Coping With Arthritis And Our Treatment Approach

What is peculiar about osteoarthritis, for example of the lumbar spine, is trying to predict who will and won't suffer from pain symptoms. Studies have repeatedly shown that some arthritis sufferers have significant ‘wear and tear’ of the lumbar joints but experience no pain at all - whereas others may have more mild wear and tear changes yet suffer from debilitating pain and dysfunction.

As such there is poor correlation between the extent of the arthritis and the severity of the pain symptoms which may arise. For this reason we also need to be careful to avoid putting all back pain suffered by those in their more senior years as being ‘arthritis’ as this may not be the case.

Indeed arthritis may be the cause, but there are many other reasons someone may be suffering from back pain. At times arthritic changes seen on MRI for example may be a chance finding and not actually the cause of the pain at all. A good clinical assessment is usually able to determine whether the pain is arthritis related.

So who is more at risk of developing pain associated with arthritis?

This is a difficult question to answer but evidence from clinical practice may give us some clues. Those who stay mobile and engage in light exercise generally are less prone to developing pain and enjoy a better level of function.

Diet may also play a part. Read more advice on diet recommendations over at Arthritistoday.org in this article - Healthy Eating for Osteoarthritis

So too does our cultural and societal attitudes towards pain have its influence which may include to what extent we think of arthritis as a ‘sinister’ condition and therefore tend to worry. It helps to remember that we all suffer from wear and tear changes over the years as a natural course of events and this does not mean our bodies are going to crumble and leave us in ongoing discomfort.

Settling pain from arthritic joints

These types of joints naturally tend to stiffen over time. Some stiffness is not a bad thing, as these joints tend to be more stable or ‘secure’ and less prone to becoming painful according to some experts. However it is important to maintain a certain level of mobility or movement at the joints so that they allow for good functional movements like getting up from sitting, bending, reaching and some twisting.

Specific manual mobilisation techniques applied by a Chartered Physiotherapist can help restore movement to stiff joints, which when supported by exercises usually prevent them from stiffening up again and allow for good ongoing function. An added bonus to the use of these mobilisation techniques is that their application also has a strong pain suppressing effect and can alter the way the nervous system processes potential pain signals arising from arthritic joints. The key is to be specific and not too vigorous when treating and always consider an integrated treatment approach. More can be read about this here - Can Manual Therapy Alone Offer Sustainable Pain Relief?

Acupuncture for arthritis

Another way to help change the way the nervous system processes potentially painful signals arising for the joints is to use medical acupuncture. This has become a very well recognised and scientifically validated way of treating back pain, as well as osteoarthritic knee pain and is featuring in the most up to date medical guidelines. See NICE Guidelines

Gentle needling alongside tender joints or into surrounding tender muscle can have quite remarkable pain relieving effects as well as leaving muscles softer and more flexible to allow for better movement.

Being physically active with arthritis

Mild to moderately arthritic joints can still function very well and if they are looked after can continue to allow many years of activity. There are many ways of achieving this. We find Pilates as an exercises system works well for individuals that prefer a low impact movement routine with specific focus on core strength leading to overall improvements in physical stability.
In fact, Pilates is the ideal exercise system for arthritis suffers according to the following treatment recommendations outlined in an article at PubMed health on arthritis.

Further supporting information can be found here - Pilates for injury prevention and rehabilitation

Other factors which influence the level of pain felt may include previous injuries and how we experienced them, how they were treated and whether or not they fully recovered. Co-morbidities, i.e other medical conditions, in particular those associated with pain sensitisation such as fibromyalgia, might encourage the nervous system to pay more attention to arthritic joints, as well as any medication being taken. This list goes on...

It is important to consider activity modification if needed and other aspects of lifestyle management. A careful assessment by an attentive Physiotherapist will be able to pick up on movements you could adjust or do differently perhaps that would allow the joints to work better in a more bio-mechanically efficient manner. You can read an example of something we call ‘Meaningful Task Analysis’ where I helped a client make beneficial adjustments for her Hip Pain : Hip Pain Assessment - Keeping it Relevant

Conclusion

Sometimes medication is required to assist the treatment process and if needed a referral to your GP or consultant can be arranged. In more stubborn or persistent cases, there is the option of various types of joint injections and even surgery as a last resort. Thankfully most of our clients in our experience don't need to resort to such measures.

by Simon Coghlan