Is It Osteoarthritis?
by Kirk Lee, D.C.
“Abnormal movement patterns
and too much early resistance
will aggravate the joints”
How often do you hear from a patient, “I would exercise, but it hurts!”? Let’s look at a case study which will be very familiar to you. Mrs. Bones is a 56-year-old female who has a history of on-and-off left hip pain and bilateral knee pain, with her right knee pain being worse. She grades the hip pain as a 4 out of 10, the left knee a 5 out of 10 and the right knee a 6 out of 10 on a visual analog scale. She denies any history of trauma to the spine or knees. Mrs. Bones also gives reference to recent weight gain of 15 pounds over the last year. She feels her weight gain and sedentary office job has contributed to her condition.
On examination Mrs. B uses a cane to assist in ambulation. Her ranges of motion note restriction with expression of discomfort on lumbar flexion and right lateral bending. Knee ranges of motion noted discomfort on extension bilaterally. Neurological examination was normal. Orthopedic examination was hard to differentiate due to Mrs. B expressing moderate discomfort involving the low back, hip, and knees when performing tests. Based on our clinical examination we took full spine radiographs, including an AP pelvic view and bilateral knee view to rule out degenerative changes.
Scanning the feet was performed to evaluate symmetry and function. Upon evaluating Mrs. B.’s digital foot scan we identified patterns of her arches breaking down, indicating a need for custom-made, flexible orthotics. The scan also shows dramatically more breakdown on the right foot in comparison to the left foot. This correlates with our pelvic radiograph which showed an 18mm insufficiency on the right iliac crest and femoral heads in comparison to the left. This clinically indicates that she puts more pressure into her right step than her left.
Based on the information provided above, it sounds like a condition that a chiropractor deals with routinely. Our primary diagnosis would include multiple levels of spinal subluxation, and complicating factors of possible degenerative knee pain, better known as osteoarthritis (OA). Let’s turn our focus to the knee and the potential degenerative OA. With chiropractic manipulative therapy (CMT) and custom-made, flexible orthotics to provide additional support, we must also recommend some form of exercise to assist in additional stabilization and overall “wellness.” But if we remember our opening line (“I would exercise, but it hurts!”) we know that Mrs. B is a typical candidate for this statement, with recent weight gains and a sedentary lifestyle as further contributors.
Numerous studies have shown that the pain of OA can be reduced by engaging in an exercise program. We must address her gait cycle to make sure she is walking with a symmetrical gait and normal heel-to-toe transition. Alterations in our gait cycle due to subluxation complexes, fallen arches and pain compensation will force us into postural changes. Using a medium-resistance elastic band we recommended abduction and extension exercises for her hips. With the knee we focused on extension and flexion movements. Education is very critical when demonstrating these exercises to the patient. We must ensure that correct form is used and not too much resistance. Abnormal movement patterns and too much early resistance will aggravate the joints and create the “it hurts to do the exercises” excuse.
After six weeks we helped Mrs. B enjoy a better lifestyle, which has included weight loss and pain-free ranges of motion. Her care plan included strengthening, stretching and a progressive walking program for our rehabilitative care, custom-made orthotics for our support phase, and chiropractic manipulative therapy (adjustments).
There are a few more points about OA that need to be addressed. In most cases it is a progressive degenerative process affecting the articular cartilage of a joint. Commonly this is demonstrated on radiographs with loss of joint space and spurring. Pain with limitations of function is usually the most common complaint. OA affects the hips, knee and spine mostly and is a contributing factor to many cases of disability. Often when left untreated it results in joint replacement surgery. As doctors of chiropractic we can provide much help for many of these patients through proper nutrition, addressing weight, physical activity, custom-made orthotic support and continued education on the importance of chiropractic manipulative therapy.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.