Write, read, retreat, relax, return, review, reflect. There is something satisfying about putting one’s thoughts into words, especially written words. New Zealand journalist Ron Palenski, who wrote fifty books including biographies of Sir Brian Lochore, Graham Mourie, Dave Loveridge, and Keith Murdoch, once said, "Writing is cathartic." Most judges would agree, perhaps more after the event than before or during. Writing for the Judge’s Association of New Zealand can be testing, as information provided to the Most Learned is scrutinised thoroughly. Therefore, words must be truthful, yet to convey the message, a little poetic licence helps when infused into the content to enhance readability. What may seem frivolous or even inaccurate still holds veracity, so please bear with the writer as ‘the scene unfolds.’
Occasionally, a line from a movie captures our attention: “Come up and meet me sometime, big boy.” — Mae West; “I’ll be baaack.” — Arnold Schwarzenegger; “Make my day, punk.” — Clint Eastwood, and so on.
But perhaps the most fitting line is, “What’s a nice girl like you doing in a joint like this?” — a line created by movie director Martin Scorsese. A slight twist, and we see what many health providers may wish they could say: “What’s a nice joint like you doing in a girl like this?” To be fair and politically correct, we could say, “What’s a nice joint like you doing in a man like this?” Too many times, joint destruction is advanced ahead of a person’s overall health. Joint replacement through surgery attests to this: new knees, hips, shoulders, and ankles are usually prescribed for those who are healthy enough to tolerate both the anaesthetic and the rehabilitation. The debilitated and infirm are more likely to be bypassed for what is termed elective surgery, which is a misnomer. No one elects to have surgery; there is a choice, but the alternative often leads to a worse quality of life.
A joint is the space between bones that allows us movement to perform manual tasks, which are essential for maintaining a quality life, particularly dexterity. Each joint is unique and specific. Two examples of the same but different are the shoulder and hip joints. Both are ball-and-socket joints, like a tennis ball in a saucer, or a tennis ball in a soup bowl. One would imagine they act the same, but a slight deepening of thought reveals that the shoulder is shallow, allowing 180 degrees of movement to the front and side but is more susceptible to dislocation. The hip is deeper, enabling 115 degrees to the front and 30 degrees to the side. Dislocation is rare but serious if it happens. Sir Bryan Williams, the ex-All Black, can attest to this; he dislocated his hip while playing against France. So rare was the hip dislocation that the initial diagnosis was, “It can’t be!”
Common to all joints is a layer of shock-absorbing cartilage at the ends of bones that form the joint. Bone-on-bone simply does not last a lifetime, so it is covered in cartilage. The most common type of cartilage is articular cartilage. While bone is strong, when bent from side to side, the ends are weak, as the matrix weave that strengthens bone is angled to take horizontal pressure, not vertical. Joints, on the other hand, are designed to take vertical pressure, but not so much horizontal force.
For most of time, medical providers believed cartilage was not viable (living) material, and once damaged, it could not be repaired. Professor Emeritus of Anatomy in Sweden, Harry Brodin, who lectured on a six-week postgraduate course in the Canary Islands, shared with me a research paper he had just written, which had been read, retreated, relaxed, returned, but was unpublished. It demonstrated that cartilage could repair. This changed orthopaedic medicine. Until then, any fracture was immobilised by placing one joint either side of the fracture to stabilise it. Remember Plaster of Paris splints? By immobilising healthy joints, health providers were treating the fracture but causing iatrogenic injury to the innocent. However, with the belief that cartilage was dead, there was no concern over damaging something already deemed ‘dead.’ A quiet and significant movement of care took place: no more Plaster of Paris immobilisations, replaced by Don Joy splints and Moon Boots, which can be easily removed, allowing surrounding anatomy to move, reducing medical-inflicted injury, maintaining cartilage health, and speeding rehabilitation.
Even more significant than understanding that cartilage is alive is the fact that recovery is possible. Research shows that in most cases where joint replacement is suggested, your chances of recovery without surgery are just over fifty percent. This presents a dilemma: is the patient willing to be patient, or do they want a quick fix? Patience is required, because the only physical assistance cartilage can receive to repair is weight-bearing, and reaching full weight-bearing can take time. From the time of birth, cartilage has a glossy surface: "As smooth as a baby’s articular cartilage!" (Poetic licence.) Colleague Justice Sir Owen Woodhouse, author of The Accident Compensation Corporation Scheme, probably recognised this. He wrote that pre-existing injury or disease had to be wholly or substantively present before an injury by accident could be declined. Sir Owen also stated it would be rare to decline ACC cover, and his format was subsequently upheld by the courts.
As we age and our shock absorbers deteriorate, the following occurs: Imagine you started with excellent-quality writing paper. If left to sit, gradually grit accumulates on the paper, and if not removed quickly, through dusting and polishing, it becomes sandpaper when you wanted writing paper. The way to recover good writing paper is to sandpaper the sandpaper, not expediently grab another piece of A4 from the photocopier. The rough edges of cartilage and bone are colloquially termed arthritis. That is not all bad news; just because a person has been told, “You have arthritis!” does not mean irreversible damage within the joint. With direction, discipline, and early intervention, including prevention and prehab, you may not need surgery in the foreseeable future.
Patients often ask if oral joint lubricants like chondroitin help joints. About 60% of patients say they are assisted, but the course required to make a difference is often six weeks to six months. While these lubricants may lubricate the cartilage, they do not buff the surfaces. Discuss with your primary health provider, as there can be side effects, especially if you are on anticoagulants.
Like our bedroom carpet, we tend to wear out the carpet at the door but don’t vacuum under the bed, where debris accumulates, putting our carpet/joint at a disadvantage. The joint is designed to be used equally and evenly, rather like the judicial system—except we may take our joints more for granted than we do justice?
Loaded joint movement to full range massages the cartilage. Quietly aim for joint command rather than joint demand. The everlasting question: Are we custodians of our joints, or are joints custodians of us? Either way, you win if the weight of the judiciary is brought to bear in a fair and even manner across the whole sector.
In McDonald, 48 Pankhurst J provided a very good summary of how ACC can exclude cover. He found that ACC must exclude it under the relevant legislation; it can’t just stop cover or entitlements. The exclusion only comes into effect when the injury is caused wholly or substantially by an exclusion defined in s 26 (2) or (4).
“There is no express definition of 'caused.' However, s 10 indicates the test to the extent that exclusions from cover only become operative when the particular personal injury is 'caused wholly or substantially by' the defined exclusion. It follows that in the present case, the disease osteoarthritis excluded cover only when it is wholly or substantially the cause of McDonald’s personal injury. The impact of the disease, less than that—say, a minor or even moderate level—would not give rise to the exclusion of cover. Put another way, the accident remains causative until such time as the disease (or other excluded conditions) is causative of the relevant injury to at least a substantial degree.”