Treating primary osteoarthritis with chiropractic care, nutrition

Research has shown that spinal manipulation in combination with moist heat was more effective than moist heat treatments alone in the management of primary osteoarthritis lower-back pain

Chiropractors treat patients with all types of conditions, one of which is primary osteoarthritis (more wear-and-tear) along with secondary (from a specific cause such as injury).

Robert Koser, DC, a chiropractic physician and clinical business development professional who works at iRISE Spine and Joint in Tampa, Fla., and is a clinical consultant to chiropractors, medical providers, and legal professionals, spoke with us about how chiropractic care helps osteoarthritis patients.

What follows is an edited version of our interview.

How can chiropractic benefit patients with primary osteoarthritis?

“Chiropractic” is often thought to be synonymous with “spinal adjustments.” In reality, “chiropractic” is just the term that describes our profession.

Within the chiropractic profession, we are fortunate to be able to offer patients many different conservative care modalities outside of spine and extremity manipulations. Complementary treatments may include cold laser therapy, nutritional counseling, and rehabilitation-based exercises to name a few. For patients specifically with symptomatic osteoarthritis (OA), these chiropractic treatment options may greatly benefit their condition.

Research has demonstrated that spinal manipulation and/or manual flexion/distraction in combination with moist heat was more effective than moist heat treatments alone in the management of primary osteoarthritis lower-back pain (1). Additionally, a pilot study demonstrated that chiropractic care may provide short-term relief for patients diagnosed with hip OA waiting to undergo hip arthroplasty (2). The goal of chiropractic treatment for symptomatic osteoarthritis truly should be focused on pain reduction and enhancing functional activities.

Can chiropractic alleviate osteoarthritis pain to the point of not needing NSAIDS?

I have seen many cases where patients undergoing chiropractic care for OA-based pain have done remarkably well and ended up postponing pain management injections and/or had physician-supervised tapering of pain medications. It is quite gratifying as a chiropractor to see your patients improve and reduce their need for pharmacologic intervention for pain management.

Besides the physical benefits of chiropractic care, there is also a secondary emotional component when it comes to a patient’s overall health and resuming meaningful activities. For example, I’ve had many patients who are avid gardeners come to me with primarily symptomatic OA joints. Due to their arthritic pain, they were unable to garden, and this caused them significant mental distress seeing weeds take over their outdoor beds while they sat inside and became more sedentary. After a course of chiropractic care, their pain levels decreased, and their ability to squat and range of motion increased. My patients were once again back outside in the garden for some physical exercise, a dose of natural vitamin D, and connecting with nature on a holistic level.

They regained their bragging rights to having the most manicured garden among their neighbors. 

With osteoarthritis patients, do you give them specific nutritional advice?  

For inflammatory-driven conditions, such as osteoarthritis, I recommend patients consult with their doctors about starting an anti-inflammatory diet. OA is often thought of as a “wear and tear” disease, but in reality, it’s a condition involving chronic inflammatory mechanisms occurring within the joints (3).

Diets that are high in sugar, flour, highly processed/refined foods, and excessive omega-6 fatty acids are the first things I recommend to reduce and cut out. These types of foods are considered pro-inflammatory, contributing to an overall low-grade systemic inflammatory state within our bodies and activate cytokines such as interleukin-1β (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-alpha) (4).

Pro-inflammatory foods are also notorious for increasing our overall body mass index and can contribute to the development of metabolic syndrome and adiposopathy (where our body fat actually perpetuates an inflammatory state) (4). Increased body mass index leading to obesity may also contribute to abnormal loading and further inflammatory changes within our joints (5).

Reducing this pro-inflammatory state naturally through the means of an anti-inflammatory diet may make a significant impact by reducing overall weight levels as well as pain expressions experienced with OA. A general anti-inflammatory diet would include consuming vegetables, lean meats, fish, fruits, and nuts.

Resources:

1. Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. J Manipulative Physiol Ther. 2006; 29(2):107-114. doi:10.1016/j.jmpt.2005.10.005

2. Thorman P, Dixner A, Sundberg T. Effects of chiropractic care on pain and function in patients with hip osteoarthritis waiting for arthroplasty: a clinical pilot trial. J Manipulative Physiol Ther. 2010; 33(6):438-444. doi:10.1016/j.jmpt.2010.06.006

3. Nees TA, Rosshirt N, Zhang JA, et al. Synovial Cytokines Significantly Correlate with Osteoarthritis-Related Knee Pain and Disability: Inflammatory Mediators of Potential Clinical Relevance. J Clin Med. 2019; 8(9):1343. Published 2019 Aug 29. doi:10.3390/jcm8091343

4. Seaman DR. Body mass index and musculoskeletal pain: is there a connection? Chiropr Man Therap. 2013;21(1):15. Published 2013 May 20. doi:10.1186/2045-709X-21-15

5. Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis?. Rheumatology (Oxford). 2018; 57(suppl_4):iv61-iv74. doi:10.1093/rheumatology/key011