Arthritis Concepts and the Role of Chiropractic Care

In this article, I will be discussing biomechanical conditions that accelerate arthritis. There are many types of arthritis but for the purpose of this article, I am referring to "osteoarthritis" (also known as degenerative arthritis) which is the most common type of arthritis, affecting the majority of people in their mid-age to later years. I will also be discussing the mechanical basis for chiropractic care and how chiropractic care can not only help people regain mobility but can also slow down these degenerative changes from taking place. The implications are astounding! It can mean a greater quality of life, reaching a greater potential, greater independence and fulfillment into one's later years.

Before we get to that, let's talk a bit about aging because there is a misconception I'd like to clear up. The misconception is that arthritis is caused by aging. This is not entirely true. Indeed as people get older, there are more and more cases of arthritis, however, arthritis is not directly caused by aging. Unfortunately, this misconception leads some people to think that there is nothing that can be done to prevent or reverse it, which is simply NOT TRUE! It encourages passivity towards health in general, which is dangerous. There are many older people with little or no signs of arthritis.

We know that degeneration occurs whenever the rate of injury of the joint is greater than the rate of repair. Thus, factors creating injury and factors affecting healing rate both play a role in arthritis. Though there are many factors involved, there are two primary theories for the mechanical cause of degeneration. One is the "wear and tear" theory and the other is the "immobilization" theory. Research supports both of these contrasting theories thus suggesting that there exists a safe window of mechanical conditions in which the joints remain healthy. (1)

The "wear and tear" theory, like it sounds, refers to demanding environments causing localized trauma or repetitive "microtrauma" which progressively injures joints and discs causing degenerative arthritis. Also repetitive tasks, even with minimal load, if done in a poor posture can cause uneven wear and tear and even an injury to occur.

In the "immobilization" theory, reduced movement results in weakness and degeneration of the joints and discs. Joint cartilage (which plays a role in shock absorption and provides a smooth gliding surface for joints) has no blood supply of its own. However, cartilage is a living structure, composed of cells and needs nutrition in order to survive and heal. Thus nutrients are derived from another mechanism: diffusion. Movement is required for diffusion of nutrients into cartilage and removal of the metabolic waste products.

This brings to mind the "use it or lose it" concept. It's a well known fact that muscles will atrophy when they aren't used. Similarly, bones and joints become weaker if they are not mechanically challenged through exercise (they adapt to forces and loads placed on them). However, there is a balancing act and injuries do occur.

Videman's research also comes to mind as support of the immobilization theory. He studied the negative effects of immobilization on the rabbit knee by casting it for set amounts of time. The results were fibrosis of tissues surrounding the knee, atrophy in weight-bearing surfaces and x-ray evidence of degenerative change. Even at 10 days, there is cellular evidence of fixation. On the plus side, mobilization of previously immobilized rabbit knees can restore range of motion even when mild degenerative joint changes have taken place. With repeated immobilization, restoring range of motion becomes increasingly less effective. (2)

Other studies show that when joints are surgically fused in the spine, there are degenerative changes to the joints immediately above and below the fused area. This is called adjacent segment degeneration.(3) This suggests that the joints above and below the surgically restricted joint are compensating for lack of motion and are being overworked (thus, wear and tear), bearing the brunt of forces.

So what does all of this tell us? Why is this important to know? The key to all of this is that we need mechanical balance. When spinal joints are "restricted" or "stuck" due to the various traumas of daily living, they need to be mobilized (or "adjusted"). This will make the spine more balanced because the other joints won't need to compensate (and thus wear out faster). This affects other joints in the body as well. For example, an ankle injury in which ankle range of motion is compromised is going to change the whole way you walk and the forces that go through related joints like the knees and hips. The various joints in the body are functionally connected.

What happens when there is an injury? When there is a soft tissue injury (for example, sprains and strains), there is inflammation and scarring that occurs. These can compromise range of motion of the nearby joint. Similarly, and injury to the joint itself can cause muscle guarding and tightness that compromises range of motion. Recalling from Videman's research, this restriction can result in degenerative changes taking place in as little as 10 days.

Thus, when an injury takes place, rehabilitation and restoration of normal range of motion is essential. Joints need to be taken through all their normal ranges of motion regularly such that scar tissue will be laid down in a functional orientation and not compromise joint function and range of motion leading to compensation reactions and early arthritis. Thus, uncorrected traumas result in joint restriction and lead to arthritis.

Consider this: We've all had minor traumas here and there. They can be from minor injuries, poor posture, sitting at a desk all day or stress/anxiety creating areas of muscle tension. Maybe you don't have any pain currently or you have great overall range of motion in your spine - for example, you may be able to touch your toes. However, you may still have areas of segmental joint restriction where a few vertebrae are not moving well. Regardless of whether or not you have pain, everyone should have their spine at least checked.

This is where chiropractic comes in. Chiropractors are biomechanical experts with a career focused on musculoskeletal and neurological function and optimizing these. Chiropractors can specifically locate the restricted joints and then adjust them to help restore optimal joint function and alignment. Go see a chiropractor! Or, if you're looking for a chiropractor in North York, come see me!

1. Stokes, I & Ratridis, J. (2004). Mechanical conditions that accelerate intervertebral disc degeneration: overload versus immobilization. Spine 29(23); 2724-2732.
2. Videman, T. (1987). Connective tissue and immobilization. Key factors in musculoskeletal degeneration? Clin. Orthop (221): 26-32.
3. Levin, D, Hale, J & Bendo, J. (2007). Adjacent segment degeneration following surgical fusion for degenerative disc disease. Bulletin of the NYU Hospital for Joint Diseases, 65(1);29-36.