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What is Arthritis and how can it be treated?



Are you concerned or curious about arthritis? It is important to understand that there are several varieties of this condition that can occur in the neck, back and limbs. Osteoarthritis (OA) is a common joint disorder that is often associated with the terms “bone-on-bone” and “wear-and-tear.” These colloquial expressions paint a vivid and discouraging image of a joint condition that is actually a very natural process.


Osteoarthritis is classified as a “degenerative joint disease.” This official nomenclature can be equally discouraging because it depicts a crumbling, weakened and diseased joint structure. Although OA is commonly represented as a process that “wears” out joint surfaces, it can more accurately be explained as the body’s adaptive response to joint decline [1].


When observed in the spine, typical features of OA fall under the designation of “degenerative disc disease.” Using the term “disease” to label this condition is problematic because the changes are common and can simply be age-related [2]. Prominent features of OA include joint remodeling and the formation of bony outcroppings known as osteophytes but often referred to as “bone spurs.” Using a term such as “spur” in the presence of joint pain generates an unsettling image of impalement.

It is important to understand that degenerative changes in the spine are prevalent in people under the age of 50 years with and without back pain; therefore, not everyone with these features suffers from symptoms.

These ominous descriptions wrongly imply that patients with arthritis are deteriorating and that jagged rubble is shredding healthy tissue while bony surfaces grind each other into further corrosion. It is important to understand that degenerative changes in the spine are prevalent in people under the age of 50 years with and without back pain [2]; therefore, not everyone with these features suffers from symptoms. Many patients feel hopeless because of the way their joints are described. An alternate portrayal of OA interprets the joint changes as adaptive rather than degenerative.


It is important to note that research indicates the removal of osteophytes (“bone spurs”) will actually decrease a joint’s ability to cope with weight-bearing during both bending movements and neutral compression. Therefore, bony outcroppings seen in OA patients are “an adaptation to joint instability, which stimulates their formation” [3].


POSSIBLE CAUSES


Although osteoarthritis (OA) is not an inflammatory joint condition such as rheumatoid arthritis (RA), OA often involves inflammation. Research indicates that obesity may contribute to OA due to additional joint stress and because of the inflammatory compounds emitted by fat cells. The rise in youth obesity is seen as a possible link to increasing rates of OA in younger populations [1].


Arthritis is generally associated with aging; however, signs and symptoms of osteoarthritis (OA) may be evident 20 years earlier than traditionally thought. Knee OA is most commonly seen in people near the age of 50 years. Hip OA rates continually increase with advanced age. Within younger populations (age range of 15 to 49 years), females suffer from OA more than males. Work disability cases linked to elevated body mass have increased for both males and females ages 15 to 49 in recent years [1].


Although a history of spinal injuries may predispose certain people to these adaptive changes, a sedentary lifestyle can also be highly provocative for the development of arthritic characteristics. Degenerative changes in the spine are strongly associated with “frank and subtle instability” of the discs and the junctions where vertebral bones sandwich the discs [2]. It is important to note that the spine is a very stable structure overall. The use of the word instability cultivates the idea that the spine is fragile, which is untrue. These areas of subtle instability are focal rather than global, and catalyze the development of adaptive changes in order to maintain a high level of spinal stability.

Risk factors for developing osteoarthritis (OA) in the lower body include previous joint injuries, a history of participation in high-intensity athletics, hip dysplasia and hip impingement. The correlation between OA and sports may result from injuries and/or repetitive joint stresses. Due to this link, risk assessments and proper injury management are important for adolescents. Of note, knee injuries are extremely common for youth athletes. High rates of adolescent sport participation and the associated injury prevalence indicate a potential for future increases in OA cases; making injury prevention paramount. Osteoarthritis can be painful and often results in decreased joint range of motion. These signs and symptoms can negatively impact quality of life by hindering simple daily activities years after adolescent sports have ceased [1].


SIGNS & SYMPTOMS


How does one determine if they are developing osteoarthritis (OA)? Common symptoms include persistent joint pain and intermittent stiffness. As mentioned above, people who have a history of joint injuries are at elevated risk. Clinical evaluation by a healthcare provider is warranted prior to imaging, such as x-ray and MRI. A comprehensive assessment without imaging can provide ample information for diagnosis and treatment of many OA cases. X-ray findings do not generally correspond well with symptoms and often fail to highlight specific pain generators. MRI findings also provide debatable clinical significance for OA diagnosis and treatment. If a clinician believes that x-ray and MRI will not impact treatment or accurately predict future disease progression, imaging is not necessary. Clinicians may require imaging for OA patients if they suspect more serious complications such as inflammatory conditions, fractures, infection, etc. [1].


What does a comprehensive joint assessment entail? A clinician will discuss your health history in detail, perform a thorough physical examination, and request feedback regarding your goals and how your symptoms are impacting daily life. Your clinician will create a tailored management plan centered around the activities in which you need to participate without the burdens of pain and joint dysfunction [1]. A plan will be formulated to achieve your desired outcome based on your input and the clinician’s expertise.


SOLUTIONS & TREATMENT


Treatment for osteoarthritis (OA) involves a variety of clinical therapies, patient education, lifestyle alterations, exercise therapy, and weight management (if applicable). Surgical consultation may be necessary for some patients [1].


“Based on past trajectories of growth in the United States, it is anticipated that 52% of all primary total hip replacements and 55% of all primary total knee replacements will be performed for younger patients (defined by the researchers as younger than 65 years) by the year 2030” [1].

You have the power to play an active role in your joint health and avoid being part of these statistics. Osteoarthritis should be depicted as a natural adaptive process rather than a disease of joint decay. Injury prevention and proper management need to be emphasized in younger populations. People of advanced ages who already suffer from OA can increase mobility and stability with appropriate clinical care, exercise and lifestyle modifications. If you believe that you are suffering from osteoarthritis or that you may be at risk, the first step is seeking a comprehensive clinical evaluation from an experienced healthcare provider.


Netley Chiropractic utilizes a thorough health history and physical examination to diagnose the source of pain and dysfunction. We create customized management plans that are effective for people suffering from arthritis. Dr. Netley practices a variety of low force and non-force techniques that do not require twisting or cracking joints. These techniques include the Activator Method, McKenzie and Mulligan Mobilization with Movement. As the pain subsides, Netley Chiropractic incorporates therapeutic exercise to help get you moving with greater ease and less pain. Our goal is to provide healthcare to empower you and improve your quality of life.


Sources:

[1] Ackerman, I. N., Kemp, J. L., Crossley, K. M., Culvenor, A. G., & Hinman, R. S. (2017). Hip and Knee Osteoarthritis Affects Younger People, Too. Journal of Orthopaedic & Sports Physical Therapy, 47(2), 67-79. doi:10.2519/jospt.2017.7286

[2] Swanson, B. T., & Creighton, D. (2020). The degenerative lumbar disc: not a disease, but still an important consideration for OMPT practice: a review of the history and science of discogenic instability. Journal of Manual & Manipulative Therapy, 28(4), 191-200.

[3] McGill, S. (2016). Low back disorders: Evidence-based prevention and rehabilitation. Champaign, IL.: Human Kinetics.