Arthritis talk 5th December 2012
Below is the transcript for a presentation given by Peter Thompson, Chiropractor and Osteopath on the 5th December 2012.
Thank you for giving me the opportunity to address you.
My name is Peter Thompson. I have been a Chiropractor and Osteopath for over thirty years. I have experience in private practice and as a Clinical Fellow and lecturer at Macquarie University. I hold a Master of Science degree.
Today I would like to discuss some concepts of arthritis.
Arthritis, simply put, is inflammation of the joint. Did you know that almost everyone over the age of 45 examined by x-ray show some level of osteoarthritic generation?
Generally speaking Arthritis can be divided into inflammatory and non-inflammatory varieties. Bear in mind that the non-inflammatory varieties can inflame periodically.
Inflammatory varieties include a range of auto-immune diseases such as Rheumatoid Arthritis or metabolic diseases such as Gouty Arthritis. These types of arthritis do not benefit from manual therapies. Management of these diseases is with the use of drugs or nutritional therapy, regulating gastric flora, limiting physical activity and using specifically modified tools and utensils to ease daily activities.
Attempts to perform manual therapy on the inflammatory arthritides result in painful irritation and are unlikely to provide benefit. However, some forms of gentle massage aiming at enhancing lymphatic circulation and decongesting fluids in the area around the joints may be beneficial in certain cases.
However, if you are a member of the large group of sufferers of the non-inflammatory arthritis, manual therapy may provide considerable relief from symptoms, improved function and can even retard the progression of the disease.
Manual Therapy also known as physical therapy includes a variety of treatment methods such as Osteopathy, Chiropractic, Physiotherapy, Massage, Exercise Physiology to name a few.
Inflammation plays a major role in all forms of arthritis. The suffix ‘itis’ means inflammation.
Osteoarthritis can be found in its non-inflammatory form. This is called Osteoarthrosis. Because it can be found in two forms it is also known by the general term ‘degenerative joint disease’, abbreviated to DJD.
I would like to spend some time discussing some of the causes of DJD.
Mechanical factors play an important role in the onset of this type of arthritis.
- Trauma and injury – the initial injury may resolve reasonably quickly, however any mechanical dysfunction resulting from the injury may continue indefinitely.
- Postural overload – poor posture loads parts of the body in an unnatural way, predisposing the body to abnormal wear and tear.
- Prolonged repetitive tasks – repeating the same tasks in the same way causes excessive wear and tear on some structures while sparing others.
- Faulty gait patterns – problems with the way we walk can severely impact our body, often causing a jarring through the weight bearing joints with every step. These small but repetitive impacts accumulate causing microtrauma and promote degenerative changes.
Signs and Symptoms of Osteoarthritis:
- Stiffness around the joint
- Limitation of range of movement
- Loss of freedom and ease of movement
- Sharp pain commonly occurs on movement
- Ache in and around the joint
- Local swelling and warmth
- A grindy sound or feeling in the joint. This is called creptitus. There are two types –
Fine C – which suggests changes in the soft tissue around the joint
Coarse C – which suggests erosion of the gliding surfaces of the joint itself
These joints become inflamed easily. When they do, pain levels rise significantly and range of movement decreases.
Sequence of degenerative processes:
- Soft tissue inflammation ( causes outline above). Binding of soft tissues causes reduced freedom of movement. This leads to:
- CT thickening, loss of elastiticity, fibrotic changes, adherence of structures that normally glide freely. This then causes:
- Progressive loss of joint range and ease of movement. If left untreated, this will result in:
- Compensation/adaptation to the dysfunction of the joint. Other tissues become tense or flaccid, eg flaccid weakness develops in the calf muscles when the ankle has been sprained. Rotary cuff spasms with shoulder injury, spinal muscles splint to protect from back pain. This is mediated through the nervous system.
- Bone remodelling – when bone is subject to abnormal or prolonged mechanical stress it responds by changing shape to meet the new forces being applied to it. Osteopenia/Osteoarthritis involves a greater rate of remodelling, resulting in an increased risk of bone fracture.
- Changes to muscle activity and motor patterning – no part of the body works in isolation. Changes in the action of one joint effect the way the nervous system controls the patterns of muscular control throughout the body. These changes may be insignificant or major.
What can be done?
Massage – releases binding of fibres in muscle and ligament that restrict normal movement. Relaxes muscle, enhances circulation, relieves fluid pressure around the joint.
Stretching – there are many types of stretching techniques. They help restore joint range of motion and improves muscle control of the joint.
Anti-inflammatory measures – Non-steroidal anti-inflammatories, natural inflavanoids
Traction – inflamed ligaments do not like prolonged stretching. Only used in certain conditions
Mobilization – moving the joint repeatedly within its normal range of movement. This “de-rusts” the joint by gently gliding the joint surfaces over each other.
Manipulation – stretching the joint to the point where nerve reflexes are produced. These reflexes cause the muscles that act on the joint being manipulated to relax. It also influences the way the brain controls the muscles around that joint.
Ergonomic ADL advice – posture, lifting, movement advice and workstation advice
Dietary modification – to help control inflammation, provide and replenish missing nutrients, maintaining healthy intestinal flora and mineral concentrations. Reduce weight.
Cartilage repair using supplements – Chondroitin, shark cartilage, cell salts, Vitamin E, mineral supplements such as calcium, magnesium, omega-3 etc
Pain control – pain clinics, medication
Electrotherapy – ultrasound, electrical pain modulation eg TENS machine
Swimming or appropriate exercise regime. Minimize impact on joints. Avoid stretching the arthritic joint beyond a comfortable limit. Don’t overload the joint with excess resistance. Swimming is an excellent choice of exercise
Jogging depending on the type of severity of the arthritis jogging may be possible provided well supportive, cushioned footwear is used and try to jog on soft surfaces such as flat grass or sand.
Heat/ice – pain can be eased and/or ice as home help therapy. Ice is advised when swelling is present, particularly soon after injury. Heat is used to promote blood circulation and relax muscle tension.
Alternating heat and ice is an effective way of promoting exchange of fluid in the injured region.
The old rule of thumb is still useful but need not be adhered to strictly. Its says:
First 24-48 hours – ice
48-72 hours – alternate heat with ice
Beyond 72 hours – heat
Heat and ice packs should be wrapped in a moist towel to avoid heat or ice burn of the skin. Leave pack over painful area for 10-15 minutes within comfort range. Repeat hourly until pain and swelling is reduced. It is best to use these treatments under the advice of your therapist.
(Peter Thompson 2012)