What is Arthritis?
For the purposes of this article we are focusing on osteoarthritis. Other kinds of arthritis, such as rheumatoid or psoriatic arthritis generally fall beyond the scope of chiropractic care, whereas osteoarthritis is something chiropractors help with on a daily basis.
Osteoarthritis is the most common type of arthritis and is one of the leading contributors to joint pain in the UK.
Osteoarthritis occurs as joints adapt to stress, such as that resulting from everyday use.
These adaptations cause changes in the shape and composition of a joint. These changes can usually be seen on an xray or scan. Arthritis is generally thought of as a degenerative condition, in that it is typically more prevalent among older populations and often gets worse over time, but this is not always the case.
Osteoarthritis can affect any joint, but is more common in more mobile and more load-bearing joints such as knees, hips, toes and fingers.
Contrary to popular belief, osteoarthritis does not always cause pain. Many people have arthritis and experience no symptoms.
Treatment options for arthritis are many, but generally osteoarthritis responds very well to exercise and manual therapy.
What Causes Arthritis?
Arthritis takes a long time to develop and so causes can be difficult to pin down.
Generally speaking, we can say that arthritis occurs when a joint and its surrounding musculature cannot tolerate the stress of regular use.
This could be because the joint is being put under too much strain and cannot cope. Or, and much more commonly, it is because the joint is not conditioned for the strain it is being subject to.
One thing that we do know about the causes of arthritis is that under-developed muscle is a major factor. Muscle serves to protect joints and while your muscles are in good condition, arthritis is unlikely to develop.
There are known risk factors that increase your chances of developing arthritis, chiefly, being overweight, smoking and other joint conditions.
Another contributor to the onset of arthritis is previous trauma. Sprains, jolts and breaks can all impact on how a joint functions, affecting its ability to cope with normal use and sometimes leading to arthritic changes.
Self help for Arthritis
There are countless self-treatment methods for arthritis. Some people will respond better to some remedies than others, so don’t discount a treatment option just because you know somebody for whom it hasn’t worked, and similarly, just because it worked for somebody else, don’t be dispirited if it doesn’t work for you.
Exercise is by far and away the best treatment for arthritis and is something that anybody can do by themselves. Exercise can be weight-bearing or non-weight-bearing, but should focus on mobilising the affected joint and strengthening surrounding muscles.
Losing weight if you are overweight is extremely helpful if you have arthritis, particularly if it is affecting load-bearing joints such as knees and hips.
Over the counter (ie. not prescribed) anti-inflammatories can be useful for reducing pain levels, which is particularly helpful if this allows you to maintain normal levels of activity. If you have stomach problems, heart problems or are on other medication, discuss this with your pharmacist before taking anti-inflammatories.
Ice packs and heat packs can also provide pain relief, with no associated risks. In most cases they should be applied for 20 minutes. Direct contact with your skin should be avoided.
Topical gels and rubs, such as those containing anti-inflammatories or menthol, have little proven efficacy, but can be worth a try.
Some people find dietary changes to be helpful for easing the symptoms of arthritis, but generally the effect is small, particularly if you have an already healthy diet.
Supplements for arthritis have mixed research supporting their use. The supplements with best research supporting their use include Green Lipped Mussel Extract, Omega-3 and vitamin D.
When to see a Chiropractor
Not everyone with arthritis gets pain, and similarly, just because you have arthritis it does not mean that this is necessarily causing your symptoms. Getting checked over is therefore a useful thing to do.
An in-depth physical exam will help establish the cause of your pain, making it easier to take effective action.
If you know that you have arthritis, seeing a chiropractor can be helpful as manual therapy is one of the best ways of keeping a joint mobile and relieving pain. Chiropractors can also advise on the best rehabilitative exercises and other treatment options that are available to you.
Seeing a chiropractor is not going to cure your arthritis, but can significantly ease the symptoms and slow its progression. We recommend that anybody with pain related to osteoarthritis seeks regular chiropractic care.
When not to see a Chiropractor
There are few instances where seeing a chiropractor is the wrong thing to do if you arthritis, but it is useful to know when you may be better seeking alternative help.
