Degenerative Joint Disease

Alternative Names: Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis-Osteoarthritis.
Causes
Unfortunately most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.


The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.


OA can be primary or secondary.
Primary OA occurs without any type of injury or obvious cause.
Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.
Symptoms
The symptoms of osteoarthritis include:
Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest.
Grating of the joint with motion.
Joint pain in rainy weather.
Joint swelling.
Limited movement.
Morning stiffness.
Of course some people might not have symptoms.

Examination and Tests
A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.
An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS
The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.
Other medications used to treat OA include:
COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the Drug Licensing Authorities to re-evaluate the risks and benefits of the COX-2s. Ask your doctor whether the drug is 1. Still available and if so 2. Right and safe for you.


Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.


LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.
Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.


PHYSICAL THERAPY
Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.
SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty )
Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthodesis)

Outlook (Prognosis)
Your movement may become very limited. However Treatment generally improves function.
Possible Complications.
Decreased ability to walk.
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking.
Adverse reactions to drugs used for treatment.
Surgical complications.

When to Contact a Medical Professional
Do contact your health care provider if you have symptoms of osteoarthritis.

Prevention
*Weight loss can considerably help in the management DJD and ceratainly reduce the risk of knee osteoarthritis in overweight women.

Let us Help?

Are you a candidate for treatment?

Our associated clinics treat both acute and chronic back conditions.

If your symptoms have appeared recently we can use the best manual physical

therapy techniques to facilitate the healing process and restore normal function as soon as possible.

If your symptoms are long-standing (more than 6 weeks) or recurrent you are likely to have developed weakness and instability in your spine and you may be a candidate for our specialised programme of intensive strengthening of the lumbar spine.

We are able to treat anyone between the ages of 18 to 80.
Treatment is as suitable for those with sedentary lives as it is for athletes - we have patients at both ends of the scale.

This list shows some of the the conditions that can be treated successfully using Natural Physical Therapy.

Lumbar strain

Herniated (prolapsed) disc

Sciatica

Degenerative disc (or joint) disease

Stenosis

Spondylolisthesis

Osteoporosis

Osteoarthritis

Hypermobility/instability

Scheuermann's disease

Many treatment methods help only with symptomatic relief but do not address the underlying cause of pain and therefore result in only a temporary solution.

That is why so many people with back pain find themselves in the "Pain Maze" confused over which therapy to undergo, or whether drugs, injections, manipulation or surgical procedures will indeed bring an end to the pain.

That’s why Back Trouble UK was formed, so that Back Pain sufferers could be both more informed and to be able to make a more informed choice of available therapies.

You Are Not Alone!

Back pain? You’re not alone

Eight out of ten people in the UK will experience some form of back pain at one point in their lives. It's a serious health problem that often goes untreated. One of the reasons back pain is so common is that it can be caused by so many different things.

Work-related injuries
Sports injuries
Poor posture
Stress
Car accidents
Improper lifting

Any of these things can cause your spine to shift from its normal position or affect your range of motion. This puts pressure on the joints, muscles, and nerves in that area, and is what causes most back pain. A healthy back is essential for a healthy body. For some people, chiropractic treatment is like a regular tune-up for their back, to help deal with the daily wear and tear of life. For others, it's an effective treatment when back pain strikes. Take the time to discuss with your chiropractor the level of care that's best for you.

Back problem warning Signs:
Here are some symptoms which might indicate that you suffer from a back problem:

Leg pain with numbness, tingling, and/or weakness

Back or leg pain with coughing or sneezing

Difficulty standing up after sitting for any period of time

Stiffness in the morning that decreases when you move around

Pain in your hip, buttock, thigh, knee, or foot

Inability to turn or bend to each side equally

Unbalanced posture, when your head, neck, or shoulder may be higher on one side than the other

Pain which prevents you from sleeping well

Pain that persists or worsens after 48 hours.

A Physical Therapist treats your back pain by addressing the cause of the pain. A Physical adjustment allows your spine to return to its proper position and improve your range of motion, letting you feel like yourself again. It's simple, and it works.

Just How Safe is Osteopathy?

How safe is Osteopathy?

Osteopathy has one of the best safety records of any medically related profession, however no form of medical treatment is ever 100% safe in every case.

Osteopaths have been trained to recognise any condition that might make osteopathic treatment inadvisable so that they can refer their patients for appropriate medical intervention when necessary. In the same way that a family physician regards safety as the most important factor in selecting the appropriate medication for a particular patient, Osteopaths also select the most appropriate style of treatment with safety as the prime consideration.

Contrary to that which some might try and lead you to believe, NO healthcare professional wants you to come to any harm.

Are there any side-effects or risks to osteopathic treatment?
Yes, but there are risks in everything that we do in life. Most of osteopathic patients feel no reactions at all.

Common: general ache or soreness for 24-48 hours following a positive response to osteopathic treatment.

Infrequent: exacerbation of symptoms due to reaction to osteopathic treatment.

Extremely rare: serious complications requiring medical intervention.

Upper Neck (Cervical HVT or HVLA) Manipulations

This leads us neatly into 'upper neck manipulations'. A topic that at best is described as "run-of-the-mill" and at worst is likened to the "handy-work of the devil himself". As is often the case, the truth is somewhere in between and YOU have to decide whom to believe as there is no simple answer.

