Problems diagnosed as Osteoarthritis CAN be cured in some cases.

Hi Veronical,

Sorry, I just spotted this post.

I had xrays taken when I was first diagnosed - about 11 years ago now. I had degenerative changes in both hips.

Several years later I was told by a physiotherapist that, based upon her physical examp, I had at most a year before I needed a hip replacement. Numerous specialists and physical therapists told me they could feel bone on bone restriction.

Once I got the muscle imbalance sorted my hips were 100% fine. Everything was caused by all the joints being pulled out of alignment. Muscles all over my body were either inactive, overtight or overstretched and that was distorting my entire skeleton. When it was put right everything still worked perfectly.

I haven't had xrays done since. I think it likely that the degenerative changes are still there. But they are not symptomatic. My hips feel perfect. Although I believe there are some studies that show cartilage DOES (or can) recover in hip OA cases. So maybe when everything is put right from a mechanical point of view some recovery of the actual joint does occur. But to be honest - who cares if it's working 100% fine as it is?

Hi Susan. Thank you for updating on that.  That's helpful to know.  I've had an xray show early stage degeneration.  I'm doing physio stretches, muscle building work which helps. An osteopath has also indentified lower spine issues which I'm becoming more aware of (pushes my pelvis forward).  I'm also taking a plethora of supplements in respect of working on the cartilage rebuilding.  There is hit and miss evidence on supplements, but I figure no harm in giving it a bash (glucosamine/chondriton, brocolli extract, omega-3 for inflamation, and a collagen suppleement).  I've also gone the route of eliminating nightshades from my diet (tomatoes, aubergines, peppers, potatoes).  

I do like the positive message you are sending out with your approach, and it counters a lot of the negative wear/tear, continual degeneration and decline model which standard NHS websites and practitioners give, so thank you for providing your information on this.

One final question - in terms of realigning the whole body system in terms of muscles that are out of whack/under-used, do you have a specific exercise regime method you can recommend? Was yoga or pilates beneficial?  

Hi Veronica,

If your xray showed early stage degeneration then in my mind (based upon my research and experiences) I'd be calling it muscle imbalance and not OA. Simply because the liklihood is that the joint degeneration is a benign consequence of the imbalance. Fix the imbalance and I doubt the joint will give you any problems. Look in my profile and you'll find my website url. I've put some info and links there that will help convince you that you really shouldn't trust that OA diagnosis. I'm not a mad conspiracy theorist - honest!! LOL The research really doesn't back up what doctors typically tell us. In actual fact Osteoarthritis isn't a diganosis. There is no test for it. It's simply a label used to describe 'joint pain with no obvious cause'.

I never took any supplements or paid much attention to diet. But if you *believe* it's working then it can only help. So much of this is in the mind. Feeling confident that you'll beat it and refusing to give up. (Research shows us this which is why it's so crazy that standard practice is to scare the life out of people and make them think they can't do anything to help themselves!).

It's the whole body imbalance you need to put right. I'd go as far as to say that chances are the problem is NOT where you feel the pain (in your hip) but elsewhere in your body. If you focus efforts around the symptomatic hip you'll only get symptomatic relief. It's not easy and in my experience and based on everyone I've spoken to you won't get far going to physical therapists of any kind. I know that's hard to accept, but the reality is that they don't know how to put this right (doctors wouldn't say OA is incurable if it was known how to treat it). They have the skills required to address muscle imbalance, but not the knowledge to put it together in order to address the kind of problem that you have.

You really do need to get your head around what's wrong and tackle it yourself. It's not that hard with someone to point you in the right direction.  You're the only one that can FEEL what's going on in your body. You're there 24/7 feeling, observing and listening. All you need to do is learn a little bit of theory, grasp what is going wrong in your body and you really can do much better for yourself. A third party can't understand in enough detail what's going on.

Yoga, pilates - none of that really helped. The trouble is, your body is out of alignment and your brain has forgotten how to make it move correctly. Any exercise you do, you do it incorectly - it doesn't work well.

