Managing Osteoarthritis
Many of my patients in clinic suffer from osteoarthritis one way or another.
It’s a natural consequence of aging and some health professionals describe it as ‘wear and tear’ or ‘degeneration’ within the joints. Patients get scared sometimes when they hear these terms, and they stop exercising because they fear causing further damage and increasing pain. The right sort of exercise can be beneficial for the joints and helps patients feel better overall so it’s important to do them when prescribed them by a health professional.
Osteoarthritis mainly affects over 40’s with the most compromised joints being the knees and hips. There are many elements responsible for the inflammatory state, but aging seems to be the main factor, with some using the term ‘inflamm-aging” (Greene, 2015). It specifically attacks cartilage on the articular joints and degradation can lead to crippling loss of function in some as cushioning between the joints reduces, creating more inflammation over time as bones move against bone when activated (Knights, 2023). Osteophytes on the bones may develop which cause heat and swelling, leading to stiffness and sometimes muscle loss and power (Terracciano, 2012). There are currently no treatments that prevent the disease intensifying and the main solution is often joint replacement surgery (Sacitharan, 2019).
When treating a patient with osteoarthritis I look at the whole picture, I ask questions to determine the events in the past that led them to experience it such as mechanical trauma or sports injuries. When exercising one tends to focus on your body and your movements are controlled, whereas in sports you’re concentrating on the ball and the competition, so the risk of uncontrolled motion is higher making the likelihood of injury incidence higher. Osteoarthritis can be a long-term consequence of a joint injury, especially if it hasn’t been rehabilitated properly at the time. Repetition tends to break down cartilage, which creates wear and tear, swelling and crepitus (noise in the joint) when moving the affected joints in certain motions.
I always tell patients to bring any recent MRI or Xray’s to see the severity of change, I can focus on the areas affected and help promote good circulation to improve bone health overall. I observe loading of joints, compromise and muscle loss through standing assessments and joint testing.
What I do manually during treatment.
Osteoarthritis can be managed with osteopathy. I do a lot of ‘mobilisations’ of joints above and below the affected areas. This helps take some of the tightness away in the muscles and ensures better movement and function. If osteoarthritis is present in the lower back, I like to ‘gap the joints’ which is a gentle way of separating the joints by adding traction to them as you lie on your side (a bit like an accordion one patient said!) and using harmonic movements to ease the muscles. Results can be fast post treatment and patients often comment on an increase in flexion and being able to reach better in putting their socks back on!
I like to massage areas where movement is compromised, it feels great for the patient, and it also reduces stress in the muscles where they are forced to work hard to support the body. I might press firmly (you always tell me the best pressure) and I use something called trigger point therapy which acts on the muscle spindles helping tight muscles relax.
Numerous studies indicate that osteoarthritis intensifies with unhealthy eating, with the western diet being an important risk factor in obesity and inflammation (Xu, 2021). It can be a vicious cycle in that the pain decreases motivation to exercise and yet movement helps you keep fit and healthy and increases the range that is compromised by the osteoarthritis. As a Naturopath I can advise on health behaviours that may be preventing weight loss and work to implement good habits in the foods that are better for you. Also, some foods might be making you feel worse, I discuss those foods and I can talk about ways in which you might focus on decreasing them.
Osteopaths are trained to manage osteoarthritis guiding patients towards better function. I’ve helped reduce symptoms in hips, knees, hands, toes, ankles and even the jaw! We can’t change the past but it’s important to maintain the function you have in order to have less pain in the future.
References:
Greene, M.A. and Loeser, R.F. (2015) ‘Aging-related inflammation in osteoarthritis’, Osteoarthritis and Cartilage, 23(11), pp. 1966–1971. doi:10.1016/j.joca.2015.01.008.
Knights, A.J., Redding, S.J. and Maerz, T. (2022) ‘Inflammation in osteoarthritis: The latest progress and ongoing challenges’, Current Opinion in Rheumatology, 35(2), pp. 128–134. doi:10.1097/bor.0000000000000923.
Sacitharan, P.K. (2019) ‘Ageing and osteoarthritis’, Subcellular Biochemistry, pp. 123–159. doi:10.1007/978-981-13-3681-2_6.
Terracciano, C. et al. (2012) ‘Differential features of muscle fiber atrophy in osteoporosis and osteoarthritis’, Osteoporosis International, 24(3), pp. 1095–1100. doi:10.1007/s00198-012-1990-1.
Xu, C. et al. (2021) ‘Dietary patterns and risk of developing knee osteoarthritis: Data from the osteoarthritis initiative’, Osteoarthritis and Cartilage, 29(6), pp. 834–840. doi:10.1016/j.joca.2021.02.571.
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