This is a nicely simplified picture of how the joint tissues change over time in response to OA.

Lately, I've had multiple friends in their late twenties/early thirties talk to me about arthritis, whether in regards to hip or back pain, or hand and elbow pain. I find that there can be a lot of confusion about different types of arthritis, so for today's purposes, I'll just discuss (and hopefully demystify) osteoarthritis.

Side note: osteoarthritis is not the same as rheumatoid arthritis. Osteoarthritis, sometimes abbreviated as OA, is sometimes called "wear and tear" arthritis, meaning that its disease progression is affected by movement and loads on a joint.

So first thing, osteo means bone (osteon in Greek), arthron comes from the Greek word meaning joint, and "itis" as a suffix almost always refers to inflammation (in the preceding structures) so we already can deduce that osteo arthritis is inflammation of the joint. The World Health Organization defines it as

“Osteoarthritis is a degenerative joint disease, which mainly affects the articular cartilage. It is associated with aging and will most likely affect the joints that have been continually stressed throughout the years including the knees, hips, fingers, and lower spine region.”

Now here's the most interesting part, at least to me.

“Worldwide estimates are that 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis.
80% of those with osteoarthritis will have limitations in movement, and 25% cannot perform their major daily activities of life.”

Women have twice as much incidence of osteoarthritis (at least based on this statistic), and 25% of those with OA cannot perform their major daily activities. Now for musicians, this is very important! The joints in our hands, elbows, shoulders, and spine are critical for music making, especially as we age. Now typically, people assume that osteoarthritis is just something that happens naturally as you age, that there's nothing you can do about it, and if your mom/brother/aunt/grandmother had it, you will too, and that's that. Some of that is perhaps true(see the CDC's statistics on genetics and OA), but we tend to ignore how our mostly sedentary lifestyle, penchant for repetitive motions (like many hours of sitting in a chair or playing our instruments more than 6-8 hours a day), and overall nutrition affect the joints.

“The specific causes of Osteoarthritis are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Disease onset is gradual and usually begins after the age of 40. There is currently no cure for OA. Treatment for Osteoarthritis focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, use of medications, and eventually total joint replacement.”

— Center for Disease Control

What does this all mean exactly? The short answer is that osteoarthritis is a major musculoskeletal disease around the world, and that its cause is unknown, as is the cure. However, the way that we move (or don't move) affects our body long term. Katy Bowman, biomechanist, has written a LOT about this, especially in response to osteoarthritis knees and hips. This particular post gives a little bit of insight into her thinking, but here's her summary of osteoarthritis as a progression.

“1. Cartilage damage comes with swelling (as you can imagine) which increases the size of the tissue and the pressure within the joint and on the bone.

2. The increase in pressure translates into a new, unique bone load, to which bone adapts.

3. Bone adjusts its shape to deal with the new load, although this new shape is not really compatible for the cartilage above it or suitable for long-term loading.

4. The new bone shape creates micro-cuts into the cartilage like a knife (especially if the loads that damaged the joint in the first place are still occurring) and slowly wears cartilage down and out until you need a joint. Or joint replacement, depending on which state you live in.”

— Katy Bowman

Still with me? So a big part of this Osteoarthritis thing is that irregular loading to a joint, joint instability, and joint misuse/abuse/overuse are key factors. This includes weight management, alignment, and movement (or lack thereof). What that means is that the way you stand, the shoes you wear (ahem, there's been research on the correlation between high heels and arthritis), and your daily movement habits affect your joints. Most of us know that we have some alignment irregularities- our feet pronate, our knees hyperextend, we slump in our upper back, etc, and over time, these habits can affect our joints. If for example, you run on pavement predominantly, in less than optimal alignment (maybe with pronated or supinated feet) and then you regularly wear high heels, you're irregularly stressing out your ankle and knee joints over time. That's perhaps nothing new to many of you, but if nothing else, it's a reminder to get off the couch, move more, get aligned, and also diversify your movement habits, especially if you're young and healthy (and wear better shoes while doing it). More on how this relates to musicians next time!