The key is to gain a good understanding of what's wrong - in what way is your body out of alignment? What muscles are tight, which are weak, which are failing to fire up, which are overactive? If you just focus on your hip you'll never get things to fall back into line. The good news is that due to the way in which the body works you can fairly reliably predict what's going on simply by understanding what the pelvis is doing.

So step one is a good diagnosis of what is wrong throughout your body. Then you need to start doing exercise that tackle the whole body problem from lots of different ways. It's a stubborn problem and your brain/nervous system won't want to let go of all the adaptations it's making. You need to tackle it from lots of different angles to coax it back into correct alignment.

I'm putting all of this into a self-help book, but it's not ready yet.

I can perhaps give you a few tips and pointers. Has your osteopath mentioned anything about you having a sacral torsion or twisted pelvis?

Try this quick and dirty test - it might give us some clues. Lie flat on your back, knees bent, feet flat on the floor. Stretch your arms out at shoulder level and keeping back and arms flat on the floor rotate your pelvis so that your knees drop to the floor on the left side. Then repeat dropping them to the right side. Is is more difficult to drop your knees to one side? If so, then what side? I'm not asking where you feel the tightness, but which direction is hardest?

Do you have any sensation of one leg being longer than the other?

Which hip is symptomatic?

Thanks Susan.  I had asked the osteoparth about twisted pelvis, but he said my pelvis seemed ok.  He was quite thorough, and did say that the muscles are tight in my lower spine (named the actual disks) and that was producing a curvature situation.  I have had ongoing problems since my late 20's with my right leg and biomechanics.  I went to many different people and was told one leg shorter than the other, which another person disputed (they measured my legs) and told me my pelvis was misaligned.  The podidatrist told me the problem was with my feet and gave me orthotics.  An NHS physio told me it was none of the above, and that the problem was that my hip joints were tight.  So, in terms of previous diagnosis, I've run the full gamut of suggestions!  

For the past ten years I've found working on my core muscles and doing cross trainer was helpful.  But sitting at a desk can literally knock the whole thing out of whack again very quickly, so it's a daily fire-fighting exercise of being ok in morning, sitting at desk and knocking everything out of whack, pain, exercises in the evening to put things right again. It was only when I developed chronic pain earlier this year, and had the xray that I realised it was taking an actual toll on my joints.  

I'm considering one solution is to find a way of working that does not involve being as sat down all day.  Other option is looking at at a new type of chair that takes strain off lower back and keeps hip joints open (saddle chair). 

I think, as you have pointed out, the biggest issue is getting a definitive diagnosis on where things are misalinged and out of balance.  Having tried a variety of professionals over the years, I've given up on wasting money finding answers.  I'm narrowing things down at the moment to looking at the lower spine curvature and finding someone who can help on working the kinks out of that situation. 

In terms of which hips - right leg has always been issue for over 10 years now.  Clicks in and out at times.  Pain was quite bad in cold weather, but mild to moderate at moment.  Hips generally feel quite tight, and there is ongoing pressure on my legs when I'm sitting during the day. I'm hoping the saddle chair can alleviate that side of things.

Building the leg muscles has been good and the biomechanics feels much better.  I do think I'm progressing in the right direction, but don't think I have quite hit the nail on the head in terms of where the original problem lies, but will keep working on that.  I will try the pelvis exercise that you've suggested this evening.

Thank you again. 

I think your osteopath is wrong. You have a twisted pelvis - almost certainly.

Your osteopath has detected bending in the spine. If your spine bends your pelvis tilts - guaranteed. So your pelvis is misaligned which means the muscles acting on your hips are out of balance. Assuming you have anterior pelvic tilt that means tight hip flexors and probably weak glutes?

A longer leg is a sign of your sacrum (pelvis) tilted to one side. It sounds as if you have that too. So on one side the abductors are tight and adductors weak. On the other side the reverse - weak/stretched abductros and tight abductors.

My bet is that it's rotated too. The tests I suggested will perhaps give us a clue as to whether that is happening.

It's normal for your pelvis (very specifically, the sacrum - the bone at the center where it attaches to the spine) to twist and bend during normal movement. During normal gait it bends and rotates one way and then the other with every step you take. For various reasons your brain/nervous system can get confused and starts to think that bent and rotated one way is the normal, neutral position. This pulls the whole body out of alignment and can eventually lead to a painful clamp down of a joint due to excessive strain on the muscles surround it - or to create stability.

