2 Types of Arthritis: How They Impact You And What You Need To Know

Arthritis is one of the most common conditions affecting the joints worldwide.1 In Latin, arthro- means joint and –itis means inflammation, so together arthritis means inflammation of a joint. Two common types of arthritis are osteoarthritis and rheumatoid arthritis. While they might sound similar, they have very different causes and symptoms.

OSTEOARTHRITIS

What is it?

Osteoarthritis is characterized by “wear and tear” of the cartilage on either end of the bone.1 With time, the cartilage may break down causing the two ends of the joints to rub against each other.

Who does it affect?

Osteoarthritis is more common in individuals over the age of 65.1 Other factors that can contribute to (or even speed up) the wear and tear of osteoarthritis are obesity, injury, and overuse, and genetic factors.

What are the symptoms?

Symptoms include morning stiffness, pain that decreases with movement, swelling, and clicking or cracking within the joint itself.

RHEUMATOID ARTHRITIS

What is it?

Rheumatoid arthritis is an autoimmune disorder that can affect the entire body. The body’s own immune system mistakenly identifies normal joints as “abnormal,” resulting in an inflammation which can be extensive and painful. If the inflammation is not controlled, damage to the surrounding cartilage and bone within the joint can occur.

Who does it affect?

Rheumatoid arthritis is more common in females around the ages of 30–60 years old.2

What are the symptoms?

Symptoms of rheumatoid arthritis are similar to those of osteoarthritis, however, a key difference is that pain and stiffness in rheumatoid arthritis generally does not resolve or see improvement with movement or exercises.

TIPS FOR TREATMENT

Arthritis can often be managed well with conservative therapy like specific exercises for the affected areas and self-care as well as manual therapy by your chiropractor. However, getting treatment from a combination of various healthcare providers may be needed. If you are experiencing discomfort in your joints, or would like more information about arthritis, visit your family chiropractor.

References

1. Arthritis facts. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/understanding-arthritis/arthritis-statistics-facts.php. Accessed August 29, 2017.

2. Rheumatoid arthritis (RA). Rheumatoid Arthritis website. Available at: https://www.rheumatoidarthritis.org/ra/. Accessed August 29, 2017.

Knee Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)

Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee, particularly as we age.  Included below are some of the conditions that commonly cause knee pain:

·    Osteoarthritis results from the protective layers of cartilage in the knee becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.  This may result in a number of symptoms including:  joint pain and stiffness, decreased ranges of motion, weakness, swelling, inflammation, and instability.

·    Patellofemoral pain syndrome refers to knee conditions that involve the kneecap and/or the structures around it.  Pain can be generated by breakdown of the cartilage under the kneecap, tight or weak muscles around the kneecap, or misalignment of the kneecap.

·     Meniscal injuries directly involve tearing/damage to the cartilage cushioning in the knee.  This type of injury can result from a sporting event or fall where the knee undergoes a sudden twisting motion or impact.  It can also occur in older individuals who develop a chronic tear in a worn-out meniscus.

·    Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the knee or there is an awkward fall or twisting motion involving the knee.

·     Tendons are strong tissues that anchor muscles to bones, and these structures can become torn or inflamed around the knee joint leading to tendonitis and muscular strains.

·      Bursitis can involve several fluid-filled structures in your knee that help provide more cushioning in the joint.  Certain activities, such as kneeling on the floor, can cause a bursa to become irritated.

Below are some useful tips that can help individuals avoid or minimize the chance of knee pain and injury:

1.    Maintain a healthy bodyweight to decrease the overall stress on your knees.

2.  Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.

3.   Prepare your knees for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the thighs and lower legs.

4.   Choose activities that are knee friendly for you.  This may include low impact activities such as walking or cycling.  Remember to start slowly and build up the intensity gradually.

5.    Strength, balance and flexibility exercises can train your leg muscles to better support your knees and avoid injuries.

In the event that you suffer a knee injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of knee pain.  For additional information on knee pain and treatment of muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Knee Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)

Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee, particularly as we age.  Included below are some of the conditions that commonly cause knee pain:

·  Osteoarthritis results from the protective layers of cartilage in the knee becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.  This may result in a number of symptoms including:  joint pain and stiffness, decreased ranges of motion, weakness, swelling, inflammation, and instability.

·       Patellofemoral pain syndrome refers to knee conditions that involve the kneecap and/or the structures around it.  Pain can be generated by breakdown of the cartilage under the kneecap, tight or weak tissues around the kneecap, or misalignment of the kneecap.

·      Meniscal injuries directly involve tearing/damage to the cartilage cushioning in the knee.  This type of injury can result from a sporting event or fall where the knee undergoes a sudden twisting motion or impact.  It can also occur in older individuals who develop a chronic tear in a worn meniscus.

·       Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the knee or there is an awkward fall or twisting motion involving the knee.

·      Tendons are strong tissues that anchor muscles to bones, and these structures can become torn or inflamed around the knee joint leading to tendonitis and muscular strains.

