For individuals managing osteoarthritis, could massage therapy provide added treatment benefits?
Osteoarthritis Massage Therapy
Osteoarthritis happens when the cartilage between the joints wears away, causing stiffness and pain. Massage therapy is a treatment used to relieve various types of pain symptoms.
There are many types of massage therapy, that healthcare providers utilize to manipulate the muscles and other soft tissues to relieve symptoms, relax muscles, increase circulation, reduce inflammation, release trigger points, and restore mobility, flexibility, and function. (Ergonomic Trends. 2023)
Professional therapists can help relieve osteoarthritis joint pain by relaxing the surrounding muscles and other soft tissues to release stiffness. (Adam Perlman, et al., 2019)
Massage Objectives and Types
Massage therapists use their hands and fingers, forearms, elbows, and/or instruments to manipulate the body’s soft tissues. Soft tissues support and surround body structures and include muscle, fat, tendons, and ligaments.
The goal of osteoarthritis massage therapy is to relax muscles and soft tissues, increase blood and oxygen circulation, warm the affected area/s, relieve pain, and restore mobility and function.
Depending on the location of the muscles being massaged, individuals may be seated or lie down on a specialized table.
The amount of pressure and direction of movement depend on the body area.
Therapeutic oils and/or massage creams may be used to increase the therapy.
Types include:
Swedish
The therapist uses long strokes, kneading, and friction on the muscles.
Joints are moved to increase flexibility.
Deep Tissue
The therapist uses deep finger or instrument pressure, focusing on muscles that are tight or knotted.
Trigger Point
Trigger points represent a source of radiating pain symptoms.
The therapist focuses pressure on these myofascial tissue points using various strokes to release them.
Shiatsu
The therapist applies rhythmic pressure with their thumbs, fingers, and palms to redirect and increase energy or chi/qi.
A massage session lasts around 30–60 minutes depending on the severity of the condition and the number of sessions the patient has undergone. Chronic pain patients usually go through a series of specialized sessions that focus on specific areas and gradually build.
Risk Factors
Certain precautions must be taken before getting osteoarthritis massage therapy. Although there are a few serious risks, certain individuals are not suitable candidates and should not receive massage therapy. The conditions include: (Medical Massage Therapy Resource & Reference. 2023)
Damaged nerves.
Damaged blood vessels.
Infection and inflammation in the area to be massaged.
Open wounds.
Fever.
Taking a blood thinner.
Deep vein thrombosis – blood clots.
Bleeding disorders.
Osteoporosis – weak and brittle bones.
Recent fractures – broken bones.
Tumors.
Cancer.
Individuals who have recently undergone surgery.
Individuals with a skin condition that is contagious, like warts or herpes, or noncontagious, like psoriasis, could be aggravated by touch or pressure.
Individuals who have cancer, fragile skin, heart problems, or dermatomyositis are recommended to discuss osteoarthritis massage therapy with their healthcare provider.
Research on the effects of massage therapy on various health conditions is ongoing. Massage therapy promotes relaxation while reducing stress, which can help with chronic joint issues like osteoarthritis.
Perlman, A., Fogerite, S. G., Glass, O., Bechard, E., Ali, A., Njike, V. Y., Pieper, C., Dmitrieva, N. O., Luciano, A., Rosenberger, L., Keever, T., Milak, C., Finkelstein, E. A., Mahon, G., Campanile, G., Cotter, A., & Katz, D. L. (2019). Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. Journal of general internal medicine, 34(3), 379–386. https://doi.org/10.1007/s11606-018-4763-5
The body makes digestive enzymes to help break down food carbohydrates, fats, and proteins. Healthy digestion and nutrient absorption depend on these enzymes, a protein that speeds up chemical reactions in the mouth, pancreas, and intestines. Certain health conditions like pancreatic insufficiency and lactose intolerance can cause low enzyme levels and insufficiency and may need replacement digestive enzymes to help prevent malabsorption. That’s where digestive enzyme supplements come in.
Digestive Enzymes
Digestive enzymes are a vital part of digestion; without them, the body can’t break foods down, and nutrients can’t be fully absorbed. A lack of digestive enzymes can lead to gastrointestinal/GI symptoms and cause malnourishment, even with a nutritious diet. The result is unpleasant digestive symptoms that can include:
Poor absorption of nutrients
Bloating
Stomach pain
Nausea
Vomiting
Digestive enzyme supplements have been used for treating common forms of gut irritation, heartburn, and other ailments.
