Problems diagnosed as Osteoarthritis CAN be cured in some cases.

The fact that you have scoliosis does indeed make muscle imbalance all the more likely.

You probably need to figure this out on your own. If you're in the UK then you won't get help with muscle imbalances via the NHS. If you go private there is no regulation so you risk getting seriously ripped off.

It seems to me that cases of OA that are down to muscle imbalance all present in roughly the same way. Try these tests and let me know the results:

1. Lie flat on your back, knees bent and feet shoulder width apart and flat on the floor. Keeping shoulders in contact with the floor but allowing hips to rotate, let your knees drop to the floor on the left - then on the right. Which is tightest? Dropping to the left or dropping to the right?

2. Are you aware of having one leg longer than the other? If so, which leg? If not, is one hip hitched up higher than the other? Is fo, which hip?

3. Which is your symptomatic hip.

The fact that you have pre-existing scoliosis would influence these tests but tell me the results and if I can predict some of your symptoms from there then I might be able to give you some pointers to help you figure things out.

"OA refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life.

...

OA is characterised pathologically by localised loss of cartilage, remodelling of adjacent bone and associated inflammation."

Their recommended diagnostic criteria is as follows:

In adults over 45 years old the NICE guidelines recommends that an OA diagnosis is made without x-rays  under the following circumstances:

1.    Diagnose OA clinically without investigations if a person:

a.    is 45 or over and

b.    has activity-related joint pain and

c.    has no morning joint-related stiffness, or morning stiffness that lasts no longer than 30 minute

So, OA is a condition where pain and dysfunction is caused by loss of cartilage, remodelling of bone etc. As the joint damage can't be reversed it's considered incurable. That's fair enough.

Yet the recommended diagnostic criteria doesn't require that they  ensure that:

a) Joint wear exists, or

b) Joint wear is causing symptoms.

To my mind it is unforgivable to give someone a diagnosis of an incurable condition without first ruling out all curable causes. It's known that muscle imbalance is extremely common and that it will cause symptoms that mimic OA. Yet at a policy level people in the UK are told they have an incurable disease when in fact the chances are that many of them could be cured via physical therapy. Part of the problem is that there is next to no research into use of physical therapy to treat OA. Within the health service they are clueless about how to go about it. In alternative health care and in sports and fitness much more is known (there is some groundbreaking material available), but as there is no regulation it's a bit of a minefield and you're likely to be ripped off.

When I get my book completed I'm going to have a go at seeing if I can get the press to draw attention to what's going on. I want to get everything documented before I do anything else - i'm still digging into the research etc. But I think people do need to start making a fuss. Everything about the condition is to my mind being handled very badly. The only thing I'll say in their defence is that it does seem that very many people don't want to get their finger out and help themselves. The annoying thing tho' is those people are hogging all of the resources and people that do work at fighting the condition aren't given any help and support.

Here's the problem. There is a possibility that all of your symptoms (including the joint wear) is a result of a muscle imbalance. It's almost certain that many of your symptoms are caused by muscle imbalance. The trouble is, these things are difficult to identify and treat and there isn't enough research done in this field for it to be considered by the NHS.

Muscle Imbalances are well researched and theory is very widely accepted. The basic principles of treatment and diagnosis are readily available in a number of books by people like Janda, Sahrmann etc. BUT they won't tell you how to apply the theory to treating problems like yours. That requires a lot of skill.

What I learned to treat myself could well be of help to you.

I'm putting all of my findings in a book. It's still a couple of months away from being ready but if you like you're very welcome to a copy when it's complete. It might help you to figure out how to resolve this.

In the meantime here's the best advice I can give:

- If you have pain look for a book called "Trigger Point Therapy Workbook" - that is extremely likely to help with pain and stiffness. It's something you do yourself and it will cost you less than £20 for the book.

- Weakness is likely to be a combination of muscle imbalance, perhaps trigger points, but probably more down to disuse.

It seems to be pretty conclusive that if you can tolerate it exercise is the best treatment. This holds true whether you really do have OA or whether the real cause is a muscle imbalance.

Regardless of age and dysfunction your body WILL respond to exercise. If you can only stand for a five minutes try doing that a few times each day. Extend it to six minutes - then severn. Google for exercises for chairbound people and do whichever ones you can tolerate. They key to getting stronger and fitter is to gradually increase the amount you do. Tiny steps so as not to aggrevate symptoms.

I know it seems impossible when you're in a bad way but I PROMISE you - your body is very capable of much, much more. You just need to build up slowly.

Someone looking to run a marathon would be advised to follow a 'couch to 5k' program. Extremely unfit people that can't run a single step are able to run marathons within a few months simply by starting out by walking for 30 mins then gradually putting short bursts of running in. Over a period of three months they're able to run for a full 5k. From there they keep slowly building tollerance until in no time they can run for 26 miles solid. Not athletes - just ordinary, unfit people.

