve outcomes in treatment, decisions for surgery etc. Statistically speaking, it's a waste of time and money. 

The hard evidence simply shows that whilst you can pick up 'radiographic OA' on film - radiographic OA is in itself 100% benign and harmless. 'Symptomatic OA' the one people are concerned about, must have another component resulting in pain that can't be identified on film. Therefore, symptomatic OA cannot be diagnosed through x-ray or mri. 

Why over 45? I think because symptomatic OA is rare in under 45's so they routinely get x-rays in the younger generation as there's a greater chance that the pain is caused by something else that may well be picked up on x-ray or mri. X-rays/MRI's are used to rule out other things - not to diagnose OA. 

As I write this, pain levels on a scale of 1-10 are approaching 8 because I was just doing some work out in the pastures refilling water buckets and putting out bales of hay. I must use both arms for this.

Could you define "slack" in the arthritic shoulder joint?  in my case, there is no more cartilage left?  In the attached link, in the description of damaged cartilage there is a also a decrease - not an increase- in joint space. Granted this is posted an organization of surgeons, but anatomical description of arthritis is the same regardless of the source https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-shoulder/

I had Perthes Disease when I was a child and my mother was told that I would be crippled by arthritis  by the time I was 35. I'm 83 now and my hip has not needed replacement. It does trouble me from time to time but often only for a day. Sometimes because I turn awkwardly and my foot does not move with it. Other times when travelling and sitting uncomfortably with pressure on the outside of my hip causes it to stiffen up. We were on holiday in Australia once and it stiffened/locked up when travelling by bus and boat to Kangaroo Island. I could hardly walk and was concerned as we had booked up for a nature safari involving climbing up sand dunes and over rocks but the next morning it was as right as rain.. 

On a few occasions when it has lasted for a few weeks I have gone to a consultant. One around 1996 said that he thought that I would never need a hip replacement. The next in 2012 said it looked much worse on the X-Rays that than it was in life and doubted if I would ever need a replacement and added that he did not like doing surgery on patients who had a heart valve replacement.

I've been to two others since then, one said that if he did a hip replacement I would go back to him within a year and complain that it had not solved my problem. More recently it troubled me for several weeks but was much better by the time I saw a consultant from MSK. He said that I needed a replacement and could quickly fit me in. I said that it was much better and as usual it would improve. He said that he would see me again in six months. I did and again turned down his offer and he said to phone his secretary if I changed my mind:-)    

The advice I had from one GP was to have it done privately as if done by the NHS you never what old retired codger they will bring in off the street to do it. That must have been one who had to redo my mothers one after she had broken her hip and  was unable to walk the replacement. 

Derek, have you ever had a little experimentation with Trigger Point treatment (self massage)? 

I know it sounds like I'm as bad as the docs - implying that muscle imbalance is the one and only cause! However, my point is that it's a very common cause that is treatable so it makes sense to rule that out!

Trigger point treatment isn't a cure, but it eases symptoms. If you have a muscle imbalance, muscles are constantly put under abnormal strain. When you do something that you're not used to (even sitting too long), that can result in the muscles going into spasms and you can get anything from mild stiffness to severe pain and complete lockdown of muscles. 

To get back to full function you need to address the muscle imbalance that's leading to abnormal strain. However, in a case like yours where all you have is occasional 'flareups' and you're happy to live with the rest then Trigger Point treatment could well be the way to effectively treat the 'flare ups'. 

It takes a bit of experimentation to learn how to find which muscles are playing up, but essentially you get a roller or hard lacrosse ball and lie on it so that it digs into the muscle. Roll around and when you find a sore spot let your weight sink into it for a bit. It hurts when you do it, but the pain subsides and the symptoms tend to go with it. It takes a while to learn about your body and where your 'key trigger points' are, but with practice you get that you know exactly which spot to massage to relieve your current symptoms.

Don't be restricted to looking for 'Trigger Points'. Trigger points are just common spots where tightness tends to form and each has it's own pain referral pattern and symptoms. Using trigger point 'maps' is a good starting point to learn what's causing your pain and symptoms. However, once you've exhausted the trigger point charts it's worth exploring the rest of the soft tissue to find 'tight spots' that are specific to you. 

Self MFR and trigger point treatment are the terms to google for. It costs nothing and his harmless so worth a try?

Thank you I will look into that. At the moment my body is way out of alignment due to an unknown type of neuropathy in my lower left leg when walking that has changed my gait and given me back pain. I have paid for CT and MRI scans that did not find a reason. As the pain only starts after standing or walking for a while. I had a standing X-Ray hoping that would show something . Next idea is to have a standing MRI at very limited locations but there I have a problem as I have an MRI compatible pacemaker that I can get the person from the makers to come and reset but we also need a doctor or physiologist to be present and that we have not yet been able to arrange.  

I say 'unknown' neuropathy but it was drug induced by  several Fluoroquinolone treatments.

It simply means that the shoulder joint has much greater range of motion than the hip, and doesn't need to withstand so much force. As such, the ligaments around the hip joint are tight, whereas there is much more slack (movement allowed?) in the shoulder joint.

The impact of this when it comes to 'lumps and bumps' on the actual joint surfaces is that a tight joint like the hip is less forgiving. 

The article you posted is actually outdated - that's no longer what researchers are saying.

