Osteoarthritis and osteopathy

Osteoarthritis is the most common joint disorder and probably the one that generates the most false beliefs and exaggerations in the collective imagination. It is a bit of a catch-all term that seems to have the magical power to explain all the pain that is not justified by other pathologies. Here is some information that should help to sort out the true from the false and especially to understand how to limit the impact on daily life and the pain it can generate.

According to the WHO definition: "Osteoarthritis is the result of mechanical and biological phenomena that destabilize the balance between the synthesis and degradation of cartilage and subchondral bone. Concretely, osteoarthritis appears when the articular cartilage (which allows the sliding of one bone in relation to the other in a joint) undergoes premature or excessive wear.

In children and adolescents, the body is able to produce cartilage in quantity to allow the growth of joints while optimizing their mobility. In adults, the body loses its ability to produce cartilage efficiently. Thus, when cartilage is worn out, the adult body is not able to replace it with an equivalent tissue. Since the body cannot match the "quality" of the cartilage, it tends to promote the "quantity" of bone tissue to try to remedy the problem. The result is an accumulation of bone tissue in the affected joints, which gives a particular appearance on radiology that is often called "parrot beaks" at the spinal level. This decrease in the quality of the cartilage tissue leads to a decrease in the mobility of the affected joints, often associated with local inflammation, which itself causes pain.

Often multifactorial, osteoarthritis develops mainly in joints that are subject to too much stress. This accumulation of stress can have several origins:

Following a major trauma involving a joint (serious sprain, fracture, dislocation, etc.) the cartilage may be damaged. This will result in a significant fragility that will lead to osteoarthritis in the medium and long term. Similarly, when this trauma requires surgery, the risks of osteoarthritis appearing in the long term are major. This is one of the reasons why we are increasingly seeking to favour the least invasive interventions possible, such as arthroscopies (few scars and less risk of "damaging" the structures during the intervention). Generally speaking, any intervention at the joint level presents a significant risk of generating osteoarthritis (for example, when all or part of a painful meniscus is removed, one of the major systems for absorbing the stresses of the knee is removed or modified, thus favoring premature wear of the cartilage and therefore osteoarthritis). This does not call into question the merits of surgery, but it is important to bear in mind the possible medium- and long-term consequences of an intervention.

This is the other major cause of osteoarthritis. Posture (the way we hold ourselves) can naturally lead to an excess of stress on certain joints. For example, someone who has a very hunched posture (buttocks backwards and lower back very deep) has a high risk of developing osteoarthritis in the lumbar vertebrae. Another example: a road accident that has caused a change in the curvature of the cervical spine (especially in frontal impacts or very sudden braking) has every chance of causing the appearance of cervical osteoarthritis, sometimes at a very long distance. Last example: a person who is very overweight will force his knees to support a much heavier load than they should, leading to premature wear of the cartilage and the appearance of arthrosis.

This is a point of debate in the medical community. For a long time, it was claimed that the genetic factor was predominant in the appearance of osteoarthritis, but this is now being reconsidered somewhat. It is in fact very likely that the major part of the "genetic" origin of osteoarthritis is linked to postural genetic factors inherited from our parents. If, for example, my mother suffered from significant lumbar osteoarthritis because of her posture, it is likely that this would also be the case for me, not because osteoarthritis itself is in the genes, but more probably because I would have "inherited" from my mother the bone architecture and therefore the posture of her pelvis and lumbar spine, and therefore the same "vulnerability" to osteoarthritis as she did.

The last important factor, which we have all seen, is the importance of age in the pain associated with osteoarthritis. If we have already mentioned the difficulties the body has in effectively replacing damaged cartilage in adults, this is compounded in the elderly by more difficult tissue hydration. Cartilage tissue needs a lot of water to function (and "glide") efficiently, and physiologically this rehydration becomes more and more difficult as the years go by (this is also a factor that is largely responsible for the changes in vertebral posture in the elderly, but that is another subject). It is therefore essential to ensure good hydration when suffering from osteoarthritis, but we will come back to this very quickly.

If there were to be only one thing to remember from this article, it would be that once osteoarthritis has set in, there is currently no treatment that can make it "disappear"; at best, it is possible to limit its evolution and impact on daily life... It is therefore essential to keep in mind a few precautions that will help to slow down the installation and evolution of osteoarthritis as much as possible, especially if you find yourself in one of the situations mentioned above. 

First of all, you have to move as much as possible. Osteoarthritis likes nothing more than immobility and sedentariness. You must avoid at all costs finding yourself in a situation where: "The less I move the more I hurt and the more I hurt the less I move". That is to say that you should try as much as possible (and as much as the pain allows) to move and mobilize, even gently, the fragile or painful joints. Frequent movement increases the efficiency of the synovial fluid (the fluid that lubricates the joints) and thus limits the impact of osteoarthritis on joint mobility and the installation of painful inflammation in the joint.

As mentioned above, the other fundamental element to keep in mind is the quality of hydration. Hydration plays a major role in the mechanical properties of the cartilage and in the efficiency of the synovial fluid, which is why regular and abundant hydration plays a major role in the fight against osteoarthritis.

There are also a few interesting concepts to take into account when it comes to food. First of all, it is important to choose foods that also promote hydration, with fruits and vegetables being the most important. Some studies also show that a reduction in the consumption of animal proteins (especially meat, less so for fish) is beneficial in the treatment of osteoarthritis. The fact of favouring the consumption of fibre also shows an effectiveness in the fight not against osteoarthritis itself but against the inflammatory process that accompanies it and which is largely responsible for the pain. Finally, as in most osteoarticular diseases, vitamin D is very important and the best way to stimulate its production is to go outside regularly, since it is largely stimulated by exposure to the sun (even when hidden behind a few clouds).

Your osteopath also has an important role to play in the prevention and follow-up of osteoarthritis. First of all, by the influence that osteopathic consultations can have on posture (even if it would be illusory to think that a consultation can radically change the posture acquired over the years by a patient) and areas of stress.

In addition, your osteopath uses multiple joint mobilization techniques that will both maintain and improve the mobility of joints suffering from osteoarthritis while stimulating the production and effectiveness of synovial fluid.

Finally, by using techniques known as traction, decompression or decoaptation, your osteopath can help to ensure that the excessive stresses suffered by joints suffering from osteoarthritis are better distributed and therefore better tolerated by the body.

In any case, do not hesitate to contact your osteopath in Versailles for more information and to see with him if an osteopathic treatment could be beneficial in the management of your pain related to osteoarthritis.

Damien Fabre
Osteopath D.O
2 rue Alexis de Tocqueville
78000 Versailles