ON Chiropractic
FEATURE STORY / OSTEOARTHRITIS
slow disease progression and potentially
delay or stave off surgery.
In patients where the presence
of central sensitization is identified,
researchers encourage the use of
neuroscience education over a
biomechanical approach. Neuroscience
education involves reducing pain
and disability by helping the patient
understand the biological processes
underlying their pain. This approach
“
other therapies have reported positive
results. An RCT involving surgical hip
osteoarthritis patients compared outcomes
of patients who received education
and manual therapy treatments by a
chiropractor twice a week for six weeks to
those of a control group that received only
patient education. The combination of
manual therapy and patient education was
determined to be more effective. Patients
who did not receive surgery reported that
A combination of exercise therapy
and patient education are likely to
be the most efficacious supplements
to your standard chiropractic
treatment protocols.”
is specifically recommended in central
sensitization cases where the patient has
developed maladaptive or coping strategies
in response to their painn. Practice
guidelines have been developed to help
explain central sensitization to patients
with chronic MSK pain.m
Spinal Manipulative Therapy:
here is not sufficient evidence
to definitively state that spinal
manipulation has a positive
impact on the treatment or management
of osteoarthritis. Randomized controlled
trails (RCTs) have demonstrated that
osteoarthritis patients who have received
spinal manipulation in conjunction with
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the benefits of their care were maintained
at 12 months.D
Another study examined three
groups of hip and knee osteoarthritis
patients. One group received manual
therapy, one received exercise therapy
and one received both therapies. Both
the manual therapy and the exercise
approaches were more effective than the
control group with results maintained
at 12 months. There was no additional
benefit to the combination of manual
therapy and exercise therapy. In this RCT
the manual therapy was performed by
physiotherapists.q Another RCT of hip
osteoarthritis patients found that manual
therapy provided no additional effects over
exercise therapy, but did increase patient
satisfaction. Manual therapy was provided
by physiotherapists in this study as well.Q
Modalities and Acupuncture:
ith respect to knee
osteoarthritis, there are
multiple studies that indicate
that modalities, specifically interferential
current (IFC), TENS, low level laser and
acupuncture are beneficial. The evidence
is inconclusive with respect to patients
managing hip, spine and other forms of
osteoarthritis.
W
Prescription Medications and NSAIDs:
ver the counter and prescription
medication use is very common
for osteoarthritis patients. As
osteoarthritis is most prevalent among
seniors, the connection between narcotic
prescription and NSAID use and the
significantly increased risk of falls and
fractures is particularly concerning.
Side effects and the risk of
dependency are also concerning. Chronic
use of NSAIDs specifically is linked to
numerous side effects, including upper
and lower gastrointestinal (GI) damage,
cardiovascular events, renal toxicity,
increased blood pressure and deterioration
of congestive heart failure. 40% of chronic
NSAID users report upper GI symptoms,
such as reflux, dyspepsia and ulcers. Many
of these side effects are more common in
the elderly.w
O
Nutraceuticals & Contemporary/
Alternative Therapies:
lucosamine and hyaluronic
acid use among osteoarthritis
patients has been recently studied
G
with moderate benefits. Glucosamine
can be beneficial in knee osteoarthritis.
Hyaluronic acid was shown to result
in a mild reduction in pain and is also
correlated with increased risk of adverse
events. Capsaicin, Indian frankincense,
methyl-sulphonyl-methane and rose hip
may also have moderate benefits. Other
contemporary and alternative therapies,
such as magnetic and copper bracelets,
hypnotherapy and music therapy have not
been proven to lead to significant positive
outcomes. Treatment options such as these
should be administered on a case-by-case
basis and under close supervision. Benefits
are likely to vary greatly.
Conclusion:
here are many approaches that
chiropractors can employ when
creating and managing treatment
plans for their osteoarthritis patients.
On balance, a combination of exercise
therapy and patient education are likely to
be the most efficacious additions to your
standard chiropractic treatment protocols.
As with many musculoskeletal conditions,
treatment options for osteoarthritis patients
will need to be managed proactively with
the expectation that what worked with
one patient may not afford the same
results to the next. Similarly, as the disease
progresses, additional interventions may
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be required. Even in the case of surgery,
though, the role of chiropractors
is growing.
The commitment of the patient is
a crucial component to establishing an
effective treatment plan. Patients must
be encouraged to follow their treatment
plan, manage their lifestyle and change
behaviours that may be contributing to
their symptoms or disease progression.
Enhanced collaboration with the other
members of the patient’s health care team
can also be beneficial. When a working
partnership between practitioners and
patients exists, the likelihood of positive
outcomes is enhanced. ON
Recommended Reading
Arden, N.K. & Leyland, K.M. “Osteoarthritis year 2013 in review: clinical.” Osteoarthritis Cartilage 21:10 (2013): 1409-1413. Online.
b
Litwik, A. et al. “Epidemiology & burden of osteoarthritis.” British Medical Bulletin 105 (2013): 185-199. Online.
s
Neogi, T. “The epidemiology and i \X