Joint Pain, Osteoarthritis and Rheumatoid arthritis

Arthritic Pain

Arthritis is a common condition that causes pain, swelling, inflammation, and often stiffness in the joints of the body. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are many other types including ankylosing spondylitis, gout, psoriatic arthritis and reactive arthritis. Certain types of arthritis can also affect children. Common areas affected include the hips, knees, feet, hands, and spine.

Everybody gets grey hair and wrinkles as we get older. In the same way, it is normal for our muscles, bones, joints and associated tissues to change as we age. Ageing does not necessarily mean that we will experience increased pain or stiffness. However, if this does become a problem, people often find that treatment and advice from an osteopath can complement GP care and pharmaceuticals management. If you do begin to notice problems, your osteopaths can work with you to keep you healthier, allowing you to enjoy the pleasures of life into your older years.

Causes and symptoms involved in arthritis: pain (this can be at rest or during movement), swelling that is sometimes associated with redness, stiffness or a creaking feeling in the joints which is often worse in the morning, decreased function of joints, weakness and muscle wasting, and difficulty doing some day to day activities.

Treatment: While osteopaths cannot ‘cure’ arthritis, we can help to reduce and manage the symptoms effectively. Gentle manipulative and massage techniques by osteopaths can help reduce the pain and symptoms experienced in many arthritis sufferers. Treatment is individual, gently moving and stretching an arthritic joint, massaging surrounding muscles and tissues to help ease discomfort, and help to move synovial fluid within the joint providing lubrication. It is important to fully understand how to manage the condition before it begins to affect our daily living tasks.

Rehabilitative exercises are a primary part of osteoarthritis care, therefore you will be guided through an exercise routine specific to you, to help get you moving. This will help by increasing your mobility and strength in the legs and arms, whilst reducing pain. You may also receive advice on your diet, posture and changes to lifestyle. X-rays, scans or other tests may sometimes be required however that is usually not the case.

150 minutes of exercise per week, in blocks of ten minutes or more can help to increase muscular strength, reduce the risk and falls, increase function and mobility, and reduce pain experienced in the joints from arthritis. This should be enough to make you warmer and breathe harder, whilst still being able to have a conversation. It can also help to improve your mood and levels of confidence. This might include activities such gentle squatting, dancing, or brisk walking. Your osteopath will often provide exercises to improve your balance, to reduce the risk of falling, particularly if you are over the age of 70.

Hip and Groin Pain

People who commonly experience hip pain include middle aged and elderly populations, sports people, or those who are on their feet or walking for large portions of the day. Hip pain can be provoked by lifting heavy objects from low off the ground, falls or spontaneous movements involving recovering from losing balance, or overreaching when running. 

Chances of developing hip pain increases if the activity involves extending the leg back and using maximal muscle strength to drive the leg such as in: football, rugby, racket sports, martial arts, or athletics

Muscles strains, joint irritation, wear and tear, and prolonged standing or sitting are the most common causes of hip pain and may only require a short series of treatments to resolve the problem. Groin pain may be mistaken for hip pain as well, this will become clearer during the case history and assessment.

Causes and symptoms associated with hip pain: 

- stiffness or restriction of movement, 

- pain lifting the knee towards the chest or behind you, 

- difficulty lifting the leg whilst walking up or down steps, 

- difficulty going from seated to standing or standing to seated, 

- sharp pain in the groin on certain leg movements, 

- difficultly putting on socks and shoes, 

- pain travelling down the back of leg to the knee or foot, 

- pain travelling down the front and/or side of the leg to the knee, 

- lower back pain or knee pain.

Treatment: The hip and groin area is a complex area to treat. Your osteopath can successfully treat patients who come with undiagnosed hip or groin pain regularly that has lasted for months or even years, despite scans, tests and various forms of treatment. 

A key component of this treatment is the correction of hip biomechanics along with hands on treatment. Due to the close relationship of the ankle and knee mechanics with the hip, a detailed examination of the lower limb mechanics is also essential in identifying the root cause of the problem. 

Examination of the lower back is also important as hip pain can be referred from the lower back.

Specific osteopathic joint mobilisation techniques will be used to improve the function of the hip joint to increase the range of motion. Manipulation may also be indicated to free up the hip ligaments. Many specific muscle contraction and relaxation sequences will enable the body to release tension in the hip and also rapidly improve muscle strains. Soft and deep tissue techniques may be used to reduce larger muscle strains and increase the speed of recovery.

Specific stretching and strengthening exercises may be advised to correct compensatory patterns and weaker muscle groups. Better muscle balance will reduce pain in the hip, whether this is through stretching tight muscles, or strengthening weaker muscles. 

If there is a change in the lower leg mechanics, corrections will be made through exercise to help change movement patterns and relieve the hip pain.

Knee Pain

Knee pain is very commonly seen in sports people and the elderly. More often than not knee pain is a result of either joint surface wear and tear due to repeated use, age, cartilage or meniscal damage through sporting injuries, muscle strains in the knee, thigh, hamstring, or calf regions, or irritation of the small fat pads called bursa that allow for muscles to glide freely over bone. 

Arthritic pains, which gradually develop over years often, give rise to symptoms such as morning stiffness, pain walking and pain bending the knees. 

If the knee does not have time to recover between intensive sessions of exercise/sports/competition then it may slowly become inflamed and irritated. If the knee has very sharp pain after a sport training session or game then the possibility of genuine ligament, cartilage or muscle damage becomes greater. 

Rapid twisting or changing of directions may place stress these structures and require treatment. Muscle strains often result from overload of the muscles and tendons either from training, running, or competition situations. 

