- Chiropractic for Arthritis A natural first step in finding relief from arthritis pain and discomfort.
- Understanding arthritis and how chiropractic care could help manage arthritis pain.
- How Can Chiropractic Help Arthritis Patients?
- Should You Go to a Chiropractor for Rheumatoid Arthritis?
- What Is a Chiropractor?
- The Pros of Chiropractic Care for Rheumatoid Arthritis
- The Cons of Chiropractic Care for Rheumatoid Arthritis
- Finding a Chiropractor for Rheumatoid Arthritis
- Rheumatoid Arthritis and Chiropractic: Making the Best of It
- Who gets it?
- What are the signs and symptoms?
- How is it diagnosed?
- How is it treated?
- What is the outcome?
- Treating Rheumatoid Arthritis
- Chiropractic Care for Arthritis
- 2 types of arthritis: how they impact you and what you need to know
Chiropractic for Arthritis
A natural first step in finding relief from arthritis pain and discomfort.
Understanding arthritis and how chiropractic care could help manage arthritis pain.
What is Arthritis?
Though common, arthritis is one of America’s most misunderstood diseases. Arthritis is inflammation of one or more joints, which can cause pain, discomfort and stiffness throughout joints and the body. Common symptoms of arthritis and joint inflammation include swelling, joint pain and stiffness and decreased range of motion — typically worsening with age.
In actuality “arthritis” is not a single disease. There are over 100 different types and severities of the disease, making it the leading cause of disability in America — affecting more than 50 million. However, there are two main types of arthritis that can benefit from routine chiropractic care:
Osteoarthritis – A degenerative disorder affecting flexible joint cartilage
Rheumatoid Arthritis – A chronic inflammatory disorder in joints
In both cases, self care combined with non-invasive, non-addictive treatment, should serve as your first line of defense to manage and relieve pain and discomfort.
How Can Chiropractic Care Help Those with Arthritis?
Chiropractic care can be a great way to manage and relieve pain caused by arthritis. Routine chiropractic care provides arthritis patients with a safe, non-invasive, non-addictive alternative to prescription opioids or over-the-counter pain medications (OTCs), which are commonly prescribed to patients to help them manage their pain.
Chiropractors deliver a gentle, non-invasive, non-addictive therapy, known as a chiropractic adjustment. Chiropractic adjustments reduce joint restrictions or misalignments in the spine and other joints in the body in an effort to reduce inflammation and improve function of both the affected joint and nervous system. By increasing joint mobility and improving your nervous system function and spinal health, your body has the ability to better manage symptoms caused by osteoarthritis or rheumatoid arthritis.
Below are some of the health benefits chiropractic care and chiropractic adjustments can provide to arthritis patients:
- Reduced pain and discomfort
- Decreased inflammation
- Improved range of motion
- Improved flexibility
- Increased activity and lifestyle
To see if chiropractic care is right for your condition, the chiropractors at The Joint Chiropractic will perform a consultation, examination and if necessary, refer you out for diagnostic imaging such as x-ray or MRI. Based on the findings of our chiropractic exam and consultation, your doctor of chiropractic may elect to co-treat your arthritis with other healthcare professionals including massage therapists, physical therapists or other primary care physicians.
To find a local chiropractor and to learn more about how chiropractic care can help those suffering from arthritis, contact or visit one of our chiropractic offices today, to speak with a licensed doctor of chiropractic.
The information, including but not limited to, text, graphics, images and other material contained on this page are for informational purposes only. The purpose of this page is to promote broad consumer understanding and knowledge of the benefits of chiropractic care. It is not intended to provide or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your chiropractor, physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this page.
How Can Chiropractic Help Arthritis Patients?
Even though I have had the good fortune of never having to deal with the aches and pains that come along with an arthritis daignosis for myself, I do know a few people who are unfortunately dealing with managing the physical symptoms of their arthritis on a somewhat regular Anyone who deals with arthritis aches and pains can tell you assuredly that it is a truly debilitating condition, and that it can very often prevent a person from living their life out to the fullest potential that can possibly be had. Arthritis requires almost constant monitoring and management, which also means that it is most certainly ideal for a person with arthritis to do their absolute best to find a long term treatment plan that can help manage and control their symptoms on a reliable, consistent, and regular basis. This is why, when I came across an article post by Care 2 that discussed some helpful treatment options for arthritis, I was compelled to write about my knowledge of how chiropractic care has worked to improve the condition of many people with arthritis. Here is a little more information on this topic.
