Successful treatment of osteoarthritis (OA) requires a multisystem holistic approach. Exercise, as per my last article, helps somewhat, but alone is not able to completely relieve arthritis pain. You could view exercise as a means of maintaining good joint function once a skilled manual therapy practitioner has helped to restore normal joint function. What does a multisystem holistic approach mean? It means being able to treat all the systems involved in normal joint function such as the nervous system, the arterial system including the critical blood supply to the subchondral bone, and the lymphatic-venous drainage system. Not something a traditional practitioner who simply mobilises or strengthens joints can offer! The treatment of all elements of the condition is usually what is required for "successful" treatment, which in my mind means a painless and functional joint.
When we think about osteoarthritis, we understand that it is a condition which affects all the tissues of a joint – the joint surfaces, underlying bones, capsule, ligaments and muscles. OA causes pain, stiffness, weakness and joint deformity, which result in difficulty in performing usual activities like walking or exercise. Many cytokines (chemical messengers or signallers) are involved in OA, and it is increasingly well-known that these cytokines transit from the bone into the joint and surrounding soft tissues. You will recall that tissues such as bone receive their blood supply via the arteries and the resulting outflow returns to the heart via the veins and lymphatics. What you may not know is that bone consumes a lot of blood – about 10-15% of cardiac output at rest.
How Blood Flow Contributes to OA
The blood supply to the joint plays a prominent role in the development of OA.
The bone cells (osteoblasts) in the subchondral bone (which is the bone just below the articular cartilage) are considered key players in osteoarthritis and have been shown to very sensitive to any change in their physical or chemical environment which can be caused by alterations in the circulation (Olansen et al 2024).
What does this mean? Any change in the blood flow to the subchondral bone such as reduced arterial inflow causing hypoxia (lack of oxygen), increased pressure, or altered pH (acidity level) causes the osteoblasts to change the cytokines they release which in turn triggers the cascade of changes that lead to OA. Similarly, the endothelial cells lining the arteries supplying the bone also alter their cytokine release (Watson and Adams 2018). In other words, altered blood flow to the joint and its bones is a cause of OA!
Scientific research this has found exactly this - poor venous outflow from osteoarthritic bone, which leads to increased pressure within the bone, and reduced arterial inflow. Remember that it is the arteries which bring oxygen and nutrients to the joint, and that for the fresh arterial blood to flow into the tissues the venous and lymphatic systems must be working to drain the fluid out. Venous outflow restriction can reduce bone oxygen content by a factor of 1.5 within 30 minutes, and the bone in an osteoarthritic joint has an oxygen concentration of 43 +/–4.6 mmHg compared to 63 +/–5.0 mmHg in normal human bone (Olansen et al 2024). That’s about 32% less oxygen – chronically!
Chronically reduced blood flow (over years) likely reduces the remodelling and repair that bodies undergo every night, which over time leads to the joint wearing out prematurely as it is less able to repair daily microtrauma.
How to Improve Blood Flow in OA
The good news is that this is something that we can actively and effectively treat using Fascial Counterstrain. To treat OA thoroughly, you need to know how the veins and arteries are controlled by the nervous system and how things can go wrong, either with the neural control system or the vessels themselves. There are treatment approaches for both the blood flow specifically into the bones, the main arteries and veins supplying these feeder vessels, and the sympathetic nerves that control the flow of blood through the vessels.
How Do Arteries Become Dysfunctional?
Like all parts of the nervous and vascular systems, the arteries are covered in deep fascia which can become irritated and inflamed. When this occurs around a section of an artery, neural connections to the spinal cord cause a reflex contraction of the smooth muscle in the arterial wall known as “vasospasm” which reduces the diameter of the vessel, resulting in reduced blood flow. The reduced flow can lead to chronic pain and weakness if severe enough, but more commonly a milder restriction in flow over longer time periods leads to degeneration as found in osteoarthritic joints (or for that matter Achilles tendons!). When this occurs, specific arterial tender points can be identified and treated.
Fascial Counterstrain uses a gentle and specific glide of the affected artery to relieve the vasospasm and drain the inflamed fascia which is maintaining the condition. Typically, a single 45 second release per vessel is enough to restore normal vessel tone and blood flow. Over time, this has clear benefits for any joint including osteoarthritic ones – instead of chronically reduced blood flow imagine how your joint will feel and function with chronically improved blood flow over a period of 6 or more weeks. This is one of the aims of Fascial Counterstrain Treatment.
Remember that the severity of wear as seen on Xrays doesn’t correlate terribly well with the severity of OA symptoms which is explained in my article here. This means that many people with worn degenerative joints have no pain at all. In OA (OA indicates that the degenerative joint is symptomatic) the goal of treatment is to alleviate pain and restore function. Although we cannot regenerate articular cartilage once damaged, we can certainly improve function and alleviate pain using Fascial Counterstrain. At this point the improved function is best maintained with regular exercise (see my article here for more information).
Take Action!
If you have arthritis, which commonly affects hips, knees, spines, and the small joints in toes and fingers, there is a lot we can do if you seek care from the right person with the right skillset.
References:
Olansen J et al (2024): Is Osteoarthritis a Vascular Disease? Front. Biosci. (Landmark Ed) 29(3): 113.
Watson EC and Adams RH (2018): Biology of Bone: The Vasculature of the Skeletal System. Cold Spring Harb Perspect Med 2018;8:a031559
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