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An Effective Approach to the Management of Osteoarthritis

by Jonathan Lawrence(more info)

listed in craniosacral therapy, originally published in issue 200 - November 2012

I was introduced to the effectiveness of complementary medicine, when as a late teenager playing hockey for my local club, one of my team mates was struck in the eye by a hockey ball. One of the opposing team happened to be a homeopathic doctor. After the administration of arnica we were amazed at how the swelling quickly subsided.

A few years later when I was training as an Osteopath a veteran player at my hockey club asked me to assess his left knee. It was apparent from the restriction in flexion the increase in size of the knee and the creaking and instability of movement that he had osteoarthritis. After a series of treatments followed by maintenance treatment, his improved function allowed him to play hockey for many years and it was decades before the knee required surgical replacement.

In complementary medicine there are a number of approaches to the treatment of osteoarthritis from homeopathy, nutritional, Chinese medicine to manipulative therapies, all of which have their merits. The osteopathic approach looks at the mechanical, vascular and neurological aetiology and works from that premise.

So what do we know about osteoarthritis?

Under normal circumstances all bones, cartilage and joints are in a dynamic process of modelling and remodelling. s because of the physical needs of the joint for simple maintenance and for adaptation to change such as sports training. Bone contains two types of cells involved in this process - osteoblasts and osteoclasts. Osteoblasts create bone and osteoclasts break bone down. Working together they maintain and adapt the bones and joints to suit the function of the organism

Inflammation

Fig 1 Showing a normal joint above and a joint subject to osteoarthritic change below.

As can be seen from the above diagram the joint pathology demonstrates an overall thickening of the joint occurring through:

  • Thickening of the synovial membrane;
  • Fibrosity of the capsule;
  • Thinning and distortion of the articular cartilage;
  • Unevenness of the joint surfaces, often with osteophytic change and calcification of the soft tissues.

In addition there will be a chronic inflammation with episodes of more acute inflammation.

Osteopaths are taught that a great deal of the pain and restriction derives from the soft tissues.

Traditionally, osteopathy sees osteoarthritis as the result of trauma to the joint. This could be from acute trauma such as falling off a bicycle onto the knee, a very common occurrence. It could derive from micro trauma on the joint from repetitive actions, overuse, sporting activities or poor posture. It could also derive from indirect factors such as a short leg or a neuromuscular disturbance of soft tissue tension of the joint. An example of the latter would be a hypertonicity of the quadriceps muscle mediated by disturbance of the femoral nerve unbalancing tensions around the knee.

This trauma leads to inflammation. The result of inflammation is to create scar tissue. Scar tissue is dense and not as well vascularized as normal tissue. This in turn reduces the efficiency of the micro circulation, reducing the efficiency of the supply of nutrients to the tissues and the disposal of wastes. This process results in a low grade chronic inflammation and a slow degeneration of the joint takes place.

The speed of deterioration is variable, and pain and disability may occur after many years.

My hockey player friend benefited from the classical osteopathic approach to his condition. The joint was articulated, that is taken through its range of movement, including laterally straining the joint which is not an voluntary motion but is a fail safe motion protecting the joint when stressed during a fall for example. This procedure is undertaken in a gentle rhythmical manner and is non-traumatic.

He also benefited from neuromuscular technique, which is a deep tissue massage of the major ligaments of the joint. This is a painful procedure designed to produce a fresh inflammatory response from the tissues thus stimulating repair.

The third technique used was fascial unwinding. This gentle procedure re-tensions the tissues around the knee, allowing the joint to be more balanced and reducing stressors, which originate from the originating trauma or the condition itself.

The final part of the treatment would be make sure the whole physical structure is in balance. This involves correcting any imbalance either directly associated with the joint such as adjacent joints; hip, ankle and tibia/fibula articulations, sacro-iliac and lumbar spine and indirect through the rest of the spine.

This approach has proved to be very successful over the years. Mostly three sessions, weekly is required to gain a significant improvement and then a maintenance regime is instigated.

One of the questions that occurs when one gets good results with this regime is the possibility that the pathology may improve as well as the function. As the body constantly remodels itself then improving the terrain via the vascular efficiency around the joint should at least slow the progression of the disease and may possible allow a degree of healing to take place.

In the last few years I have started to use homotoxicology in practice and have found this to not only be a very useful therapeutic tool in treatment of patients, but also the theory and practice of this modality is very much in line with classical osteopathic thinking.

