What causes joint pain? What is joint inflammation?

Movable joints are designed for motions which allow the body to move around.   Complex joints enable more complex modes of motion.  For example, cervical spine has seven bones and eight joints which allow the neck to turn many different ways. Hands and feet have so many joints that allow us to do an incredible array of maneuvering.

To accomplish such task, joints have complex and integrated structure; bones which are strong to take physical load, cartilages to cushion contact surfaces between bones, synovial fluid to lubricate the joints, capsules to contain fluids, bursas to store the fluid. Furthermore, vascular systems around the joints supply nutrients and oxygen, neural networks to direct the motions and to provide feedback for status of joints. Don’t forget tendons and ligaments are what keep separate pieces of bones together. It sets the tension between two adjacent bones. They also are responsible for holding the bone pieces in the proper geometric arrangement necessary to accomplish the intended movements.

One important point to remember is that the spacing between the bone is avascular- no blood vessels, no nerves. It does not produce any pain. The joint gap can be totally destroyed and we would not know it. That is why artificial joints are possible. As we ages, the gaping between the joint such as in the knee become narrower and we have no inkling that is happening. Joint pain is not the pain inside the joint spacing. The purpose of joint spacing is that it provides a physical structure which allows the motion feasible and productive.

With arthritis, quite likely, there is inflammation at the surroundings of the joint by definition. The inflammation may or may be not the cause of pain.

The deep joint pain that often felt by some arthritic patients does not come from the space between the joint. It is produced by the nerve receptors which surround the joints. Injuries, strain, sprain of any kind around the joint, tendons, bursa, nerves, muscles all can irritate nerves. The swelling of any origin can cause irritation of nerves.  Muscles that are incapable of relaxing (either through overwork, neurological disorder or coldness)can cause irritation to nerves. All of these events produce the sensation that are not comfortable and contributed to various sensation, soreness,  pain– It can be like knifing, dull, achy, throbbing, distention, cutting, electrical shock, pulsating.

The 1^st responder for our body to the pain is the reflex protective shortening of muscles which reduce free motion at the joint. Inflammation process would likely also initiated which dilates blood vessels, allowing more blood, oxygen and body defender-immune apparatus to move in. Unfortunately, too much of these stuff all at one time and the flow becomes congested like traffic in an auto accident scene. The congestion results in swelling. Our nerves then sound alarm with pain and discomfort sensation. This explains why common anti-inflammatory medications which reduce inflammation process relieve joint pain to a certain degree. The “muscle relaxants” also brought certain pain relieve sometimes because it inhibits the contraction of muscles.

However, the most important question left unanswered is why inflammation occurs in the first place for people who never do anything to injure their joints but develop arthritis anyway. Most times, it is explained as “wear and tear”. If it is so simple, people in bed should not have arthritis. On the contrary, they do. Worse off, they would soon have atrophic muscles and degenerated joints throughout the body. It is interesting to watch doctor regularly tell patients that arthritis is caused by “wear and tear” of joints due to use and then turned around and advice patient to do more exercise, more walking to prevent arthritis.

Inflammation has been getting a bad rap. Such reputation did not start today. It was called “Fire” in Traditional Chinese Medicine for thousands of years. So is ancient Greek and Indian. People had been trying to extinguish the bad “fire” in the body for many thousands of years.  It has made lots of money for drug makers these days. Just take a visit at drug stores and you would be surprised to discover how much of the remedies are anti-inflammatory of some sort.

Yet, inflammation is the tool body heals itself. Without it, healing will be very difficult. Anybody who chronically uses anti-inflammatory will notice that. All the side effects attributed to the anti-inflammatory are caused by this reduction of healing process. The most notorious is cortisone. I once had a patient who came with whole body pain, bad joints, moon face, and hump upper back, severe cataract on both eyes. She was on cortisone for half of her life and she was only 50. I was able to reduce her pain and reduce cortisone dependency though acupuncture.

Granted, when the inflammation is overwhelming, it can be debilitatingly painful. In such event, steps have to be taken to bring pain under control. No question about it. Otherwise, normal body function will be impossible. Anti-inflammatory remedies can be necessary under such condition. This applied to the inflammation situation caused by autoimmune disorders as well in some acute phase severe inflammatory incidents.

