Arthrosis is one of the most common degenerative diseases. In arthrosis, cartilage wear and joint changes occur. Starting from the 65th year of life practically everyone is concerned however with only 1⁄4 subjective complaints are noticed. Osteoarthritis of the spine outweighs osteoarthritis of the knee-hip and shoulder joint.
Introduction
Arthrosis develops from a mismatch between the load and load capacity of the joint cartilage and can be divided into primary and secondary arthrosis. Primary arthrosis is an inferiority of the cartilage, the cause of which is unknown. Secondary arthrosis is based on external factors, such as overloading in joint dysplasia, axial malpositions and instabilities.
Trauma, such as a fracture or dislocation, may lead to changes in the joint surfaces, which over the years may promote osteoarthritis. Inflammatory joint diseases or gout can also be responsible for the development of arthrosis. The progression of arthrosis is slow.
There is a decrease in cartilage substance, formation of gaps in the joint cartilage, increased proliferation at bony protrusions and cyst formation. The severe abrasion of the bones when there is too little cartilage can lead to an activated arthosis, which means an inflammation of the joint. The resulting symptoms of arthrosis are manifested by pain during stress and rest, recurring swelling, muscle tension in the directly surrounding muscles, as well as somewhat more distant muscles.
Of course, restrictions in movement, which usually occur in a certain order, increasing deformities of the joint, pain after getting up in the morning or after sitting for a long time are also symptoms of arthrosis. In general, the ability to bear weight decreases, so that distances that were previously possible without problems can now only be covered with severe pain. The arthrosis is mainly visible on an x-ray, which is made on the basis of the symptoms.
This reveals the above-mentioned changes, which are not, however, information about the actual pain of the patient. In general it is important to say that an osteopathic treatment (osteopathy) is only carried out if a detailed medical history has been taken. It is especially important to clarify the Red and Yellow Flags.
Red Flags are symptoms which absolutely prohibit a treatment (tumors, cancer, etc. ), Yellow Flags are symptoms which may suppress a success (psychological component, long lasting illness, etc.). The aim of osteopathy in osteoarthritis is to relieve the patient’s symptoms and to delay the onset of osteoarthritis as long as possible.
It is important to find out the cause of the problem and to treat it specifically. In general, it can be said that the structures of the patient have changed after years of resting. At first, there may not have been any pain felt or only subconsciously but suppressed by a change in posture.
This leads to a shortening of structures (ligaments, tendons, muscles), additional strain on muscles that should normally take over other functions and a change in statics, which in turn causes increased wear and tear on the joints. Physiological statics is manifested by lordosis of the cervical and lumbar spine, kyphosis of the BWS and sacrococcygeal joint, a track width in the normal range (the feet should not be further apart than the hips to each other), the longitudinal axis of the foot points forward, and the head, thorax and pelvis are superimposed. Similarly to the physiotherapy for osteoarthritis, the osteopath also provides a detailed diagnosis in osteopathy.
In this process, it differs in general visual findings, specific examinations and tests. In the visual findings, the osteopath looks at the complete statics of the osteoarthritis patient and pays attention to deviations of the axis. He also recognizes a different muscle tone of the sides, which can already indicate a problem.
During the gait of the osteoarthritis patient, changes in the track width, stride length, rolling phase, loading of the sides may become apparent, or special gait mechanisms such as Duchenne or Trendelenburg may already be evident (if the gluteal and posterior thigh muscles are too weak, the pelvic side will sag or the upper body will be shifted to the weakened side).These are indications of a weakened musculature. During the specific examinations, the osteopath allows the osteoarthritic patient to actively move all extremities in a final degree and compares it with his performed passive movement. This usually reveals restrictions in movement in the affected joint.
In addition, the osteoarthritis patient usually reports pain during the final movement, which is due to a change in the joint space. Furthermore, the osteopath carries out a muscle function test to find out differences between the two sides. He also palpates the muscle on trigger points in the muscle.
At the same time, he can determine whether a muscle is shortened by actively testing the osteoarthritis patient. (e.g. the patient lies on his back and pulls one leg as far as it will go, the stretched other leg lifts off the support if the M. Illiopsoas is shortened = Thomas’ handle). It is equally important to check the dermatome and reflexes.
The dermatome shows the sensation on the skin divided into the different nerve impulses. If the patient shows less sensation in one area, this may have to do with a disorder of the corresponding nerve. In general, the osteopath still looks for changes in the skin, temperature, swelling or similar abnormalities.
This provides information about possible changes in blood circulation, vegetative disturbance or lymphatic congestion. After the detailed findings, it becomes clear where the patient’s problems may come from. As already mentioned above, it is usually a result of a developed relieving posture, which leads to ongoing problems.