Arthritis is a pain related chronic condition that is often caused by a build up of inflammation throughout the joints and soft tissues of the body. This inflammation can be very painful and can cause a lot of stiffness in the joints as well, which makes even the most basic of movements very difficult to do for many people who suffer from arthritis. The good news is that chiropratic treatments work to, among other things, treat this painful and harmful inflammation at the source. During a typical session of chirorpactic treatment and care, a licensed doctor of chiropractic will work to examine the spinal column as well as the whole musculoskeletal system of the body in order to find out if there are any misalignments that may be causing inflammation to falre up in the body. The chiropractor then uses manual manipulation techniques in order to succesfully and gently coax the spinal column back into its proper position. When the body is placed back into its natural and proper alignment, communication between the body and the brain is restored, so that the body can begin to heal itself up naturally. In this way, inflammation is also brought down.
Used under Creative Commons Licensing courtesy of handarmdoc
Should You Go to a Chiropractor for Rheumatoid Arthritis?
Many people with rheumatoid arthritis (RA) feel aches and pains and think about going to see a chiropractor as one way to relieve some of their pain. There are pros and cons to including a chiropractor in your rheumatoid arthritis treatment plan. Let’s explore.
What Is a Chiropractor?
A chiropractor is a professional who is trained, through a four-year training program, to adjust or manipulate the spine. For many people, visiting a chiropractor regularly can be very helpful for such medical issues as back pain and related symptoms. Chiropractors can also help you plan exercise and diet changes that may help with pain and inflammation. In the United States, the majority of insurance carriers provide at least some coverage for chiropractic care.
Another type of health care professional, an osteopathic physician (DO), is similar to a chiropractor in that a DO is also trained in manual therapies such as spinal manipulation. An osteopathic physician receives additional training comparable to that for an MD degree.
The Pros of Chiropractic Care for Rheumatoid Arthritis
The American Chiropractic Association recommends that chiropractors focus on helping people with rheumatoid arthritis by:
- Helping them improve their range of motion.
- Improving flexibility and endurance.
- Increasing muscle tone and strength.
- Providing diet and nutritional advice and supplements to address inflammation (a key part of the pain and worsening of rheumatoid arthritis).
Debra DeMarco, DC, of DeMarco Wellness Care in Princeton, New Jersey, who has been in practice for more than 25 years, says working with a chiropractor can indeed make people with RA more comfortable. The “first thing that I would say is that I would never profess to cure it, but I do treat the symptoms by trying to mobilize joints and slowing the progression of the disease,” she says.
Most chiropractors use other treatments in addition to manipulation, including massage, heat and ice, ultrasound, electronic stimulation, rehabilitative exercises, and magnet therapy. Such therapies might be helpful in someone with RA who has other conditions that could benefit: massage therapy for tight muscles, for example, or ultrasound for a condition of the feet called plantar fasciitis, which causes pain on the bottom of your foot because of tight and inflamed tissues.
The Cons of Chiropractic Care for Rheumatoid Arthritis
“I think that chiropractors provide a very useful service for many different problems,” says John M. Stuart, MD, professor of medicine and rheumatology at the University of Tennessee Health Science Center. “However, their role in RA is somewhat limited.”
Dr. Stuart explains that the pain and disability in rheumatoid arthritis are due to inflammation in the joints, instead of vertebrae that are out of alignment. Medication remains the best way to treat inflammation, says Stuart. Chiropractors cannot prescribe the medications that are needed to treat rheumatoid arthritis.
Robert W. Hoffman, DO, in Miami, expresses concern about seeing a chiropractor if your rheumatoid arthritis is affecting your cervical spine (neck).
“Manipulation in RA can be dangerous because of RA involving the cervical spine,” he says. This concern relates to the fact that one of the side effects of some medications for RA is deterioration of bones, including vertebrae — the bones that protect your spinal cord. It is possible that aggressive manipulation of vertebrae that are losing bone density could result in fractures and breaks. While any vertebrae damage is concerning, involvement of the cervical spine is particularly so because damage to the bones protecting your spinal cord in the neck area increases the risk that the upper spinal cord could be hurt, which could lead to paralysis from the neck down.
Finding a Chiropractor for Rheumatoid Arthritis
If you decide that a visit to the chiropractor is right for you, Demarco advises finding a reputable chiropractor with experience treating someone with rheumatoid arthritis. Conduct Internet research (the American Chiropractic Associations has a searchable database) and talk to people who have used chiropractors.