·   Bursitis can involve several fluid-filled structures in your knee that help provide more cushioning in the joint.  Certain activities, such as kneeling on the floor, can cause a bursa to become irritated.

Below are some useful tips that can help individuals avoid or minimize the chance of knee pain and injury:

1.     Maintain a healthy bodyweight to decrease the overall stress on your knees.

2.  Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.

3.  Prepare your knees for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the thighs and lower legs.

4.    Choose activities that are knee friendly for you.  This may include low impact activities such as walking or cycling.  Remember to start slowly and build up the intensity gradually.

5.    Strength, balance and flexibility exercises can train your leg muscles to better support your knees and avoid injuries.

In the event that you suffer a knee injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of knee pain.  For additional information on knee pain and treatment of muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Hip Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)

Hip pain often limits physical activities such as walking, running, squatting, and going up and down stairs.  It can also create problems with sleeping and sitting positions.

Depending on what the source of the hip pain is, symptoms can be felt in a number of  different regions which may include:  the low back, deep in the hip joint, on the outer aspect of the hip, in the groin, at the front of the thigh, and in the buttocks.  Listed below are some of the conditions that commonly cause hip pain:

·    Osteoarthritis results from the protective layers of cartilage in the hip becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.

·      Osteoporosis is a disease of bones that decreases bone mass and strength, making them more fragile and susceptible to fracture.  Hip fractures usually occur in older individuals after a fall injury.

·     Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries (sprains) can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the hip or there is an awkward fall or twisting motion involving the hip.

·     Tendons are strong tissues that anchor muscles to bones, and these structures can become over-stretched or inflamed around the hip joint leading to tendonitis and muscular strains.

·       Bursitis can involve several fluid-filled structures in your hip that help provide more cushioning in the joint.  Repetitive hip strain and blunt trauma to the hip bursa are two common causes of bursitis.

·     Injuries and conditions in the low back can radiate symptoms into the hip region.  This includes things such as osteoarthritis, sprains and strains, disc herniations, sciatica, and spinal stenosis.

Below are some useful tips that can help individuals avoid or minimize the chance of hip pain and injury:

1.     Maintain a healthy bodyweight to decrease the overall stress on your hips.

2.    Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.

3.    Prepare your hips for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the hips, thighs and lower legs.

4.   Choose activities that are "hip friendly" for you.  This may include low impact activities such as swimming, walking or cycling.  Remember to start slowly and build up the intensity gradually.

5.   Strength, balance, flexibility, and core exercises can train your body to better support your hips and avoid injuries.

If you have hip pain that limits your daily functioning, you should contact a licensed health professional who deals in the diagnosis and treatment of hip pain.  For additional information on hip pain and treatment of muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding Sciatica

By Dr. John A. Papa, DC, FCCPOR(C)

The sciatic nerve is the longest nerve in the human body.  It is made up of five separate nerve roots originating from the low back region on each side, and runs from your pelvis through your buttock and hip area and into each leg.  It controls many of the muscles in your legs and provides feeling to your thighs, lower legs and feet.

"Sciatica" is a common term used to describe any type of pain/symptom that radiates into the leg.  "True sciatica" occurs when there is a mechanical and/or inflammatory irritation directly affecting any component of the sciatic nerve.  This differs from “referred” pain/symptoms which can arise from a bone, joint or muscle that can send pain/symptoms into the leg.

True sciatic symptoms may be felt almost anywhere along the nerve pathway.  These symptoms can radiate from the low back region, into the hip or buttock, and down the leg, into the calf, and even the toes.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and leg muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as bending forward or to the side, walking, prolonged sitting or standing, and even coughing or sneezing may aggravate sciatica.

Below is a brief summary of three common causes of true sciatica:

1.  Spinal disc herniation/bulge – Spinal discs separate and cushion lumbar vertebra.  Repetitive and cumulative loads or a single heavy load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.  Degeneration and Osteoarthritis – The normal aging process causes lumbar disc degeneration, osteoarthritis of lumbar joints, and occasionally vertebral slippage.  The consequence of these processes is that mechanical irritation from bony spurs and vertebrae, along with inflammation can cause symptoms of sciatica.  This most commonly occurs in adults over 50.

3.   Lumbar spinal stenosis – This condition causes sciatica due to narrowing of the spinal canal and/or nerve pathways.  This puts pressure on the spinal cord or nerve roots and causes neurovascular irritation.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of "true sciatica" include: direct irritation of the sciatic nerve by the piriformis muscle; direct trauma or injury to the sciatic nerve or nerve roots; and postural and mechanical changes associated with pregnancy.  Some common causes of sciatic-like symptoms or "referred" pain include: muscular trigger points and ligament sprains from the low back, hip, gluteal and pelvic regions; sacroiliac joint dysfunction; and arthritic low back, hip and knee joints.

Sciatica is a set of symptoms of a problem, rather than a diagnosis for what is irritating the nerve and causing the pain.  This is an important point to consider because the treatment for sciatica will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis from a qualified health professional.

