Knee Osteoarthritis

Knee Osteoarthritis

Knee Osteoarthritis: Understanding the Condition, Risk Factors, Management & the Role of Osteopathy , Dr Guy Wolton

Knee osteoarthritis (OA) is one of the most prevalent presentations that we see in the clinic. Knee OA contributes majority of the populations knee pain and is the  cause of chronic joint pain and disability. It results in progressive degeneration of the knee joint, impacting daily function and making simple activities difficult. (Oneil & felsion, 2018)

Pathophysiology of Knee Osteoarthritis: What Happens in the Knee Joint

Knee OA is the progressive degeneration of articular cartilage, changes in subchondral bone, synovial inflammation, and formation of bony spurs called osteophytes. Cartilage loss reduces the knee joint’s ability to absorb shock and maintain smooth movement, leading to pain and stiffness. Synovial inflammation contributes to joint effusion which is excess fluid that causes pain and further loss of cartilage. (Hunter & Zeinstra, 2019)

As the OA progresses the joint spaces narrows, and the bony spurs (osteophyte formation) occur. This is what X-ray imaging helps to diagnose through these findings. The condition is driven by both mechanical wear and inflammatory processes.

Risk Factors for Knee Osteoarthritis

OA risk is influenced by a combination of biological, biomechanical, and lifestyle factors. There are some risk factors that can’t be avoided and these include age, as cartilage health diminishes over time, genetics, with family history playing a role in susceptibility.

The Modifiable risk factors include:

  • Obesity: Increases joint loading and systemic inflammation.
  • Joint injury: Prior trauma (e.g. ACL tears) increases OA risk due to altered biomechanics.
  • Occupational stress: Repetitive kneeling or squatting contributes to cartilage wear.
  • Muscle weakness and alignment issues: Poor quadriceps strength and varus/valgus deformities raise OA risk.

(Blagoeievic et al, 2010)

Management Strategies for Knee Osteoarthritis

There is no cure for OA, but symptom management and functional improvement are achievable. These include:

1. Education and Lifestyle Modifications

  • Weight management is crucial; even a 5% body weight reduction can significantly reduce pain.
  • Activity modification helps prevent flare-ups. (Altering seated positions, work stations)

2. Exercise Therapy

Structured exercise programs focusing on strength, mobility, to reduce pain and improve joint function. Strengthening the musculature around the knee will help support and de-load the joint therefore leading to increased function and decreased pain. Some of the exercises include Sit to stands, Glute bridges, Calf raises, hamstring slides and step ups.

3. Manual Therapy –

Hands on techniques and guided rehab support improved mobility, reduce stiffness and pain and educated patients about the condition.

4. Pharmacological Management

Analgesics such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and intra-articular corticosteroids are commonly used. Another option that is effective in decreasing pain and symptoms in patients with knee OA is a hyaluronic acid injection which is a gel that provides support and cushioning to the joint which will decrease symptoms felt. However, this is only used for moderate to severe knee OA with patient that have no cartilage or bone on bone contact.

5. Surgical Intervention

Reserved for end-stage disease, total knee arthroplasty (replacement) can restore function and reduce pain.

(Bannuru et al, 2019)

How Osteopathy Can Help Manage Knee Osteoarthritis

Osteopathy provides a holistic, hands-on approach to managing the patients symptoms with knee OA, as osteopaths we will assess the whole bodies mechanics and movements patterns to identify what may be exacerbating the patients symptoms.

Osteopathic techniques may include:

  • Joint mobilisation to reduce stiffness and improve range of motion in the knee, hip, and ankle.
  • Soft tissue therapy for surrounding muscles such as quadriceps, hamstrings, and calf muscles.
  • Muscle energy techniques (METs) to reduce asymmetry and muscle imbalance.
  • Postural and gait analysis, addressing compensatory patterns that contribute to joint overload.
  • Rehabilitation exercise prescription, supporting strength and neuromuscular control.
  • Dry needling and taping, to release muscles that may be causing pain and taping to support the knee.

(Robertson et al, 2013)

Summary

Knee osteoarthritis is a chronic, progressive condition with significant physical and psychosocial impacts. Early intervention, including exercise, education, manual therapy, and weight management, is key to symptom control and maintaining independence. If you or someone you know suffers from persistent knee pain, consider seeing an osteopath as part of a comprehensive care plan.