Enzyme Types
The main digestive enzymes made in the pancreas include:
Amylase
It is also made in the mouth.
Breaks down carbohydrates, or starches, into sugar molecules.
Low amylase can lead to diarrhea.
Lipase
This works with liver bile to break down fats.
Lipase insufficiency causes decreased levels of fat-soluble vitamins A, D, E, and K.
Protease
This enzyme breaks down proteins into amino acids.
It also helps keep bacteria, yeast, and protozoa out of the intestines.
A shortage of protease can lead to allergies or toxicity in the intestines.
Enzymes made in the small intestine include:
Lactase
Breaks down lactose, a sugar found in dairy products.
Sucrase
Breaks down sucrose, a sugar found in fruits and vegetables.
Insufficiency
When the body does not produce enough digestive enzymes or doesn’t release them correctly. A few types include:
Lactose Intolerance
The body does not produce enough lactase, making digesting the natural sugar in milk and dairy products difficult.
Exocrine Pancreatic Insufficiency
EPI is when the pancreas does not produce enough of the enzymes necessary to digest carbohydrates, proteins, and fats.
Congenital Sucrase-Isomaltase Deficiency
The body does not have enough sucrase to digest certain sugars.
Talking to a doctor if symptoms persist is recommended, as these could be signs of gut irritation or indicate a more serious condition.
Supplements
Prescription Enzymes
Depending on the severity, individuals diagnosed with enzyme insufficiency may need to take prescription digestive enzymes. These supplements assist in food breakdown and nutrient absorption. The most common enzyme replacement therapy is pancreatic enzyme replacement therapy or PERT. PERT is a prescribed medication that includes amylase, lipase, and protease. Individuals with cystic fibrosis often have pancreatic enzyme insufficiency, as the body can’t release the enzymes properly. And individuals with pancreatitis require PERT because their pancreas develops mucus and scar tissue over time.
Over-The-Counter Enzymes
Over-the-counter digestive enzyme supplements can contain amylase, lipase, and protease and can help with acid reflux, gas, bloating, and diarrhea. Some contain lactase and alpha-galactosidase. Alpha-galactosidase can help break down a non-absorbable fiber called galactooligosaccharides/GOS, mostly found in beans, root vegetables, and certain dairy products.
Certain foods contain digestive enzymes, including:
Supplementing the diet with some of these foods can help with digestion.
Functional Nutrition
References
Beliveau, Peter J H, et al. “An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST.” Journal of manipulative and physiological therapeutics vol. 42,5 (2019): 353-365. doi:10.1016/j.jmpt.2018.11.015
Brennan, Gregory T, and Muhammad Wasif Saif. “Pancreatic Enzyme Replacement Therapy: A Concise Review.” JOP: Journal of the pancreas vol. 20,5 (2019): 121-125.
Corring, T. “The adaptation of digestive enzymes to the diet: its physiological significance.” Reproduction, nutrition, developpement vol. 20,4B (1980): 1217-35. doi:10.1051/rnd:19800713
Goodman, Barbara E. “Insights into digestion and absorption of major nutrients in humans.” Advances in physiology education vol. 34,2 (2010): 44-53. doi:10.1152/advan.00094.2009
Vogt, Günter. “Synthesis of digestive enzymes, food processing, and nutrient absorption in decapod crustaceans: a comparison to the mammalian model of digestion.” Zoology (Jena, Germany) vol. 147 (2021): 125945. doi:10.1016/j.zool.2021.125945
Whitcomb, David C, and Mark E Lowe. “Human pancreatic digestive enzymes.” Digestive diseases and sciences vol. 52,1 (2007): 1-17. doi:10.1007/s10620-006-9589-z
Inflammation is the body’s response to infection, injury, or irritation. It causes swelling, redness, pain and sometimes causes the affected area to be unable to function. Acute inflammation happens after spraining the ankle or getting a mosquito bite and is the body’s method of preserving itself. This type of inflammation helps remove harmful irritants and pathogens, so healing ensues, along with healthy beneficial swelling that disappears with time. Chronic inflammation is when the body generates a stronger-than-necessary inflammatory response from an imbalanced immune system or a condition that causes the immune system to attack healthy tissue. Certain foods, lack of sleep, and constant stress increase the risk of developing chronic inflammation. Chiropractors are known for their expertise in stretching the muscles, ligaments, tendons, and adjusting/realigning joints and bones. Chiropractic treatment can also affect inflammation positively.
