Arthritis, Injuries, and Pain

Author: Dustin Moffitt, ND

Case Study: A 56-year-old male presents to the office for a second opinion. He has had debilitating pain in his knees for ten years and lives an active lifestyle as a farmer. His primary doctor has referred him to an orthopedic specialist for knee replacement. Unfortunately, he will miss all of the harvest season and may need a second knee replacement in 10-20 years, as the knee replacements are not meant to sustain his lifestyle. So the patient visited our Hays location for regenerative injections. He was treated with four rounds of regenerative platelet-rich plasma knee injections, resulting in pain relief and the ability to participate in harvest. His story is not the only one with a successful ending. We help dozens of patients each month heal their bodies with regenerative injections, including those referred for surgery.

Arthritis is the inflammation that occurs at the level of bone. Over years of poorly controlled inflammation, our bones can start to break down and lead to osteoarthritis. While many have a negative association with the word “inflammation,” it is a very crucial process used daily for our body to heal itself from acute trauma, like stubbing a toe on the couch, hammering our finger instead of a nail, or touching a hot stove. Does this mean that all inflammation is a bad thing? No, it is a necessary part of healing all our wounds! Think of short-term inflammation as a way to clean up the damaged area and prepare it for healing and regeneration. 

What Causes Arthritis?

Many factors can contribute to the onset of arthritis. Arthritis can be caused by physical injuries that never had an optimal chance to heal, infections, gout, food allergies, metabolic disorders, diabetes, poor circulation, nutrient deficiencies, hormone imbalances, and environmental toxins, to name a few. If all or even most of these issues were addressed, could the body heal well on its own? Absolutely. The body first enters hemostasis through a wound healing cascade, blocking any additional blood loss through coagulation or blood clotting. The second phase of the wound cascade healing process is the inflammatory phase. This phase peaks 24-48 hours after an injury and is responsible for removing any damaged tissue or debris from the injury. The third phase is the proliferative phase, where the wound is filled with new nutrients and covered with new tissue. This phase may last up to 24 days in acute injuries. Finally, the wound healing cascade completes its cycle with maturation, where the new tissue gains strength and flexibility from surrounding structures and new collagen is formed.

Most Common Types of Arthritis

The most common non-inflammatory types of arthritis are osteoarthritis and degenerative disc disease.¹ The most common inflammatory arthritic type is rheumatoid arthritis.¹ Osteoarthritis can be age-related or induced from an old injury. Rheumatoid arthritis has an underlying autoimmune issue that leads to attacking the joints. Another common type of arthritis is acute inflammatory arthritis, or infectious arthritis, which is often due to metabolic waste build-up or localized infection—both of these need to be addressed quickly to reduce total damage done in the affected joints. 

What Prevents Healing Naturally? 

Malabsorption and malnutrition can be leading causes of nutrient deficiencies. Primary nutrients needed to promote the healing of ligaments, tendons, and bones include protein, vitamin A, C, D, E, and minerals.² Primary nutrients needed for inflammation control include essential fatty acids,³ vitamins A,⁴ C, D, E,⁵ glutathione, carotenoids,⁶ etc. Protein⁷ is necessary as amino acids are the primary building blocks of tendons, ligaments, and bones. Vitamin C plays a crucial role in collagen production, and chronic vitamin C deficiency leads to the weakening of tendons and ligaments by preventing collagen synthesis. Vitamin E reduces inflammation and may help to minimize tendonitis. Vitamin A is essential in cell division, collagen renewal, and tissue repair.⁸ Minerals such as calcium, manganese, and copper are vitally important in the structure of bone material and are needed in trace amounts for the development of tendons. Vitamin D is important in utilizing calcium in the bones and acts as a pro-hormone that may contribute to muscle growth.⁹

Arthritis and NSAIDs

Studies suggest that NSAIDs such as ibuprofen adversely affect bone physiology by delaying bone healing.¹⁰ In addition, NSAIDs, specifically COX-2-selective inhibitors, negatively impact soft-tissue healing.¹¹ Despite these findings, we are still being told to take these medications by healthcare providers, or are encouraged by advertising to self-medicate. The wide use of these products contributes to chronic pain and arthritis development by not allowing our bodies to do what it is naturally good at, healing. 

