Degenerative Joint Disease & ART®
Degenerative Joint Disease – Active Release Techniques®
Dr. Sebastian Gonzales D.C., C.S.C.S., ART , Orange California
Keywords: osteoarthritis, degenerative joint disease, active release techniques, sebastian gonzales, treatments, NSAIDs, aspirin, cortisone injections, surgery, surgical replacement, scar tissue, muscle spasm, adhesions, pain
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Treatment for:
Osteoarthritis (Degenerative Joint Disease)
What treatments are available for Osteoarthritis?
How can Active Release Techniques® help with Osteoarthritis?
Who gets Osteoarthritis?
Osteoarthritis is a normal condition, which is seen as age increases. Typically people over the age of 40 get some form of it, whether it is in the spine, knee, hip, or feet. Normally osteoarthritis happens with more severity in weight-bearing joints, named previously, but it can also show up in the shoulder, fingers, hand and wrist; the most common place to get osteoarthritis in the hand is at the base of the thumb. As stated before, it is very common in the United States, effecting 21 million people. 80% of people over the age of 65 will have radiographic evidence of osteoarthritis, however only 60% will have the pain that goes along with it. Half of all NSAID prescriptions are attributed to patients with osteoarthritis.
What is Osteoarthritis?
Osteoarthritis is evident when a cartilage inside a joint has become worn down and destroyed or when the amount of fluid within the joint has decreased. As the surfaces of the joint become less and less protected, the patient will begin to experience pain.
There are actually two types of osteoarthritis, primary and secondary. Primary osteoarthritis merely means that it happened without any cause. Secondary osteoarthritis is osteoarthritis that can be attributed to an injury or something that happened to the joint; this is much more common. When an injury occurs, abnormal stresses, whether they are from muscle tightness or postural compensation, are put on the joint, which can change the weight distribution and wear on the joint. A study in 2000 stated, “Young adults with knee injuries are at considerably increased risk for osteoarthritis later in life and should be targeted in the primary prevention of osteoarthritis,”1
As osteoarthritis becomes more advanced, the joint may become enlarged. This is primarily due to the increase amount of bone around the joint and the accumulation of fluid. The bony enlargement is what is seen on x-ray and CT imaging. Both types of osteoarthritis present the same on radiographic imaging.
What treatments are available for Osteoarthritis?
Osteoarthritis is commonly treated by the use of NSAIDs, such as aspirin and ibuprofen. Although these medications can relieve pain for a few hours at time, it is not a long-term solution. The prolonged or continual use of NSAIDs has also been responsible for a number of side effects. A study in 1999 stated “60 –100% of patients on NSAID therapy for only 1 –2 weeks develop submucosal hemorrhage, erythema, superficial erosions, or increase fecal blood loss”3 In so many words, this says that almost 100% of NSAID users develop GI ulcers after 2 weeks.
Another common form of treatment is the use of Cortisone injections. One injection will definitely decrease pain for a few weeks and make the patient feel great, but it too is not a long-term solution. Before considering this as a treatment your osteoarthritis, find out more about it. Throughout my research I have found the process is not standardized, as it should be; different doctors inject from different locations for the same exact conditions, not always hitting the intended target.2,4 In addition to this, multiple studies questioned the safety of the injections on the ground of the possible suppression of collagen formation, granulation of tissue, and release of noxious chemicals from damaged cells, which will limit the body’s ability to heal itself.
The last resort for most osteoarthritis patients is complete surgical replacement of the joint. Although there are no clear guidelines to indicate the need for joint replacement, candidates for this type of surgery are patients who have not responded to more conservative therapy and are in severe pain, making normal everyday activities impossible. In regards to outcome, the hip is the most successful joint to be replaced, followed closely by the knees.3 Recovery time is still a major factor is the decision to have a surgery or not. Many people will not have any benefits from the surgery until a year after.2 Normally I would not recommend surgery for anything, but for advanced osteoarthritis, it is not a bad idea to play around with.
How can Active Release Techniques® help with Osteoarthritis?
There is no known cure for osteoarthritis, since there is no known way to regenerate cartilage inside the joint. Once osteoarthritis is here it is here to stay, but there is the possibility of slowing down the degenerative changes. When there is pain in a joint, patients normally reduce activities or stay off the injured limb altogether. Common sense would say this is a great idea, but when considering what is happening to the soft tissues surrounding the joint as a result, you might think twice. When a joint is chronically immobilized or kept in the same position, the muscles and tendons surrounding it will develop adhesions, or scar tissue, making them less elastic, as they should be. An example almost everyone has experienced is with an arm that has been in a cast for a long period of time. When the cast is removed, frequently the joint has limited range of motion. These adhesions create a compressive force on the immediate area, causing a decrease in blood flow and oxygen to the muscles. This then cause enzymatic changes, which increase the rate at which cartilage is destroyed. Active Release Techniques® can help by eliminating adhesions from the muscles and other soft tissues surrounding the joint. The patient will more than likely feel much looser following even the first treatment. The main goals of an Active Release provider in cases of osteoarthritis are to increase joint range of motion and decrease the amount of muscle spasm. Once these have been accomplished, patients should then be instructed to keep that range of motion, as well as stretch and strengthen the surrounding musculature. Active Release Techniques® combined with the proper strengthening exercise is best bet to eliminate the pain of osteoarthritis.
For more on Active Release Techniques® or to find a provider in your area: www.activerelease.com
1. Gelber, Allen, Marc Hochberg, Lucy Mead, Nae-Yuh Wang, Fredrick Wigley, and Michael Klag. "Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis." Annals of Internal Medicine Volume 133 Issue 5 (2000): 321- 328.
2. Nilsdotter, A.K., L. S. Lohmander. "Age and waiting time as predictors of outcome after total hip replacement for osteoarthritis." Rheumatology Volume 41(2002): 1261-1267.
3. Simon, Harvey. "Surgery." MyOsteoarthritisCentral.com. 19 April 2006. www.HealthCentral.com . 24 Jun 2008 <http://www.healthcentral.com/osteoarthritis/index-000035_11-145_5.html>.
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P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Orange, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.
Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.
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