By the same reason, frequent icing on the body also discourages body healing and should be avoided, unless it is followed by heating afterwards.

How does acupuncture help arthritis?

A lady in her 60s came in for knee pain, hurting day and night. She was referred from regional Kaiser Permanente.  In the past two years, she has had four cortisone shots that have minimal effects, followed with elastic tissue infusion into the joint. I did acupuncture and moxibustion (Acumoxa) on her right knee. Her knee pain disappeared, no pain for four days. Gradually pain started to creep back. Obvious, she had a severe case of arthritis.  This is but one of arthritis cases successfully treated with Acumoxa. Why did acupuncture help her knee and why did the pain come back? Because her condition needs long term continued care.

6.1       Painful joints or arthritis- degeneration

 “Degeneration” does sounds alarming, especially for the patient. In truth, it is not so dreadful at all. It can be minimized with proper care.

What is the degenerate disease? First of all, degeneration is a nature process that can’t be reverted, not even stopped. It is just part of life process- everybody over the growth spurt starts to have degeneration. The only thing that can be done is to prevent the unnecessary degeneration.

So, what causes excessive degeneration? The causes are too many to count. We will revisit this latter. In the end, it is the lack of blood supply that is the culprit. No blood, no oxygen, no nutrients, cells starved and wielder. Tissues weaken and decay. This will raise alarm and induce inflammatory reaction for relatively healthy individuals. Inflammation has been portrayed as villain in causing all kind of mischief. Indeed, it causes capillaries to enlarge, tissues to swell, temperature to rise, color to turn red. For sure, blood flow is increased but unfortunately, it is likely to bring pain with it.

Pain is a double edged sword. It  triggers protection reflex from the muscle which on one hand reduces mobility of the area preventing undue movement of the area but also increase the muscle, tissue tension that has unintended consequence of restricting blood flow.

So, the body has created a dilemma for itself. The art of healing lies in resolving this dilemma. The easy way out is to reduce the inflammation somehow. Such approach makes pharmaceutical companies a lot of money. They have developed varieties of anti-inflammatory medication from aspirin to naproxen, cox-2 inhibitor, all the way to the all powerful cortisones. They work wonderfully in reducing the inflammation but leaving the body to heal the problem without the tool-inflammation.

A 45-year old male was diagnosed with a severely-degenerated cervical disc and was told that surgery is the only option. His neck and right upper arm are painful. The right arm is numb. Numbness extends all the way down to the fingers. He had difficulty falling asleep because of pain.  

Put acupuncture needles on the right hand and elbow, the result was immediate. According to the patient, not only did the pain at the neck shoulder begin to diminish, but also a sensation of warmth traveling down the arm and hands. After 5 treatments, the patient was able to manage with infrequent successive treatments.

Comment:

Degeneration is a dirty word that provides covers for the doctor’s frustration. In truth, our body is in a constant balance act between regeneration and degeneration. Before 16 year of age, more regeneration, after that, more degeneration. This fact can’t be changed. Nobody can prevent degeneration. However, most people don’t have pain most of the time. Degeneration does not equate pain.  Pain of any origin accelerates degeneration and needs be addressed as soon as possible.

6.2       Golf elbow, tennis elbow

Either one can be very painful. The cause is similar- overuse of certain muscles. The muscle than shorten to protect itself which results in the stress at the respective tendons and the attached bones. The joints become stressed and immobilized from pain. In addition, the antagonistic muscle becomes overly stretched. The tension is then transferred to the attachment of corresponding tendon to the elbow, either medial or lateral epicondyle of the humerus muscle. As the result, either biceps muscle or triceps spasmed and become painful in addition to the corresponding insertion location at the joint.

Palpate and find the tenderest spots and do indirect moxa until the pain subsides. Do exercise to strengthen the underused muscle group and the problem will disappear. Meridians involved typically are Large intestine, Lung, San Jiao or Small Intestine. Again, keep the joint as warm as comfortable, stretching frequently the whole arm, especially the underused muscles is the best way to prevent future problem.