Arthritis and knees.

Wear and tear = Osteoarthritis??? I was listening to Radio 4's Inside Health featuring Osteoarthritis, which has enhanced my understanding of the condition. Dr Mark Porter GP come journalist presents a seemingly bipartisan radio series covering many and varied health issues. Dr. Porter set the scene with the current medical beliefs that arthritis is also known as wear and tear and unfortunately can often lead to joint replacement surgery! This then is not the case, apparently when people hear “wear and tear” they imagine both ends of the bone rubbing together. Arthritis is not where the ends of bone grind together. It is the natural and normal degeneration of the cartilage that reduces the friction at the end of the bone. According to Inside Health and this where my ears pricked up, rest is definitely not the solution to arthritis. The pain, heat, redness and loss of function that you feel are a healthy inflammatory response by your body summoning immune troopers and a wrecking crew to gobble up damaged cells, allowing new chondrocytes to flourish and build new tissue. Inside Health, and NICE are kicking some old myths into touch. 1.) Arthritis needs rest. 2.) Cease exercise.

Exercise then promotes the imbibition of synovial fluid and the laying down of new tissue. This is especially the case in the knee joint where the knee cartilage is the premium hyaline type which is mostly likely to revive. Excessive and inappropriate exercise can be damaging, but a useful rule-of-thumb is to exercise in a pain free and poised manner. If your leg extensions hurt your knees then reduce the weight! Strengthening the muscles that bend and straighten the knee improves the function of the knee by improving knee stability, muscular efficiency and increasing venus and lymphatic return.

Dr. Porter discussed the research that shows good evidence for the use of physiotherapy, osteopathy and chiropractors in the treatment of arthritis.

Chondrocytes are cells that build connective tissues like cartilage.

Imbibition is how synovial fluid is absorbed into connective tissues.

Neck cracking, to do or not to do

Letting a chiropractor `crack` your neck to relieve pain could trigger stroke. I was recently presented with the Daily Telegraph article concerning neck cracking. (June 8, 2012) I was worried that anyone denied all of the details might read the article and draw the conclusion that osteopaths induce strokes in their patients. To induce a crack in someone's neck is not that difficult to achieve. Simply rotate their neck quickly beyond the normal range of motion, then behold the tell-tale click can be heard. Please do not try this at home. Clicking is not the point of the technique, rather it is a by-product. 

Why would an osteopath or chiropractor perform such a technique? Hollis King PhD in, The Science and Clinical Application of Manual Therapy, 2011 discusses the modification of muscle tone, reduction in local tissue strains and to encourage better postural positions. This means tight muscles relax around the joint and tissues held in strained positions adjust. Happily osteopaths deliver these techniques  with the minimum of rotation, as it is excess rotation of the neck which often causes the trauma in the vertebral artery. Osteopaths are trained to use as well as rotation, side bending, side shift, traction and compression to avoid the need to wrench the neck around! 

 
The vertebral arteries travel up and through the little bones on the side of your neck, then a weakened artery in combination with a neck crack could occlude the artery or allow a blood clot to be dislodged and cause stroke. Doing a head stand in yoga, arching your neck over a wash basin to have your hair washed at the hair dressers, being hit in a rugby tackle or scrum incident, or other traumatic incidents could also cause such a traumatic ischemic accident. People who don't visit osteopaths also suffer strokes. perhaps a better discussion would be what percentage of the normal population suffer strokes compared to those who visit osteopaths. (20.0 strokes per 100 000 normal population.Those receiving neck cracking have a greater risk of suffering strokes. This reality makes the exhaustive screening of patients all-the-more important. At my osteopathy practice I discuss and use an up-to-date NHS VBI checklist. )

Given the extreme consequences of such a technique it would seem logical then to limit the use of this technique to only persons whom are safe to treat and where treatment is not contraindicated. Osteopaths will ask questions to illicit that the patient does not demonstrate signs of VBI, ( Vertebrobasilar insufficiency ). 

Given the real improvements in patient's expressed symptoms the conservative use of these techniques once NHS clinical screening methods have been applied is safe and appropriate. The fearful views expressed in the article need to be weighed up with the counter arguments. 


 Daily Telegraph article.