A twisted pelvis will CAUSE:

- one leg longer than the other

- hip dysfunction

- knee strain / pain

- problems with foot mechanics

- shoulder, back and neck problems

For years you can manage without any real symptoms but gradually as your body compensates more and more things start to sieze up or cause pain.

In terms of your own experience, is there any particularly body-work area that is most effective on the pelvis realignment (osteo, physio, bowen, etc, etc.) or did you suss out the best exercises for your own pelvis?

(apologies for more questions!)

There was no single approach that worked for me - and I don't think a single approach would work for anyone. The secret (once you've got a clear idea of what is wrong - what your imbalance is) is to use multiple approaches. The difficulty is that these imbalance become self-reinforcing. You end up with multiple dysfunctions layered on top of each other as your body tries to adapt and compensate. It's a bit like peeling the layers of an onion. So for example, one week massage might move you forwards but things will stall and you'll need to find a new approach to shift the next layer.

- massage to loosen off trigger points and ease sore muscles.

- activating lazy muscles that have forgotten how to fire

- strengthen weak muscles

- stretch tight muscles

- retrain posture

- retrain movement patterns.

You can't just do random exdercises though. You need to construct a model in your mind of what is wrong and that way you can tackle it in a logical way.

First step is to figure out what's wrong. The way in which human beings work means that you can identify from the pelvis/sacrum what is wrong. You simply don't have a stiff, sore hip with out compensatory twisting in the pelvis.

It sounds as if your left leg is the long leg then (and yes, that means sacrum tilted to the left.

Right leg symptomatic.

We now need to know what way your sacrum is rotated and that little test I suggested might answer that. Also, are you aware of one side of your pelvis hanging back when you walk? If you lie flat on your back and look down at your pelvis do you see the bone on one side sticking up higher than the other?

It's also relevant to know whether you have an overriding tendency towards anteior or posterior pelvic tilt. Or possibly swayback posture. Can you clarify more about what you mean by your pelvis springing forwards? Does one side of it spring forwards or your whole pelvis? You're saying you have a curve at the base of your spine, but what way does it curve?

Anterior pelvic tilt is when your bum and belly stick out. Hip flexors will be tight. This is common with people that have desk jobs.

Posterior pelvic tilt is when lower back flattens out - no bum. Hip flexors will be stretched. This is rare

Pelvic shift (swayback posture) is when your whole pelvis stays level but is fowards of your feet when standing. Glutes and hamstrings tend to be very tight.

Do you know which of the above you have? This is connected to the curve that you say the osteopath has spotted in your spine. It's not clear from your description which way it's curving.

The lower spine is curving inwards (I think), so my pelvis pushes forwards.  A physio described it as how a gymnast stands before they do their routine (she had asked me if I had done gymnastics - answer was no!). From what you describe in your descriptions above, it would be more the anterior tilt, but I need to recheck this is the mirror at home and also with the floor test you outlined. 

Hi Susan.  

I've been giving the pelvis role a go, as you had suggested.  Not too sure if I'm doing it right in that I'm not sure if my feet are still meant to be flat on the floor when rolling my pelvis.  Have tried it both ways, so not much roll either way if try to keep feet flat on floor.  If I let my feet move with the roll, there is more of a drop to the right than to the left.  Slight twinge of pain also on the drop to the right, but think that's more to do with the stretches I've been doing.  Checked the pelvis tilt by mirro and it does seem to be the anterior pelvic tilt. 

More of a drop to the right suggests that your pelvis and sacrum are rotating to the right more freely than they are to the left. This suggests that your pelvis/sacrum is rotated to the right.

When your pelvis is rotated to the right your RIGHT femur will be jammed in internal rotation. Physical thearpists very frequenly misdiagnose this - their tests show that you LACK internal rotation and they'll often insist that your hip is jammed in EXTERNAL rotation. But they aren't taking account of the twist in your pelvis.

The LEFT femur will be jammed in external rotation. Now in my case the left femur moved freely - it wasn't locked up like the right. But both could be stiff.

