Osteoarthritis (OA) is the most common joint disease worldwide. It affects an estimated 10% of men and 18% of women over the ages of 60. (1) OA is not only debilitating to those who suffer from it, but it is also a significant social and financial burden for them. (1) There are many risk factors of OA and it’s easier to break these down into two subtypes: person level factors and joint level factors. Person level factors include age, gender, genetics, obesity and diet, while joint level factors include injury and abnormal loading of the joint.
Studies show that OA develops through the action of ‘hostile’ biomechanics (oppositional movement or structure) on a susceptible joint. (1) This is further reinforced by studies showing the relationship between certain joint dysfunctions/disorders and osteoarthritis. For example, femoroacetabular impingement (FAI), a joint disorder in which extra bone grows along one or both of the hip bones, can cause up to a ten-fold increased risk that end-stage hip osteoarthritis will develop within five years. (1) Similarly, abnormal tibial and femoral bone structure seems to suggest possible development of OA as does limb alignment. Some evidence has shown that irregular varus and valgus knee alignment increases the risk of development or progression of OA in the more loaded region of the joint.
How Chiropractic and Massage Can Help Osteoarthritis
The clinical importance of evidence-based research is that it helps practitioners predict the onset and progression of symptoms of OA. Moreover, given a chiropractor’s knowledge of the biomechanics of the joint, effective strategies can be implemented to alter loading patterns. Thereby reducing the biomechanical stressors on the joint.
The strongest therapeutic evidence to manage OA (hip and knee) is the introduction of knee and hip exercises. However, it is unknown which specific type of exercise is deemed best. Therefore, it’s important that your clinician prescribes an individualised and patient-specific exercise program, taking your personal preferences and capabilities into account. The program should be progressed in terms of frequency, duration, intensity and volume/load of the exercises. If results do not begin to show immediately then exercise should not be stopped, but altered. There is also a known relationship between weight loss and the symptomatic relief of OA. As a result, the introduction of weight-loss strategies, targeting a 5 to 7.5% weight loss goal, is highly recommended.
In combination with the above treatment methods, there are secondary interventions that can be trialed or introduced. Secondary methods should rarely (if ever) be used as standalone treatments. Instead, they are applied to help support you with your primary intervention methods. Consider how soft tissue therapy and joint-based treatments would help you, then apply them in this scenario. For example, soft tissue therapy/massage helps relieve localised muscle pain and function. Whereas chiropractic manipulation and mobilisation helps improve biomechanical function and movement. Both therapies allow you to exercise more effectively, which results in a greater therapeutic benefit.
If you’ve been diagnosed with OA or suspect it, please book a consultation with your chosen musculoskeletal health professional. You and your practitioner can work together to implement an exercise-based strategy and/or an assessment to determine if there are any biomechanical triggers that can be dealt with to help you get back to doing the things you love most.
Lachlan Fisher BHS/AppSc (chiropractor)
(1) S Glyn-Jones, A J R Palmer, R Agricola, et al. Osteoarthritis. The Lancet. 2015; 386: 376-387 (2) R. Christensen, E.M. Bartels, A. Astrup, Et al. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007; 66: 433-439. (3) The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.