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Arthritis

Posted on 16. Feb, 2015 by in Read

 Arthritis and chiropractic

Joseph J Ierano B.Sc., D.C.

 

The literature, whilst relatively scarce regarding chiropractic and arthritis, contains many studies that examine chiropractic care of the patient with arthritis and support the notion that all arthritides are not a contraindication to chiropractic care.

 

Pain and spinal degeneration

Please note the distinction between the terms “chiropractic care” and “manipulation”. Not all chiropractic visits consist solely of manipulation. As far as the existence of arthritis in the spine, or more properly termed Osteoarthritis, or Degenerative Disc Disease (DDD), we shall briefly cite several studies.

 

A study published in the journal of Neuroimaging in 1991 showed that in patients without low back pain undergoing MRI, 39% of this normal group had evidence of DDD.[i] A New England Journal of Medicine Article in 1994 found similar results.  It demonstrated that of 98 subjects without low back pain, 52% had DDD on MRI.[ii] This can be found in the thoracic spine (upper back) in the Journal of Bone and Joint Surgery in 1995.  Thoracic MRI’s were performed in 90 asymptomatic adults.  73% of these patients had DDD at least one level.[iii] This also goes for the cervical spine[iv] with the prevalence of DDD increasing with age. There are no studies that determine that DDD is a painful condition.

 

Therefore, we may assume that the DDD creates a situation where other functional problems eventuate, such as the case where arthritic joints or degenerative discs move abnormally predisposing them to injury.[v]

Medical research says Chiropractic helps arthritis

Medical researchers Fiechtner and Brodeur[vi] state clearly that arthritic conditions may benefit from chiropractic, with reflexive muscular function being normalised during spinal manipulation:

 

Manipulation is practiced primarily by chiropractors and osteopaths and is one of the most commonly utilized alternative treatments for rheumatic diseases… Manipulation has been shown to decrease joint pain and normalize function. The mechanisms of action, however, are not well understood. Current theories propose an imbalance of muscle activity is a source of pain that manipulation can relieve through reflexive actions. Such muscle imbalances would exacerbate rheumatic and arthritic conditions, suggesting that manipulation may be an important therapy that is appropriate for early conservative care as part of a comprehensive treatment program.

 

Drug dangers

Other authors[vii] have evaluated the rationale behind the most commonly used treatments of osteoarthritis, including nonsteroidal anti-inflammatory drugs (NSAIDs), and to assess more effective conservative treatment options. In conclusion they state:

The rationales for using NSAIDs in the treatment of osteoarthritis is controversial and openly contested. Given the detrimental effects of NSAIDs on joints and other organs, their use should be discouraged and their classification as a first choice conservative treatment should be abolished. A truly effective and conservative approach to the treatment of osteoarthritis should include chiropractic manipulation, essential nutrient supplementation, exogenous administration of glucosamine sulfate and rehabilitative stretches and exercises to maintain joint function.

 

“Alternative” therapies widely used by arthritis sufferers

Use of chiropractic is a prominent part of the medical literature, and commonly praised. Saag, from the Department of Internal Medicine, University of Iowa College of Medicine, wrote:

 

Advances in rheumatologic arthritis health services research continue to be of interest to clinical rheumatologists and arthritis researchers interested in healthcare delivery and policy. New therapeutic programs have been proposed to better coordinate efforts between generalists and specialists. Many arthritis patients also seek alterative therapies. Of these, chiropractic care is one of the most common nontraditional therapies. Chiropractic management appears to be as cost-effective as traditional back care in certain settings.[viii] (italics mine)

 

Safety of chiropractic care

Manipulation of the spine carries with it inherent risks. University trained Chiropractic, which incorporates spinal adjustment and manipulation, is relatively safe and carries a minuscule risk when compared to medical treatment. In an Australian government paper, “Complications of medical/surgical care ” is, quite shockingly, rated as the fourth greatest cost to the community. Greater than superficial injuries, contusion, burns, poisoning, toxicity, and internal crushing injury.[ix] We question the notion that chiropractic care is categorised as a high-risk procedure for arthritis patients.

 

In contrast, in a paper entitled “Side-effects to chiropractic treatment: a prospective study”[x] looked at chiropractic iatrogenesis. They found that:

 

Reactions to spinal manipulation are common and benign. They typically arise and disappear shortly after treatment (usually gone the day after treatment). The most common reactions are local discomfort in the area of treatment (two-thirds of reactions), followed by pain in areas other than that of treatment, fatigue or headache (10%, respectively). Nausea, dizziness or “other” reactions are uncommonly reported (<5% of reactions)… Common and uncommon reactions to chiropractic spinal manipulation have been identified, are to a large degree foreseeable, and appear to be predominantly physiological in nature.

 

 

Conclusion

Chiropractic remains one of the safest procedures for the arthritic patient. Further research is needed to assess its mode of action and efficacy in the various forms of conditions commonly described as “arthritis”.


REFERNCES:



[i]Greenberg JO; Schnell RG. Magnetic resonance imaging of the lumbar spine in asymptomatic adults. J Neuroimaging 1991 Feb;1(1):2-7

[ii] Jensen MC; Brant-Zawadzki MN; Obuchowski N; Modic MT; Malkasian D; Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994 Jul 14;331(2):69-73

 

[iii] Wood KB; Garvey TA; Gundry C; Heithoff KB. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am 1995 Nov;77(11):1631-8

 

[iv] Parfenchuck TA; Janssen ME. A correlation of cervical magnetic resonance imaging and discography/computed tomographic discograms.1994 Dec 15;19(24):2819-25

 

[v]Mimura M; Panjabi MM; Oxland TR; Crisco JJ; Yamamoto I; Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine 1994 Jun 15;19(12):1371-80

 

[vi] Fiechtner and Brodeur. Manual and manipulation techniques for rheumatic disease. Rheumatology Diseases Clinic of North America 2000 Feb: 26(1): 83-96.

 

[vii] Gottlieb MS. Conservative management of spinal osteoarthritis with glucosamine sulfate and chiropractic treatment. J Manipulative Physiol Ther. 1997 Jul-Aug;20(6):400-14

 

[viii] Saag KG. Curr Opin Rheumatol. 1997 Mar; 9(2):118-25

 

[ix] Mathers C, Penm R. Health system costs of injury poisoning and musculoskeletal disorders in Australia 1993-4. 1999. Australian Institute of Health and Welfare. Canberra.

 

[x] Charlotte Leboeuf-Yde, DC, MPH, PhD, Bjorn Hennius, DC, Erik Rudberg, DC, Patrick Leufvenmark, DC and Marija Thunman, DC. Side-effects to chiropractic treatment: a prospective study. J Manipulative Physiol Ther 1997; 20:511-515.

 

 

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