Homotoxicology was developed by Dr HH Reckeweg as a means of building a bridge between modern medicine and homeopathy. He updated many of homeopathic ideas to fit in with scientific and social advances in the 20th century. He noted that the demographic of disease had changes since the advent of homeopathy and whereas the incidence of acute to chronic illness in Hahnemann’s time (the founder of homeopathy) was 4:1, this in the early 20th century was now reversed and at 1:4.

He postulates that this was due to the increase of homotoxins (substances poisonous to human beings) in the industrial age. He developed medicines composed of mixtures of homeopathic remedies to detoxify the tissues. This toxic load occurs mostly in the extracellular matrix (ECM) and it is the ECM where classical osteopathic theory places the cause of osteoarthritis; the metabolic by-products of the inflammatory process remaining in the tissues and acting as Reckeweg’s homotoxins.

Products that address inflammation and healing have proved to be extremely helpful. The mode of action of these remedies are gentle and in concert with the healing processes of the body. Inflammation is a natural process and designed to promote healing. When the process is blocked, the inflammation becomes chronic and damaging. However chronic inflammation is increasingly being associated with many modern chronic diseases such as heart disease and possibly cancer.. Conventional medications such as NSAIDs  kill the inflammation, reducing swelling and therefore pain.

The homotoxicology preparations support the process of inflammation, removing the blocks to what is in effect the attempt by the body to heal the tissues.

Process of inflammation

Fig 2. Process of inflammation showing 5 stages.[1]

This is now being well understood and has been the subject of extensive research.[2]

Other preparations are designed to aid tissue repair by including homeopathic components that stimulate healing. These include homoeopathically prepared vitamins, key components cellular repair and sarcodes, which are homoeopathically prepared from healthy target tissue. One of these preparations has been shown to stimulate the regeneration of cartilage tissue in vitro.[3, 4]

In the last few years in practice I have been using these preparations alongside the osteopathic work, and in addition have been able to inject them subcutaneously and intramuscularly into acupuncture points around the joints which gives the remedies a ‘turbo effect’. This method has been used in Europe for many years and is known as homeopathic mesotherapy, homeosynatry (use of acupuncture points) and biopuncture.[5, 6]

These remedies have very few side effects and have the benefit of having a systemic effect even when injected. This is useful when the arthritis is in multiple joints and in polyarthritic conditions such as Rheumatoid Arthritis. There are only a handful of practitioners in this country who are using these techniques; in response to this training courses are being set up.[7]

Of course, each patient is unique and the context of the arthritic change is very important in managing the disease. For example lifestyle, obesity, predispositions, allergies and food sensitivities are factors that need to be individually addressed in order to achieve an optimum effect.

References

1.         From Presentation by Dr Alta Smit, Society of Homotoxicology and Anti Homotoxic Medicine-GB Conference, Royal College of Physicians, May 12th 2012.

2.         Porozov S, Cahalon L, Weiser M, Branski D, Lider O, Oberbaum M. Inhibition of IL -1beta and TNF -alpha secretion from resting and activated human immunocytes by the homeopathic medication Traumeel S. Clin Dev Immunol. 11(2):143-149. 2004.

3.         A.Orlandini - M. Rossi - M Setti Co-ordinator : G. Cantaluppi The Effectiveness Of Zeel And New Research Methods In Rheumatology www.biopathica.co.uk/documents/clinical%20trials/Effectiveness%20of%20Zeel.pdf

4.            Birnesser H, Stolt P. The homeopathic antiarthitic preparation Zeel comp. N: a review of molecular and clinical data. Explore (NY). Klinik für Sportorthopädie/Sporttraumatologie, Universitätsklinikum Freiburg, Freiburg, Germany. brinesser@msm1.ukl.uni-freiburg.de  Jan-Feb; 3(1):16-22. 2007.

5.            Kersschot J. The Clinical Guide to Biopuncture –- Belgium, Inspiration. 2010.

6.            www.kersschot.com/Biopuncture.html

7.            http://www.turningpointtraining.org

Further Reading

8.         Smit A et al. Introduction to Bioregulatory Medicine, Stuttgart, Thieme 2009.

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About Jonathan Lawrence

Jonathan Lawrence BA DO Cert Ed, following 4 years teaching Environmental Science, trained at the European School of Osteopathy graduating in 1985. Jonathan has been practising Osteopathy in private practice for 25 years, treating patients of all ages – from babies to the elderly. Having lectured to audiences ranging from small technique classes to presenting at the 2008 Advancing Osteopathy Conference, he established Turning Point Training in order to bring high quality and affordable professional courses in Craniosacral and positional release techniques to practitioners trained in conventional or complementary medicine. He may be contacted on Tel: 01769 579004; info@turningpointtraining.org   www.turningpointtraining.org  

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