I'd avoid stretching anything on the right side. It will all feel tight but in actual fact (assuming we're right about the rotation of the pelvis) the right side muscles are already overstretched. Stretching is entirely the wrong thing to do.

The stretch most likely to help (a little) is a lunge stretch (kneeling psoas stretch) to stretch out that left psoas and iliacus. Be careful about form - make sure you squeeze the left gutes to put the stretch on your psoas rather than simply arching your back. You want to feel the stretch down the front of your left groin. Hold for a couple of minutes at a time. Repeat a few times a day if possible. This should result in some improvement within a few days.

The other thing most likely to give improvement without agrevating is thoracic spine mobilisation. You want to get your upper spine rotating either way and from side to side. I expect it'll be tight in some directions but keep working it in all directions and it should loosen off a bit. This whould free up the pelvis too as when one end of the spine is tight so too is the other end.

It's always tricky when going by descriptions as we may be at crossed purposes. Don't try anything that aggrevates symptoms or anything that sounds wrong to you. But if what I'm saying makes sense to you then give these exercises a try and see if you get any improvement.

Let me know how you get on. Does it give improvements? Any comments - what do you feel when you try these exercises - what feels tight?

One more test to try. Lie on your back, knees bent, feet flat on floor. Place your hands, palm down underneath the small of your back. Is the space between your back and the floor greater on one side than the other? If so, which side has the biggest gap?

I rolled upper and lower body

I was amazed that others difficult

The easiest I believe was the right leg over and most difficult was the right arm!!!!

I was surprised by that

Coming back over from the first move was harder in all 4

My left shoulder didn't feel great at one point...

I'm a mess....ha

I hope I can get better

Thanks again....

Joe

OK, this is good in that it supports the theory that you have a twisted pelvis. However, the fact that you found right leg over to be easiest suggests that it's not twisting the way I thought.

This exercise makes use of the rotational slings in the body - they are partly responsible for rotation around the spine (so rotating the torso in relation to the pelvis, turning to look behind you etc).

Anterior sling = inner oblique and opposite side outer oblique ('connecting' hip to opposite shoulder at the front).

Posterior sling = glute and opposite side lat ('connecting' hip to opposite shoulder at the back).

So for example, when you lead with upper arm you *should* be using right shoulder to left hip anterior (front) sling and  left shoulder to right hip posterior (back) sling. Thinking of these patterns might help you to fire up the right muscles.

If your body is functioning correctly you can do all of these rolling patterns with equal ease. The fact you can't do some shows that some of your oblique slings are not firing up correctly. Probably your brain / nervous system has forgotten how to use them.

So, some doubt about what way you're twisting still so don't put too much trust in the other exercises I suggested, but a good, safe exercise for you is to keep working on is these rolling patterns - practice the ones that you have most difficulty with and that should help. Watch out for that sore shoulder though - be careful not to agrevate it. This exercise will help wake up the lazy muscles.

Speak to your friend and see if what I've told you helps move you forwards. The info I'm putting in my book should help you to build up a very accurate picture of what's wrong, but in the meantime get back to me here or on my website if you have any more questions. Use MFR to find the tight knots and loosen them off - use the book I suggested for this.

That is the trigger point book you are referring to

When I am done with my session with her I will show her the rolling patterns and what she says I will send to you

My left knee has been cracking a bit ...no pain

I can't wait to start to feel some relief

I look on the Internet for exercises to help internal rotation

I don't know if you recommend that or not

Thanks

I'd leave the hip internal rotation alone for now.

If you're standing upright in a neutral position and, without moving feet you rotate the pelvis to face the right (so rotate your body round to the right) this will cause external rotation of the left femur and internal rotation of the right femur. If you get 'stuck' in this position the tight external rotators on the right will pull the sacrum (base of spine) to the left side which means all the muscles on the right of the pelvis and the right hip are overstretched. The last thing you want to do is stretch them further!!! With your sacrum in this position it's very difficult to stretch the left side muscles as what tends to happen is the muscles on the right of your body stretch instead. It's hard to get the leverage you need.