Osteopathic treatment of osteoarthritis primarily leads to an improvement of the joint situation. Among other things, this is achieved by improving the general and also the local blood circulation in the joint. In the process, the osteopath looks at the corresponding segments of the spine.
The heart and lung segment, which is located at the level of TH 2/3, is decisive for this; the blood circulation is controlled from there. If there is a blockage here, which the osteopath can find out by careful examination, there could be a disturbance in the oxygen supply and a change in the balance between oxygen and carbon in the entire body. A blockage in the Th12 to L2 segment causes a change in arterial tension, which can also lead to a circulatory disorder in the affected joint.
Locally at the joint, the therapist, in osteopathy for osteoarthritis, improves the mobility and thus also the production of joint cartilage through mobilization. If the joint is blocked, the osteopath brings it into the correct position by careful manipulation, so that further wear and tear due to incorrect positioning is compensated. In general, the relief of the joint is also proven to be effective for osteoarthritis patients.
This is achieved by manual decompression of the osteopath. In doing so, he pulls on the distant joint partner in extension of the joint space to reduce the pressure on the joint. The traction can be supported with intermittent movements.
To improve muscle tone, general soft tissue techniques such as massage and lateral stretching (the osteopath stretches the muscle directly crosswise to the fiber line), but also the search for and treatment of trigger points have proven to be particularly effective in osteopathy for osteoarthritis. One of the main focuses of osteopathy for osteoarthritis is the treatment of the fascia. This can be applied to any affected joint, since a circulatory disorder can cause the fascia to stick together.
It is important for the osteopath to know whether the altered tone is related to a trophic change, i.e. if, for example, nodularity indicates a longer-lasting spasm of the muscles, which can be treated by trigger point treatment, soft tissue techniques. A high tonus without trigger points indicates a blockage in the corresponding segment of the spine. It is important to release the blockage and thus stimulate the blood circulation in the affected muscles.
In contrast to physiotherapy, the osteopath takes a more holistic view, so that a relieving posture in the pelvic area can also lead to a change in muscle tension in the abdominal area, which may result in increased intestinal blockages. The intestine expands and the blood circulation in the small pelvis and also the blood circulation of the femoral head could be reduced, since the vessels are very close together.In this case, the osteopath loosens the adhesions in the abdomen and stimulates mobilization. In order to improve the muscular imbalance, a specific training program is developed in osteopathy for osteoarthritis for the corresponding muscles and, especially after the reduction of pain, care is taken to ensure that a normal, physiological load is applied.
In addition to the passive treatment options, the osteoarthritis patient should also be guided to an active therapy. Appropriate, individual movement with as little pressure on the joint as possible is particularly suitable here. Water gymnastics, cycling, appropriate strength training for the surrounding weak musculature are particularly in demand.
Since osteopathy should only be performed every 6 weeks to give the body time to work, physiotherapy is recommended in the meantime. The therapy also provides relief for the joint, improves muscle tone and activates the surrounding musculature. Likewise, the arthrosis patient is clearly informed about his or her incorrect posture, so that he or she can counteract this incorrect strain even in everyday life.
Furthermore, an appeal is made for a change/improvement in lifestyle. Extreme physical and psychological stress weakens the immune system and thus the body’s self-healing powers. The regeneration of cartilage remains primarily critical.
In addition, an appropriate diet can support the build-up of cartilage, for which a nutritional consultation can be consulted. In general, it can be said that unhealthy nutrition disturbs the metabolism and can lead to an undersupply of certain minerals, vitamins and trace elements. From a medical point of view, certain medications can alleviate the pain and in the best case delay an operation.
If the complete therapy does not work and the patient suffers severely from the arthrosis, a surgical joint replacement remains. Osteopathy for arthrosis is very effective. After a detailed diagnosis and recognition of the main problems (poor posture, muscle imbalances, pain, etc.
), an individual treatment is performed. The main aim is to reduce the pain by relieving the corresponding joint (traction) or detonating the tense muscles. Different techniques can be applied, such as trigger points, fascial treatment or stretching.
Especially the stretches play a major role, but in the long run a static change can occur due to a shortening of the musculature to counteract the pain. The patient is instructed to do the stretching exercises at home. Since the osteopath works globally, he also looks at the spine to see if a blockage could lead to a circulatory problem in the affected joint.
Furthermore, he also treats the corresponding organs of the appropriate segment. By mobilizing the organs and the joint, the blood circulation is stimulated and harmful substances in the affected areas can be better removed and the body is stimulated to heal itself. Muscles that are too weak are trained with the corresponding exercise program.
Since the osteopathy session demands a lot from the body to regain its order and get back into the right position, this session is only recommended every 6 weeks. The patient may not notice any improvement immediately after the treatment but over time he will notice a process in the body.
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