Back Clinic Arthropathies Chiropractic and Physical Therapy Team. Charcot’s is degeneration of a weight-bearing joint and arthrogryposis which means, “curving of joints.” this is a general term that describes any disease of the joints. A group of disorders can afflict the joints, such as sacroiliitis, which causes inflammation in the sacroiliac joint. Doctors use arthropathy interchangeably with arthritis, which means “joint inflammation.”The forms that are distinct from arthritis are Neuropathic arthropathy, nerve damage from diabetes, or other nerve conditions resulting in slow damage to joints.
In diabetic people, arthropathy usually affects the foot and ankle. Hypertrophic pulmonary osteoarthropathy is where the bone ends of the ankles, knees, wrists, and elbows start to grow abnormally and painfully. Fingertips start to become rounded, called “clubbing.” This form of arthropathy usually happens to people with lung cancer. And Hemarthrosis is when blood leaks into a joint like the knee. This occurs after injuries or medical procedures and is a problem in people with hemophilia.
Can understanding what knee tests are used help a healthcare provider diagnose the cause of individuals experiencing knee pain?
Knee Pain Tests
A knee examination is the first step in determining the cause of knee pain. Different knee tests may be performed during the exam to help the healthcare provider find the cause and develop an optimal treatment plan. These tests evaluate knee function and range of motion and look for conditions and injuries such as arthritis, meniscus tears, ACL tears, other ligament injuries, and kneecap issues.
Checking If There is Fluid in the Knee
Many individuals know if their knee is swollen, as they can see or feel the swelling. However, if there is excess fluid in the knee joint, the healthcare provider may compress the joint to feel for excess fluid. Fluid is often visible above the kneecap and can be compressed in this area. Fluid may also be detected in the back of the knee, referred to as a Baker’s cyst if the fluid has collected into a cluster. (Frush T. J., & Noyes F. R. 2015)
Arthritis Tests
Certain characteristic findings can detect knee arthritis:
Crepitus
Crepitus is the sensation when rough cartilage or exposed bone is rubbing when the knee is bent. (Lo G. H. et al., 2018)
The examiner will feel and listen for grinding as the knee is bent back and forth.
Deformity
As knee cartilage wears away, the knees can become progressively knock-kneed or bow-legged.
Limited Motion
If arthritis, bone spurs, and swelling prevent normal mobility, the knee’s range of motion often becomes limited.
Torn Meniscus Tests
Tests used to determine if there is a meniscus tear include:
Joint Line Tenderness
Joint line tenderness is a non-specific test in which the area of the meniscus is felt. It is considered a positive test when there is pain in this area.
McMurray’s test
This test is performed with the patient lying flat. The examiner bends the knee and rotates the shin bone.
This test is performed with the patient squatting.
The test is performed with the leg fully externally rotated or internally rotated, depending on whether the lateral or medial meniscus is being tested.
A click is heard or felt over the area of the tear.
ACL Tear Tests
These knee pain tests are for an anterior cruciate ligament (ACL) tear:
Lachman Test
The Lachman test is one of the most reliable to diagnose an ACL tear.
With the knee slightly bent, the examiner stabilizes the thigh while pulling the shin forward.
The shin shifts too far forward with a torn ACL.
Anterior Drawer Test
This test is performed with the patient lying flat.
The knee is bent 90 degrees, and then the shin is pulled forward to check the stability of the ACL.
Pivot Shift Test
The pivot shift test can be difficult, especially if the patient is experiencing discomfort and cannot relax the knee.
This test places stress on the knee joint and assesses the rotational stability of the ACL.
Other Ligament Injuries
For a suspected injury to other ligaments, including the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), the following tests may be used:
Posterior Drawer Test
The posterior drawer is performed similarly to the anterior drawer test, in which the patient lies flat.
The knee is bent 90 degrees; the shin is pushed backward to check stability and function and detect if the posterior cruciate ligament (PCL) has been injured.
Collateral Ligament Stability
Side-to-side stability of the knee detects problems with the MCL and LCL.
The shin is shifted to each side, with the patient lying flat and the knee slightly bent.
The LCL or MCL damage causes the knee to open up too much, a condition known as varus (LCL) or valgus (MCL) instability. (Ohori T. et al., 2017)
Kneecap Tests
Tests for kneecap issues include:
Patellar Grind
In this test, also called Clarke’s sign, the patient lies on their back with the leg extended.
