Osteoarthritis: To Move or Not To Move?

Osteoarthritis (OA), which is also known as degenerative joint disease, involves a wearing down of the flexible cartilage tissue at the ends of the bones that form joints. It is the most common form of arthritis, and it is estimated that over 32.5 million US adults are affected by it!(1) Prevention strategies of arthritis before it occurs is the most effective way to make sure it will not become an issue in your life. These strategies may include improving movement patterns, staying active, keeping your muscles strong and joints flexible, having good nutrition while avoiding processed and pro-inflammatory foods, staying hydrated, maintaining a healthy weight, and ensuring adequate recovery from exercise with enough sleep and gentle movement.

Once a joint has become arthritic, what are some strategies to keep in mind to optimize functioning, improve joint health, and mitigate the impact that this condition could have on quality of life? 

There is plenty of misinformation out there regarding arthritic joints. Even the terms used to describe OA colloquially can impact the public’s perception in a negative way. Degenerative joint disease. Wear and tear arthritis. Bone on bone! These types of descriptions bring scary images to mind, and imply that movement and exercise is actually unhealthy for joints and can contribute to joints wearing out. Certain doctors may tell their patients with OA that they should not do certain things any more- bend, lift, squat, kneel, run.

Too often, adults with arthritic joints begin to fear movement, or the pain that they may associate with movement, and will begin to exhibit compensations in the way they move. They may begin to become more sedentary, limit participation in various activities, and develop a resentful relationship with the involved body part. These changes contribute to a snowball effect, in which case the changes in mindset and behavior lead to further decline in joint function and tissue weakness, which continues the arthritic process, thereby leading to further pain, fear, and avoidance of movement and activity.

On the other hand, some people may overdo vigorous activity, which can increase inflammation and contribute to additional strain on compromised joints. It can be difficult to find the balance between too much and not enough. Lower impact, moderate activity performed on a consistent basis tends to be the sweet spot in which those with arthritis can keep their joints mobile and strong without contributing to flare ups and potential joint injury. 

Movement is absolutely essential for all of us, and especially for those with OA. If the question is move or don’t move an arthritic joint, the answer is to move intelligently and often.

As arthritic joints tend to become hypersensitized to loading, we must load the joints efficiently without strain, and allow the muscles and other tissues around the joint to get stronger. Stronger, smarter muscles will provide shock absorption and support for the joints, which helps attenuate the forces from daily life, movement, and exercise (like having your own built-in knee brace!) Movement has been shown to limit pain and improve joint motion, as well as prevent the risk of a future injury or fall. (2)
Joints that become arthritic tend to be synovial joints, meaning the joints rely on synovial fluid (the lubricating WD-40 of our joints) to move smoothly. In order for the synovial fluid to stay healthy, slippery, and plentiful, we must move the joint! Movement of joints helps to improve synovial quality and distributes the fluid around the joint so we can move without friction. Additionally, movement helps to distribute blood flow (which contains nutrients and oxygen) around the joint tissues, and can help decrease excessive muscular tension which may be associated with a pain pattern. Exercise has even been shown to activate genes that can help to rebuild cartilage!2 Cartilage has a limited potential to rebuild, but it is possible, and the cartilage that we do have can be strengthened just like other tissues. 

If you have OA, it can be very difficult to get your joint moving and begin the process of regaining strength and mobility. When joints have been painful for a long time, central sensitization may have occurred, which involves central nervous system changes in our perception and response to pain. The pain perceiving pathways may now be embedded deep into our brain circuits, including the prefrontal limbic regions, which is associated with our emotional responses. (3) Combined with structural, tissue-level changes, it is no surprise that many with OA fear movement and require guidance from a physical therapist or other health practitioner to get moving again. Fortunately, physical activity has been shown to have a positive effect on central sensitization, as it can help modulate the pain response by decreasing excitability in the motor cortex as well as stimulating the release of endogenous opioids (endorphins and other substances that are our brain’s natural pain relievers). (3) 

At the Wellness Station, we will be able to guide you intelligently and compassionately towards building strength, improving function, and opening up your life to greater possibilities.