These are clear because moving the joint will cause pain in the muscle each time and you will begin to avoid specific movements. Knee pain can also be referred from the lower back through compression of nerves that exit the spine or through the muscles controlling the hip.

Causes and symptoms of knee pain can include: 

-  sharp pain bending the knee, 

-  stiffness in the morning lasting up to 60 minutes, 

-  weakness sensation going up and down the stairs or when walking, 

-  locking or ‘catching’ of the knee, 

-  giving way in the knee, 

-  constant aching within the joint, 

-  grinding sensation within the knee, 

-  swelling or redness of the knee itself, 

-  associated hip or ankle pain.

Treatment and Management: Knee injuries can happen suddenly, or build up over time. Your osteopath can successfully treat knee pain caused by a variety of factors. 

The knee is located between the hip and the ankle. These areas can therefore significantly impact the knee and in many cases are the root cause of knee pain. 

After examination of the pelvis, hip, and ankle mechanics and movement, it will be evident if their involvement will require treatment. 

If these areas require treatment this will be discussed with you.

Specific osteopathic mobilisation techniques and manipulation increase the mobility of the knee joint and improve the range of motion. 

Mobilisations also help to pump inflammation out the knee joint and further aid healing. Restoring correct balance to the muscles of the thigh, hamstring and calf regions also help in reducing impact and strain to knee joint. 

This can be done through both soft and deep tissue massage techniques.

Exercises to both increase the flexibility of the muscle groups surrounding the knee, and increase the strength may be required to improve knee function. 

If the muscles are too tight or too weak then the knee must absorb much greater pressure and so the joint surfaces will become more easily inflamed.

Medical acupuncture and ultrasound therapy can be used by your osteopath to reduce inflammation and improve your rate of healing.

Elbow Pain 

Elbow pain is most commonly seen through direct trauma to the arm or through repetitive movements. Examples of trauma include falling onto your arm, sports collisions, or injury while lifting heavy furniture or weights. Repetitive strain examples include sports such as tennis, squash, cricket; and jobs such as builders, brick layers, carpenters, and decorators. 

Another major cause for elbow pain is desk related jobs that require lots of keyboard and mouse use, causing strain to the muscles that move the wrist and elbow. This could be through incorrect desk height set up, chair height, keyboard and mouse position, or frequency of use. This applies not only to the working population but anyone using laptops, computers, or gaming consoles for many hours in the day.

Elbow pain can also be caused from problems in the neck, upper back, or shoulder, travelling down to the elbow.

Often painful elbows are a result of wear and tear related inflammation of the associated arm and forearm muscles. Grip related tasks can become difficult in terms of pain and sensations of weakness. Gradually the arm, elbow or grip becomes less durable to the pain and so onset of pain or muscle fatigue becomes quicker.

Associated symptoms of elbow pain can include: constant ache or low-grade pain within the joint, sharp pain when gripping objects, weakness in holding objects, pain or inability to fully extend elbows, neck pain, shoulder pain, wrist pain.

Treatment: It is always incredibly important to assess the muscles and joints of the wrist, elbow, shoulder, neck and upper back. Elbow pain can be a result of nerve entrapment in the neck or shoulder, or as a result of muscle compensation from hand or shoulder problems.

Treatment will involve osteopathic mobilisation techniques to improve mobility of the joints that make up the elbow including manipulation techniques. Often a great deal of deep tissue massage is required to ease the tension in the forearm, upper arm, and shoulder to reduce elbow pain. 

Strengthening or flexibility advice for the muscles associated with the wrist, forearm, shoulder or neck may be advised. This will depend on whether the elbow pain is caused by muscular weakness, or tightness.

Specific postural advice will also be given; whether it be sitting or desk based, the way in which you’re using your arms and shoulders during manual labour tasks and jobs, sports specific movements, and using musical instruments.

If you are suffering with elbow pain, book an appointment with your osteopath and let them help you out of pain.

Hand and Wrist Pain

Hand and wrist pain have many similar causes to elbow pain, these include fine and intricate movements such as writing, typing, and using a mouse; larger movements such as opening jars, gripping a screwdriver or sports equipment, and carrying heavy objects. 

Problems in the hands may be caused by many different factors including ‘wear and tear’ and arthritic conditions, lack of blood flow to the fingers, trauma such as falling on an outstretched hand, or problems in the forearm, elbow, shoulder or neck. Pins and needles in the hands can be a result of nerve compression in the hand, forearm, upper arm, shoulder, neck muscles, the neck itself, diabetes, pregnancy or thyroid issues.

Causes and symptoms of hand & wrist pain can include: pins and needles or numbness in the hand or fingers, stiffness or difficulty bending the fingers or wrist, sharp pain when putting pressure down through the hands, difficulty holding objects including drinks or cutlery, stiffness lasting up to 60 minutes in the morning, to sharp pain when performing heavy tasks.

The hands are often the location for systemic symptoms to present such as pins and needles, swelling, or hypersensitivity to temperature changes. Your osteopath will take a thorough case history to rule out any more serious pathology before starting treatment.

Treatment: Osteopathy can be incredibly helpful in treating and managing hand & wrist pain. As mentioned above, a proper assessment of the hands, forearms, elbows, shoulder and neck will reveal the root cause of the symptoms in the hands. 

Improving the mobility of the wrist and all associated joints through osteopathic mobilisation techniques can free up the muscle and nerve tension and improve blood flow through the hands. Manipulation techniques can also be used to improve joint alignment and reduce muscle tightness.

Grip strength and wrist mobilisation exercises may be given in order to improve strength, muscle endurance and stability of the wrist. Stretching advice may be given to promote ease of motion of the elbow, forearm and hand muscles.

Advice on how to make subtle modifications to your daily activities that may be irritating the area can also be given.