What is arthritis?
The term arthritis describes a group of conditions that affect the cartilage (the smooth protective surface covering joints) in joints. Degeneration of cartilage can cause pain, inflammation, and decreased mobility in affected joints.
Osteoarthritis is the most common form of arthritis, affecting millions of Americans. It used to be thought that osteoarthritis was the result of “normal wear and tear” in joints. Evidence is growing, however, that biomechanical factors such as muscle control, muscle weakness, and obesity play a significant role in the development and progression of the disorder.[i] Since chiropractic treatment restores function to joints, it is a wonderful tool for preventing arthritis. In joints that are already arthritic, chiropractic is the treatment of choice to rehabilitate and delay or arrest further degenerative change. It has also been found that in some cases diet may play a role. This information has led to a great deal of research about the role of exercise and diet in the treatment and prevention of osteoarthritis.
I thought exercise caused my joints to “wear out”.
It is true that long-term practice of certain high impact sports (soccer, football) may increase the incidence of osteoarthritis.[ii] It is also true that exercise is one of the best proven long-term treatments for osteoarthritis. In fact, muscle weakness has been shown to be an accurate predictor of future disability in people with osteoarthritis of the knee. Movement provides joints with nutrients needed for repair and healthy function. There is very little blood supply to cartilage—regular movement serves to “squeeze out” nutrient depleted fluids and “draw in” fresh, nutrient rich fluids.
Walking and resistance training have been shown to both decrease pain associated with osteoarthritis of the knee and increase physical function (i.e. rising from a chair, walking up stairs).[iii] [iv] [v]
The key to building a successful exercise program with osteoarthritis is to find activities that do not aggravate the condition. Activities should target muscle groups that cross the affected joint (for example the quadriceps for osteoarthritis of the knee). Consider non weight-bearing exercises (i.e. leg extensions for the knee rather than squats) when developing a resistance routine. When picking an aerobic exercise consider low impact choices (elliptical trainer, swimming, walking) rather than high impact (basketball, running). Exercises that cause either a significant increase in pain, or an increase in pain that lasts greater than 2 hours after the exercise, should be avoided. If exercise involving movement is too painful, consider beginning with isometric exercises.[vi] [vii] Use gentle, controlled stretching techniques to maintain joint mobility.
Chiropractic Care and Arthritis
Chiropractors are experts in joint mechanics and movement. If your joints move too much or too little they will experience forces that lead to early breakdown and arthritis. Regular chiropractic care ensures the best possible movement patterns in your joints. Chiropractic care combined with exercise allows joint tissue access to the nutrients needed to maintain health.
What about diet?
Being overweight is the single most important modifiable risk factor for osteoarthritis. Studies show that losing weight decreases risk and also improves symptoms in people who have osteoarthritis in the weight-bearing joints (hips, knees, ankles). Losing as little as 10 pounds can have a significant effect.
The “nightshade free diet” is reported to reduce osteoarthritis symptoms in many people, although more research needs to be done. The nightshade family includes tomatoes, white potatoes (not yams or sweet potatoes), eggplant, hot and sweet peppers, and tobacco. This food group contains natural toxins including solanine that may be capable of causing joint problems in sensitive people. It is reported that abstaining from these foods for up to 6 months may be necessary to obtain relief.[viii] [ix]
Are there any supplements that will help?
Yes! Several studies have shown that glucosamine sulfate is very effective in relieving pain associated with osteoarthritis. Some studies show that taking this supplement can cause joint cartilage to rebuild and repair itself. This is especially noteworthy because while one gets about the same pain relief from glucosamine sulfate as with NSAIDs[x] (i.e. ibuprofen), many NSAIDs have been shown to be destructive to joint cartilage! [xi] [xii][xiii] [xiv] [xv] Most studies have used 1500mg of glucosamine sulfate 1 time per day. This supplement takes about 2 weeks to take effect.
An herbal supplement that has undergone a great deal of research and which I have used with fantastic results in my practice is Zyflammend. This product is a blend of several herbs containing anti-inflammatory properties. It has been shown to be about 90% as effective as prescription anti-inflammatories, but without the side effects. In fact, whereas pharmaceutical anti-inflammatories pose a great risk to your digestive track and your cardiovascualr system, Zyflammend is beneficial to both systems.
Other supplements that have been shown to be helpful are:
q MSM 2250mg/day[xvi]
q SAMe 1200mg/day[xvii]
q Capsaicin ointment .025%-.075%[xviii]: This can be applied to superficial joints like the hands and feet. It is applied 4 times per day and may take up to 4 weeks to become effective. It does not penetrate deep enough to treat deep joints such as the spine or hip.
What can I do to deal with flare-ups?
During flare-ups ice and rest are your best friends. You can ice a joint with an ice pack or a bag of frozen vegetables. Ice for 15-20 minutes and be sure to have a layer (like a shirt or pants between your skin and the ice pack. Do not ice more than 20 minutes.
As you are able to, begin isometric exercises (exercises during which the joint does not move). As you make a comeback to exercise ice after your workout to minimize inflammation and damage.
Take the time to try the various strategies outlined above. I find that exercise, chiropractic care, and supplementation alleviates most patients' arthritic pain. This translates to more ease of movement and a higher quality of life. You deserve the best, make a commitment to implementing these strategies.
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[ii] Spector TD, Harris PA, Hart DJ, et al. Risk of osteoarthritis associated with long-term weight-bearing sports. Arth Rheum 1996;39:988-95.
[iii] Kovar PA, et al. Supervised fitness walking in patients with osteoarthritis of the knee. Annals of Internal Medicine. 1992;116:529-34.
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[vi] Petrella R. Exercise for older patients with chronic disease. The Physician and Sports Medicine. 1999:27;11.
[vii] Petrella R. Exercises for patients with knee osteoarthritis. The Physician and Sports Medicine. 1999:27;11.
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[ix] Childers NF, Margoles MS. An apparent relation of nightshades (Solanaceae) to arthritis. J Neurol Orthop Med Surg. 1993;14:227–31.
[x] Muller-Fassbender H, Bach G, Haase W, Rovati L, Setnikar I. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994 Mar;2(1):61-9
[xi] Brooks PM, et al. NSAID and osteoarthritis: help or hindrance? Journal of Rheumatology. 1982;9:3-5.
[xii] Brandt KD, Palmoski MJ. Effect of salicylates and other non-steroidal anti-inflammatory drugs on articular cartilage. Am J Med. 1984;77:65-69.
[xiii] Rashad S, Hemingway A, Rainsford K, Revell P, Low F, Walker Fl. Effect of non-steroidal anti-inflammatory drugs on the course of osteoarthritis. Lancet.1989; (8662):520-22.
[xiv] Dingle JT. The effect of NSAIDs on human articular cartilage glycosaminoglycan synthesis. Eur J Rheum Inflam 1996;16:47-52.
[xv] Brandt KD. Should nonsteroidal anti-inflammatory drugs be used to treat osteoarthritis? Rheum Dis Clin N Am. 1993;19:697-712.
[xvi] Lawrence RM. Methylsulfonylmethane (MSM): a double-blind study of its use in degenerative arthritis. Int J of Anti-Aging Med. 1998 July;1(1):50.
[xvii] Montrone F, Fumagalli M, Sarzi Puttini P, et al. Double-blind study of S-adenosyl-methionine versus placebo in hip and knee arthrosis. Clin Rheumatology. 1985;4:484–85.
[xviii] McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatology. 1992;19:604–7.