Also, things can be deceptive. I know you think you lack internal rotation on the left side, but there's some doubt as to what way your sacrum/pelvis is rotating. If it's actually rotating towards the left (which some of tests suggest) you would actually have a left hip JAMMED in internal rotation. It feels very much like it's externally rotated and that it lacks internal rotation. But this is due to incorrect position of pelvis. Trained specialists are easily fooled by this. I was told by many that my right hip lacked internal rotation when in fact it was JAMMED in internal rotation.

So leave the hips alone for now. Correct things with the rolling patterns initially. Also some thoracic spine mobilisation. Always remember - the problem isn't where you feel it. You rarely need to work on the painful hip as correcting everything else takes the strain off it.

When we have a bit more confidence in the diagnosis of your pelvic twisting we can get more specific about corrective exercise.

Yes, the book I recommended will I think be helpful re trigger points.

Correction "If you get 'stuck' in this position the tight external rotators on the **LEFT** will pull the sacrum (base of spine) to the left side which means all the muscles on the right of the pelvis and the right hip are overstretched. "

Thanks Susan.  Appreciate that advice.  I shall give the back-gap a check  this evening.  The damage is definetely happening in the sitting during the day at work - do think it's my lower back is getting out of whack, so will have to figure where the challenges are in that.

Psoas will shorten and tighten when sitting all day. If you have a tight psoas on one side (as happens with twisted pelvis) then that psoas will tighten up more when sitting which will increase lordosis (curve in spine) on that side but also it will increase the tilt and rotation of your pelvis.

The psoas is also prone to tightening up when you get stressed, so perhaps you've found stress makes your symptoms worse?

If when you do the 'back gap' test you find a bigger gap on one side then it's a clue that the psoas on that side is tight and short. The kneeling stretch would help. But it won't be the complete answer.

Thank you again.  That is really helpful and gives me something now to work on that has a bit more substance.  Stress - not so sure if it does/doesn't so I will keep an eye on that one to see what the difference is. 

Meaning: when im lying face up I am limited in hip motion against my fixed upper trunk

Thanks...

I've never heard of PVA or pelvic approximation before. However, from your description it sounds like left psoas is weak.

So that fits with sacrum rotated left. Psoas would be tight on the right and weak on the left. If this is the case it's better initially to work on the tight right psoas - the left may well then strengthen up on it's own.

Posterior sling is a 'chain' of muscles. So glute on one side and the opposite lat.

Ok....

I feel tight on left

My friend the MAT practitioner helps me fire weak muscles so I don't think she will hurt me

The level 1 body rolls were done today for real to asses

Right leg over was easiest to do but hardest to bring back

Only after doing left 5x(I did them all 5x)

Was I able to go back to the right and perform it backwards

I did the kneeling psoas stretch moving torso to find sticking points held and squeezed glute for 2 mins did right side once left twice as left was ...is....does feel tighter

Bought the trigger point workbook today

Question:

While all of this was happening to you....

Did you continue to train and if so what did you do????

Also not sure if I'm cueing right on these rolls but after doing them and the psoas stretch I felt a bit better....psychosomatic maybe...

Thanks again

Joe

Be very careful stretching psoas on both sides. If your pelvis is rotated (it's highly likely that it is) then you'll have one tight psoas and one overstretched, weak psoas. It *sounds* as if your left psoas is the weak one. It could do more harm than good to stretch it.

I'll try and explain...

Your psoas connects hip to spine. When your psoas is tight it pulls the spine sideways towards your hip. If only one psoas is tight (lets assume your right psoas is tight) then it will pull your spine TOWARDS your right hip but AWAY from your left hip. In other words, your left psoas will be lengthened.

Your left psoas will FEEL very tight, but that's because the gap between the bones is increased and it's being stretched constantly.

My LEFT psoas was the tight one - although it felt fine. Stretching that out did a LOT of good. Yet for years I was convinced my right psoas was tight because it FELT tight. Yet stretching it was the worse thing I could do.

So keep this in mind. See what your MAT practitioner thinks. Can he get that left psoas to fire up? That (if we've got the diagnosis right) will do more good than stretching.

As for whether to keep training....

You know what a repetitive strain injury is, right? Tennis elbow, housemaids knee.....basically a painful soft tissue (or sometimes bone) injury caused by overuse. Essentially trigger points, tendonitis, bursitis etc.