The examiner pushes the kneecap down to reproduce the knee pain while the patient flexes the thigh muscles.
Damaged cartilage can cause a grinding sensation/crepitus.
Patellar Tenderness
The examiner can slightly lift the kneecap and place direct pressure on parts of the underside.
The examiner looks for regions of sensitivity or pain.
Patellar Apprehension
This test indicates an unstable kneecap.
The examiner places pressure on the kneecap in a certain direction, and the patient may feel like the kneecap is going to pop out.
Injury Medical Chiropractic and Functional Medicine Clinic
Knee pain tests typically check the range of motion, discomfort symptoms, and sounds that could indicate a specific type of knee injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Overcoming an ACL Injury
References
Frush, T. J., & Noyes, F. R. (2015). Baker’s Cyst: Diagnostic and Surgical Considerations. Sports health, 7(4), 359–365. doi.org/10.1177/1941738113520130
Lo, G. H., Strayhorn, M. T., Driban, J. B., Price, L. L., Eaton, C. B., & Mcalindon, T. E. (2018). Subjective Crepitus as a Risk Factor for Incident Symptomatic Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis care & research, 70(1), 53–60. doi.org/10.1002/acr.23246
Gupta, Y., Mahara, D., & Lamichhane, A. (2016). McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?. Ethiopian journal of health sciences, 26(6), 567–572. doi.org/10.4314/ejhs.v26i6.10
Ohori, T., Mae, T., Shino, K., Tachibana, Y., Fujie, H., Yoshikawa, H., & Nakata, K. (2017). Varus-valgus instability in the anterior cruciate ligament-deficient knee: effect of posterior tibial load. Journal of experimental orthopaedics, 4(1), 24. doi.org/10.1186/s40634-017-0087-3
Can individuals dealing with psoriatic arthritis find non-surgical treatments to reduce joint pain and improve skin health?
Introduction
The body is a complex machine with a communal relationship with the joints, organs, bones, muscles, and tissues, each of which has a specific function to ensure the host is alive. The brain is the main control system that gives each body’s systems, organs, muscles and joints a job. When environmental factors or pathogens enter the body, the immune system is the first one to defend the body and eliminate the pathogens to initiate the natural healing process. However, when the immune system is attacking the body constantly, over time, it can lead to autoimmunity and cause overlapping risk profiles in the body. This, in turn, can lead the development of chronic conditions and cause individuals pain and discomfort. In today’s article, we look at an autoimmune disorder known as psoriatic arthritis, its causes and symptoms, and how treatment can help reduce its pain like effects. We discuss with certified medical providers who inform our patients how psoriatic arthritis can affect the joints. While asking informed questions to our associated medical providers, we advise patients to incorporate various non-surgical treatments to reduce psoriatic arthritis symptoms and help manage joint pain that affects a person’s quality of life. Dr. Alex Jimenez, D.C., encompasses this information as an academic service. Disclaimer.
What Is Psoriatic Arthritis?
Do you experience swelling in your joints that causes pain and discomfort when moving? Do you feel your skin itchier and warmer than usual? Or have you noticed that everyday tasks are more difficult now than before? Many of these pain-like scenarios are associated with joint pain associated with an autoimmune or musculoskeletal condition. Since autoimmunity is developed when environmental factors cause the immune system to attack healthy cells, it can envoke pain and discomfort to the body. When a person is dealing with an autoimmune condition, it can impact not only the individual but also the rest of the body’s system. For instance, if a person is dealing with an autoimmune condition, they could be dealing with skin issues that can cause them to develop scaly, itchy, red skin patches known as psoriasis. If they have joint pain combined with psoriasis, it can develop into psoriatic arthritis. (Skornicki et al., 2021) Now psoriatic arthritis is a heterogeneous autoimmune condition with musculoskeletal involvement that can manifest various symptoms including inflammation and arthritis. (Hackett et al., 2022) This in turn causes many individuals to think they are dealing with rheumatoid factors.
Causes & Symptoms
As a multifactorial pathology, psoriatic arthritis causes care often influenced by a complex interplay of immunological, environmental, and genetic factors that cause its development. (Zalesak et al., 2024) When the immune system starts to attack the healthy cells in the body, the inflammatory cytokines can become haywire and attack the “problem,” causing the development of autoimmunity. Within this integration, some of the causes can include predisposing genetic backgrounds with the presence of environmental factors that can activate the innate immune system precipitate the onset of psoriatic arthritis. (Azuaga et al., 2023) Some of the symptoms can many individuals with psoriatic arthritis can include:
Tendon tenderness
Joint pain
Stiffness
Fatigue
Joint swelling
Skin rash
Musculoskeletal pain
However, there are ways to manage psoriatic arthritis, reduce joint pain from affecting a person, and help them manage the symptoms.
