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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine (no longer in print).

October 2000

Arthritis

By Rick Allen, DC

"Better health leads to better dancing."

The next cause of back and joint pain that we will review is arthritis. Arthritis simply means inflammation in the joints. Since inflammation is usually painful, arthritis is usually painful. Inflammation occurs when the joint is overused or abnormal pressure or stress is put upon it. Arthritis can occur wherever there is a joint in the body. Different types of arthritis will affect different regions of the body. I will limit this presentation to two major types of arthritis: degenerative and rheumatoid. In the accompanying side bar article, I give some nutritional steps you can take to maximize the health of your joints and minimize the possibility of arthritis.

As an introduction to the subject of joint pain, Dr. Michael Gazdar, from whom I have drawn most of the material for this article, observes, "Often patients tell me they feel their pain is a result of 'old age.' I ask them what they mean by old age and they say the things that happen to everyone such as arthritis, as if it's a birthright. I tell them that old age does not necessarily mean guaranteed pain, and I mean this. Usually it takes only a few adjustments before they believe me, but chiropractors can almost always get people out of pain."

Healthy Knee diagramArthritic Knee diagram


Degenerative

Degenerative arthritis is also known as osteoarthritis ("osteo" means bone). [I wrote three articles on osteoarthritis for Instep in June, July and August 1998.] Due to a loss of the shock-absorbing pad made of cartilage between the two bones that form the joint (figures 1 & 2), the bones are closer to each other than they should be. This causes them to grind bone on bone and wear out faster as they are used. This causes inflammation and lots of pain.

According to the Merck Manual, osteoarthritis (OA) is seen universally in all vertebrates, primarily in weight-bearing joints. This suggests it is really more the body's repair process in response to adverse pressure than a disease. It is even seen in animals that have their weight supported by water, such as dolphins and whales, but not in animals that hang upside down, such as bats and sloths.

There are many causes of this process, most of which are unknown, yet we do see a genetic disposition towards degeneration. Other factors such as infection and neurological or vascular problems may be causes. Trauma to a joint, such as when vertebrae are knocked out of their normal position by some force and have restricted motion, is a likely cause. What happens to the joint is that the hyaline cartilage becomes damaged, and the tissue that replaces the healthy synovial membrane is scar tissue inside and around the joint. It is weaker, more brittle and more sensitive. This may eventually take the form of little bone spurs that look like spikes around the joint. The fluid that is normally inside the joint begins to leak out and does not return without proper rest, specific mobility and exercise to the area.

Many times OA will go unnoticed because it does not hurt until the problem has advanced. Early signs are stiffness in the morning or following inactivity that gets better with motion and pain that gets worse with vigorous exercise. As time goes on without proper care, you can expect things to get worse. The joint wears out and gets stiffer and more painful. The ligaments surrounding the joint become lax and cause more instability and increased pain. Injuries are more likely with daily activities. In the neck and the low back, there is a chance the pain will radiate into the arms or down the legs as the nerve roots are affected by the degeneration.

The chiropractor will try to keep the joints mobile with adjustments but may also give exercises and stretches to do on your own that enhance mobility and help develop stress-absorbing tendons and muscles. You will be encouraged to rest at appropriate times to allow the cartilage to rehydrate as much as possible. You will be instructed to avoid soft chairs and beds and perform postural exercises to minimize abnormal wear on the joints. As long as the vertebrae are in proper alignment, the wear on the discs will be reduced and distributed more evenly. Nutritional supplementation as described by Robert Crayhon, M.S. in the side bar article is helpful, too.

Arthritic foot x-ray

Rheumatoid

Rheumatoid arthritis (RA) is in the classification of diseases known as "autoimmune disorders." This means that the body is attacking itself in some way. This disorder is usually chronic and is characterized by symmetric inflammation of the peripheral joints, such as the foot (figure 3). This disorder is different from OA mentioned above. Whereas OA is characterized by a loss of synovial membrane between the joints, RA is characterized by an increase in this tissue. The membrane folds and thickens, causing an increase in joint size and a change in the articulation or movement of the joint. Other responses of the body include a combination of fibrosis, necrosis (death), and erosion of tissue in the joint.