As with all health care choices you make, check with your health insurance provider to find out what kind of chiropractic care benefits are covered by your specific policy before you make an appointment. And talk to your primary care doctor or rheumatologist. “Communication is the most important thing,” says Stuart, who emphasizes that patients should always tell their rheumatologist if they are trying any alternative or complementary therapies.
Rheumatoid Arthritis and Chiropractic: Making the Best of It
Arthritis by definition from Mayo Clinic is inflammation of one or more joints within the body. Symptoms are generally joint pain and stiffness that typically worsen with age. There are more than 100 different types of arthritis, but one of the most common is rheumatoid arthritis. While rheumatoid arthritis is progressive and incurable, the good news is that there are non-invasive, drug-free ways to manage the potentially debilitating pain it can cause.
Let’s first start off by understanding how rheumatoid arthritis impacts the body, then take a look at a natural treatment option commonly used to combat the pain and regain control of daily life.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is an autoimmune disease in which the body’s immune system attacks the joints. A properly functioning immune system attacks and disables foreign substances, such as viruses and bacteria. In the case of RA, the immune system sees the body’s joints as the foreign substance/invader and responds accordingly by attacking them. This attack creates an inflammatory response in the joint lining (synovium) and associated cartilage and tissue. Pain, swelling and — over time — degradation of the joint can occur. If left unchecked, joints ultimately become loose, unstable, experience loss of mobility and become deformed. Joint damage cannot be reversed.
RA generally affects the most distal joints (joints farthest from the spine) first, such as fingers, hands, wrists, ankles and knees. One distinguishing factor of RA is that it affects joints symmetrically, so both ankles or both hands.
While there are cases of rheumatoid arthritis being present in toddlers to seniors, it most commonly affects women more than men and symptoms generally begin to appear between the ages of 19 and 60.
Treating Pain from Rheumatoid Arthritis with Chiropractic Care
Chiropractic adjustments are a phenomenal way to provide some much needed relief while dealing with the pain of RA. The chiropractic adjustments performed are unique to the individual’s needs — they provide a non-invasive, non-addictive and safe option compared to prescription opioids, which are commonly prescribed to patients to help them manage their pain.
Below are some benefits of chiropractic care for those with RA that certainly will aid the body’s journey to be healthy as possible:
Clearer communication in the body – A chiropractic adjustment supports proper functioning of the nervous system. The nervous system is the master communication system, which controls the function of every system and organ in the body. If the immune system is not functioning correctly — for example, perceiving the joints as foreign invaders — it is of utmost importance there are no interferences in the master communication system. Clearing the interference in the nervous system doesn’t guarantee a correction in immune system malfunction, but it does give your body the greatest chance for decreasing any additional stressors that may exacerbate symptoms and increase the need for the immune system to work harder than necessary.
Increased motion – One of the symptoms of RA is decreased range of motion — and a chiropractic adjustment helps to restore joint restrictions in joints. When doctors of chiropractic restore movement to the spinal joints, it’s called a chiropractic adjustment. When done to extremities, it’s called a joint manipulation. Regularly maintaining joint motion through adjustments and extremity manipulation is a very important step in joint health; in my professional opinion as a chiropractor, it is logical to infer that such action may assist in decreasing or prolonging the effects of rheumatoid arthritis.
Decreased inflammation – Chiropractic adjustments help decrease the inflammation process when proper joint motion is restored and proper nervous system functioning is supported. The entire premise of RA is that it is an inflammatory process. While the adjustment may not target the specificity of the immune system for recognizing a joint as an invader, by nature it can help decrease the inflammation process and associated pain.
As you can see, with so many benefits that directly combat symptoms caused by RA, chiropractic care can be an important tool to have in your health toolkit.
Yes, rheumatoid arthritis can leave you feeling overwhelmed, but understanding what it is and how your lifestyle and choices play a role in the disease are an important part of staying healthy. It is also important to have a partner in health to walk with you on the journey to good health, even with the obstacles of rheumatoid arthritis.
If you or a loved one is dealing with rheumatoid arthritis, visit the chiropractors at The Joint Chiropractic today to learn more about the many benefits of chiropractic care.
Dr. Vic Weatherall
Rheumatoid arthritis (RA) is a chronic widespread inflammatory disease of unknown cause. It is an autoimmune disease in which joints, usually those of the hands and feet, are inflamed resulting in swelling, pain, and often the eventual destruction of the joint’s interior.