Here is one of my favorite, low-impact exercises for building strength and control in the lower body and core. This can be especially helpful for individuals with knee and/or hip arthritis, in which cases standing exercises like squatting may be inefficient and painful. Many people have done the “bridging” exercise. The Feldenkrais-inspired bridge is known as “spine like a chain”. It involves pressing through the feet to begin to lift one vertebrae at a time from the ground, and lowering down in reverse. This can help to strengthen the glutes and thigh muscles, mobilize the spine, and improve awareness of how we utilize the forces from the ground to move our bodies. Check out this video from Paul McAndrew to get a visual and verbal demonstration of the movement: Spine Like a Chain

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. https://oaaction.unc.edu/oa-module/oa-prevalence-and-burden/ 

2. https://lonepeakpt.com/blog/living-arthritis-move-more-or-move-less#:~:text=Moving%20is%20essential%20if%20you,helps%20your%20joints%20be%20healthier 

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074793/ 

My Feldenkrais-Inspired Journey

Almost three years ago, my life changed for the positive when I was introduced to the Wellness Station and the methodology that influences our practice. I had barely heard of the Feldenkrais Method® at this point as a PT student, and certainly had no idea how to implement its principles into my own life or into therapeutic care. This was a pivotal moment in my life in which the end of my academic journey and the start of my career was just around the corner. I knew that I wanted to bring some new ideas into the therapeutic space, as my experience with traditional physical therapy left me searching for deeper meaning. Beginning to blend my learnings of the traditional therapy model with my study and practice of yoga was extremely helpful, but I knew I had much more to learn.

Following an auspicious introduction to the Wellness Station team, I began to open my mind and body to the greater possibilities that are achievable through a Feldenkrais approach. I began to receive mentorship, attended Feldenkrais movement classes, participated in my own body explorations at home, and improved my knowledge through reading various books on the topic. Through this journey, I have achieved personal growth and a refinement in motor skills, which are gifts that keep on giving.

Below I will reflect on some of the key takeaways of my journey that have helped me feel better in my body and motivated me to share these tools with the world. 

Keenly aware of more body parts and connections between

A key part of the Feldenkrais Method is to become more aware of our body in a non-judgmental way. With a background in anatomy as well as yoga, Feldenkrais helped to deepen my self awareness to a greater level of precision. Using the spine as an example, I used to be only generally aware of my spine, more as a series of “chunks”: my low back, mid/upper back, and my neck. Through slow, controlled movements with a keen attentiveness, I have been able to expand my sensorimotor skills to be aware of specific parts of my spine, and how to move and adjust my position to feel more comfortable in these various areas. Key lessons that helped to build this ability have been the pelvic clock, as well as piano keys and spine like a chain. This idea of each vertebrae being like a piano key can allow us to move with the precision of a skilled piano player- flowing up and down the scales with ease, rather than being limited to mashing many keys all at once. These practices allow us to feel “flow” and connections between various body areas, as the spine is our center, our core, the foundation for our head, and the bridge between our upper and lower body. 

Moved away from strain and over-efforting

Many of us have a tendency to put in too much effort, which can contribute to strain and tension. In fact, we all have inefficient movement patterns, which is just part of the human experience. These neuromuscular inefficiencies may present themselves during exercise, daily tasks, occupational duties, and more. For me, this tendency may have related in some part to perfectionism and competitiveness, as well as a reflection of the overall psyche of our society: do more, work hard, no pain no gain. Certainly it manifested into the way I exercised and practiced yoga to some extent. The Feldenkrais Method teaches us to do just enough, and no more. To become aware of unnecessary effort and tension, and find ways to move without our typical patterns of strain. By practicing movement in this way, I became aware of some of my habits that may have been less than helpful. Fitting myself into a tight yoga shape that didn’t feel good, but doing it because I felt like I should be able to. Overtraining because more is always better. Judging and being hard on myself when I felt like I wasn’t achieving something perfectly. My journey with Feldenkrais has not erased all of these habits, but it has done wonders to help me become more aware of them, and has allowed me to be able to make the conscious decision to be more kind to myself and my body. This has actually done wonders for my yoga and other fitness practices. By finding ways to unlock my emergency brake (unnecessary tension), work with my body instead of on my body, as well as a refined sense of awareness and biomechanics, I have been able to find new growth in terms of the physicality of my movement practices. Better ability to move into difficult shapes with ease, strengthen my body in three dimensions, walk and run with a sense of flow, all while respecting the limits of my body in the moment. 