If your joint mobility is very severely restricted, you may be beyond the point at which manual therapy will benefit you. In this instance it is likely that you will have had joint pain and stiffness progressing for many years.
If you have been feeling generally unwell, have noticed several of your joints have become painful at once, or are waking up in the early hours with pain, you should go to your GP before seeing a chiropractor.
Diagnosis of arthritis is almost always based on your description of symptoms. Your clinician may also decide to factor in your age as a diagnostic criteria.
Rarely are scans or x-rays required, although arthritis is easily spotted using these methods.
Strictly speaking, a diagnosis of arthritis is not always very helpful. As we have already mentioned, many people have arthritis but no symptoms, so it is more helpful to narrow a diagnosis down further.
After physical assessment, a clinician should be able to advise how much of your problem is coming from various structures within the joint and how much is associated with the adjacent muscles. This is important when it comes to deciding on treatment options.
You do not need a blood test to diagnose osteoarthritis, but sometimes these are used to rule out other causes of pain.
Treatment options for Arthritis
In addition to self-management methods, there are a number of different treatment options that can provide relief from pain related to osteoarthritis.
While no treatment is going to reverse the adaptive changes to your joints, there are lots of good means of easing pain and improving function.
These treatment options can be broadly categorised as conservative and invasive. Conservative options centre on manual therapy and exercise, whilst invasive methods include injections and surgery.
Conservative Options For Arthritis
Manual therapy, usually consisting of joint mobilisation or manipulation, can be very effective at improving range of movement and flexibility, often alleviating pain at the same time.
Since arthritis is a complex condition, often involving muscles and other soft tissues as well as joints, manual therapy aimed at improving the flexibility and function of these tissues is also beneficial.
In cases of foot, ankle, knee and hip arthritis some people benefit from shoe orthotics to help address gait issues.
Some people report relief from acupuncture, but research is conflicting.
Exercise of almost any kind is helpful for patients suffering from arthritis, but targeted exercise is more effective. Research also suggests supervised exercise is more effective than unsupervised.
Chiropractors are able to provide manual therapy and advise the most effective corrective exercise strategies for patients with osteoarthritis.
If conservative options have been exhausted you may be a candidate for more invasive treatments. You may benefit from further diagnostic tests before having more invasive treatments. These may include blood tests and imaging to ensure nothing else could be contributing to your pain.
A common course of action for patients with arthritis is a corticosteroid injection (a potent anti-inflammatory). These injections reduce any inflammation affecting the arthritic joint and in some cases can provide several months of relief.
Ideally, patients should resume manual therapy and rehabilitative exercise shortly after having a corticosteroid to best use this pain free period to build resilience in the affected joint, lessening the likelihood of recurrence.
Risks from injections include infection and osteonecrosis (a condition in which bones degenerate).
Numerous surgical options exist for osteoarthritis. Most commonly these include debridement and replacement.
Debridement is less severe, involving shaving away roughened parts of the surfaces inside a joint. This is not a permanent solution, as joint surfaces will roughen again, however it can provide good relief for a few years.
Joint replacement is available for severely arthritic large joints, such as elbows, shoulders, hips and knees. Sometimes this process is referred to as joint resurfacing.
This is a significant surgery and all other options should be exhausted first. Being in good physical condition, of healthy BMI and with strong muscles greatly improves the outcome of this surgery.
Proper rehabilitation must be continued after surgery to ensure maximal return to function.
Prevention of Arthritis
Arthritis is not inevitable. Not everybody gets arthritis and not everybody with arthritis gets pain.
Research has shown that arthritis is less common in people who maintain muscle strength into older age. Strength training, therefore, is one of the best things you can do to protect yourself from osteoarthritis.
Taking this one step further, a type of training called proprioceptive training is also very helpful. Proprioceptive training involves exercise to challenge your control of joint movement. A good example is squatting on one leg, progressing to doing this on a wobble cushion.
Exercising in this way improves flexibility, strength and muscle coordination, three essential elements to maintaining healthy joints.
There can also be benefits to seeing a chiropractor on a preventative basis. Chiropractors look at how your body is moving and what you can do to improve its resilience. Addressing any weaknesses before arthritis develops is the best way to keep your joints in good condition.