Arthritis Explained-Video
Treatments For Psoriatic Arthritis
When it comes to treating psoriatic arthritis, healthcare professionals need to develop therapeutic options to educate the individual and develop a treatment plan that can include conventional therapies and non-pharmacological therapies that are affordable and customized with the individual’s condition. (Ogdie et al., 2020) Since psoriatic arthritis is a complex inflammatory musculoskeletal condition and skin disease, individuals must try to find ways to reduce the inflammatory effects of causing more joint issues. Non-surgical treatments like chiropractic care, physical therapy, and diet changes can help mitigate the burden of psoriatic arthritis by reducing the complications and the socio-economic impact. (McGonagle et al., 2022)
Another way individuals can reduce the inflammatory effects of psoriatic arthritis is by consuming anti-inflammatory foods to dampen the inflammatory cytokines attacking the joints and going to physical therapy sessions like water aerobics to help stabilize the joints and help people be more mindful about their bodies. Since psoriatic arthritis can be managed through non-surgical therapy, low-weight bearing exercise regimes and incorporating anti-inflammatory foods to reduce inflammation can help people minimize psoriatic arthritis symptoms from impacting their health and wellness journey.
References
Azuaga, A. B., Ramirez, J., & Canete, J. D. (2023). Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci, 24(5). doi.org/10.3390/ijms24054901
Hackett, S., Ogdie, A., & Coates, L. C. (2022). Psoriatic arthritis: prospects for the future. Ther Adv Musculoskelet Dis, 14, 1759720X221086710. doi.org/10.1177/1759720X221086710
McGonagle, D. G., Zabotti, A., Watad, A., Bridgewood, C., De Marco, G., Kerschbaumer, A., & Aletaha, D. (2022). Intercepting psoriatic arthritis in patients with psoriasis: buy one get one free? Ann Rheum Dis, 81(1), 7-10. doi.org/10.1136/annrheumdis-2021-221255
Ogdie, A., Coates, L. C., & Gladman, D. D. (2020). Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford), 59(Suppl 1), i37-i46. doi.org/10.1093/rheumatology/kez383
Skornicki, M., Prince, P., Suruki, R., Lee, E., & Louder, A. (2021). Clinical Burden of Concomitant Joint Disease in Psoriasis: A US-Linked Claims and Electronic Health Records Database Analysis. Adv Ther, 38(5), 2458-2471. doi.org/10.1007/s12325-021-01698-7
Zalesak, M., Danisovic, L., & Harsanyi, S. (2024). Psoriasis and Psoriatic Arthritis-Associated Genes, Cytokines, and Human Leukocyte Antigens. Medicina (Kaunas, Lithuania), 60(5). doi.org/10.3390/medicina60050815
Back pain is one of the most common reasons for seeking health care. Individuals dealing with back pain but don’t know the cause may have some inflammatory joint disease or autoimmune condition. Can seeing a rheumatologist help?
Rheumatologist
Depending on what’s causing the back pain, individuals may need to see their primary doctor for a referral. Individuals are recommended to see a rheumatologist if they have back pain that doesn’t come from an injury that doesn’t go away after a few weeks, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. Rheumatologists treat severe or persistent back pain and are experts in autoimmune diseases, including lupus, Sjogren’s syndrome, rheumatoid arthritis, ankylosing spondylitis, axial spondylitis, Psoriatic arthritis, and other forms of inflammatory or autoimmune arthritis.
What Do They Do?
A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:
Inflammatory
Autoimmune
Related to painful joint disease
The doctors diagnose, treat, and manage these conditions long-term. Depending on diagnosis and care needs, they may also lead or be part of a team that includes other healthcare providers.
Symptoms
When muscles ache, pain presents, or joints hurt, and especially if there are signs of inflammation that don’t go away, seeing a healthcare provider is recommended. Symptoms of inflammation include:
Redness
Swelling
Pain
Stiffness
Loss of joint function
Usually, to see a rheumatologist, individuals need a referral from their primary care provider and may be referred when:
There is no evidence of a back injury.