A muscle imbalance isn't really a bad thing. Most people have them without ever having symptoms. The imbalance only becomes a problem when the added strain it puts on the body causes a repetitive strain injury. So maybe just trigger points or tendonitis, tendonosis, bursitis etc. It's really the Repetitive Stress Injury causing the pain, but the muscle imbalances makes you prone to Repetitive Stress Injuries. A muscle imbalance can also make RSIs very hard to recover from as the soft tissue is constantly under strain - your can't rest it.

The treatment / cure is to realign the skeleton so that the strain comes off the soft tissue. Hence the corrective exercise.

This is where it gets complicated. Often, a Repetitive Stress Injury needs to be rested in order to heal. If it's something like tendonitis that can take months. If you rest for months your tolerance to exercise will go down which will make you more prone to RSI's in future. So the answer is that you need to listen to your body. Try and maintain your fitness - you don't want to go into retreat. If pain gets worse you need to adapt exercise or back off a little. I tend to ignore discomfort or pain that clears up in 24 hours, but anything that lingers is a sign that I need to rest or change what I'm doing. Ensuring that you get adequate recovery is more important than ever when you have muscle imbalances. Provided you're recovering fully between training sessions then it shouldn't do any harm.

Even with a severe muscle imbalance you can build up tolerance in the soft tissue so that you're able to do a lot without problem. However, you can run into big problems when you start to correct the muscle imbalance. For example, in my case - when I got that psoas stretched out and I started to walk more normally it felt great. Yet within a couple of days I was out of action with tendonitis in my ankle. Although my mechanics were now much better my muscles weren't used to being used properly and exercise levels that were previously well within my capability were too much for those newly exposed muscles.

So short answer - listen to your body. Make sure you are recovering fully between workouts to minimize the risk of overuse injuries. Increase volume gradually. All the normal rules, but extra important when you have these imbalances. Good nutrition, keeping weight down, plenty of sleep, low stress levels etc can all help with recovery. I like to take L-Glutamine - not sure if it's placebo or not but my feeling is that it does help with recovery.

I did run, but it's not the best thing simply because it will make the twisting in your pelvis worse. Cycling, stepper, cross-trainer can all be good - focus on keeping your pelvis level so that both hips/legs are working equally. I'd day there are no hard and fast rules about what is good for you. Tendons, cartlage etc get nutrient from osmosis - regular activity is good for you provided you keep within your tolerance levels. However, the reality is that those sports that you've done for years have probably contributed to the problem so it might be hard to correct things if you keep doing them. If you want to continue with one-sided sports then switching sides - practicing mostly on your weak side could help. Variety in what you do will help prevent bad movement patterns from getting too deeply engrained.

I hope this makes sense? Mainly you need to listen to your body and make sure you're recovering fully between sessions.

One of the reasons that treating trigger points is so good is that it can reduce the chance of Repetitive Strain Injuries and speed up recovery.

Think of a trigger point as a knot in the muscle. It can weaken a muscle by preventing it from contracting fully and it can shorten a muscle by preventing it from stretching fully. They can be painful and anoying but you can usually train through them. However, a weakened or tightened muscle will put more strain on the tendons and ligaments. This in time could lead to tendonitis which, when you have a bad muscle imbalance, can be almost impossible to treat. So as well as helping to reduce symptoms trigger point treatment can help preven the RSIs that are responsible for the pain and dysfunction associated with OA.

I have mesh in my groin from a fully me hernia repair...thought you should know that....

So it's my right side.....

Ok

I wanted to do second level TUF

Has some ground moves

Mostly gun and knife defenses as well

Don't know....

I will keep reading

Keep rolling

And do right psoas stretch

Thanks

Have you heard of Functional Patterns? Look it up - they have lots of youtube videos. They emphasise the rotational slings and it's also very much martial arts inspired. I think it might be quite good for you.

Google "cross crawl pattern" and "rotational slings". This is the type of thing that you should try and work into your training as I think it'll help.

Hi .....

Hope you're well

Interesting reading

Quick question

Do you own a Thera Cane???

Thanks