When sciatica strikes, there are conservative treatment options available.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, laser therapy, acupuncture, ice/heat application, electrotherapy, and rehabilitative exercise.  A qualified health professional can determine the cause of your sciatica and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Low Back Or Leg Pain Aggravated By Back Extension

By Dr. R. Greg Lusk, DC

Spine flexion, or bending forward of the spine, has been the main movement or function discussed in the articles I've written to date, and rightly so as it is the dominant activity that produces and perpetuates low back pain. However, it's counterpart, spine extension, which often plays a relieving role for most cases of low back pain, can be a source of aggravation in others. Specifically, in a low back with prominent osteoarthritis (OA), which is the general term for degenerative disc and/or joint disease, the structural changes can result in disc space narrowing between our vertebrae, the development of bone spurs, and/or the thickening (i.e. hypertrophy) of the bony sides of the joints (facets) or other soft tissues (e.g. ligamentum flavum). Collectively, these changes can narrow the hole(s) between the vertebrae (foramen) where our spinal nerves exit and even compress the nerve(s) as it passes through the opening. Back extension exaggerates this narrowing (i.e. stenosis) further and can lead to low back and leg pain, numbness, weakness, and a reduced ability to stand or walk. Medically, this is referred to as neurogenic claudication or degenerative lumbar spinal stenosis (DLSS).

Now, since low back OA is incredibly common, particularly with increasing age, it is important to realize that this doesn't mean that back extension is bad for everyone with OA. Remember that disc bulges are in fact part of low back OA and can irritate nerves that travel down the legs, but that they often respond well to back extension exercises while being aggravated by spine flexion. This highlights the need for case by case management with investigation of the patient's symptoms and then confirmation via assessment. With respect to a patient with DLSS, it is often reported that low back or leg symptoms are aggravated with either standing or walking, but alleviated with sitting or bending forward. It may even be noted that walking while pushing a shopping cart or riding a bike, which flex the lumbar spine and open up the spaces where the nerves exit the spine, are comfortable. Assessment of ranges of motion and nerve tension in the legs are components of an examination that could then be done to increase confidence in the diagnosis of DLSS.

For patients with severe symptoms, surgery may be an option where bone and ligaments around the stenosis are removed to decompress the nerve. However, for those with mild to moderate symptoms related to DLSS there have been encouraging results published when participants completed a 6 week spine mobility boot camp. The multimodal program included manual therapies to improve mobility in the low back and hips, numerous daily exercises that promote spine flexion, and education with respect to body repositioning for symptom relief. Self-rated disability, leg pain intensity, and improved walking tolerance were improved upon completion of the program and persisted for 3.5 years. Exercises examples include lying on your back and pulling either one or both knees to your chest, pulling one knee to the chest and then leaning it across the body toward the opposite hip, seated toe touching, and riding of a stationary bike. Walking with a posterior pelvic tilt, where you rotate your pelvis to tuck your tailbone and/or raise the area where a belt buckle would rest, which opens up the lumbar joints, is an example of body repositioning during activity. Timing your baseline walking duration prior to symptom onset, and then re-checking after performing these sorts of things for a number of weeks would allow you to monitor your progress and assess the value of your effort.

This article is for general information purposes only and is not to be taken as professional medical advice.

Hip Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)

Hip pain often limits physical activities such as walking, running, squatting, and going up and down stairs.  It can also create problems with sleeping and sitting positions.

Depending on what the source of the hip pain is, symptoms can be felt in a number of  different regions which may include:  the low back, deep in the hip joint, on the outer aspect of the hip, in the groin, at the front of the thigh, and in the buttocks.  Listed below are some of the conditions that commonly cause hip pain:

·     Osteoarthritis results from the protective layers of cartilage in the hip becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.

·      Osteoporosis is a disease of bones that decreases bone mass and strength, making them more fragile and susceptible to fracture.  Hip fractures usually occur in older individuals after a fall injury.

·     Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries (sprains) can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the hip or there is an awkward fall or twisting motion involving the hip.

·     Tendons are strong tissues that anchor muscles to bones, and these structures can become over-stretched or inflamed around the hip joint leading to tendonitis and muscular strains.

·       Bursitis can involve several fluid-filled structures in your hip that help provide more cushioning in the joint.  Repetitive hip strain and blunt trauma to the hip bursa are two common causes of bursitis.

·     Injuries and conditions in the low back can radiate symptoms into the hip region.  This includes things such as osteoarthritis, sprains and strains, disc herniations, sciatica, and spinal stenosis.

Below are some useful tips that can help individuals avoid or minimize the chance of hip pain and injury:

1.      Maintain a healthy bodyweight to decrease the overall stress on your hips.

2.    Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.

3.      Prepare your hips for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the hips, thighs and lower legs.

4.  Choose activities that are "hip friendly" for you.  This may include low impact activities such as swimming, walking or cycling.  Remember to start slowly and build up the intensity gradually.

5.   Strength, balance, flexibility, and core exercises can train your body to better support your hips and avoid injuries.

If you have hip pain that limits your daily functioning, you should contact a licensed health professional who deals in the diagnosis and treatment of hip pain.  For additional information on hip pain and treatment of muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.