Osteosignal Episode 002

Video: https://youtu.be/ycyIenMbN6w Lightly edited transcript: duplicated caption fragments and obvious transcription errors have been corrected while preserving the substance of the discussion. Introduction ANNOUNCER: This is OsteoSignal with Neal O’Neal, a podcast dedicated to helping you understand the osteopathic model of health so you can live a better life. Today’s episode discusses oncogenes – parts of our genetic code that can cause unwanted cell growth – and their relationship to arthritis and cancer. And now, here is Neal. ARTHRITIS AND CANCER: TWO SIDES OF A GROWTH-CONTROL SYSTEM NEAL O’NEAL: Today, I would like to talk about arthritis and cancer, and how those two conditions can be viewed as opposite sides of the same coin. In our effort to understand medical science and medical decision-making, this is something people should understand so they do not develop the wrong idea and then choose the wrong course of treatment. Arthritis and cancer are flip sides of the same coin. That may sound like the craziest thing you have ever heard, but the reason involves growth-control genes called oncogenes. Most people know what an oncologist does: an oncologist treats cancer. One growth-control instruction in a cell can be summarized as, “If you are pushed on, die.” This helps prevent cells from overgrowing their area, crowding neighboring cells, and causing tissue damage. A cancer cell has disrupted that control mechanism. The disruption may result from a virus inserting genetic material into DNA, a chemical exposure damaging DNA, radiation, or another mutagenic event. The other growth-control instruction is less commonly discussed. It can be summarized as, “If you are pulled on, grow.” Who treats the consequences of that growth signal? Often, it is an orthopedic surgeon. Normal Bone Growth In Response To Pull NEAL: Many normal bony landmarks develop because muscles and tendons pull on bone. Terms such as tuberosity and trochanter describe bony prominences that form in response to mechanical loading. For example, people who ran or played sports extensively while growing may develop more prominent bony structures around the knees. Bone grows to meet the mechanical demands placed upon it. Someone who spent childhood primarily playing chess rather than running may not develop the same degree of bony prominence. This is a normal use of the growth-control system. Bone responds to tensile force – especially at tendon-to-bone insertions. When Normal Growth Occurs In An Abnormal Mechanical Environment NEAL: The problem arises when the same normal growth response occurs under abnormal conditions. A person may be told, “You have arthritis,” as though arthritis itself were always a disease. In many cases, osteoarthritis is better understood as a natural bone-growth process occurring in a dysfunctional mechanical environment. Bone spurs commonly form near joints because of chronic traction on bone. During childhood and adolescence, muscles and tendons can create substantial changes in bone because growth hormone is abundant and bone is highly responsive. In adulthood, muscles alone are less likely to create large new bony prominences unless the pull is repetitive and sustained. That chronic pull often comes from the joint capsule. The Joint Capsule And Synovial Fluid BRENT MAYBERRY: Is that because joints have a capsule around them? NEAL: Exactly. Synovial joints contain fluid, so they are enclosed by a fibrous capsule that retains the synovial fluid. BRENT: Does that fluid allow the joint to move smoothly? NEAL: Yes. Healthy joint surfaces are not supposed to grind directly against each other. They are designed to move on a thin film of synovial fluid. When synovial fluid production becomes inadequate, or when the quality of the fluid changes, cartilage wear can accelerate and the joint may progress toward bone-on-bone contact. The capsule is a fibrous bag attached around the bones forming the joint. It often has thicker regions that we call ligaments. For example, the ischiofemoral ligament is a thickening of the hip capsule. Bone spurs often form near the points where these capsular and ligamentous tissues attach to bone. If someone has a painful hip and imaging shows a bone spur, the spur may reflect chronic abnormal traction on the capsule rather than being the primary cause of the problem. A cortisone injection may reduce inflammation, but it does not necessarily correct the mechanical process that caused the bone growth. How Abnormal Joint Motion Creates Chronic Traction NEAL: A joint may have been injured, overused, or held in a restricted position for years. If it never regains full motion, the capsule no longer distributes force evenly. A person may be able to rotate the hip outward but not inward, or may be unable to raise an arm fully overhead. That loss of motion means part of the capsule is being chronically tensioned. The bone responds normally to the abnormal pull by growing. If the spur becomes large enough, it may mechanically block the joint and eventually require surgery. The important distinction is that osteoarthritis is not always a primary disease process. Rheumatoid arthritis is a separate autoimmune disease. Osteoarthritis, by contrast, is often a normal adaptive growth response occurring in a dysfunctional system. “Normal Wear And Tear” Is Not Necessarily Normal NEAL: People are often told that osteoarthritis is simply normal wear and tear. But seeing something frequently does not make it healthy or inevitable. The process may be common, but it still reflects abnormal mechanics and tissue dysfunction. Bone spurs are also commonly misunderstood in conditions such as plantar fasciitis. A person may see a sharp spur on an X-ray and assume it is stabbing the foot. But the spur sits within dense fibrous tissue and formed because something repeatedly pulled on that bone. The traction may come from the plantar