Watch the rheumatoid arthritis video. This disease can also cause a variety of symptoms throughout the body, for example, it may cause nodules under the skin, lymph node enlargement, inflammation around the heart and lungs, and inflammation of the blood vessels.
In RA, the immune system attacks the tissues that line and cushion the joints, eventually causing the cartilage, bone, and ligaments of the joint to erode, and causing scarring within the joint. The rate of joint deterioration is highly variable. The autoimmune reaction can also affect other tissues, as described above.
The cause of RA is unknown, but many factors, including genetic predisposition, may influence onset. Many researchers suspect that it could be triggered by an infection with a common germ causing the immune systems of susceptible people to react abnormally.
This article discusses
- who gets it
- signs and symptoms
Who gets it?
An estimated 293,000 people in Canada suffer from rheumatoid arthritis. It develops in about 1% of the population, affecting women 2-3 times more than men. This disease usually appears between the ages of 25-50, but can occur at any age.
What are the signs and symptoms?
Rheumatoid arthritis may start gradually or with a sudden, severe attack with flu-like symptoms. Common signs and symptoms include:
- pain and swelling in three or more joints, primarily in the hands, wrists, or fingers (for at least 6 weeks)
- usually symmetrical (on both sides)
- morning stiffness of joints and muscles lasting for more than 1 hour (for at least 6 weeks)
- general weakness and fatigue
- fever and weight loss
Symptoms vary from person to person. In some, the disease may be mild with periods of activity or joint inflammation (flare-ups) and inactivity (remissions), in others it may be continuously active and get worse as time goes on.
How is it diagnosed?
Many arthritic diseases can mimic rheumatoid arthritis, therefore, if RA is suspected it is vital to have the appropriate tests to confirm the diagnosis. The diagnosis is generally made based on
- signs and symptoms as above
- increased rheumatoid factor (RF) and increased sedimentation rate (ESR) in the blood
- characteristic changes on x-rays
- abnormal findings on joint fluid analysis or tissue biopsy (not commonly performed)
Early diagnosis is very important to help avoid disability or deformity.
How is it treated?
Although there is no cure for RA today, much can be done to manage the condition. A variety of treatments exist to treat the symptoms resulting in less pain, stiffness, and easier movement. There are four major treatment approaches for RA: physical management, lifestyle management, medication, and surgery. Active patient involvement during treatment plan is essential.
Treatment should start with the least aggressive measures moving to more aggressive ones if required.
There are a variety ways to help manage the pain of RA and regain optimal function in the affected joints without using drugs, or in combination with them.
Heat and cold
Heat reduces pain by relaxing tight tissues surrounding the joint and by improving blood flow in the area. Cold blocks pain signals from the area and decreases inflammation. Note that during periods of increased inflammation, heat may exacerbate the situation.
Chiropractors, physical therapists, and occupational therapists teach techniques to reduce the pain and restore joint motion and muscle strength to increase comfort throughout daily life.
Contact Dr. Weatherall if you have any questions or to see if he can help you with a problem.
Exercise helps lessen symptoms of RA and make the patient feel better overall. Appropriate and moderate stretching and strengthening helps relieve pain and keeps the muscles and tendons around the affected joint flexible and strong.
Low impact exercises like swimming, walking, water aerobics, and stationary bicycling can all reduce pain while maintaining strength, flexibility, and cardiovascular function. Patients should always check with their health care provider before beginning an exercise program.
Patient must protect their joints by avoiding excess stress from daily tasks. For example, alternate heavy tasks with lighter ones, avoiding stressful joint positions and support them where necessary, using assistive devices such as canes and grab bars. They must strive to stay at their recommended weight to avoid increased stress on their joints. Note that most RA sufferers are not obese.
A basic principle of RA treatment is resting the joints. Regular rest periods often help relieve pain and complete rest may be needed during severe flare-ups. Splints can be helpful to help immobilize and rest the joints; however, some overall movement is needed to prevent the joints from stiffening.
A regular healthy diet is generally appropriate. Some people have flare-ups after eating certain foods. A diet rich in fish and plant oils but low in red meat may help reduce the inflammation. Calcium supplementation may also be helpful. Food allergy testing may be considered as well.
Developing good relaxation and coping skills gives the a patient a greater feeling of control over their arthritis and a more positive outlook.
