The Morning Stiffness Hypothetical
This hypothetical person is either fairly active, very active or a totally sedentary couch potato. It doesn’t actually matter. For a while now, typically more than six months, when they wake in the morning, they are stiff, and some mornings more than others. They don’t think of the word “arthritis.” They get themselves out of bed, maybe with difficulty, and sometimes after stretching a bit, moving down the hall or taking a shower, they feel quite a bit better – they may not even notice the stiffness at all. If they do, an ibuprofen helps. During the day, if this person sits or drives for a long time, they may notice this stiffness again. Aft the end of that long day of activity, this person may feel stiff – but not necessarily. If they “overdo it”, they may have a “fare-up” with more stiffness in the morning; after “taking it easy” for a day or two, they are then back to the same old same old morning stiffness. They just “deal with it.” This may be worsening, lasting longer, and flare-ups becoming more frequent, or things may just be staying the same. Sometimes with advances in age, or with increases in body weight and belly girth, or decreases in activity/exercise, this person wonders, “is this getting worse?”  The question then arises – is this arthritis?

Is this you?

This is not an uncommon story. It is the profile of someone who most likely has Osteoarthritic degeneration in their joints. Don’t despair. There are things that you (and me, as your doctor) can do, Read more about Arthritis under “I am stiff in the morning, at the end of the day or when I stay in one position too long”.

Q: “I am stiff in the morning, at the end of the day or when I stay in one position too long”;

Frequent morning stiffness, particularly in multiple sites (multiple joints, different ends of your spine, one or more places than you can put a single finger on at once) in the absence of an injury, is quite possibly the sign of degenerative change at joints in a region. Single joints (knee, wrist, shoulder, finger) may also degenerate after trauma. Following an injury, a single joint may degenerate, causing an entire region to be problematic, but only because of a single joint. When you put your finger on that joint, it may be painful, or when you spring the joint, it may hurt. Entire regions of your back may be stiff, either in the morning on waking, or after activity, or after maintaining a single position for a while. An example might be if you sit too long, or fall asleep on a couch. Note that if an area is also hot and swollen, there may be something additional occurring. The Chiropractic Orthopedics Paradigm, including a functional, full-body holistic perspective, is good for diagnosing and treating this problem. We have to take a lot of factors into account. Let’s not jump at a decision. Let’s treat this conservatively if we can. Oh, and by the way, you simply can’t treat everything with hot packs, sorry.

Osteoarthritis is the most common form of arthritis. This is the form that usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.

What’s the definition of Osteoarthritis?
1. A non-inflammatory degenerative joint disease, characterised by degeneration of the articular cartilage, hypertrophy of bone at the margins and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. (On-line Medical Dictionary) – (Source – Diseases Database)
2. Chronic breakdown of cartilage in the joints; the most common form of arthritis occurring usually after middle age – (Source – WordNet 2.1)

Now. Don’t be fooled by phrases like “occurring chiefly in older persons”, “usually after middle age”, or “appropriate amount of arthritis for your age”. Osteoarthritis can be found in young patients, even ones without prior injury. And what constitutes injury? Does subtle postural failure, chronic excessive overload or overuse, and repetitive strains due to an overweight condition count as injuriy? They certainly can. There is also a trick to describing diagnoses, and here it is: Symptoms of osteoarthritis (even severe symptoms) can show up long before the Xray will show anything. And how soon before? No research has tied this down, it seems to vary with body chemistry. We are typically not going to film a 20 year old to check for arthritis unless sympotms are severe. And if we do film that 20-something and there is nothing there, does that mean they don’t have arthritis? Technically yes, but they may be in the process of developing it. Should we treat them for it? Yes. The treatment for Arthritis or developing arthritis? Similar.

The bottom line is this. If you have chronic recurrent stiffness in the morning, which becomes forgotten with movement, but then gives way to stiffness after activity, and stiffness with prolonged postures or positions, there is some form of joint degeneration occurring, be it systemic, metabolic, post-traumatic, or infection based. There are ways to treat this. Let’s diagnose it! Note also that I will typically not apply an official diagnosis of osteoarthritis in a “suspected” or “developing case”, until it can be confirmed by x-ray. We will probably refer to you as having “dysfunctional joints” and there will be a note for me and only me to watch for suspected joint degeneration. We will not label you with a diagnosis until we can differentially narrow it down. However, you can begin doing things for yourself, and making lifestle changes, that will support you in recovering or maintaining yourself.

Note that with a diagnosis of Osteoarthritis, it is also important to consider whether there is an underlying condition causing Osteoarthritis. Underlying medical conditions are other medical conditions that may possibly cause Osteoarthritis. I will also treat persons with arthritic conditions differently. A major percentage of patients who have had painful reactions to being adjsuted by a chiropractor have some sort of undiagnosied degenerative conditions underlying that act up when they are mobilized. We can eliminate this by doing “Diagnostic Detective” work. There are specialized forms of arthritis that look like osteoarthritis initially. Sometimes lab work is ordered to focus in on what may be the cause.

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