Expansion of therapeutic toolset

One of the most important characteristics of an effective physical therapist is to walk the walk. These practices are part of my life not only for myself but also for my clients. Even though I am not currently a certified Feldenkrais practitioner, my experience with the method greatly influences my therapeutic style to provide clients with a unique approach to therapy. By practicing what I preach, I am able to share an integrative person-centered therapy that can be very helpful for those who are looking for an alternative option. While every person is very different, the tools obtained from mindful awareness practices can be applied to any person. We all have tissues, and our tissues all want attention!

At the Wellness Station, the therapist and client work together as “body detectives”, discovering neuromuscular inefficiencies that may be contributing to pain and movement challenges.

Based on these findings, lessons that are unique to each individual are taught with improved comfort, biomechanical efficiency, and fitness as the outcomes. To learn more about how Feldenkrais can be applied into physical therapy, read our Feldenkrais Method White Paper.  

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Your Spine is Not “Out of Alignment” - A Holistic Approach to Pain Science

Have you ever been to a practitioner who assured you that the cause of your pain was one of the following, or some combination of these very technical sounding terms? “Your ____ (spine, hips, etc) is out of alignment.” “Your pelvis is twisted.” “Your SI joint is jammed.” “Your pain is because of your leg length discrepancy.” The list goes on and on.

These types of claims are not helpful, and can be downright destructive due to the nocebo effect.

First of all, joints don’t go “out”. If your joint was dislocated, it would be a medical emergency that you would be well aware of, and warrant a trip to the ER. Additionally, structural explanations for pain (aside from acute pain due to tissue injury) are generally unsupported by evidence. These claims (e.g. joints being “out”) have extremely low interrater reliability, meaning two different clinicians would almost never agree on them.(1)

By teaching people that these minor asymmetries are “serious”, clinicians are over-medicalizing normal human conditions. We all have asymmetries, and we do not have good evidence that asymmetries will lead to pain and dysfunction. By believing that your pain is structural, it is taking you out of the healing equation, and will consciously or subconsciously rely on external sources for healing, including surgeries, injections, and frequent chiropractic adjustments. 

Fortunately, the human body is not like a car. Because issues as complex as pain are not due typically due to structure alone, they typically do not require a structural solution. Unlike a car, the human organism has a nervous system, an immune system, and higher consciousness that allows us to think, feel, move, make decisions, and change our beliefs and behaviors. It may be convenient for some clinicians to blame structural issues as a scapegoat, as it can be easier and quicker to explain than the other contributing factors, and can also be an effective business model. Also, many patients may also be looking for some structural issue to blame, as it can be extremely frustrating and distressing to be in pain for a long time and not understand why. However, it is crucial for clinicians to educate patients on the real causes of pain, and move away from teaching people the body is a machine that breaks down, inevitably leading to pain. We need to lean in to educating people on the messier science, including physiology, neuroscience, psychology, as well as social and lifestyle factors. 

The truth is, pain is multifactorial. Sometimes it is very simple, sometimes it is extremely complex. Simple cases tend to be acute- you stub your toe, the nociceptors (pain receptors) fire, your brain registers the sensation as pain, and you say “Ow!”. However, chronic pain is a different beast. After pain persists and the initial injury is gone, brain changes tend to be what keeps the pain cycle alive. Our nervous system can get a bit confused, and the helpful pain perceiving pathways can start to run awry. We begin to get overly sensitive to stimuli that normally wouldn’t cause pain (known as allodynia), and perceive that pain is more intense than we normally would (hyperalgesia). It is very hard to turn that sensitivity back down, and it requires neuroplasticity (brain change). 

So how do we change our brain to affect our pain? We have to address pain biopsychosocially, meaning we address the biology, the psychology, as well as social factors.

Biologically (or physiologically), we rehabilitate the physical body through movement and exercise, improving efficiency of movement, decreasing unnecessary tension, and improving fitness. This might mean gradually desensitizing our body to painful movements or activities. We also want to make sure we are sleeping well, eating healthful foods, staying hydrated, and being very mindful regarding consumption of certain substances.

To address psychology, we must challenge our beliefs, improve our mental health, find appropriate coping mechanisms for stress, and change our relationship to our pain to become less reactive and more responsive.

To address the social factors, we have to make sure we are surrounding ourselves with the right people, participating in activities that bring us joy, and seeking support rather than battling with pain alone. 