Nonsteroidal anti-inflammatories (NSAIDs): NSAIDs reduce pain when taken at a low dose and relieve inflammation when taken at a higher dose. Non-prescription drugs include ASA (Aspirin, Anacin) and ibuprofen (Motrin IB, Advil). Prescription NSAIDs include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider a stomach protectant such as misoprostol (Cytotec). COX-2 selective inhibitor NSAIDs directly target COX-2, an enzyme responsible for inflammation and pain. They reduce the risk of peptic ulceration, the main feature of drugs such as celecoxib (Celebrex). However, this class of NSAID can pose a risk to other organs.
Disease modifying anti-rheumatic drugs (DMARDs): DMARDs may be prescribed when inflammation continues for more than 6 weeks or when RA strikes many joints at once. These drugs target the cells in the immune system causing the inflammation, but do not reverse permanent joint damage. The most common medications are gold salts, methotrexate, sulfasalazine, hydroxychloroquine, chloroquine, and azathioprine. A DMARD is usually prescribed in addition to an NSAID or corticosteroid. Side effects may include mouth sores, diarrhea and nausea. More serious side effects, monitored through regular blood and urine tests, include liver damage, and excessive lowering of white blood cell count (increasing susceptibility to certain infections), and platelet count (affecting blood clotting).
Corticosteroids: Corticosteroids are man-made drugs that closely resemble cortisone, a hormone natural produced by the body. In RA, these drugs are used to treat extreme inflammation accompanied by severe pain and stiffness. They are also used to treat systemic RA which may affect the lining of the lungs and blood vessels. The most common form of corticosteroid is prednisone, taken in pill form. Side effects from long term use may include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis), weight gain, and susceptibility to infections. The goal with this and most drugs is to find the lowest effective dose that will avoid as many of the side effects as possible.
Corticosteroids sometimes injected into one or more joints or other areas of inflammation. While eliminating the serious side effects, injections may harm joints if given more than a few times a year.
Severe cases that have not responded to treatment may benefit from surgery. There are a number of different kinds of surgery for RA ranging from minor procedures to complete joint reconstruction.
What is the outcome?
The course of RA is variable and the results of various types of treatment differ from person to person. Most people can maintain an active lifestyle and manage very well with the combined benefits of balanced exercise, rest, modified lifestyle, and medication.
- Wouterstomp at en.wikipedia , from Wikimedia Commons.
Arthritis refers to inflammation of one or several joints within the body. Most patients with arthritis experience chronic pain and stiffness that worsens over time. Although our Atlanta Chiropractors treat hundreds of types of arthritis, the most common is rheumatoid arthritis. This particular kind of arthritis is progressive and does not currently have a cure. However, Chiropractic Treatment does serve as a natural, non-invasive resource for managing the symptoms associated with rheumatoid arthritis.
Treating Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease that causes the body’s white blood cells to attack its joint tissue. As a result of this assault, the body responds with joint inflammation, which causes significant swelling and pain. If left untreated, the affected joints will become unstable and deformed to a state that’s beyond repair.
Atlanta Chiropractic Treatment For Rheumatoid Arthritis
For patients who manage rheumatoid arthritis throughout Atlanta, Chiropractic Adjustments are an excellent solution for alleviating painful symptoms like inflammation. Adjustments are customized to meet the unique needs of each patient’s condition and are a safe alternative to painkillers or other potentially addictive medications.
Chiropractic Adjustments also help restore proper functioning of the nervous system, which helps prevent the body’s immune system from attacking itself. And, patients who manage rheumatoid arthritis can restore flexibility to their joints through ongoing Chiropractic Treatment.
Contact AICA Atlanta For Rheumatoid Arthritis Relief
If left untreated, rheumatoid arthritis can significantly impair your ability to follow through with everyday activities, professional obligations, and favorite pastime hobbies. While painkillers or prescription medications can provide relief from the symptoms associated with arthritis, they only serve as temporary solutions that are not capable of providing permanent support.
Chiropractic Treatment helps patients experience long-lasting pain relief, while also reversing the effects of inflammation and joint stiffness. If you or someone you know experiences rheumatoid arthritis, contact AICA Atlanta to schedule a free consultation or a complete examination for treatment.
Our Atlanta Chiropractic Clinic is open Monday through Sunday for your convenience and provides 24/7 access in case you have any questions. Contact or call our office today to speak with one of our friendly staff members about scheduling an appointment – (404) 889-8828.
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Chiropractic Care for Arthritis
If you’ve had back pain or a stiff neck, whether from arthritis or an injury, you’ve likely considered seeing a chiropractor. While it’s true that chiropractors manipulate or adjust the spine to improve pain and mobility, the benefits may extend beyond the back and neck. By using varying degrees of force in an effort to adjust misaligned joints, chiropractors try to improve the relationship between the spine and nervous system, which they believe may affect the function of all the organs and systems in the body.