At-home therapies like heat application, prescription medications, or physical therapy are unsuccessful.
There is uncertainty about what’s causing the back pain, but I suspect it’s rheumatological.
Blood tests for inflammatory markers or certain antibodies yield abnormal results.
There is a diagnosis of a rheumatic condition and recommend a specialist to manage it.
There is a family history of a rheumatic or autoimmune condition that may cause back pain.
Some types of arthritis can cause permanent, progressive joint damage.
Conditions
Conditions that can affect the spine and cause back pain and are treated by a rheumatologist include: (Johns Hopkins Medicine, 2024)
Rheumatoid arthritis (RA)
This often starts in smaller joints of the hands and feet and later moves to the neck and/or back.
It can also affect different body organs and have systemic symptoms.
Ankylosing Spondylitis (AS)
Primarily a disease of the spine, it may also impact the shoulders, hips, knees, and ankles.
Systemic symptoms, including fever and fatigue, can manifest.
Axial Spondylitis
This primarily affects the spine, chest, and pelvis.
It may also cause problems with the connective tissue, eyes, bowel, and skin.
Psoriatic Arthritis (PsA)
Pain in the lower back is common, especially in severe cases.
It can affect other joints and cause psoriasis.
Reactive Arthritis
This is a reaction to infection.
It is more common in the limbs, hands, and feet joints but can involve the spine.
Enteropathic Arthritis
This mainly affects the spine but can include other joints.
It is associated with inflammatory bowel disease.
Autoimmune diseases that don’t specifically target the spine but can also cause back pain include:
Lupus
Sjögren’s syndrome
Hashimoto’s thyroiditis
Finding a Doctor
Individuals may be fine with their primary healthcare provider’s choice regarding which rheumatologist to see. However, they may want to research other options to ensure the right rheumatologist is chosen. Things to look at include:
Search online medical directories.
Visit the websites of the doctors being considered to learn more about their training, approach, and specialties.
Check online reviews.
Check on health insurance coverage.
Ask members of the healthcare team, friends, and family for recommendations.
Contact rheumatologists’ offices to see if they are accepting new patients.
Once decided, pass along the information to the primary care doctor so they can make the referral.
Preparing For The Initial Visit
Before seeing a new rheumatologist, take a few minutes to prepare so you can make the most of the appointment. Individuals will want to have:
A list of back-related symptoms, including frequency and severity.
A list of what makes symptoms better or worse.
A copy of recent test results and records from other doctors.
Individuals can ask their provider/s to send their medical information to the rheumatologist’s office in advance.
A list of treatments that have been tried and how well they worked.
A list of all medications, over-the-counter and prescription, supplements, and herbal products taken.
A list of medication allergies.
Complete medical history and family history of potentially related diseases.
A list of any questions regarding conditions, treatment, etc.
If possible, fill out any paperwork for the new office beforehand to save time on the appointment day.
Injury Medical Chiropractic and Functional Medicine Clinic
Talking with a healthcare provider is important. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
For individuals with arthritis, can incorporating acupuncture with other therapies help manage pain and other symptoms?
Acupuncture For Arthritis
Acupuncture has been around for thousands of years and is a form of traditional Chinese medicine that utilizes needles inserted into various parts of the body to relieve pain and inflammation. The practice is based on the concept of life energy that flows throughout the body along pathways called meridians. When the energy flow becomes disrupted, blocked, or injured, pain or illness can present. (Arthritis Foundation. N.D.) Further research is needed to determine how the acupuncture therapeutic mechanisms work and the overall effectiveness. However, there is emerging evidence suggesting that acupuncture can provide symptom relief for individuals with joint pain, especially those with osteoarthritis and rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Benefits
The actual method that reduces the pain and inflammation is still unclear. Theories include that the needles suppress inflammatory responses, improve blood flow, and relax muscles. Although acupuncture cannot cure or reverse arthritis, it may be useful for managing pain and decreasing associated symptoms, especially in combination with other therapies. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Rheumatoid Arthritis
A systematic review of 43 studies, including humans and animals with rheumatoid arthritis, demonstrated varied results. Several studies showed improvement in symptoms and decreased biological markers of rheumatoid arthritis following one to three sessions of acupuncture for four weeks or more. (Sharon L. Kolasinski et al., 2020) Beneficial outcomes following acupuncture treatment for rheumatoid arthritis include:
Reduced pain
Reduced joint stiffness
Improved physical function
The results of the human and animal studies suggested that acupuncture has the potential to down-regulate:
Levels of interleukins
Levels of tumor necrosis factor
Specific cell signaling proteins/cytokines involved in the inflammatory response, which become elevated in autoimmune conditions like rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Most of the study subjects were also receiving other forms of treatment, especially medication. Therefore, it is difficult to conclude how beneficial acupuncture is alone or as a supplemental addition to other medical treatments. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Osteoarthritis
Acupuncture for osteoarthritis of the hand, hip, and knee is recommended, according to the American College of Rheumatology and Arthritis Foundation, meaning that it may be worth trying, although more research is needed to confirm its effectiveness. However, since the risk is relatively minor, acupuncture is generally considered a safe alternative treatment option for managing the symptoms. (Sharon L. Kolasinski et al., 2020)
Chronic Pain
As clinical trials suggest that acupuncture may be effective in providing pain relief, it may be a recommended option for individuals suffering from chronic pain. A recent systematic review of 20,827 patients and 39 trials concluded that acupuncture is effective for the treatment of chronic musculoskeletal pain, headache, and osteoarthritis pain. (Andrew J. Vickers et al., 2018)
Triggering the release of endorphins/hormones that help reduce pain.