You need to apply the same principles. Slowly build up the number minutes you can spend on your feet. When that gets easier get yourself a little pedometer (step counter) and build from 100 steps a day; 200 steps - get up to 10,000 steps a day if you can. I don't care how impossible it sounds - it IS possible. You will feel so much better. You've just got into a very bad place but you CAN get yourself out of it.

If pain holds you back I'll help you figure out what's causing that pain. It will be easier to address the root of the problem when you're a bit fitter and stronger.

Run this plan by your doctor. See if he's willing to support you in it.

It's a coincidence that you should post today as I'm currently struggling over what to write in the book re seeking out professional help.

I consulted so many experts over the years and spent thousands of pounds. For the most part they did substantially more harm than good. The reality is that precious few are geared up to actually treat OA - it's still deemed incurable so most won't try. Those that do have a go simply don't have time and inclination to put the level of effort in that's needed. Yet obviously there are the 'good guys' out there - like you.

Some people simply won't have the background knowledge, inclination or time to tackle this on their own. But those people are the ones most vulnerable when it comes to seeking expert help. How do they separate the good advice from the bad? If their chosen expert tells them they're incurable they'll believe it. If their chosen expert tells them they'll get full recovery but it will take endless expensive treatments they'll believe it. The very fact that the person is an expert means their opinion carries huge weight. If that opinion turns out to be wrong it can send someone off on completely the wrong tangent. They'll never think to re-evaluate their assumptions because they'll have blind faith in the expert.

Anyway, I'm still not sure what I'm going to write on that subject but you have highlighted the point that there ARE people that will really take the time to try and treat a condition - even if it means putting in a lot of unpaid time.

Take a look at your patients internal obliques. If they're inactive on one side that can destabilise the whole pelvis. All the muscles acting on the legs, back and hip go into overdrive trying to take up the slack and that means they can't do their job properly. It's not always that simple because there could be a reason why the obliques can't fire up, but it's worth a try as once you get the pelvis stable everything else comes back online so much more easily.

For what it's worth, I think the best thing you can do to help someone with this kind of problem (as a professional) is to do all you can to educate them about what you're observing. That way if their money runs out before you find the solution at least they can move forwards on their own from a better place.

Thanks again for the feedback

I'm not sure how best to advise you on that one. I think as with all professions you will be faced with those that are better informed, more enthusiastic to solve the problem, those genuinely willing to help and others out there who are just ignorant, not prepared to think outside the box, short of time or in it for the money.

I suppose the key thing, not considering the NHS where you have no particular choice, when considering whether to go to a private professional is to do what you may do for other services and try and get some testimonials off people of they say they can help.

Also really important to have a good chat with the person before you agree to hand any money over. Be armed with some information and don't try and test professionals to see if they can work out something you already know. Education works both ways and every person is different so it's important to have as much information as possible. In an ideal world you would like to find someone who has detailed knowledge of your issues and knows how they can help. However, more realistically you may be looking for someone like me - I do not proffese to know it all or try and BS. In fact I am aware that I only know a fraction of what there is to know because really there is so much detail. BUT I am willing and want to do whatever research is needed to try and determine what is wrong and whether there may be a way to help someone.

For instance one of my current clients had collapsed arches. This has led to a series of issues in her back and hips. Now when researching online you get website after website state all you can do is try to pause the condition from getting worse. However, luckily I stumbled across a research paper which found exercises plus fitted insoles can reverse some of the issues and relieve symptoms. In just a couple of weeks her feet are no longer swollen and she is no longer getting pain in her feet. We are still working on the back pain but I think that will take a bit longer to figure out. But this would not have happened if I hadn't have researched around common advice.

i would also note that those that are trying to help may not get it right first time. It may be a journey. There may be no simple fix and so many parts of our body are connected. BUT what you want from your professional is openness and information. I'm not afraid to say I don't know, but I will try to find out. Or it could be this and I think we should try this. What you need is someone you can build a trusting relationship with and who will be open. 

I hope that helps. I completely understand your frustration and it can really make you lose confidence in people and even yourself. I hope you can see there are good people out there who are willing to try.

i have been really moved by yours and the other people's experiences on this post and it has really inspired me to do what I can to help. If you need any help with your book please let me know. I will also do what I can to promote your experiences with other health professionals. I also want to support this with some case studies of my own. 

Thank you for your suggestions on the obliques I will consider those in my testing next week. 