References (APA 7th Edition)

  • Abbott, J. H., Robertson, M. C., Chapple, C., et al. (2013). Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: A randomized controlled trial. Osteoarthritis and Cartilage, 21(4), 525–534. https://doi.org/10.1016/j.joca.2013.01.013
  • Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
  • Blagojevic, M., Jinks, C., Jeffery, A., & Jordan, K. P. (2010). Risk factors for onset of osteoarthritis of the knee in older adults. Osteoarthritis and Cartilage, 18(1), 24–33. https://doi.org/10.1016/j.joca.2009.07.013
  • Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet, 393(10182), 1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9
  • O’Neill, T. W., & Felson, D. T. (2018). Mechanisms of osteoarthritis (OA) pain. Current Osteoporosis Reports, 16(6), 611–616. https://doi.org/10.1007/s11914-018-0477-1
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Ankylosing Spondylitis

Ankylosing Spondylitis

What is Ankylosing spondylitis?

Ankylosing spondylitis is an autoimmune condition where inflammation occurs first in the sacroiliac, intervertebral and intercostal joints. From there inflammation also occurs in joint cartilage causing degeneration, ossification (making bone) and then joint fusion.

Patients are more likely to develop ankylosing spondylitis if a family member has the disease due to the hereditary nature of the condition.

It is more likely to occur in the Caucasian population, males more than females and between the ages of 20-40 years. It typically presents as a sudden onset of low back pain that lasts for three months or more. The stiffness is worse after periods of inactivity, improved through the day, and is helped with heat. Pain and grinding can occur in the spine alongside muscle weakness and balancing issues.  

You may also develop associated issues such as tendonitis, fasciitis and dactylitis. Sometimes patients may also present with eye issues such as uveitis and iridocyclitis – inflammation of the eye. This can present with sudden eye pain, redness, light sensitivity and decreased vision.

Assessment:

When you come in for your appointment your osteopath will assess different regions of your body and spine including your neck, back, pelvis and hips.

We may send you for a blood test looking for HLAB27 and an increased level of inflammatory factors interleukin 12, 17 and tumour necrosis factor which can be an indication of a genetic disposition for ankylosing spondylitis. X-ray’s may also be ordered to confirm the presence of the disease.

To be diagnosed with ankylosing spondylitis you may need to have a combination of the below;

  • Inflammatory pain and morning stiffness in the low back for a minimum of three months. This should improve with exercise and is not relieved by rest.
  • Limitation of range of motion in the lumbar spine in rotation, flexion/extension and side bending
  • Decreased chest examination.
  • Sacroiliitis identified on X-ray that is between grades two and four.
  • Decreased joint space, calcification of ligaments, squaring of the vertebrae and joint fusion.

Medical Treatment:

Corticosteroids can be beneficial in a short course and long term non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs can assist in preserving quality of life.  

Osteopathic Treatment:

Osteopathic treatment is unable to cure ankylosing spondylitis, however it aims to improve quality of life and activities of daily living. This is through a holistic approach that focuses on the local biomechanical changes as well as the greater impact on muscles and posture.

Treatment focuses on mobilisation of joints, ligament and soft tissue techniques and decreasing swelling. There has been evidence that suggests significant improvement in pain and quality of life when combined with physical strengthening focusing on weightlifting, resistance training and core stability.

Typically, due to the progression of ankylosing spondylitis no manipulation is used as it poses significant risk of damage to soft tissue and joint structures.

Needling:

Use of needling through the modalities of acupuncture or dry needling has been shown to be effective.

Needling can have a pain-relieving affect and assist in immune function. In addition, the meridian theory followed in acupuncture believes that needling points related to the kidney can have a benefit in alleviating spinal pain, improving spinal function and reduce the levels of tumour necrosis factor and inflammatory factors.

Specific needling/acupuncture points that can be used to decrease pain include KD3/6, LV8, ST36, GB34, BL11/23/29/52/40

Referencing:

Ebrahimiadib, N., Berijani, S., Ghahari, M., & Golsoorat Pahlaviani, F. (2021). Ankylosing Spondylitis. Journal of Ophthalmic and Vision Research, 16(3). https://doi.org/10.18502/jovr.v16i3.9440

Seiler, M., Vermeylen, B., Poortmans, B., Feipel, V., & Dugailly, P.-M. (2020). Effects of non-manipulative osteopathic management in addition to physical therapy and rehabilitation on clinical outcomes of ankylosing spondylitis patients: A preliminary randomized clinical trial. Journal of Bodywork and Movement Therapies, 24(4), 51–56. https://doi.org/10.1016/j.jbmt.2020.06.028

Xuan, Y., Huang, H., Huang, Y., Liu, D., Hu, X., & Geng, L. (2020). The Efficacy and Safety of Simple-Needling Therapy for Treating Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine, 2020, 1–10. https://doi.org/10.1155/2020/4276380

Zhang, Y., & Song, A. (2022). Clinical research progress of acupuncture therapy in the treatment of ankylosing spondylitis. Medical Theory and Hypothesis, 5(2), 4. https://doi.org/10.53388/tmrth202206004

 

 

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Nerve Impingement

Lymphatic system

What is Nerve Impingement?