“We are certainly the front-line providers for back pain, but we’re also primary-care professionals who look at and evaluate the whole body,” says Ron Boesch, a chiropractor and professor and director of clinics at Palmer College of Chiropractic in Davenport, Iowa. Chiropractic treatment continues to grow in mainstream medicine. In a 2015 Gallup poll commissioned by the college, 60 percent of the more than 5,400 people polled believed chiropractic care is an effective treatment for neck and back pain. But what should you expect from a chiropractor visit and is it safe for arthritis?
What to Expect From a Chiropractor
If you’re looking for a non-medication way to take the edge off of those painful joints chiropractic medicine may be for you, as long as you remember to listen to your body.
Most of what chiropractors do today is gentler than cracking backs or popping necks into place. In fact, there are more than 150 techniques that chiropractors use to manually adjust the spine, joints and muscles with varying degrees of force.
While an athlete with lower back pain may benefit from a high-velocity spinal adjustment, you would receive care specific to your needs and your type of arthritis. A chiropractor may gently manipulate your soft tissue to stop muscle spasms and relieve tenderness. Or she may use active exercises or traction to slowly stretch your joints and increase your range of motion. Your visit may feel like a more hands-on version of physical therapy.
Chiropractors focus on the relationships between structure and function, explains Robert Hayden, PhD, a spokesperson for the American Chiropractic Association and a chiropractor of 22 years. They are different from an osteopath, who uses manual manipulations but also treats the entire body and may use medication or surgery.
The thinking is simple, he says. If the structure of a joint is not right, then it can’t work as it was designed. “The place where chiropractic really shines is in maximizing the function of an arthritic joint,” he adds. “Our goal is to restore patients’ function so they can have the kind of life they want.”
During your first visit, the chiropractor should take a detailed medical history and perform a physical exam of every joint to determine what approaches are right for you. The doctor may also take an X-ray of your spine.
Is Chiropractic Care Safe for Arthritis?
If you have back or neck pain due to osteoarthritis, chiropractic is one of the safest therapies you can use, explains Scott Haldeman, MD, a neurologist in Santa Ana, California and Chairman Emeritus of the Research Council for the World Federation of Chiropractic. But if you have an inflammatory disease, like rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, you are going to need to be more careful.
If you have active inflammation (due to a flare, for example), a fused spine or osteoporosis in the spine or neck, you shouldn’t be treated with chiropractic therapy. “If a patient has joints with active swelling, I would not recommend going to a chiropractor,” says Alyce Oliver, MD, PhD, assistant professor of rheumatology at the Medical College of Georgia in Augusta. “If you can’t get swelling under control, it would be dangerous to get an adjustment.”
Dr. Hayden agrees that inflamed joints should be “off-limits,” but notes that chiropractors offer several adjunctive therapies that can help.
- Ultrasound. Many think of ultrasound as imaging technology, but when applied to soft tissues and joints, sound waves can also produce a massaging effect that helps reduce swelling and decrease pain and stiffness.
- Electrotherapy. These tiny electric pulses are not painful. They treat soft tissue injuries by stimulating nerves and muscles.
- Low-level laser or “cold laser.” This technique uses a non-heat-producing laser or light that penetrates deep into the tissue, sometimes reducing inflammation.
- Infrared sauna. Imagine having a hot compress warm up your joints from the inside. These rooms use controlled amounts of heat to relieve pain and increase circulation.
Even if they never touch your arthritic joint, David Feschuk, a chiropractor in Stone Mountain, Georgia, says treating the surrounding tissues may significantly reduce overall pain.
“If someone is having a flare in a knee that is causing him to walk awkwardly, it may lead to a secondary pain syndrome in the lower back. I would not treat an inflamed joint, but if I adjust the pelvis I may be able to reduce overall pain by four to five units on the 1-to-10 pain scale and make daily living activities easier.”
What Medical Doctors Think
In the past, chiropractic got mixed reviews from physicians. However, in early 2017, The American College of Physicians released new guidelines. It now supports the use of nonpharmacologic therapies, such as chiropractic and acupuncture, as first-line treatments for low back pain, before using medication.