Safety
Acupuncture is considered a safe procedure by a licensed and certified professional.
To practice acupuncture in the United States, an acupuncturist needs a minimum of a master’s degree from a program accredited by the American Academy of Acupuncture and Oriental Medicine and a license in the state where they received their acupuncture treatment.
Doctors with an MD or DO degree licensed in the United States to practice medicine can also be licensed by the American Academy of Medical Acupuncture after additional training.
Risks
Risks associated with acupuncture are bleeding and bruising, especially for individuals who have a bleeding disorder like hemophilia or take a blood thinning medication. Individuals are recommended to talk to their healthcare provider to determine if acupuncture is a safe option.
Side Effects
Most individuals do not experience any side effects, although possible reactions can include: (Shifen Xu et al., 2013)
Soreness
Bruising
Scarring
Needle shock: a vasovagal response that presents as feeling faint, clammy hands, chills, and slight nausea.
Acupuncture Session
During the initial treatment, individuals will discuss their medical history and what joints and areas of their bodies are presenting with symptoms.
After a physical exam, the individual will lie on a treatment table.
Individuals may be face up or down depending on what areas of the body the acupuncturist needs to access.
It is recommended to wear loose clothing that can be rolled up or moved out of the way to access different areas easily.
Depending on what areas need to be accessed, individuals may be asked to change into a medical gown.
The acupuncturist will use alcohol swabs to disinfect the area before inserting the needles.
The needles are made of stainless steel and are extremely thin.
Individuals may feel a slight pinch in sensitive areas like the hands and feet, but needle insertion should be comfortable and well-tolerated without significant discomfort.
For electroacupuncture, the acupuncturist will pass a mild electric current through the needles, typically 40 to 80 volts.
The needles stay in place for 20 to 30 minutes.
After the treatment is finished, the acupuncturist will remove the needles and dispose of them.
Frequency
The frequency of acupuncture sessions will vary depending on the severity of the symptoms and whether the visits are approved and reimbursed by the health insurance company.
Cost and Insurance
Costs for acupuncture can vary from $75 to $200 per session.
The first session, which involves an initial assessment and evaluation, usually costs more than follow-up visits.
Whether the health insurance will cover some or all of the costs of acupuncture sessions depends on the individual insurance company and the condition being treated.
Medicare currently covers acupuncture services up to 12 visits within a 90-day period for chronic low back pain only.
Medicare will not cover acupuncture for other conditions. (Medicare.gov. N.D.)
Acupuncture is not a cure for arthritis, but it may be a useful tool to help manage pain and other symptoms. Make sure to consult a healthcare provider if acupuncture is safe to try based on medical history.
Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain, 19(5), 455–474. doi.org/10.1016/j.jpain.2017.11.005
Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B., Shen, X., & Lao, L. (2013). Adverse events of acupuncture: a systematic review of case reports. Evidence-based complementary and alternative medicine : eCAM, 2013, 581203. doi.org/10.1155/2013/581203
Can individuals with osteoarthritis incorporate spinal decompression therapy to restore spinal mobility and quality of life?