Nerve impingement or entrapment occurs when nearby bone – whether it be vertebrae or otherwise, impinge on the pathway of the nerve or the nerve itself resulting in neurological symptoms.

Nerve impingement typically only occurs on a single side unless it presents in the spine when caused by a disc or narrowing of the spinal foramen (gaps where the nerves exit the spinal cord). In the extremities it can occur at the elbow, knee, fibular, hips, wrists and shoulders.

It is more common if the patient has experiences trauma in the past. There can be feelings of the joint “Giving out”, decreased sensation of hot/cold, fine touch, sharp and dull as well as tingling, numbness or weakness. 

In the legs the most common nerve impingement is of the peroneal/fibular nerve which runs on the outside of your shin. When this nerve is impinged it can cause a foot drop where the food cannot lift the ball of their feet or toes. They may have pain in the knee or below, weakness in the movement of pulling the toes to the ceiling and a burning/tingling pain on the top of the foot.

The most common form of nerve impingement in the upper limb is of the median nerve. This is commonly known as carpal tunnel and affects 3% of the adult population, mostly female and between the age of 40 and 60 years old. Like nerve entrapment of the lower limb patients will experience neurological symptoms and weakness. Repetitive movements found in occupations such as admin (office work) and trades can increase the risk of carpal tunnel syndrome.

 

Assessment:

Firstly, your osteopath will look at the area of symptoms and the associated chain. For example, if it is the foot they will look at the foot, knee, hip and low back. They will assess range of motion, the nerve pathway and possibly perform a Tinel tap (taping the nerve to reproduce neural symptoms). They may refer you to a radiographer for imaging such as an x-ray if this was after an acute trauma, ultrasound to identify soft tissue lesions or scar tissue build up. In addition, general practitioners (GP’s) can perform motor conduction studies where they test musculature innervated by nerves in the same chain to identify what nerve may be impinged.

Lower limb neurological assessments will also be performed that identify reflexes, strength of muscles/nerves, light touch sensation of nerves, sharp and cold sensation of nerves. These tests will be performed on both sides to make sure it is an issue with the peripheral nervous system and not the central nervous system (spinal cord). 

 

Treatment:

Osteopathically your practitioner will work on decreasing tissue tension in the area – this includes muscles and ligaments. They will work on the joint itself as well to increase space and range of motion.

As the nerves begin in the spinal cord you may find your practitioner works on the entire chain (Neck, shoulder, elbow wrist or low back, pelvis/hip, knee and ankle). This can be done using a variety of techniques such as soft tissue, mobilisation, manipulation (if deemed appropriate) as well as more indirect techniques such as balance ligamentous tension, osteopathy in the cranial field and functional techniques. In addition, we may prescribe stretching, strengthening and nerve gliding exercises.

As we are a holistic therapy, we will also ask about your lifestyle factors such as sleeping position, work, exercise and more. We may suggest changes to the positions or activities you are doing to see if it makes an improvement of the symptoms.

Surgically, nerve blocks using a lidocaine solution may be used or a local corticosteroid injection. If there is a build-up of scar tissue in the area the practitioner may work on that or refer you to a specialist for a procedure called neurolysis for nerve decompression – this has been seen to be effective in patients with nerve injured less than or equal to 8 cm in length. There is a healing time of 3-4 months however healing can take up to 12 months depending on a range of factors.

 

References

Carpal tunnel syndrome: MedlinePlus Genetics. (n.d.). Medlineplus.gov. https://medlineplus.gov/genetics/condition/carpal-tunnel-syndrome/

Fortier, L.M., Markel, M., Thomas, B.G., Sherman, W.F., Thomas, B.H., Kaye, A.D. (2021). An update on

peroneal nerve entrapment and neuropathy. Orthopaedic reviews, 13(2). Pp 24937. https://doi.org/10.52965/001c.24937

Klifto, K.M., Azoury, S.C., Gurno, C.F., Card, E.B., Levin, L.S., Kovach, S.J. (2022). Treatment approach

to isolated common peroneal nerve palsy by mechanism of injury: systemic review and meta-analysis of individual participatnts’ data. Journal of plastic, reconstructive and aesthetic surgery, 75(2). Pp 683-702. https://doi.org/10.1016/j.bjps.2021.09.040

LaPrade, R. (2022). Peroneal Nerve Entrapment.