Hopefully, this path to healing does not seem overwhelming. By addressing these biopsychosocial factors, we can take control of our lives and make decisions that better ourselves and improve our quality of life. We can take an active role in our own healing, and won’t be as reliant on expensive and harmful procedures. While the healing journey is not linear and will come with challenges, it is the direction to go for all of us, with and without chronic pain. 

It is our job at the Wellness Station to take the role as educator, detective, and coach. We strive to teach you about the science of pain, figure out the greatest contributor factors, and provide guidance, encouragement and support as you begin or continue your healing journey.

References:

1. https://www.painscience.com/articles/structuralism.php

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

PT Recipe: What to Look for in a Therapist

Physical therapists come in many flavors, and it can be challenging to figure out if your therapist is a good fit. It was interesting and informative to read this article by the NY Times that describes qualities to look for (and some qualities to stay away from!) in a PT. One common misconception in the public is that one size fits all, that PT either works for someone or does not. This is certainly not the case. Sometimes, there is a personality clash in which the therapist and client simply are not a good fit for each other. Other times, the therapist might not be utilizing the best treatment options, or might have difficulty with empathy, critical thinking skills, or other factors that can determine therapeutic outcomes. And of course, sometimes clients do not “buy in”, do not participate in the prescribed exercises, and perhaps may not be ready to make substantial lifestyle changes. All of these factors will determine whether the therapy is successful or not. A strong therapeutic alliance between practitioner and client is required, and the best way for this alliance to be created is for the client to have faith in their therapist.

Here are some qualities to consider when embarking on your therapeutic journey. Keep in mind that these qualities are also important for other therapeutic treatment options, including mental health therapy, chiropractic, as well as speech and occupational therapy. 

Prioritizing active over passive interventions:

Historically, physical therapy has relied heavily on passive treatment modalities, such as ice, heat, ultrasound, electrical stimulation, and laser therapy. Manual therapies could also be considered passive, in which cases the practitioner would “perform” techniques such as joint mobilizations, manipulations, and massage on the client without the client having any kind of active role. This type of therapy has a different intention and effect than a hands-on Feldenkrais-inspired lesson. In a passive manual therapy procedure, the practitioner has the mentality of “fixing” something. They may use language such as describing joints as “out of alignment” or something of that nature. This type of treatment can be harmful for several reasons, one of which is that it teaches clients that they do not have agency over their own healing, and require an external source. This differs from a Feldenkrais-inspired technique in which the client may not be participating with volitional movement, but is instead actively participating by visualizing, sensing and feeling effortless movement, and may be asked to join in as the therapist initiates various movements. In the latter case, learning will occur, as clients will begin to feel how they can improve their movement without strain.

While passive manual therapy techniques may have their place, they should certainly not be the primary intervention. Fortunately, over the past several years the field has begun to move away from these options in favor of more active interventions. The passive treatment options are generally not evidence-based, and are often no more effective than sham or placebo interventions. Additionally, relying on these passive modalities could potentially have negative impacts on client’s self-efficacy, or the belief in their intrinsic capacity to heal and improve. By feeling like you need to see a practitioner every week so you can be the recipient of passive interventions can really take away from your motivation to improve independently and trust in your body’s natural healing abilities. Active treatment options are more effective, sustainable, and help to improve your self-efficacy as well as your body’s resilience and healing response. Active interventions are typically exercise and movement based- make sure your therapist is helping to guide you towards these options rather than relying solely on passive modalities. 

Using evidence-based treatments:

Research in a field often takes up to 17 years to become implemented in clinical practice. That is why it is important for clinicians to stay as up to date on new research as possible, and not rely on outdated or inefficacious treatment options. The best evidence shows that movement is medicine. Movement and exercise should be the primary lines of treatment in physical therapy to help people move better, feel better, and participate more in life. At the Wellness Station, the primary interventions are almost exclusively movement-based, because this type of intervention has been shown to be the most effective and long-lasting. The services we provide are influenced by the Feldenkrais Method®, which is a gentle and highly effective complement to traditional physical therapy. To learn more about the Feldenkrais Method®, its application into physical therapy, and clinical research that supports its use, please read our white paper written by Paul McAndrew.

