…isn’t always what you’ve got.
One of the more involved discussions that I have with patients is going over what their x-ray or MRI findings mean, especially when the radiologist mentions arthritis. For runners, this is a bit of a hot button topic because of the myth that running causes arthritis. I cannot begin to count the number of people who’ve told me that my running is going to give me arthritis in the knees, back, hips or whatever other joint they can name. To my knowledge, there has never been any credible research that points to any such trend. In fact, it appears that quite the opposite effect occurs—running seems to reduce the incidence of arthritis. But, let’s discuss what happens when we do find arthritis from our imaging studies.
Seeing words such as spondylosis, enthesopathy and impingement on x-ray reports tends to set off alarm bells in most people. However, this is simply the language used by radiologists to describe what they see. It does not tell us what the patient will actually present with. In a nutshell, what you see on imaging may in fact have little or no correlation to your symptoms.
It is possible to see very severe arthritis on x-rays and yet the patient will have little or no symptoms. Conversely, few arthritic findings can be quite debilitating for some people. The key to interpreting what your x-ray/imaging findings mean to you is called “clinical correlation”.
Clinical correlation is finding agreement between the imaging and the patient’s presentation. In many cases, we find arthritis incidentally when we are looking for other things such as pathology or trauma. The arthritis is present, but does not produce any symptoms for the patient. In these situations, the arthritic change is clinically insignificant.
In other cases, where the patient has symptoms of arthritis such as stiffness, deformity, or crepitus (grating or grinding joint sounds) there can be good clinical correlation with the imaging.
The point I want to make is that I have come across patients with no arthritis symptoms who feel that they are somehow “damaged goods” because they have been told they have arthritis. In many of these cases, there was little or no clinical correlation nor explanation to the patient as to the significance of the arthritis. The result was a lot of these people discontinued physical activities for no good reason and they lost fitness, muscle tone and strength.
The irony is that treatment of arthritis focuses on the preservation of movement, strengthening muscles in the affected areas and activity to tolerance. We may modify our activity so as not to aggravate an arthritic joint, but rarely is activity discouraged. Symptomatic arthritis is managed and the patients are encouraged to be part of the solution by actively participating in their own care.
For those of you who have had x-rays or other imaging that show you have arthritis but you do not have symptoms- carry on. What you see isn’t necessarily what you’ve got!