Introduction
As the body ages, so does the spine, as the spinal disc between the joints and the bones starts dehydrating from constant compression through repetitive motions. The many environmental factors contributing to this degenerative disorder can vary within the person and lead to arthritic conditions within the upper and lower extremities. One of the most common types of arthritis is osteoarthritis, and it can affect many people worldwide. Dealing with osteoarthritis in their joints can cause numerous pain-like symptoms that correlate with other body conditions, causing referred pain. However, many treatments can help slow the process of osteoarthritis and relieve the body from the pain-like symptoms of the joints. Today’s article looks at how osteoarthritis affects spinal mobility and how treatments can restore spinal mobility from the effects of osteoarthritis. We talk with certified medical providers who utilize our patients’ information to provide various treatments to reduce the impact of osteoarthritis on the joints. We also inform patients how multiple treatments can help slow down the degenerative process of osteoarthritis. We encourage our patients to ask their associated medical providers intricated and important questions about the pain-like symptoms they are experiencing from osteoarthritis. Dr. Jimenez, D.C., incorporates this information as an academic service. Disclaimer.
How Does Osteoarthritis Affect Spinal Mobility?
Have you noticed morning stiffness after a good night’s rest? Do you feel tenderness in your joints after some light pressure? Or do you feel limited mobility in your joints, causing a restricted range of motion? Many of these pain-like scenarios are correlated with osteoarthritis, a degenerative joint disorder that has affected many individuals, including older adults. As stated earlier, when the body ages, so do the joints, bones, and spine. Regarding osteoarthritis, the joints will degenerate through natural wear and tear around the cartilage. Osteoarthritis affects multiple joints like the hips and knees, which are the most common, and the spine, and causes numerous sensory-motor dysfunctions. (Yao et al., 2023) When the cartilage around the affected joints starts to deteriorate, the pathogenesis of osteoarthritis causes a disturbed cytokine balance of the proinflammatory cytokines to initiate a vicious cycle that causes cartilage and other intra-articular structure damage around the joint. (Molnar et al., 2021) What this does is that when osteoarthritis starts to affect the joints, it can lead to numerous referred pain-like symptoms.
However, although osteoarthritis can affect the joints, naturally, numerous environmental factors do play a part in the development of osteoarthritis. Physical inactivity, obesity, bone deformities, and joint injuries are some of the causes that can progress the degenerative process. The symptoms that are associated with these environmental factors include:
Pain
Joint stiffness
Tenderness
Inflammation
Swelling
Grating sensation
Bone spurs
Many individuals dealing with pain-like symptoms caused by osteoarthritis will explain to their primary doctors that the pain varies in duration, depth, type of occurrence, impact, and rhythm. This is because the pain from osteoarthritis is complex and multifactorial. (Wood et al., 2022) However, many individuals can look for the help they need to reduce the pain-like issues caused by osteoarthritis through treatments that can slow down the degenerative progress.
An In-depth Look At Spinal Decompression-Video
When it comes to seeking treatment to reduce the effects of osteoarthritis, many individuals seek out treatments that are cost-effective and safe for older individuals. Non-surgical treatments could be the solution many individuals seek to reduce the progress of osteoarthritis. When people experiencing osteoarthritis go to non-surgical treatments, they find out that the pain is decreased, their range of motion is increased, and their physical function has improved. (Alkhawajah & Alshami, 2019) At the same time, non-surgical treatments can be combined with other therapies to the individual’s personalized treatment plan. No-surgical treatments can range from chiropractic care to spinal decompression as they work on gently realigning the spine through traction and help reduce joint and muscle pain. The video above gives an in-depth look at spinal decompression and how it can benefit individuals who are in pain.
Spinal Decompression Restoring Spinal Mobility From Osteoarthritis
Since spinal decompression is a form of non-surgical treatment, it can help slow down the process of osteoarthritis. Spinal decompression incorporates traction to gently pull on the spine, allowing the discs and joints to be lubricated and permitting the natural healing process to occur. This is because the surrounding muscles that protect the joints are being stretched gently and the vertebral disc space is being increased to allow the disc to be rehydrated and the protrusion to recede back to its original position. (Cyriax, 1950) Spinal decompression can help slow down the degenerative process of osteoarthritis, and when combined with physical therapy, the surrounding muscles, tissues, and ligaments are strengthened.
In contrast, joint and spinal mobility and flexibility are increased. Spinal decompression can also help many individuals reduce their chances of surgery, as consecutive sessions can help provide pain relief and functional improvement to the spine. (Choi et al., 2022) When people regain their spinal mobility back to their bodies from spinal decompression, they can make small changes in their daily routine to slow down the degenerative process of osteoarthritis.