Thanks Susan and keep up the good work. By the way your website looks really good

The problem is that when it comes to OA there is no established cure. Exercise is known to help, but there is next to no research to guide health professionals into establishing what kind of exercise. If you look at the actual research you see that physical therapy comes under the exercise umbrella, but it's just generic stretching and strengthening that's been studied. Not highly targetted, complex treatments. In addition, most research is done into knee OA. Hip OA is a very different beast requiring different approaches.

Muscle imbalances are well understood but with upwards of 650 muscles in the body it's no easy task figuring out which are tight and which are weak. Varous people have developed models that describe common scenarios - upper crosssed syndrome, lower crossed syndrome for example.

The type of imbalance that often leads to an OA diagnosis is highly complex and there is no model that exists to help figure out what needs to be addressed.  I think I've come up with such a model, but time will tell if it explains other peoples symptoms as well as it explained mine.

Most people making a living out of physical therapy have come up with a business model and way of working that allows them to work efficiently. A complex, poorly understood muscle imbalances (i.e. the typical hip OA case) is not going to be treatable within that model. It takes someone that's willing to put in the time to figure it out, to research and so on.

The best help I've had was from a newly qualified phsyio. He hadn't yet got stuck in his ways. He was keen to try and put a lot of work in that I wasn't paying him for.

Strictly speaking someone shouldn't take on a case if a) they aren't certain how to treat it or b) they aren't willing to put in whatever time it takes - unpaid time - to learn how to treat it.

I've spent about £4000 over the years on people that couldn't help me. I learned the hard way. I want to try and help people to avoid the same mistakes. The reality is that most people won't find someone that can help them and they'll lack the knowledge and experience to know when they're in the clutches of a bad one. I'd like to tell people to just knuckle down and figure it out for themselves. Long term that will yield the best results. If you have what threatens to be a lifetime disease then surely it's worth the effort. But I know some people are just unwilling or unable to do it on their own.

Once the book is complete I'd love feedback to help me make it better. I've tried to get help from OA charities, OA research places, local physios etc that I've worked with. They don't want to know. So I'm doing the best I can with the knowledge I have. But it could be made better with input from others.

This is why I keep coming back to telling people they need to bite the bullet and become their own expert. What if they can't be completely cured? If they can manage their condition for the rest of their lives through corrective exercise, self massage etc they can lead a full life despite the problems.

If they rely on someone else for treatment it won't be sustainable. Unless they are very wealthy the won't be able to afford it for long.

If a quick cure was possible then maybe going to a pro would be best. But how many people will get a quick cure? It took me 9 years on total - a year after I'd figured out exactly what was wrong. It's not the kind of thing where you come up with a treatment plan and keep doing it. You need to keep changing what you're doing as your body gradually adapts and moves back into alignment.

Who can afford to pay someone for that amount of help?

Drugs are surgery are options if that doesn't work. Well, you're already taking drugs and sugery has been ruled out.

So exercise. That's all the health pros have to offer you.

My advice re what to ask your doctors is "what is the most appropriate exercise for me to do?". He may refer you to a NHSphysiotherapist but you won't get much help there as research has shown that the approach to OA taken by NHS physiotherapists doesn't work.

This is the problem. They have established enough to know that exercise is the best chance most people have, but they don't know enough, nor do they have the relevant expertise and training in place, to tell you HOW to exercise.

Sometimes with knee OA (which in 70% of cases is partly down to weak quads) it's enough to just change your habits. That can balance things out without too much thought on your part.

Hips are far more tricky as with an imbalance in the hips the whole pelvis is thrown out which will take out back, neck, shoulders etc (as you're experiencing).

That's the bad news.

The good news is that complex imbalances like this CAN be fixed. You just need someone with the relevant skills. When you have OA physical therapists have traditionally been told to do sod all to help you. Their view is often that it's just a part of aging and you should live with it. Research is now showing otherwise. Exercise is HUGELY important but people (especially those with hip OA) need help in balancing their bodies so that they can do that exercise!

See what your doctor can suggest re getting help with physio. I know that a while back there was a scheme where they paid for people to go to a private physio in order to get NHS waiting lists down. Your doctor might know of something like that. If you can afford it pay to see someone yourself.

What you need to stress when you see that physio (before you see them - when you talk on the phone) - is that you've been diagnosed with OA but surgery isn't an option. The primary treatment is exercise but you're struggling to do that because of the complex muscle imbalances (I guarantee you have them). You're looking for a physical therapist that can help you address those muscle imbalances and get you to the point where you can do some form of exercise that is helping you.

I had hip, back, neck, shoulder, knee, foot, hand pain. I also had evidence of sever degenerative changes in my neck. It's now completely symptom free. A good private physio will have the skills to help you. The difficulty will lie in persading them that they shouldn't just write you off because you have OA!

Tell me more about your pain. Where do you feel it? What does it feel like?