What Causes Injuries to Occur? 

The leading cause of injuries is improper body mechanics and overuse. If you are constantly sore after doing activities or work, then odds are you are overusing the affected area and not allowing ample conditions for healing. The most common type of shoulder injury is a torn rotator cuff or tendon tear. These injuries often result from improper positioning that overextends the shoulder in a forward reach outside the scapular plane. Low back injuries often occur due to flexion of the spine while lifting or torsional stress (turning and lifting). Knee pain is usually caused by meniscal injuries, patellar chondromalacia (kneecap degeneration), or ligament tears. To avoid knee pain, warm-up before significant activities, stretch muscles, do not plant the foot and turn, avoid kneeling without protecting your knees, and avoid jumping out of high areas. 

Managing Injury or Arthritis Pain

Options to manage pain are vast and can vary from simple at-home remedies to those handled by health care providers. Immediately following an injury, when large amounts of swelling or pain are present, it is okay to ice. However, applying ice 30 minutes or more after an injury may delay healing.¹² If the pain is manageable, then let your body do its thing. However, if the pain is too much, there are natural and pharmaceutical options to regulate pain. NSAIDs and acetaminophen are common over-the-counter medications to help with pain and swelling. They help with the pain but at what cost? Is the short-term pain reduction worth the potential long-term pain from an unhealed injury? Natural pain reducers can include fish oil, Boswellia, turmeric, and serrapeptase. In cases of bone fractures, complete tendon ruptures, and eroded bone, surgical revision or replacement may be the best option. For pain options that may be covered by insurance, a local corticosteroid injection is often a first-line agent that tends to help the pain almost immediately, and can last up to 6 months before a repeat is needed. Still, after a while, patients tend to yield fewer results. Corticosteroids may stop inflammation, but without inflammation, we may increase degeneration.¹³ Choosing to work with personal trainers, physical therapists, occupational therapists, and massage therapists can help reduce pain,¹⁴ increase mobility and strength, and avoid the need for further treatment. 

Regenerative Injection Therapies  

Regenerative injections utilize natural healing processes to help rebuild injured tissues,¹⁵ including ligament, tendon, and articulating cartilage on bone. These therapies also manage pain by addressing the underlying or contributing causes versus the symptoms. Regenerative Injection Therapies are injection-based modalities that target the injury directly by providing nutrients and attention. This shuts off the pain receptors, decreases long-term inflammation, and promotes natural healing. Therapies include; Stem Cells, Exosomes, Platelet Rich Plasma (PRP), Dextrose Prolotherapy, and Prolozone. Regenerative injection therapies are excellent tools for treatment that allow most individuals to return to normal activity following treatment with little to no downtime. The best time to treat with regenerative injections is at the first sign of injury, before an injury becomes complete. For example, complete tendon ruptures need surgery. Anything less than 80% tear has the potential of healing. 

Summary

According to the Arthritis Foundation, 54 million individuals are living with arthritis in the US today.¹⁶ The pain and discomfort can be debilitating and disruptive. Conventional treatments help with the pain, but may interfere with the healing process leading to further degeneration. Natural interventions address the pain and discomfort while encouraging healing from within. When combined with proper diet and exercise, natural interventions may help control inflammation, slow or reverse degeneration, and return function to the affected joints. 