"Also known as "wear-and-tear" arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain."

It is now known as "Wear and REPAIR" - it's now considered normal for joints to wear and repair themselves. This is why most people with signs of 'degenerative changes' are symptom free. 'Radiographic OA' (which is basically evidence of this normal 'wear and repair' process) isn't a disease, but a normal process - like a harmless scar forming on the skin. In most people it's completely harmless - as the research I posted earlier shows, more than 93% of over 30's have radiographic OA, but no symptoms. 68% of under 30's. 

Now, It CAN become problematic if the joint repairs in ways that leads to interference with normal functioning of the joint. Yet research shows that this isn't detectable on x-ray/MRI. Often, what looks horrendous on film is 100% functional and symptom free.

The upshot of all of this is that there is no way of knowing if what is seen on x-ray is anything to do with your symptoms. This is why there is no diagnositic test for OA - it's not really a condition. It's a catch all term used to describe unexplained joint pain.

A very likely and treatable cause of joint pain is muscle imbalance. That can be diagnosed - it's possible to test for weak muscles (although most health pros lack the skills to do this reliably) - however, the only way to know if your muscle imbalance is causing your symptoms is to correct the imbalance and see if any symptoms remain. This can only do good no matter what the root cause, because even if you go on to get a shoulder replacement, the better your muscles are functioning the more successful your surgery will be. 

I've already had my muscles tested in the shoulder, both weak and strong, by a physiotherapist. After several months of working on them it was obvious to her that some muscles and ligaments just could not respond to any active (and some passive) motion in normal ways. She told me I was the worst patient she had ever seen, in terms of incapability to perform normal ROM with such high pain levels.

So back to shoulder anatomy, when there is loss of cartilage, bone spurs, a glenhoid head abnormality clearly shown through diagnostics, and I happen to feel great pain in the areas of bone spurs and bone one bone - and the muscles are not responding and still "locked up" unable to move normally, its safe to say there is something wrong whether it's osteoarthritis or traumatic arthritis. The joint is quite tightly put together in it's healthy state, and yes it does have the greatest range of motion over all other joints. That's why it's the most difficult to treat and hence not getting treated can be very painful to live with.  In the link I sent you, osteoarthritis, is still being defined in the US by cartilage loss, which either may or may not cause pain. In my case, it does.

My case was said to be without doubt due to the state of the joint. Many, many physios worked on my hip without success. Over time, they would say things like "Look - you've had chiros, physios, osteopaths all try to solve this and they can't. At what stage are you going to accept the inevitable - that it's the joint?". At one point they said I was at most a year away from surgery.

They were wrong. I was right - it was muscle imbalance! 

This is my point. I'm not saying your case ISN'T down to the joint. Simply pointing out that physios, doctors etc aren't able to tell the difference between muscle imbalance symptoms and joint wear symptoms. So, when there is no way of telling either way, why do they opt for the 'incurable' condition rather than work on ruling out the treatable / curable condition first? The big problem is, because they've decided to go with the 'joint disease' theory they aren't bothering to research muscle imbalance and properly train physios. Consequently, as time goes by physios get less and less capable of treating muscle imbalances - more and more gets written off as 'joint disease'. 

There is never a case that's hopeless. I was told my case was hopeless, yet they were very wrong! That's all I'm saying. Sure, it's totally reasonable to make an individual decision about what you think the most likely cause is and act accordingly. However, no case is hopeless - it's always worth working on imbalances if someone wants to try that route. 

It's very possible that the imbalance that is causing the misalignment in your body is actually causing your hip symptoms. Certainly that was the case with me. Do you feel that your pelvis is rotated back on one side, and that one leg feels longer than the other? That's the normal pattern of imbalance with hip OA. Very many people find that the hip symptoms (even severe symptoms) go completely when they address the imbalance. I had a hip that had zero range of motion, severe shoulder pain and restricted movement, severe neck pain - couldn't turn to look behind me, back pain and foot pain. ALL caused by the imbalance that caused the hip symptoms (hip oa was my initial diagnosis). Pain and stiffness in all joints now gone.

Trigger point treatment provides symptomatic relief only and you need to keep doing it. The muscle imbalance is the CAUSE of the trigger points - you need to address the imbalance to eliminate the trigger points permanently. However, you'll probably get a good bit of pain relief from trigger point treatment. 

I'm not sure what you mean by a trigger point mat? I tend to use a combination of foam roller and lacrosse ball to get at all the trigger points. You'll find free info online on how to treat them and where to find them on your body.

If you go into my profile you'll find a link to my website and you'll get some info there to help you if you're wanting to try and tackle the underlying imbalance. 

I would say that at some point the Alexander technique could be very helpful. However, you may find it doesn't help much initially. The problem is, when you have a muscle imbalance your brain has learned to fire up all the wrong muscles in the wrong order. Your body isn't doing what it is supposed to do, so corrective exercise designed for normal people typically won't work for you and *could* make things worse.

However, as you start to untangle the imbalance something like the Alexander technique could be a great help in restoring correct function.

The book explains all the theory and gives you a generic treatment plan to get you started. From that, you'll start to understand the nature of the imbalance and some of the 'risks' of doing 'normal person exercise'. Armed with that understanding you'll be able to experiment with things like Alexander technique and 'customise' your rehab to suit your preferences and circumstances.