Increasingly, studies in mainstream medical journals are demonstrating the benefits of chiropractic for back and joint pain. A 2017 review in the Journal of the American Medical Association, found that spinal manipulation reduces lower back pain. And a 2013 study published in Osteoarthritis and Cartilage found that patient education combined with 12 chiropractic treatments (twice a week for six weeks) were more effective for hip OA than a daily stretching program or patient education alone. Reports from the chiropractor-led spine program at Beth Israel Deaconess Hospital in Plymouth, Massachusetts, are also positive: Most patients with bad backs experience significant pain relief in about five visits.
But while research shows clear benefits for musculoskeletal pain, namely of the back and neck, its effects beyond pain-relief are not known. And the jury on manual therapy for hip and knee arthritis is still out. “There is no clear evidence that chiropractic or any other treatment offers long-term change in the X-ray findings in arthritis,” says Dr. Haldeman.
The bottom line, he says, is chiropractic is worth a try. “However, if any clinician says her treatment will permanently cure your arthritis, you should walk out,” he warns. “If you don’t see improvement within four to 10 treatments, either switch chiropractors or try a new treatment path.”
For more information, or to find a chiropractor near you, visit:
- The American Chiropractic Association (ACA)
- National Institutes of Health
- The Arthritis Foundation Arthritis Resource Finder
This case illustrates how management of thoracic pain may be complicated in a patient with co-existent underlying conditions. Clinicians are often faced with this dilemma as the typical plan of management or interventions utilized need to be evaluated with an emphasis on the potential changes to risks and benefits which may be altered based on the individual characteristics of each patient. The patient in this case had a history of RA and presented with what was considered to be a recurrent episode of acute mechanical thoracic pain.
Literature suggests a limited role for manipulative therapy in managing the inflammatory component of RA6, yet it may provide symptomatic pain relief of mechanical origin caused by abnormal compensatory kinematics (of non-inflammatory origin). Shaikh suggests that clinicians differentiate inflammatory back pain from mechanical back pain during the clinical history.7 Inflammatory back pain typically presents as morning stiffness greater than 30 minutes, relief of pain with exercise but not rest, pain may be present at night which wakes the individual, and alternating buttock pain.7 However, the available scientific evidence is limited in guiding clinicians in differentiating between inflammatory and non-inflammatory pain when they may both be present and furthermore in the management of these cases.
The general consensus is that management of patients with RA includes a multidisciplinary approach incorporating both pharmacologic and non-pharmacologic interventions.8,9 In regard to non-pharmacologic interventions, dynamic exercises have been shown to be beneficial in improving aerobic capacity and muscle strength without detrimental effects on disease activity.10 Education has been shown to increase self efficacy, knowledge of disease management and decrease morning stiffness.11 Physical therapy modalities (e.g. interferential current) have been reported to potentially facilitate pain modulation but their effectiveness is inconclusive.12 While orthoses and assistive devices have been shown to decrease the swelling and pain of RA, they may limit dexterity and function when performing activities of daily living.13
As for manual therapy, recent guidelines recommend mobilizations but the level of evidence is that of expert opinion.14 Mobilizations involve positioning a joint at its restrictive barrier (i.e. end of passive range of motion) and then the practitioner uses a series of gentle, repetitive movements towards and through the restriction.15 Manipulation, commonly referred to as “an adjustment” by chiropractors, is another form of manual therapy which involves a joint positioned at its restrictive barrier and then the practitioner applies a quick, short impulse (HVLA) thrust.16 Both procedures are typically directed at hypomobile joints.
Hypomobile vertebral segments have been thought to result from “adhesions” within the zygapophysial joints.17 This hypomobility or aberrant joint motion is thought to be amenable to manipulation.18 Cramer et al. have suggested that spinal manipulation increases the gapping of vertebral joints compared to controls, presumably facilitating the breaking of these adhesions and improving joint kinematics.19 Considering the potential for alterations in joint kinematics and subsequent pain generation from compensatory mechanisms, as well as the inherent joint changes in rheumatologic patients, manipulative therapy may be a viable therapeutic option.
Alternatively, others have suggested a more neurophysiological theoretical framework to explain how spinal manipulation may modulate pain and movement. These include spinal reflex excitability20, decreased electromyographic activity of paraspinal muscles21,22, motor-neuron excitability23, strength modulation24,25, reflex inhibition of pain by stimulation of joint mechanoreceptors26, activation of endogenous opioids27, altering chemical mediators28, and activating segmental inhibitory pathways or descending pain inhibitory systems29,30. Hence manipulation may have mechanistic and neurophysiologic effects that should be considered when justifying its use.