fascia, an intrinsic foot muscle, an extrinsic muscle, or one of the many joint capsules in the foot. The spur is often an indicator of dysfunction rather than the true source of symptoms. Why Restoring Capsular Function Matters NEAL: If a manual therapist understands how to restore joint-capsule function, that may be more useful in the long term than repeatedly suppressing inflammation with cortisone or injecting regenerative products without correcting the mechanics. A normally functioning joint has a far better chance of staying healthy. Even after a hip replacement, the patient still needs restoration of proper motion. The surgery restarts the clock, but the mechanical conditions that damaged the original hip may still be present. In fact, long-standing compensation elsewhere in the body may cause the replacement to wear even faster if those patterns are not corrected. Function is the key. Arthritis is a process of adaptation within dysfunction. What Exactly Is Abnormal? BRENT: What is happening to the capsule that causes arthritis? Is there abnormal motion, or are the cells receiving the wrong growth instruction? NEAL: The bone-growth response is normal for the circumstances. The abnormality is the mechanical environment. For example, many people sit for long periods with the hips held around 90 degrees. The capsule is repeatedly tensioned in the same pattern. The iliopsoas, gluteal muscles, and other tissues crossing the joint are used through limited ranges over and over. Eventually, the joint may lose full motion. The capsule becomes restricted and maintains a constant pull on the bone. That continuous tension signals bone cells to grow. At the same time, the joint may stop moving normally on synovial fluid. Cartilage begins to wear, the joint becomes irritated and warm, and the synovium may become thickened and sticky rather than thin and serous. The growth response is normal. The sustained mechanical state is dysfunctional. Why A Whole-Body Assessment Is Necessary AUTUMN MAYBERRY: This is why the practitioner has to take the person’s full history and determine what created the problem. Did the person tear an Achilles tendon? Is the talus restricted? Was there a knee or ACL injury? Is there a hip-flexor problem? Is the diaphragm restricted against the top of the psoas? Any of those factors can alter force transmission and create abnormal pull on a capsule somewhere else. NEAL: Exactly. There is the deforming force, and then there is the location where that force could no longer be dissipated or transmitted. Those sites are often distant from each other. That is a central osteopathic concept: do not draw a six-inch box around the painful area and assume the cause must be inside it. A force acting at a distance through a lever arm can create a much larger effect elsewhere in the body. Treatment Before And After Joint Replacement AUTUMN: Patients often ask whether they will need surgery. Early in treatment, we may not know yet. Whether we ultimately save the hip or proceed to a replacement, the early treatment may be similar: remove the mechanical “hammer,” restore function, improve fluid movement, and reduce the forces driving the damage. Eventually, we may reach a point where we know whether conservative treatment is enough or whether replacement is necessary. NEAL: And even if the joint is replaced, the same functional restoration is still required. Otherwise, the replacement may wear out. The Practical Takeaway BRENT: What is the main takeaway for listeners? NEAL: Understand why you have osteoarthritis and how you want it treated. People in pain will often do almost anything to obtain relief. A clinician may image the painful six-inch area, identify damage, label it arthritis, and treat only what appears inside that box. But arthritis is often a process, not an isolated disease. Think of a sandbar in a river. The sand accumulates at a particular bend, but it came from somewhere upstream. The visible deposit is not necessarily the original source of the problem. There may be smoke in the hip, while the fire is somewhere else. Put out the fire rather than simply moving the smoke around. That means looking beyond clamshell exercises, cortisone, stem cells, or platelet-rich plasma when those interventions are used without correcting the underlying biomechanics. PLATELET-RICH PLASMA: USEFUL, BUT NOT A COMPLETE SOLUTION BRENT: What is PRP? NEAL: PRP stands for platelet-rich plasma. Platelets are separated from a person’s own blood and injected into an injured site. Platelets are involved in clot formation. When tissue is cut, platelets form a sticky web that helps stop bleeding and creates a scaffold on which healing can occur. For a small or partial tendon tear, PRP may be useful because it can create a biological framework for tissue repair. This is why it is categorized as regenerative medicine. But the question remains: why did the tissue tear? Sometimes the answer is a clear trauma. Other times it is a chronic mechanical process, or the delayed consequence of an old injury. PRP may help the damaged tissue, but the joint capsule still has to move normally. The distant mechanical driver still has to be identified and treated. The Limitations Of Six-Inch-Box Medicine NEAL: Insurance-based medicine tends to demand a diagnosis within a defined body region: identify the code, treat the coded area, and do not look outside it. That framework is often guaranteed to fail when the true cause is part of a larger mechanical system. The goal of osteopathic manual assessment is to identify the distant force, restore normal motion and fluid dynamics, and treat the body as an integrated whole rather than a collection of isolated parts. Conclusion BRENT: Excellent. Thank you. NEAL: Thank you. ANNOUNCER: Thanks for listening to OsteoSignal with Neal O’Neal. For more information, visit pursuitpt.com or pursuitperformancetraining.com. Music provided by Sky Toes.