Peroneal Nerve Entrapment (drrobertlaprademd.com)

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Osteoarthritis

Osteoarthritis

What is Osteoarthritis?

Osteoarthritis is a degenerative condition in which there is progressive loss of articular cartilage of the joints in the body such as the hands, wrists, shoulders, neck, back, hips and knees. It can be primary (without underlying causes) or secondary (with underlaying cause)

It is most common in women compared to men. Typically, it presents in women 55 years and older however onset can occur at 45 years of age. There is often a history of mechanical joint injury earlier in life such as a repetitive sport, fall or other trauma. Another cause can be repetitive motions or an uncoordinated gait that causes repeated stress on the joints of the legs.

Typically, osteoarthritis presents as a gradual pain that gets worse with activity. Joints can be stiff, have decreased range of motion, be tender and have visible swelling. They are typically tender to touch. Sometimes the joint may feel like it is giving out and pain typically presents as an intense or dull ache that is worse after aggravating activity, in cold weather and with the consumption of alcohol. Arthritis pain after rest typically subsites less than 30 minutes after movement however that depends on the activity.

Co-morbidities (common disease that occur alongside osteoarthritis) include diabetes mellitus and gout. In Australia 33% of people over the age of 75 have symptomatic osteoarthritis, of which 13% of women and 10% of men have arthritic knees. Osteoarthritis affects 6% of all adults and as such is one of the most common degenerative diseases.

Assessment:

When you come to see an osteopath, we will run through an assessment that can help identify the presence of osteoarthritis if it is not already diagnosed. Visually we will look for inflammation, redness and if located in the hands Hebeden’s nodes (small bony growths). We will examine the range of motion in all of your joints and compare them to the other side to ensure that the are the same. We will listen and feel for any joint crepitus (grinding) and look to see that everything is in alignment. We may decide to refer you to your general practitioner for x-ray and a calcium scan if we think there may be any complications of osteoarthritis.

Treatment:

The best treatment outcomes have been seen to occur when there is a combination of health practitioners working together on a case. This can include a rheumatologist, PT, dietician, pain specialist, orthopaedic surgeon, pharmacist, internist and nursing staff. It is important that as a patient you understand the mechanism of osteoarthritis and as such the health professional you are seeing will educated you on the pathology of this condition.

The aim of treatment for osteoarthritis is to decrease the progression of OA, increase joint function/muscle strength, decrease pain and inflammation and increase overall patient outcomes. Common forms of treatment include mobilisation, traction, massage and acupuncture/dry needling if it is appropriate. Every patient is different and so treatment will vary.

It is important to reduce the level of inflammation as it will relieve pain levels. This can be done through lymphatic drainage to remove swelling as well as diet modification to include garlic, ginger, capsicum, turmeric, omega 3 and cacao as well as other anti-oxidants.

Other lifestyle changes include heat, improvement of cardiovascular and aerobic fitness and low stress strengthening. Corticosteroid injections can also be a form of treatment if thought appropriate. Surgical intervention through the use of arthroscopy (removal of impacted tissue), osteotomy, arthroplasty are considered if conservative treatment fails. 

If you would like to receive treatment for osteoarthritis our osteopaths at eclipse health and osteopathy have experience treating this condition and are happy to help! To book an appointment call 5613 3505 or use our website.

References

Arden, N.K., Perry, T.A., Bannuru, R.R. Bruyere, O., Cooper, C., Haugen, I.K., Hochberg, M.C., McAlindon, T.E., Mobasheri, A., Reginster, J.Y. (2021). Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Nature Reviews Rheumatology, 17. pp 59-66. https://doi.org/10.1038/s41584-020-00523-9

Hsu, H. and Siwiec, R.M. (2018). Knee Osteoathritis. StatPearls Publishing. PMID: 29939661. https://europepmc.org/article/nbk/nbk507884

Katz, J.N., Arant, K.R., Loeser, R.F. (2021). Diagnosis and Treatment of Hip and Knee Osteoarthritis. JAMA, 325(6). pp 568-578. https://doi.org/10.1001/jama.2020.22171

Vizniak, N.A., (2019). Evidence-Informed Orthopaedic Conditions. 3rd edition. Prohealthsys.

