Arthritis: What You See…

Posted by Filed Under: Health & Fitness

…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!

About Lee Miller D.C.

9536 - 87 Street Edmonton, Alberta T6C 3J1 Phone: (780) 426-6777 Fax: (780) 469-6930

  1. Juls on November 26th at 11:29 am

    I wonder if you could delve into this topic where a bulged disc is involved. In my friend’s case, I believe it is at the L5-S1 level and has been causing a stream of sciatic pain issues. He just received a cortisone injection and has yet to reap the benefits from it. His current plan is to give up running and focus on cycling. Yet, I wonder if the hunched over position from cycling would be better or worse for this ailment.

    Julss last blog post..pulling back

  2. Lee Miller on November 26th at 6:25 pm

    Juls- Discs are tricky. A bulged disc may in some cases produce no symptoms. We are assuming that the disc is at fault, however, sacroiliac joint irritation, facet joint irritation or even piriformis muscle entrapment of the sciatic nerve can all cause leg pain that is often mistaken for disc pressure on a nerve. As the article indicates this condition must be clinically correlated using specific orthopedic and neurological tests. If there is no inflammation causing the condition then cortisone will not work.

    As far as flexion from cycling; most clinicians feel bending forward produces increased pressure on the disc and is therefore a movement to be avoided until the condition has stabilized.

    This was a great question Juls, and I am just touching the tip of the iceberg with this limited response.

  3. David A. Shaver on November 29th at 5:27 pm

    I am of the school of thought that running reduces the incidences of arthritis and other signs of aging. I am 60 and still in far better shape than when I began running in my 30s. I always thought the people who said running would damage your joints were lying on the couch when said that. Surely a sedentary life is much harder on your joints and more prone to cause arthritis.

    David A. Shavers last blog post..FOLEPI River Trail Classic 4 mile East Peoria, IL Photos

  4. Lee Miller on November 29th at 5:52 pm

    I agree, David. The body is really a “if you don’t use it- you lose it” creature. Not only is there improved joint health, but there is a reduction in preventable illness such as cardiovascular disease, bone density issues, obesity, diabetes etc. I believe that the increased oxygenation and hence ability to nourish the body at a cellular level that cardiovascular exercise provides reduces the likelihood of many ailments. Throw in a healthy diet, add in some weight training to get the testosterone/growth hormone levels up and you have a dynamite combo for combating illness and aging.

  5. Juls on December 2nd at 10:56 am

    I just wanted to say thank you so much for your response to my question.

    Julss last blog post..sucking wind…and just plain sucking

  6. Ami @ Fat Loss Guide on December 13th at 1:21 am

    Thanks for this article
    You will find though that running on the wrong surfaces that increase the impact to the joints e.g pavements does hasten the rate of degeneration of the joints. This accelerates the onset of osteoarthritis
    You could argue that the increased muscle mass comoared to fat does go a way in reducing the risk of arthritis

  7. Lee Miller on December 13th at 10:05 am

    Running, regardless of the type of surface has not been shown, by evidence based research, to lead to arthritis. If you already have arthritis, then running may exacerbate the condition. Once you do have arthritis activities should be modified to reduce impact on joints. You are correct about increasing muscle mass, since a stable joint is a happier, stronger joint.

  8. health matters on March 6th at 4:20 pm

    I have had a form of Arthritis called Ankylosing Spondylitis for 15 years and have never had any help from my GP. The best thing I ever did was buy a Tens machine. It really does work for my particular ailment. Better than any pills.

    health matterss last blog post..How bad does my arthritis have to get before I can claim disability?