When I decided to write a column on arthritis, I immediately thought of a patient from years ago who was a bull rider in the rodeo out West. No one would be surprised to learn that his X-rays showed multiple areas of advanced arthritis (along with several fractures).
There are two main types of arthritis. The first type is disease-based; in this group are autoimmune conditions such as rheumatoid and lupus, as well as metabolic types (gout) and joint infections.
But by far the most common form is osteoarthritis, sometimes called the “wear and tear” type. It is typical to see arthritic damage in the joint years after an injury, or with overuse; once we reach a certain age the X-ray changes are almost universal.
There seems to be a genetic component to it as well. Some people are more prone to this type of arthritis if there is a strong family history.
X-rays are a great way to diagnose arthritis, but they are a poor tool to determine how much pain the patient actually will have or how well the patient will respond to treatment. I used to X-ray most of my patients and grade their arthritis by how much cartilage loss there was, but I stopped when I found that information wasn’t really helpful.
Much of the pain in an arthritic joint is not from the arthritis itself; our bodies can work around a tremendous amount of damage. The pain is often caused by the same mechanical joint and muscle dysfunctions that cause pain in so many people without arthritis. These dysfunctions are more painful when they are in an arthritic joint, but when the joint is freed of these mechanical problems the arthritis is much less painful.
I have seen patients with “bone on bone” arthritis become pain-free when the joints were treated; clearly, their pain was due to something other than the loss of joint space and spurs that seem so dramatic when seen on X-ray. Of course, the more loss of joint space there is, the less likely the patient will get complete relief with treatment, but we don’t know how well any patient will respond until the treatment is tried.
Manipulation is the treatment that we start with for most of our arthritic patients. Chiropractors are trained in many styles of manipulation, and we often modify our treatments for arthritic joints. Special tables allow us to use much less force (and no “cracking”) to get the joint working better and improve alignment, and hand-held instruments allow us to use even less force, perfect for the patient who has both arthritis and osteoporosis. Other tables provide gentle traction on the spine, which is a great relief for low-back arthritis.
If there is advanced arthritis, the relief may not be complete, but most patients do benefit from manipulation.
Acupuncture is also very helpful in treating arthritis. It reduces pain and inflammation, relaxes the surrounding muscles, and makes most patients feel more relaxed afterwards. These treatments are helpful both in stopping or reversing the downward cycle common in arthritis — activity causes pain, so the patient does less and less until he or she ends up sitting most of the day. Unfortunately, inactivity is also bad for arthritic joints, so anything that improves their tolerance for exercise helps prevent further damage to the joints.
Of course, any health problem can be made worse by lifestyle, and osteoarthritis is no exception. The “itis” at the end of the word means there is inflammation involved. This inflammation is made worse by the mechanical problems I talked about earlier, but also is fueled by our diets. We eat a lot of “pro-inflammatory” foods.
The worst offenders for many patients are grain products, with their low ratio of omega-3 to omega-6 fatty acids, but the worst of the worst are white flour and sugar-laden foods. Another culprit is factory-farmed beef, chicken and fish, because they are raised on grains. We also consume a lot of vegetable oils, which have the same problem with the fat ratio. These dietary imbalances have helped make anti-inflammatory drugs among the best-selling drugs today.
With many arthritic patients, the greatest difficulty is not the actual treatment. It is fighting the pessimism instilled in us. We are taught there is no real treatment for arthritis other than painkillers and anti-inflammatory drugs, and eventually joint replacement. Getting a patient to even try an alternative treatment for arthritis (or changing their diet) can be like pulling teeth.
Wellness care is not a cure for arthritis, but most patients get enough relief that they wonder why they waited so long to start. This is true even for rodeo bronco busters.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.