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The Effectiveness of Osteopathy in Treating Fibromyalgia

Osteopathy for Fibromyalgia: Managing Pain and Improving Quality of Life

Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive issues. It affects around 4 million adults in the United States alone, primarily women. Despite its prevalence, fibromyalgia remains a complex and challenging condition to diagnose and manage effectively.

What is Fibromyalgia?

Fibromyalgia is a disorder that amplifies the way the brain processes pain signals. It is believed to result from changes in the way the central nervous system processes pain messages. Though the exact cause of fibromyalgia is still unknown, it often develops after physical or emotional trauma, infections, or surgery.

Fibromyalgia is characterized by tender points, widespread pain, and several other symptoms such as:

  • Generalized muscle stiffness
  • Fatigue and sleep disturbances
  • Restless leg syndrome
  • Anxiety and depression
  • Cognitive difficulties (commonly known as “fibro fog”)

The Impact of Fibromyalgia on Patients

Living with fibromyalgia can be incredibly challenging. The constant pain and accompanying symptoms can significantly impact the quality of life for patients. Fatigue and sleep disturbances further worsen their overall well-being. The ongoing pain and other symptoms make it difficult for fibromyalgia patients to engage in daily activities and maintain their social life.

Fibromyalgia patients also often experience higher levels of anxiety and depression, which can further exacerbate their pain and negatively impact their mental health. The heightened sensitivity to pain makes it challenging for healthcare providers to find suitable treatment options.

Osteopathic Treatments for Fibromyalgia

Gentle Stretching

Osteopathy is a holistic approach to healthcare that focuses on the proper alignment and function of the different body systems. For fibromyalgia patients, osteopathic treatments can play a crucial role in managing pain and improving their overall quality of life.

Gentle stretching exercises are a common component of osteopathic treatments for fibromyalgia. These exercises help improve flexibility, reduce muscle tension, and alleviate pain. Stretching specific muscle groups can also help increase blood flow and promote better circulation, which can improve overall muscle function.

Manipulation Techniques

In addition to stretching, osteopaths may use manipulation techniques to relieve pain and restore proper musculoskeletal function in fibromyalgia patients. These techniques involve applying gentle pressure or force to specific areas of the body to realign joints, reduce muscle tension, and improve overall mobility.

Osteopathic manipulation techniques, such as myofascial release and craniosacral therapy, can target specific areas of pain and discomfort. By addressing the underlying musculoskeletal issues, osteopathic treatments can help alleviate the pain and discomfort associated with fibromyalgia.

The Importance of Osteopathy for Fibromyalgia Patients

Osteopathy offers fibromyalgia patients a non-invasive and drug-free approach to managing their symptoms. Unlike medication-based treatments, osteopathic treatments focus on addressing the root cause of the pain and improving overall musculoskeletal function.

By relieving muscle tension, improving flexibility, and promoting better circulation, osteopathy can reduce pain and enhance overall well-being in fibromyalgia patients. Additionally, osteopathy can help improve sleep quality, reduce anxiety and depression, and enhance the body’s ability to self-heal.

Collaborating with healthcare professionals, such as osteopaths, who have an interest in managing fibromyalgia, can provide patients with a more comprehensive and holistic treatment plan. These professionals can tailor osteopathic treatments to the individual needs and symptoms of each patient, ensuring the best possible results.

Conclusion

Fibromyalgia is a complex condition that poses various challenges for patients. However, osteopathic treatments, such as gentle stretching exercises and manipulation techniques, offer potential relief from the pain and discomfort associated with fibromyalgia. By addressing the underlying musculoskeletal issues and improving overall function, osteopathy can help patients manage their symptoms and enhance their quality of life.

If you are living with fibromyalgia, considering osteopathic treatments may be a viable option. Discussing your condition with a qualified healthcare professional, such as an osteopath, can help you develop a personalized treatment plan that focuses on your unique needs. Remember, you don’t have to face fibromyalgia alone – explore the possibilities of osteopathy and take a step towards managing your pain and improving your overall well-being.

References:

  1. “Fibromyalgia Information Page.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/Disorders/All-Disorders/fibromyalgia-information-page. Accessed 25 Sept. 2021.
  2. Fleet, Ronda-lynn, et al. “Quantitative Review of Studies of Non-Cognitive Symptoms of Fibromyalgia Syndrome.” Arthritis Research & Therapy, vol. 13, no. 4, Springer Nature, 2011.
  3. Giopato, Clarissa, et al. “Into the woods: How osteopathic treatment can soothe fibromyalgia symptoms.” Journal of Clinical Medicine, vol. 9, no. 5, MDPI, 2020.