REFERENCES:

1. Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/
2. Luke Curtis, Nutritional research may be useful in treating tendon injuries, Nutrition, Volume 32, Issue 6, 2016, Pages 617-619, ISSN 0899-9007, https://doi.org/10.1016/j.nut.2015.12.039.
3. Calder P. C. (2017). Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochemical Society transactions, 45(5), 1105–1115. https://doi.org/10.1042/BST20160474
4. Spinas, E., Saggini, A., Kritas, S. K., Cerulli, G., Caraffa, A., Antinolfi, P., Pantalone, A., Frydas, A., Tei, M., Speziali, A., Saggini, R., Pandolfi, F., & Conti, P. (2015). Can vitamin a mediate immunity and inflammation?. Journal of biological regulators and homeostatic agents, 29(1), 1–6.
5. Shaik-Dasthagirisaheb, Y. B., Varvara, G., Murmura, G., Saggini, A., Caraffa, A., Antinolfi, P., Tete’, S., Tripodi, D., Conti, F., Cianchetti, E., Toniato, E., Rosati, M., Speranza, L., Pantalone, A., Saggini, R., Tei, M., Speziali, A., Conti, P., Theoharides, T. C., & Pandolfi, F. (2013). Role of vitamins D, E and C in immunity and inflammation. Journal of biological regulators and homeostatic agents, 27(2), 291–295.
6. Kaulmann, A., & Bohn, T. (2014). Carotenoids, inflammation, and oxidative stress–implications of cellular signaling pathways and relation to chronic disease prevention. Nutrition research (New York, N.Y.), 34(11), 907–929. https://doi.org/10.1016/j.nutres.2014.07.010
7. Wu M, Cronin K, Crane JS. Biochemistry, Collagen Synthesis. [Updated 2021 Sep 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507709/
8. Polcz, M. E., & Barbul, A. (2019). The Role of Vitamin A in Wound Healing. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 34(5), 695–700. https://doi.org/10.1002/ncp.10376
9. Abrams, Geoffrey D. MD; Feldman, David MD; Safran, Marc R. MD Effects of Vitamin D on Skeletal Muscle and Athletic Performance, Journal of the American Academy of Orthopaedic Surgeons: April 15, 2018 – Volume 26 – Issue 8 – p 278-285 doi: 10.5435/JAAOS-D-16-00464
10. Pountos, I., Georgouli, T., Calori, G. M., & Giannoudis, P. V. (2012). Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. TheScientificWorldJournal, 2012, 606404. https://doi.org/10.1100/2012/606404
11. Ghosh, Niloy BS1; Kolade, Oluwadamilola O. MD1; Shontz, Edward BS2; Rosenthal, Yoav MD1; Zuckerman, Joseph D. MD1; Bosco, Joseph A. III MD1; Virk, Mandeep S. MD1 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Their Effect on Musculoskeletal Soft-Tissue Healing, JBJS Reviews: December 2019 – Volume 7 – Issue 12 – p e4 doi: 10.2106/JBJS.RVW.19.00055
12. Singh, D. P., Barani Lonbani, Z., Woodruff, M. A., Parker, T. J., Steck, R., & Peake, J. M. (2017). Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Frontiers in physiology, 8, 93. https://doi.org/10.3389/fphys.2017.00093
13. Zeng, C., Lane, N. E., Hunter, D. J., Wei, J., Choi, H. K., McAlindon, T. E., Li, H., Lu, N., Lei, G., & Zhang, Y. (2019). Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 27(6), 855–862. https://doi.org/10.1016/j.joca.2019.01.007
14. Şahin, N., Karahan, A. Y., & Albayrak, İ. (2017). Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: a randomized-controlled trial. Turkish journal of physical medicine and rehabilitation, 64(1), 52–58. https://doi.org/10.5606/tftrd.2018.1238
15. Alderman, D. D., Alexander, R. W., Harris, G. R., & Astourian, P. C. (2017, September 19). Stem Cell Prolotherapy in Regenerative Medicine: Background, Theory and Protocols. Journal of Prolotherapy. Retrieved March 17, 2022, from https://journalofprolotherapy.com/stem-cell-prolotherapy-in-regenerative-medicine-background-theory-and-protocols/
16. “Historical Research: Arthritis Foundation.” Historical Research | Arthritis Foundation, https://www.arthritis.org/science/impact/funded-research-timeline.