If someone is NOT trained and experienced, you are asking for trouble. If your practitioner (osteopath or chiropractor) REFUSES to manipulate your neck, even if they are trained and you insist upon it, then you are a liability to both yourself and your practitioner.

Neck manipulations, whether osteopathic or chiropractic, are exceptionally safe when done by trained and experienced professionals. For example, a woman in the UK has more chance of dropping dead from using the contraceptive pill than suffering a stroke (or worse) from a neck manipulation. Think about it. how many women do YOU know who have died from using the contraceptive pill? For me, none, but I am very aware that inexperience in neck techniques can still be a liability.

Let's clear up exactly what a "stroke" is: a stroke is damage to the brain due to the interruption of its blood supply either by a small clot or a narrowing/overstretched blood vessel. Symptoms can involve headache, dizziness, confusion, visual disturbance, slurred or loss of speech, a difficulty in swallowing and, in some cases, death.

The causes of a stroke are unpredictable and can occur through sudden or extreme end of range positions. Look at the list below:

· leaning your head back over a basin at the hairdressing salon
· coughing
· sneezing
· turning your head while reversing your car
· or any of a number of other day-to-day neck movements.

The problem is this: there is no way possible for any osteopath, physician or chiropractor to predict with 100% certainty whom (if anyone) is susceptible to a stroke, just as we cannot predict which (if any) woman will suffer from using the contraceptive pill.

So how safe are osteopathic manipulations? The British health benefits (insurance) company BUPA describes osteopathy as follows: "There is a general consensus that osteopathy is less risky in terms of spinal injury because osteopaths usually use less forceful manipulation techniques on the spine."

Add the above quote from BUPA to data from North American chiropractors suggesting that 1 in every 1.46 million chiropractic neck manipulations will result in a stroke (1 in 1 million women in the UK will die from using oral contraception) and you can see how safe UK osteopaths can be... and that is not to take anything away from chiropractors and their expertise either.

So why do all the scare-mongers lay in to osteopaths and chiropractors? For me, it is a matter of some members of the public wanting someone to blame rather than taking responsibility for their own actions and also some physicians clinging to "medical paternalism" when the world of healthcare is changing rapidly.

Experience in these matters is essential and that is why full-time specific osteopathic training is second-to-none in the UK. I know that it will upset other countries trained osteopaths when I say this, but if someone is going to manipulate MY upper neck I know exactly whom I want to do it (and whom not). If they haven't had a tutor breathing down their neck daily for 4 years non-stop, then they are probably not as badgered about neck manipulations as our Osteopaths are in Britain.

The bottom line:

· If you have any concerns about neck manipulations, you should refuse them.

· If your Osteopath is concerned, he/she has the right to refuse to manipulate your neck, no matter how much of a fuss you create.

· If you are concerned with ANY symptoms either before or after osteopathic treatment, see your physician.

· If experienced osteopathic and chiropractic neck manipulations are as dangerous as some say, patients would be dropping like flies on a daily basis.

· Make up your own mind and don't let anyone (including me) convince you of something that you are not happy with.

www.backtrouble.co.uk/

Osteoarthritis

Osteoarthritis embraces a broad spectrum of clinical conditions with the common feature being that of primary joint failure.
Prevention is the ideal goal, however opportunities to achieve this are limited by our incomplete understanding of the aetiopathology.

The principles of Preventive Intervention are education about the condition, modification of lifestyle, and judicious exercise and joint protection, together with adequate pain relief. Optimum management involves a team approach that includes orthopaedic surgical expertise, as surgery can provide an alternative to continuing discomfort and limited mobility.

Osteoarthritis (OA) is the most common joint disorder in humans and increases with increasing age. It affects up to 70% of the world population over 65 years of age as well as a significant proportion of younger people. Osteoarthritis is multifactorial in causation and may be defined as primary failure of the joint with degeneration of articular cartilage.

The pathophysiology of the condition has been well reviewed.

Physical, Genetic, Chemical and Immunological factors are involved. The disorder may be primary or the almost inevitable sequel to previous joint damage.

Clinical Presentation:

There are 3 broad groups:

a. symmetrical peripheral arthritis
Heberden's nodes

Primary generalised osteoarthritis (PGOA) in females
Non-nodal OA in males

b. Oligoarticular large joint disease

c. Spinal arthritis
Spondylosis
Apophyseal OA

While OA is generally accepted as non-inflammatory in nature, localised inflammation can be demonstrated and may be prominent in certain forms such as 'erosive OA' of the fingers. However, in most instances, the precise aetiology cannot be defined and changes in articular cartilage are present long before clinical manifestations become apparent.

Preventive intervention:

Osteoarthritis is aggravated by several factors including obesity, occupation, and the nature of any previous joint damage and the presence of underlying joint disease. Recognition of these factors provides an opportunity for primary, secondary and tertiary preventive interventions, which include:

1. Weight reduction
2. Occupational modification (Posture/Occupational Assessments)
3. Joint protection
4. Team management approach (GP, Osteopath, Chiropractic, Surgeon, and Physiotherapist)
5. Analgesic techniques
6. Education groups for patients and relatives

Conclusion:

There are many approaches to the management of patients with osteoarthritis. It is my belief that Preventive Intervention has an important role in the total care of the patient and is often undervalued and under-utilised.

T. O'Brien (Back Trouble UK)