Inflammation Affects Health
When inflammation presents, there is significant potential that disease is also present in the body. Inflammation is a natural response to restore the body to homeostasis or balance. White blood cells and other immune cells are sent to the area to ward off invading bacteria, viruses, debris, etc., and reduce or defeat the infection. For some individuals, inflammation occurs within their body regularly and reappears repeatedly. This can be caused by injuries that never completely healed, frequent strains, and injuries from a weakened musculoskeletal system. Inflammation can also come from infection, irritation, the production of diseased cells, or allergies. Organs and tissues can be inflamed for a long time and can cause damage to the cells that comprise those regions of the body. This can lead to:
Thinning and weakening of organ walls and tissues.
Decreased organ function.
The overall deterioration of the body’s systems and wellness.
Causes
Some common diseases and conditions that create chronic inflammation are:
Asthma
Chronic peptic ulcers
Tuberculosis
Rheumatoid arthritis
Periodontitis
Ulcerative colitis
Crohn’s disease
Sinusitis
Active hepatitis
Risk Factors
Certain risk factors that can increase the likelihood of inflammation are:
Stress is one of the leading causes of illness and disease in the body and contributes significantly to inflammation. Organs and tissues can also become inflamed under pressure. When stress kicks in, chemical reactions occur, causing the release of the hormone cortisol. Cortisol is initially an anti-inflammatory hormone, but a prolonged release can eventually create a dysfunctional cycle of widespread inflammation. Chronic stress can cause inflammation throughout the body. Usually, the body’s weakest or most strained region will suffer the most effects of overall inflammation. Even after the stress reduces or is resolved, the inflammation effects can continue to linger. Inflammation can:
Decrease organ function
Strain tissues
Strain ligaments
Force bones and joints out of alignment and subluxation.
Cause decreased efficiency and performance of the body’s systems and organs.
Chiropractic Affects On Inflammation
When the body is out of alignment, it can compress tissues, muscles, and ligaments. Chiropractic works primarily on the skeletal structure and the nervous system. The nervous system plays an essential role in regulating immune response, which creates or decreases inflammation in the body. When the bones and joints are out of alignment, they cause strain on the nervous system and the immune system, often triggering an immune response. Chiropractic adjustments of the bones and joints reset and rejuvenate nervous system function. Realignment of the spine, including neck, shoulders, arms, pelvis, hips, knees, and feet, enhances nerve circulation and alleviates abnormal immune system function. To begin relieving inflammation from injury, misalignment, stress, and strain on the body, consult and see how chiropractic affects inflammation.
Body Composition
Dietary Fats
There are four main types of dietary fats listed on food labels:
These are not to be confused with adipose tissue/stored fat in the body. These four fats have different physiological effects once they are digested. Some are beneficial, and some can negatively impact health and are recommended to be taken in moderation.
Saturated vs. Unsaturated fats
Fats are made up of chains of carbon atoms with a carboxyl group COOH at one end and methyl groups CH3 at the other end. Carbons are attached to each other and to hydrogen atoms. The way the carbons are chained differentiates saturated and unsaturated fats and impacts how the body processes them. Unsaturated fats have one or more double bonds between the carbon atoms, and foods rich in unsaturated fats are usually liquid at room temperature, like olive oil. Saturated fats contain no double bonds and are generally solid at room temperatures, like butter and cheese.
References
Arulselvan, Palanisamy et al. “Role of Antioxidants and Natural Products in Inflammation.” Oxidative medicine and cellular longevity vol. 2016 (2016): 5276130. doi:10.1155/2016/5276130
Hannibal, Kara E, and Mark D Bishop. “Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation.” Physical therapy vol. 94,12 (2014): 1816-25. doi:10.2522/ptj.20130597
Pahwa R, Goyal A, Bansal P, et al. Chronic Inflammation. [Updated 2021 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/
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Digestive Enzymes