Patients feel pain in the inflamed joints and often see the swelling in the same joint on each side of the body (as seen in the small joints of the hand, wrists, elbows and ankles). Stiffness in the morning or after inactivity may last 30 minutes or more. Unlike OA, rheumatoid arthritis is usually diagnosed easily with laboratory and x-ray findings. Osteoarthritis and rheumatoid arthritis look different on an x-ray (figure 4).

Good/Bad knees x-ray

Conservative management such as chiropractic adjustments to help the neurology and passive motion to help the symptoms is usually recommended. In a study done by Toshima Yamauchi, M.D., et al., rheumatism occurs at night when there is little or no movement in the joints. This leads to a decrease in the circulation of synovial fluid and a decrease in the pH (increase of acidity) in the joint. The authors found passive slow motion to the affected joint at night was better than no motion.

Although the Merck Manual makes an issue out of being careful about diet therapy and "quackery," John A. McDougall, M.D. draws some important conclusions in the relationship between diet and arthritis. He cites people in Africa, Japan and China, with lifestyles and dietary customs different from Americans, who have very few instances of RA. Unlike the United States, where animal fat is a major part of our diet and we have an incidence of 1% to 4% Of Americans suffering from RA, these people consume very few animal products; the diet is basically starch-centered (complex carbohydrate). However, when these people are moved to the United States and/or adopt a rich Western diet, rheumatoid arthritis becomes as common with them as it does with Americans.


Dr. McDougall cites several studies that show how diet plays an important role in the cause and care of RA patients. He tells of a study done at Wayne State University Medical School where six RA patients were fed a fat-free diet. Within seven weeks all six were in complete remission from RA. The symptoms recurred within seventy-two hours when animal fats or vegetable oil were consumed by the patients.

Dr. McDougall adds to the conclusions of the investigators by noting that the elimination of cheese and meat from their diet probably made a major contribution to the remission. His reasoning is that dairy products and meats are common sources of the antibodies that enter the bloodstream and joints, form an irritant, and then are attacked by the antibodies of the immune system.

If you have known food allergies and suffer from RA, stay away from these foods. Also, if you have RA, you would probably benefit from a diet low in fats and proteins and high in complex carbohydrates. For further information, pick up a copy of McDougall's Medicine at your local bookstore. I have a copy in my library that I lend to patients.

Next article: I plan on picking up with some other causes of back pain. However, if you have a question or topic that is bubbling inside, let me know. Perhaps we will have a surprise for next month.

References:

  • Taking Your Back to the Future by Michael Gazdar, D.C., C.C.S.P.

Nutritional Steps to Prevent Arthritis

This month's article describes the two most common forms of arthritis that attacks your joints. A great deal of arthritis can be prevented with healthy nutrition and lifestyle. You can maximize the health of your joints with the following daily nutritional protocol recommended by nutritionist Robert Crayhon, MS:

Glucosamine hydrochloride 1,000-2,000 mg
Chondroitin sulfates 300-1,500 mg
Niacinamide 250-1,000 mg
Pantothenic acid 100-1,000 mg
Folic acid 2,000 mcg
Vitamin B12 2,000 mcg
Vitamin C 1-3 g
Vitamin E 200-800 IU's
Curcuminoids 100-500 mg
Zinc picolinate 25 mg
Copper sebacate 2 mg
Molybdenum 500 mcg
Selenium 200-400 mcg
Boron 6 mg

Diet

No safflower, sunflower or corn oils. Use flax, olive and sesame oils instead, and coconut oil for cooking. Drink plenty of water, eat lots of green vegetables and eat cold-water fish like salmon and sardines. Check for food allergies and digestive problems. No fried foods, margarine or iron-fortified foods. Organic produce is best.

Reference

"Maximizing Joint Health" by Robert Crayhon, M.S. in Total Health magazine, vol. 19, no. 3.

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