References
Alkhawajah, H. A., & Alshami, A. M. (2019). The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial. BMC Musculoskelet Disord, 20(1), 452. doi.org/10.1186/s12891-019-2841-4
Choi, E., Gil, H. Y., Ju, J., Han, W. K., Nahm, F. S., & Lee, P. B. (2022). Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc. International Journal of Clinical Practice, 2022, 6343837. doi.org/10.1155/2022/6343837
Molnar, V., Matisic, V., Kodvanj, I., Bjelica, R., Jelec, Z., Hudetz, D., Rod, E., Cukelj, F., Vrdoljak, T., Vidovic, D., Staresinic, M., Sabalic, S., Dobricic, B., Petrovic, T., Anticevic, D., Boric, I., Kosir, R., Zmrzljak, U. P., & Primorac, D. (2021). Cytokines and Chemokines Involved in Osteoarthritis Pathogenesis. Int J Mol Sci, 22(17). doi.org/10.3390/ijms22179208
Wood, M. J., Miller, R. E., & Malfait, A. M. (2022). The Genesis of Pain in Osteoarthritis: Inflammation as a Mediator of Osteoarthritis Pain. Clin Geriatr Med, 38(2), 221-238. doi.org/10.1016/j.cger.2021.11.013
Yao, Q., Wu, X., Tao, C., Gong, W., Chen, M., Qu, M., Zhong, Y., He, T., Chen, S., & Xiao, G. (2023). Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther, 8(1), 56. doi.org/10.1038/s41392-023-01330-w
As the body ages, individuals want to stay active and maintain a healthy pain free lifestyle. Can regenerative cells for arthritis and cartilage damage be the future of neuromusculoskeletal medicine and joint healing?
Regenerative Cells For Arthritis and Cartilage Damage
Individuals want to continue to do the physical activities they love, which require healthy joints. Scientists are learning how to harness the abilities of regenerative cells to repair and regrow damaged and deteriorated cartilage. Current stem cell treatment of cartilage problems has not been shown to reverse the effects of arthritis and while studies show clinical improvement, further research is necessary. (Bryan M. Saltzman, et al., 2016)
Cartilage and How It Gets Damaged
Cartilage is a type of connective tissue. In the joints, there are a few types of cartilage. The most commonly referred to is the smooth lining known as articular or hyaline cartilage. This type forms a smooth layer of cushion on the end of a bone at the joint. (Rocky S. Tuan, et al., 2013)
The tissue is very strong and has the ability to compress and absorb energy.
It is very smooth allowing a joint to glide effortlessly through a limb’s range of motion.
When joint cartilage is damaged, the cushioning can wear down.
In traumatic injuries, a sudden force can cause the cartilage to break off and/or suffer damage, that exposes the underlying bone.
In osteoarthritis – degenerative or wear-and-tear arthritis, the smooth layer can wear down thin and unevenly.
Eventually, the cushion wears away, the joints become inflamed and swollen and movements become stiff and painful.
There are treatments for arthritis and cartilage damage, but these treatments are usually focused on relieving symptoms by smoothing down the damaged cartilage or replacing the joint surface with an artificial implant, like knee replacement or hip replacement surgeries. (Robert F. LaPrade, et al., 2016)
Regenerative Cells
Regenerative stem cells are special cells that have the ability to multiply and develop into different types of tissue. In an orthopedic surgery setting for joint problems, stem cells are obtained from adult stem cell primary sources which are bone marrow and fatty tissue. These cells have the ability to develop into cartilage cells, called chondrocytes. (Rocky S. Tuan, et al., 2013)
They also help by stimulating the body to reduce inflammation, stimulate cell repair, and improve blood circulation.
This process is caused by cellular signals and growth factors to stimulate the body to activate the healing processes.
Once stem cells have been obtained, they need to be delivered to the area of cartilage damage.
Cartilage is a complex tissue that is described as a scaffold structure that is composed of collagen, proteoglycans, water, and cells. (Rocky S. Tuan, et al., 2013)
To regenerate cartilage, the complex tissues must also be reconstructed.
There are studies on types of tissue scaffolds engineered to recreate a similar type of cartilage structure.
The stem cells can then be injected into the scaffold, in hopes of restoring a normal type of cartilage.
