Encouraging patient diet, exercise and orthotics play a large part in joint pain in elderly patients
As the baby boomer population of the U.S. continues to age, the number of patients presenting with joint pain continues to rise. These joint pain symptoms are typically the result of injury or chronic mechanical stress.
To achieve an optimal outcome, a reasonable strategy should be implemented to:
1) reduce the symptoms;
2) improve mechanical function; and
3) prolong the avoidance of surgery or drug use to address the pain.
Optimal results can be obtained with a good plan that is well understood by the patient and executed with their enthusiastic participation. Addressing all of the factors that are causing joint pain is important, because it is the component that is missed or ignored that can lead to the need for a surgical solution – and that should always be the last resort.
Replacements on the rise
According to the National Center for Health Statistics, the number of total hip replacements among patients 45 and older grew from 138,700 in 2000 to 310,800 in 2010 – a 124.64% increase.1 The rate of total knee replacements also increased for men (86%) and women (99%) in the same time frame. In fact, in 2010 total knee replacements were the most frequently performed inpatient procedure on adults over the age of 45 (693,400 total).2
The fact that the number of these procedures is increasing and most likely will continue to increase is supported by other studies. But even without an increase in rates, the aging population alone will result in an estimated 11 million people with total hip or knee replacements in 2030 (4 million total hip and 7.4 million total knee replacements). 3
OTC and prescription meds
Due to the successfully persuasive education of our society by the pharmaceutical and medical entities, many people operate under the illusion that health can be obtained by suppressing symptoms with over-the-counter, non-steroidal anti-inflammatory medications. It’s pretty simple: Inflammation causes pain; they want the pain to go away; so the obvious answer is to take a pill to make the inflammation and joint pain in elderly patients go away. It works; and I have to admit that in an acute situation, it can be a godsend to someone who is suffering.
The problem with NSAIDS is that using them routinely can lead to several complications. First, the chance for liver and kidney damage is very real. Every year people die from the misuse and the resulting damage of these common pain killers. This is also a major reason for the opioid crisis. In 2017, 17,029 people died from prescription drug overdoses, up from 3,442 deaths in 1999.4 Second, it allows the mechanical cause to be overlooked, prolonging the mechanical stress and resulting in additional degenerative changes.
The topic of obesity in this country is well documented. Being overweight is now a problem that is shared equally by adults and children. It comes as no surprise that the predictions for the rising number of joint replacements includes a decrease in the median age of the joint replacement recipient. Weight is a factor in how well joints function.
Excessive weight has several implications in joint health. The average American diet includes a disproportionate amount of grains and processed carbohydrates. This is responsible for a significant amount of excess weight due to the fact that the body stores the excessive carbohydrates as fat. We consume more than we burn off with exercise, so we get heavy and don’t want to exercise. The grain-laden diet also throws off the optimal ratio of omega 3 versus omega 6 fatty acids, creating inflammation in the body. This is fuel for the fire of inflammation, leading to pain and degenerative changes in the joints.
Pain has a tendency to remove every ounce of desire to exercise, which also has anti-inflammatory benefits, so we have created this biochemical, biomechanical conundrum which accelerates deconditioning, inflammation, weight gain, pain and degeneration.
Patients interested in taking responsibility for their joint health have to proactively execute some basic components of a joint preservation/restoration strategy. This strategy has to take into account all of the components to the problem, which includes diet, exercise, spinal and extremity joint biomechanics, as well as the current state of dysfunction of the joint(s).
The chiropractic component of care must include a thorough evaluation of the biomechanics of the extremities and spine, including the feet. Excessive pronation of one or both feet can be a primary contributor to structural stress in the knees, hips, pelvis and spine. Failure to address this with appropriate orthotic support can be a major limiting factor in how well your patient responds to care; and for the younger patient, how well their joints endure the mechanical stress over time.
For a vast majority of patients, custom-made, flexible orthotics meet this need. They provide a balanced, symmetrical foundation while blocking the excessive motions of the feet that twist the knee internally and cause the femur head to rotate anteriorly, creating stress in the pelvis and spine.
Addressing inflammation is key to reversing the process of joint pain. It is also a critical component to preventing future joint pain in elderly patients for those who currently have healthy joints and want to keep them!
Eliminating inflammatory grains and sugars is critical. Getting a healthy amount of omega 3 fatty acids from fish, eggs, nuts, seeds and free-range beef or game meat will help reduce inflammation. Supplements can be helpful, but keep in mind that they are designed to supplement a healthy diet – not be the diet.
If old injuries are part of the patient’s history, rehabilitation may be a necessary part of the journey to optimize joint function. Old injuries often contribute to aberrant biomechanics which result in soft tissue dysfunction. Muscle weakness, trigger points and diminished flexibility must be addressed.
The effects of exercise are beneficial to our strength, flexibility, balance and immune system function. Exercise acts as a natural anti-inflammatory and is known to improve mental health. It should be part of every patient’s daily routine to regain or maintain healthy joints.
The complete package
Chiropractic adjustments, as powerful as they are, cannot overcome a poor diet that creates inflammation, obesity and postural stress that is the result of a compromised pedal foundation. All of these factors must be addressed in order to achieve an optimal result regardless of the age and condition of the patient.
BRIAN JENSEN, DC, graduated from Palmer College of Chiropractic in 1987. He speaks on a wide variety of topics, including orthotic therapy, posture, structural preservation, breaking free of the medical model of health care, and innovations in nutrition. He has his own practice in Roanoke, Va., and can be reached at cavespringchiropractic.com.
- Centers for Disease Control and Prevention: “Hospitalization for Total Hip Replacement Among Inpatients Aged 45 and Over: United States 2000-2010.” (Link: https://www.cdc.gov/nchs/products/databriefs/db186.htm)
- Centers for Disease Control and Prevention: “Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010.” (Link: https://www.cdc.gov/nchs/products/databriefs/db210.htm)
- The Journal of Bone and Joint Surgery: “Prevalence of total Hip and Knee Replacement in the United States.” (Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551172/)
- National Institutes of Health: “Overdose Death Rates” (Link: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates)