ON Chiropractic
FEATURE STORY / OSTEOARTHRITIS
I
t is very common for chiropractors
to provide treatment to
osteoarthritis patients both
before and after the onset of
symptoms and diagnosis. Recent
research indicates that chiropractic care
in conjunction with other therapies,
predominantly exercise and education,
can result in reduced pain and increased
mobility for these patients.
Risk Factors and Diagnosis:
f more than 100 types of
arthritis, osteoarthritis is the
most common. It is a leading
cause of pain and disability worldwide,
predominantly impacting the hips, knees,
hands and spinal facets.
Prevalence of osteoarthritis increases
with age, with a sharp increase after age
70. It does not only impact senior patients,
however. Previous injury and overloading
joints, for instance, have been connected to
onset of secondary osteoarthritis. Systemic
factors, such as family history and lifestyle,
can play a role in the development of
osteoarthritis as well. Excessive weight
in the lower extremities is particularly
problematic as the added strain can hasten
or exacerbate symptoms. At least one study
has demonstrated that incidences of knee,
hip and hand osteoarthritis in women
increase around the time of menopause,
indicating a possible hormonal causation.
A 2013 article in Osteoarthritis
Cartilage points out that osteoarthritis is
not a single disease, but rather a common
end stage phenotype of many different
disease processes which involve joint
tissues.b Osteoarthritis involves damage to
and loss of articular cartilage, remodeling
of subarticular bone, osteophyte
formation, ligamentous laxity, weakening
of the periarticule muscles and possibly
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18
WINTER 2014
synovial inflammation. This has led to
inconsistent approaches to the diagnosis of
osteoarthritis.s
The Arthritis Society of Canada
tells patients to expect a combination
of diagnostics to be used to form an
osteoarthritis diagnosis, including patient
history, discussion of symptoms, manual
examination of joints and radiographic
analysis. However, the use of radiographic
criteria alone generally leads to a higher
diagnosis rate of osteoarthritis.l A balance
of radiographic and clinical evidence is
encouraged.
Understanding Osteoarthritis Painn:
steoarthritis pain is difficult
to pin down. In fact, for
some time there has been an
incomplete understanding of the etiology
and mechanics of pain in osteoarthritis
patients. In some cases, observed
radiological changes are not consistent
with pain reported by patients. These
findings seem to contradict the belief
that greater degeneration of joints would
result in greater levels of pain. This can be
explained by variance in individual patient
perceptions of pain levels, but the lack
of a clear relationship between structural
damage and pain has led some researchers
to consider whether other mechanisms may
be responsible for the pain experienced by
osteoarthritis patients.
Like other chronic musculoskeletal
conditions, central sensitization has been
proposed as one such mechanism. A focus
of recent study has been on osteoarthritis
pain being the result of central pain
mechanisms. Several conditions, including
fibromyalgia and temporomandibular
disorder, have been grouped together in the
category of “central sensitivity syndromes”
(CSS). To date, osteoarthritis has not been
O
Statistics
According to The Arthritis
Society of Canada:
100+
Number of types
of arthritis
4.6m