Walking the walk:

It is extremely important for a client and clinician to develop a strong therapeutic alliance that is rooted in honesty, genuinity, and integrity. Clinicians must set a positive example, and clients must be able to trust and believe in their clinicians. Perhaps the most important way to find a therapist that you can believe in is considering the question of whether they “walk the walk”. Does your therapist seem like they take their own fitness, health, well-being very seriously? In order for a therapist to be an effective teacher and role model, it is crucial that they are able to feel in their own body the recommendations and lessons that they suggest. They should be able to relate to what you are doing that could be contributing to strain, and help you devise a way to improve the efficiency of various tasks. For example, imagine a client that is having trouble looking up or reaching overhead due to neck pain or mobility restrictions. The therapist should be able to demonstrate how functional movements involve relationships between various body areas (e.g. how movement of the tailbone relates to movements of the neck), rather than isolated movements of specific body parts. If someone is having trouble with this task, the therapist should be able to feel in their own body and help teach the client that by lifting the tailbone while sitting, ease of looking overhead or reaching overhead can be greatly improved. Over the course of therapy, the practitioner should also help develop a plan to improve overall fitness using biomechanical and physiological principles in the context of the client’s individual characteristics.

Interpersonal skills:

Interpersonal skills are exceedingly important for a provider to have. Without good bedside manner, it will be very challenging for clients to feel comfortable, safe, and able to discuss sensitive topics. A therapist must demonstrate empathy, which is the ability to understand and share the feelings of others. Without empathy, the client will not feel listened to, understood, and cared for. Empathy requires the therapist putting themselves into their clients metaphorical shoes, understanding the pain they feel, and meeting them where they are at in life with sensitivity and grace. An empathetic therapist will listen, make eye contact, not interrupt, and not try to force changes. They will ask questions that demonstrate understanding of your life circumstances, express genuine interest and care, and refrain from unsolicited “fix it” advice (e.g. telling you what you “should” do).

Another factor to consider is, how do you feel during your sessions? Is your therapist encouraging? Do they help to calm you down and feel optimistic about your healing journey? Or perhaps, do they make you feel rushed? Does the therapist seem to be rushed? Unfortunately, many providers are rushed, with unrealistic productivity requirements that limit the time they can spend with each client.

At the Wellness Station, we are able to take the time needed with every client in a supportive environment to facilitate healing and enhanced lifelong fitness.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Movement Snacks

What is a movement snack, you ask? This catchy term (which I do not take credit for) describes taking brief movement breaks throughout the day. These breaks are especially important if we spend a long time sitting in the same position, such as during computer work, in the car, or on the couch. They can also be used as a way to warm the body up in the morning after sleep, or perhaps simply as something to do while waiting for the coffee to brew or the food to heat up.

Many people fall into all or nothing thinking when it comes to movement. Some less than helpful ideas out there are… “It has to be intense to be effective.” Or, “I went to the gym already today, so I checked that box.” Or, “I didn’t have time to do all my PT exercises, so I will wait to do them on a day when I have more time.” These mentalities are not so helpful, as they can contribute to moving less throughout the day, as well as equating movement to a chore that we should do as opposed to something joyful that we get to do. Rather than all or nothing, it can be helpful to shift to a mindset in which we reframe our daily movement practice into realistic, bite-size chunks, incorporating the mantra: “a little bit, very often.”

The brain and body respond well to repetition, so it is important to develop a routine that we are doing often in order to get the greatest benefits out of our practice. However, this does not mean that we have to spend a very long time all at once on our movement practices. A better strategy is to have “snacks” throughout the day in which we get our body moving in order to change positions, take strain and tension off our joints, get our blood flowing, and bring about positive changes to our mood and energy levels. Of course we want to also have “meals” regularly in which we are spending a longer period of time moving and exercising, but snacks throughout the day are an excellent way to stay moving in between these metaphorical meals, especially if we are busy.

The snacks you choose should ideally incorporate movement in more than one dimension, as well as include options for variations. Variety is the spice of life- you wouldn’t want to have the exact same snack every day! You might also choose snacks that are specifically targeted towards areas that you want to bring movement into based on what your day has been like. For example, number one below (back extension with thoracic pivot point) is an excellent way to mobilize the upper back, an area that can get stiff and stagnant after spending a long time hunched over a computer.

Here are some of our favorite movement snacks:

Back extension with thoracic pivot point-

Thigh to chest, tail wagging, circles-

Hip and shoulder extension-

Bridge gliding with figure 4 option-

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team