20th FEBRUARY 2018
Osteopathy & Arthritis
Here in the clinic we often get asked if osteopathy can help people suffering from arthritis. The answer is that the gentle manipulative and massage techniques we use in an osteopathic treatment can certainly help some arthritis sufferers. Treatment is individual, gently moving and stretching an arthritic joint and massaging surrounding muscles and tissues can help ease some of the discomfort. Sometimes we work on general mobility of the other joints and muscles in the body to help the mechanics of the body work better.
Read on to find out more about the two main types of arthritis and how we approach these at the clinic…
Do you suffer from Osteoarthritis?
Osteoarthritis is the most common type of arthritis, which is often referred to as “wear and tear”. It’s normal degeneration within joints and is not painful in a lot of people. It is most common in adults over 40 however it can occur at any age due to injury or existing joint problem.
Cartilaginous joints are most prone to osteoarthritis- examples of these joints include knee joints, hip, and spinal joints. Both bones of the joint are covered in thick cartilage. The process is simply a degeneration of the cartilage covering the bones in the joint. If it occurs in the spine is it known as “spondylosis”. As mentioned above, osteoarthritis can occur without any symptoms, or there may be some pain, crunchiness or clicking in the joint (crepitis), there may also be locking or giving way in later stages (this is more common in the knee).
If the lining around the joint becomes inflamed and the fluid in the joint expands there may be pain or swelling around the joint. Osteoarthritis is the most common cause of knee and hip replacements. Healthy articular cartilage undergoes a good amount of compression and decompression through the day.
If we use a hip joint as an example, think about how the joint moves when you walk. Bringing the leg forwards will compress some of the joint and allow the rest to decompress, and bringing it back will do the opposite. If you were to start shuffling and taking shorter strides, then some of this cartilage will be under more pressure, and other areas may never be compressed. This is one opportunity for osteoarthritis to begin- “use it or lose it” is a good mantra here!
Overuse or misuse of a joint can also lead to osteoarthritis, which makes sense when you think about the example above: over-compression in one area and under-compression elsewhere is not good for the joint. This helps to explain the symptoms a patient might feel. As the joint surface becomes rougher, as the smooth cartilage degenerates, movement can become crunchier and possibly reduced. Locking can be caused by loose or floating pieces of cartilage in the joint, or the osteophytes (commonly referred to as bone spurs or boney growth) that form to both fill the space left by lost cartilage and in an attempt to stabilise the joint. This occurs in the latest stage of osteoarthritis.
They can grow from any bone but commonly are found in neck, shoulder, knee, low back, fingers, big toe and heal, they do not always cause pain however they occasionally cause stiffness, reduced movement. More specifically, an osteoarthritic hip is often stuck in a slightly flexed (forward) position, which means that strides are normally shorter and the body may have to compensate for lost movement elsewhere, such as in the lower back. The small joints in fingers can be visibly affected, becoming stiff and appearing swollen. These swellings are called Herberden or Bouchard nodes depending where they form, but these terms are only used for osteoarthritis and do not constitute a diagnosis in themselves. Other conditions can appear similarly, so it’s best to have any changes looked at.
How we can help
Osteopathic treatment will not cure arthritis, but by passively moving a joint in the way it’s meant to can help improve its health- we’re going back to compressing and decompressing in more evenly. The osteopathic treatment aim is to reduce the pain. Reducing pain and increasing slightly range of movement can have a really beneficial effect on overall function and comfort. This promotes wellbeing and enhances quality of life. Patients who find benefit from Osteopathy often decide to have regular maintenance treatment, this might involve coming every 2-3 months for a session with one of us, some patients combine a mixture of massage and osteopathy and some prefer to combine physiotherapy and pilates. The advantage of a multi disciplinary team is for you to find the best personal approach for your lifestyle.
References: arthritis.org.uk, osteopathy.org.uk, NHS, Oxford Journals, Medscape.
Do you Suffer from Inflammatory Arthritis?
There are many types of inflammatory arthritis, such as Rheumatoid arthritis (RA), Psoriatic arthritis (PA)and ankylosing spondylitis these differ from Osteo arthritis in that instead of excessive wear occurring in a joint from injury, overuse or malformation, the joint tissues becomes inflamed due to irritants in the blood system or autoimmune responses in the cell fluids.
This inflammation creates effusion in the joint capsular tissues which can lead to damage and destruction of cartilage and bone. Episodic inflammation can be very painful and make movement difficult but not actually leave behind much permanent physical damage.
Medical treatment for inflammatory arthritis tends to concentrate on reducing inflammation and also on modifying the auto immune response. There are some very effective treatments available and a Rheumatologist can be hugely helpful. Where an inflammatory arthritis is suspected, your GP will carry out a number of specific blood tests to determine if there is an active problem going on. Initially it can be difficult to decide if there is just wear and tear degenerative problems or an active process of inflammation going on which may benefit from rheumatological assessment. The time course and pattern of your symptoms will be important in deciding whether you need secondary referral.
Some of the medical treatments available include:
Anti inflammatory medication (Naproxen, Ibuprofen) and gels for topical application
Steroid therapies (Prednisolone)
Sulphasalazine and Methatrexate (Immunomodulators)
And a newer generation of treatments, Anti TNF therapies such as (infliximab, adalimumab, certolizumab pegol and golimumab.
It is always helpful to understand the nature of the causes of your pain and stiffness as this helps you as a patient plan how you manage your problem. There are many ways to facilitate a better quality of life and having a diagnosis of inflammatory arthritis does not have to stop you living the life you want. The less you move the less you can move because life habits are hard to break. Other than medical treatments there are many factors involved where you may be able to help yourself. Diet can play a big part in the inflammatory process and it can be useful to look at possible irritants. A nutritionist can be very helpful for this.
How we can help
We find here in the clinic that patients often benefit from soft tissue treatments and gentle mobilization using fascial and muscular oscillations. Osteopathy and Massage are both beneficial here. Alongside these the Physiotherapy and Pilates help enable you to move more comfortable and improve your stability and strength. Some inflammatory processes are temporary and some last for many years. It can be helpful to try and come to terms with the possibility of this being a long term and find a few areas of support which allow the process to have minimum impact on your daily living.
We’re here to make your walk around the earth more comfortable.
References: Osteopathy.org.uk, arthritis.org.uk, Medscape, NHS