More-on OA: Bone Spurs

As long as I’ve delved into the world of osteoarthritis, I might as well tackle another issue that regularly presents itself in my clinic: bone spurs.

At least one patient per week walks into my office with x-rays in hand showing bone spurs. Yes, they can be very problematic. But my experience is that--far more often than not--the cause of the patient’s pain is not the bone spur. The pain generator may be related to the spur (as with bursitis resulting from the compression of a bursa against the spur) or completely unrelated.

My view on health care is to treat as conservatively as possible and move to more aggressive types of therapy when the conservative ones fail. Because of this philosophy, I am (unfortunately) often at odds with another physician who may have recommended surgery to grind down the spur and, hence, do away with the patient’s pain.

To quote the Mayo Clinic (because they wrote this as succinctly and correctly as could be):

Most bone spurs cause no signs or symptoms. Often you don't even realize you have bone spurs until an X-ray for another condition reveals the growths.

While the presence of bone spurs does not equate to pain, it does mean that something abnormal is occurring in the bone/joint/tendon in question.

When I am able to rule out the scary causes of bone spurs (i.e. DISH, CPPD) I look for aberrant causes of stress: far too much or too little motion in a joint, strength imbalances, movement pattern deficiencies, etc.).

If you ever do find yourself with an x-ray of a bone spur, my advice is to find a health care provider that will determine WHY the spur is there. If you can figure out why the calcium deposited in the first place, you can work on treating the CAUSE rather than the SYMPTOM.

Osteoarthritis: Surgery versus Therapy

A great aspect of treating patients is never becoming bored. I see nearly every condition on a fairly regular basis. What is odd is the patterns of conditions that develop. I might not treat a case of tennis elbow for a month, then 6 new cases of it in a day.

That's been the case over the past week with osteoarthritis of the knee. It's a very common condition, related to use (actually to misuse rather than overuse), body weight, lifestyle (smoking!) and genetic factors.

It is very common for a patient to tell me--in a depressed and resigned tone--that he/she had an x-ray of the knee and has been diagnosed with arthritis of the knee. I usually reply, "Okay. Big deal. "

What I mean is that x-rays and MRIs and CT scans only tell a tiny portion of what is going on in your body. Some people with hideously awful x-ray findings have no pain whatsoever. While others with nearly normal x-ray findings have truly debilitating pain.

My opinion is that the over-reliance on these imaging modalities is the reason that surgery for osteoarthritis is no more effective than exercise therapy. I think that often both patient and doctor see the scariness of the x-ray results rather than the treatable patient and condition.

There are times when surgery is necessary, but many of the post-operative patients I see could have and should have undergone a thorough strength, flexibility and endurance regime before opting for surgery.

What does all of this mean? As I tell all of my patients: you're the boss. You pay me and other practitioners for a service. Ultimately it is your decision, your motivation and your consequences. Don't rely on just one x-ray or just one opinion or just one course of therapy. In today's health care system, you need to take the lead on all decisions regarding your health.

Exercise for......smarties

I've had a goal for at least the past year---to post the one hundred (or so) exercises that I most commonly prescribe so my patients may have access to them at any time. After a lot of wasted time and effort, I have finally made some head way.

If you proceed to http://www.coastalhealthandfitness.com/page25.php you can see the first few dozen exercises that I've uploaded. Please keep in mind that this is still a work in progress.

Last week, over Thanksgiving, I reviewed almost 100 patient charts and found 245 different exercises that I had prescribed. SOOOOoooooo, I hope Youtube can afford a little space on their server. Eventually, we will have every exercise that I would offer to a patient available on our site.

Feel free to send me any comments or critiques! Thanks.