WEBVTT

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I am Dr.

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Cyril Fischhoff,

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a chiropractor and a specialist in musculoskeletal ultrasound practicing in Mauritius.

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I invite you to listen to a new episode of the Vertebra & Co.

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podcast every first and third Monday of the month.

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This podcast is dedicated to the world of musculoskeletal medicine and is for everyone.

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We discuss the mechanisms involved,

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diagnoses,

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treatments and the prevention of various musculoskeletal pathologies through short clinical stories,

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the latest scientific research and interviews with specialists.

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Hello everyone,

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today we are going to talk about a topic that saturates search engines and waiting rooms,

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yet remains one of the most misunderstood.

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Osteoarthritis.

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For too long we've been sold osteoarthritis as an inevitability,

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simple wear and tear,

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as if our joints were mechanical parts destined for the scrap heap.

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But before we dive into this new biological perspective,

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I want to clear up a confusion I hear almost daily in my practice.

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People often ask me,

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wait,

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do I have osteoarthritis or arthritis?

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In many people's minds,

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they're the same thing.

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Yet,

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understanding the difference is already half the battle toward healing.

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So,

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to clearly distinguish the two,

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I like to use the image of fire and stone.

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Arthritis is fire.

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It's a primary inflammation,

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often sudden.

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It can be autoimmune,

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infectious,

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or linked to crystals,

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as in gout.

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The joint is red,

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hot,

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and swollen,

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and the pain is often nocturnal.

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It wakes you up.

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Osteoarthritis,

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on the other hand,

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has long been perceived as stone,

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like stone,

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a cold,

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slow,

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purely mechanical process.

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But beware,

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this view is outdated.

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Today,

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we know that osteoarthritis is a biological remodeling process.

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It's not so much that the joint wears out,

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but that it's trying to adapt to an environment it can no longer manage.

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And sometimes this process flares up.

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This is what we call a flare-up,

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where osteoarthritis suddenly takes on the characteristics of arthritis.

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But it isn't.

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So why is it important and urgent to talk about osteoarthritis?

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Well,

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because we are facing a true global pandemic wave.

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According to data from the Global Burden of Disease,

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osteoarthritis now affects over 500 million people worldwide.

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In France,

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it's estimated to affect about 10 million people.

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But what's striking is the trend in the numbers.

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The number of cases has increased by over 110%

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in 30 years.

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And contrary to popular belief,

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it's not just an issue for seniors.

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We're seeing a staggering 40%

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increase in 40 to

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60-year-olds. We can no longer ignore the impact of youth sports injuries,

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like those famous torn ACLs in the knee,

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which program osteoarthritis 15 or 20 years down the road.

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Today,

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it's the leading...

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cause of disability in people over 65.

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So,

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we're going to talk about the different structures that make up the joint,

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starting with what we call the subchondral bone.

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When we look at an x-ray,

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we always focus on the joint space narrowing,

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where the cartilage seems to have disappeared,

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and we think,

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well,

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it's my cartilage that hurts.

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Well,

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that's wrong.

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Cartilage has neither nerves nor blood vessels.

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It's incapable of sending you a pain signal.

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The real culprit,

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the one screaming when you walk,

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is the subchondral bone.

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Unlike cartilage,

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this bone located just underneath is extremely rich in nerve fibers.

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Imagine a house.

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The cartilage is the carpet.

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The subchondral bone is the concrete slab.

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If the concrete slab is healthy,

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it absorbs shock silently.

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But in osteoarthritis,

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the bone is under enormous pressure.

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It becomes too hard,

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what we call sclerosis,

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or develops microedemas.

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This bone distress causes high pressure inside the joint.

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And it's this pressure,

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picked up by the bone's many nerves,

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that creates that deep pain.

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sometimes like a toothache.

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Plus,

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this bone releases enzymes that digest the cartilage from underneath.

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Cutting-edge research,

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notably the work of Loris and Goldring,

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proved this toxic dialogue.

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To save the cartilage,

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we must first soothe the bone supporting it.

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Another structure making up the joint is the ligaments,

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which really act as pain sentinels.

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If,

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as we've just seen,

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the bone is the source of deep pain,

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the ligaments are the transmitters of movement pain.

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In osteoarthritis,

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ligaments undergo two phenomena.

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First,

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a sort of microtraumatic instability.

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When the cartilage thins,

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the joint becomes loose.

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The ligaments are then put under abnormal tension.

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They stretch and send sharp pain signals as soon as you change direction.

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The second phenomenon is the loss of proprioception.

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Ligaments are packed with position sensors.

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Inflammation scrambles these sensors.

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As a result,

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you feel less stable,

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which brings us directly to the crucial role of your muscles.

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Indeed,

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we too often forget that the joint doesn't hold itself up.

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Your periarticular muscles around the joint are your active shock absorbers.

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The problem in osteoarthritis is what we call arthrogenic muscle inhibition.

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It's a defense mechanism of the brain and nerves.

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of a system.

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Because the joint hurts,

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the brain,

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quote-unquote,

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partially shuts down the surrounding muscles,

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like the quadriceps for the knee,

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to protect the joint.

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As a result,

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the muscle wastes away,

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it atrophies.

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And since the muscle no longer acts as a shock absorber,

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the subchondral bone takes 100%

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of the impact with every step.

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It's a dramatic vicious cycle.

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The less muscle you have,

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the more your bone suffers,

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the more your cartilage degrades,

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and the more the ligaments stretch.

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Muscle isn't just a tool for movement.

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It is truly the biological shield for your cartilage.

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And then there's that moment when everything shifts,

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what we call a flare-up.

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Your osteoarthritis was silent and suddenly your joint is on fire.

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Microdebris falls into the joint fluid.

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Your body detects them as intruders.

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The synovial membrane becomes inflamed and produces excess fluid filled with inflammatory molecules called cytokines.

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These molecules act like tiny acids and a flare-up isn't just painful,

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it's an acceleration phase of the disease.

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At this stage,

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inflammation is the engine of destruction that must be stopped urgently to protect your tissues.

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So to conclude this first episode on osteoarthritis,

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remember that osteoarthritis is a puzzle.

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It's not just wear and tear,

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it's bone distress,

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a warning from the ligaments,

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a failure of the muscles,

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all against a backdrop of inflammatory chemistry.

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But the good news is that we have solutions for each of these points.

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So in the next episode of Vertebrinco,

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we'll take action.

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How do you wake up your muscles despite the pain?

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How do you put out the chemical fire of a flare-up?

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And what are the cutting-edge therapies,

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from nutrition to regenerative medicine,

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that are changing the game today?

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Take care of your structure.

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It is your freedom of movement.

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See you next episode.

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Join me again very soon for a new episode of the Vertebras & Cobra podcast.

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Meanwhile,

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take care,

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stay active,

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and if you ever have any questions for me,

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please feel free to contact us on the podcast page vertebranco.com.