Non-Surgical Arthritis Treatments
Standard treatments such as cortisone shots or physical therapies work as well and provide benefits that could be utilized in combination with regenerative cells for arthritis and cartilage damage in the near future. Data takes time and therefore how this impacts the long-term health of a joint needs continued research in terms of tissue engineering and cell delivery to determine the best approach to help individuals.
Arthritis
References
LaPrade, R. F., Dragoo, J. L., Koh, J. L., Murray, I. R., Geeslin, A. G., & Chu, C. R. (2016). AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 24(7), e62–e78. doi.org/10.5435/JAAOS-D-16-00086
Saltzman, B. M., Kuhns, B. D., Weber, A. E., Yanke, A., & Nho, S. J. (2016). Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist. American journal of orthopedics (Belle Mead, N.J.), 45(5), 280–326.
Tuan, R. S., Chen, A. F., & Klatt, B. A. (2013). Cartilage regeneration. The Journal of the American Academy of Orthopaedic Surgeons, 21(5), 303–311. doi.org/10.5435/JAAOS-21-05-303
Ankylosing spondylitis is an inflammatory condition that causes pain and stiffness in the spine’s joints. Over time, it can progress to fusing the bones of the spine/vertebrae, limiting the spine’s mobility and leading to discomfort symptoms. The condition is more common in men but also affects women. There is not a known, singular cause, but individuals with a particular gene, HLA-B27, have an increased risk of developing the condition. However, the gene itself does not mean an individual has ankylosing spondylitis; genetics and other outside and environmental factors also play a role. DMARDs, or Disease-Modifying Antirheumatic Drugs, suppress inflammation. An emerging DMARD treatment uses biologics that further target and suppresses specific inflammatory compounds.
Biologics
Unlike regular medications, which are synthesized, biologics are made from and inside living sources.
They are grown in cultures or harvested from blood.
Biologics are complex and expensive.
Biologics provide some of the most powerful treatments for many conditions.
Two biologics commonly used to treat ankylosing spondylitis are:
TNF – tumor necrosis factor, TNF inhibitors are a biological medication that targets and suppresses TNF, which is involved in inflammatory processes throughout the body.
Blocking or suppressing TNF decreases inflammation and can delay the progression of ankylosing spondylitis.
It could be administered through an injection or infusion to provide the medication.
Side Effects
Side effects associated with this medication, along with other conditions, include:
IL – interleukin – IL-17 is a protein involved in inflammatory processes and conditions.
IL-17 inhibitors suppress inflammation which are newer medications that have been shown to benefit those with ankylosing spondylitis.
Doctors often administer IL-17 inhibitors through an injection.
Side Effects
Minor side effects include:
Headaches
Runny nose
Irritation at the injection site.
More serious side effects include:
Certain cancers
Severe infections
High blood pressure
Other Treatments
Treatment goals for ankylosing spondylitis include:
Slowing the disorder’s progression.
Decreasing inflammation.
Reducing pain.
Improving or maintaining joint and spinal range of motion.
Biologics are not the first-line treatment for ankylosing spondylitis.
Providers usually first treat an initial diagnosis with anti-inflammatory medications, like NSAIDs, to decrease inflammation and slow the condition’s progression.
Chiropractic care and physical therapy are recommended to maintain and/or improve posture, muscle strength, and endurance.
Recommended lifestyle and nutritional modifications.
Posture training stretches and exercises.
Optimal movement strategies to safely and confidently complete everyday tasks.
Biologic Medications
Biologics for ankylosing spondylitis may or may not be suitable. These medications are meant to help relieve the inflammation associated with the condition and slow the disorder’s progression. Your healthcare team will work with you to determine the right treatment option/s and explain the benefits, risks, and types of treatment. They will monitor the condition, track progress, and adjust the plan accordingly.
Chen C, Zhang X, Xiao L, Zhang X, Ma X. Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis: A Systematic Review and a Network Meta-Analysis. Medicine (Baltimore). 2016 Mar;95(11):e3060. doi: 10.1097/MD.0000000000003060. PMID: 26986130; PMCID: PMC4839911.
Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. [Updated 2022 July 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK482425/
Lindström, U., Olofsson, T., Wedrén, S. et al. Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 21, 128 (2019). doi.org/10.1186/s13075-019-1908-9
Yin, Y., Wang, M., Liu, M. et al. Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Res Ther 22, 111 (2020). doi.org/10.1186/s13075-020-02208-w
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