Empirically, the use of manipulation is limited to non-inflammatory regions, and joints susceptible to inflammatory pathology are avoided. The World Health Organization reported that joint manipulation in patients with RA is an absolute contraindication in anatomical regions of involvement.31 For example, cervical spine manipulation in patients with RA is considered an absolute contraindication due to instability of the atlanto-axial joint and predisposition to transverse ligament rupture.32 It appears the utilization of the term “absolute” in patients with RA may have been generalized to all joints rather than being restricted to joints where risks associated with manipulation outweighs the potential benefits.
The thoracic spine has not been researched as much as the cervical and lumbar spine when considering manipulative therapy.15 The case described was that of a patient with RA and co-existent thoracic pain. Manipulation to the thoracic spine appears to be effective at restoring joint mechanics and the recovery of thoracic range of motion immediately after treatment.18 Treatment of this region also requires a more cautious approach due to the presence of numerous joints, the thoracic cage, autonomic ganglia, and the passage of the neurovascular bundle in the thoracic outlet.33 Thus training and experience may be important in modulating the selected manipulative procedure.34
Bergmann35 reported that manipulation requires a controlled delivery of the HVLA thrust that is developed with extensive training to perfect the psychomotor skills. Such training develops the palpatory sense and control to enable delivery of a thrust of appropriate depth and force and that has been postulated to be more effective compared to those with less training.34
Additionally, timing of delivery of therapeutic interventions such as manipulation needs to be considered in patients with RA. The unpredictable pattern of changing symptoms in rheumatologic patients can differ day to day.4 Thus, the patient’s symptoms need to be evaluated on each visit to ensure that the appropriate management options are being provided.
During episodes of acute pain, clinicians are faced with the challenge of sifting through the many grey areas of evidence which also includes clinical experience and patient values.36 Patient preferences are a component of patient value that should be integrated into clinical decision-making.37 In this case, the patient presented with RA and a history of adverse reactions to medications. She also reported a preference for alternative therapies for pain relief especially in light of prior benefit. In situations where a patient is seeking care for a therapy with limited evidence, clinical expertise becomes invaluable. In consideration of the patient’s pre-existing condition and the rationale for conservative care, clinical experience guided the selection of an appropriate procedure and the applied force and location of intervention were modified to the patient’s tolerance and preference.
Finally, co-management of the patient’s pain was achieved with appropriate communication with the patients’ family physician and rheumatologist to address the multiple factors that were contributing to the patient’s symptoms.
2 types of arthritis: how they impact you and what you need to know
Arthritis is one of the most common conditions affecting the joints worldwide.1 In Latin, arthro- means joint and –itis means inflammation, so together arthritis means inflammation of a joint. Two common types of arthritis are osteoarthritis and rheumatoid arthritis. While they might sound similar, they have very different causes and symptoms.
What is it?
Osteoarthritis is characterized by “wear and tear” of the cartilage on either end of the bone.1 With time, the cartilage may break down causing the two ends of the joints to rub against each other.
Who does it affect?
Osteoarthritis is more common in individuals over the age of 65.1 Other factors that can contribute to (or even speed up) the wear and tear of osteoarthritis are obesity, injury, and overuse, and genetic factors.
What are the symptoms?
Symptoms include morning stiffness, pain that decreases with movement, swelling, and clicking or cracking within the joint itself.
What is it?
Rheumatoid arthritis is an autoimmune disorder that can affect the entire body. The body’s own immune system mistakenly identifies normal joints as “abnormal,” resulting in an inflammation which can be extensive and painful. If the inflammation is not controlled, damage to the surrounding cartilage and bone within the joint can occur.
Who does it affect?
Rheumatoid arthritis is more common in females around the ages of 30–60 years old.2
What are the symptoms?
Symptoms of rheumatoid arthritis are similar to those of osteoarthritis, however, a key difference is that pain and stiffness in rheumatoid arthritis generally does not resolve or see improvement with movement or exercises.
TIPS FOR TREATMENT
Arthritis can often be managed well with conservative therapy like specific exercises for the affected areas and self-care as well as manual therapy by your chiropractor. However, getting treatment from a combination of various healthcare providers may be needed. If you are experiencing discomfort in your joints, or would like more information about arthritis, visit your family chiropractor.
References 1. Arthritis facts. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/understanding-arthritis/arthritis-statistics-facts.php. Accessed August 29, 2017. 2. Rheumatoid arthritis (RA). Rheumatoid Arthritis website. Available at: https://www.rheumatoidarthritis.org/ra/. Accessed August 29, 2017.