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Chiropractic And Osteoarthritis

Chiropractic And Osteoarthritis

The Chiro.Org Blog


SOURCE:   University of Maryland Medical Center


Although the vestiges of medical harassment against chiropractic still resonate, and are now supplanted by fringe web sites which continue to ignore the body of peer-reviewed research supporting chiropractic care, the ice is slowly melting.

Below you can read comments from the University of Maryland Medical Center website , which openly acknowledges the benefits of chiropractic care for patients suffering from the pain of osteoarthritis.

There are many more articles like this @ our:

Degenerative Joint Disease and Chiropractic Page


Although there is no evidence that chiropractic care can reverse the joint degeneration that causes OA, some studies indicate that spinal manipulation may:

  • Increase range of motion
  • Restore normal movement of the spine
  • Relax the muscles
  • Improve joint coordination
  • Reduce pain

In fact, a comprehensive review of the scientific literature suggests that chiropractic, especially when combined with glucosamine supplements and rehabilitative stretches and exercise, is an effective supplemental treatment for OA

2 comments to Chiropractic And Osteoarthritis

  • DCs – you can effectively help many suffering Hip Osteoarthritis patients grounded in new evidenced based trials and studies that clearly show that grade 5 thrust manipulation significantly helps these patients! Find out more by reading about this below!

    Manipulation of the hip for hip osteoarthritis is efficacious and effective. Many new randomized controlled or clinical trials (RCTs) significantly support this statement (see below and at http://www.jamesbrantingham.com).

    DCs need to update themselves on all the research and the researched protocols immediately. DCs can update themselves on this research immediately by ordering most or all of the (particularly) 6 RCT papers listed below and also from the Meta-analyses and systematic reviews and many other case series and reports (each about $32.00 to $36.00 dollars each. Or conversely simply by going to http://www.jamesbrantingham.com). I have written a book summarizing all of these trials and studies and it is illustrated. It is extremely reasonable cost wise. Or again the papers individually can be purchased.

    At my website the contents of my book on diagnosis and managing hip OA is accessible and can be viewed.

    This is a crucial time and there is a vacuum because arthroscopic surgery for hip OA has not been demonstrated to be better than placebo in many well designed methodologically strong RCTs (I am not talking about “debridement and lavage” or arthroscopic surgery not arthroplasty or total joint hip joint replacement) see below:

    Note the massive meta-analyses and systematic reviews of Zhang et al 2010 and Hochberg et al writing for the American College of Rheumatology (2012) that strongly state arthroscopy (debridement and lavage) is no longer recommended for common knee OA:

    Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. Apr 2010;18(4):476-99.

    Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis care & research. Apr 2012;64(4):465-74.

    Loss of Hip arthroscopic surgery means a great many patients will Hip OA will suffer (there are a few exceptions of course in which arthroscopic surgery may still help – but it is no longer recommended for common Hip OA and; some cannot take NSAIDs, and -repeated steroid injections or narcotics are dangerous. Many are too young for total hip joint replacement.

    So, what can these suffering patients do?

    Well, they can see you! But you need to get informed. You need to know what to do and what to not do.

    There is a vacuum for treatment of especially, mild to moderate (and even “severe hip OA” – as described by the patient as long as certain co-morbid disorders or diseases are ruled out) hip OA. But this vacuum will be quickly filled!

    I want DCs to work to get MDs, DOs – from family practitioners to MD & DO orthopedists to refer to us to and for us to these patients and other practitioners this service! I want DCs to fill this vacuum! If we don’t do this very soon – now – others will (especially) Physical Therapists.

    Here is the Research starting with the most recent and methodologically strongest RCTs, followed by Case series. The Physical Therapy profession and even the medical profession is gearing up to provide this manual therapy treatment now (we need to get ahead of them on this issue.

    If you don’t already know it, it is legal in all 50 United States for Chiropractors to diagnose and treat Hip OA locally, just at the hip joint or, also adding manual therapy to contiguous joints above and below from the SI joint to the feet). Here are the RCTs:

    Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. Apr 2013;21(4):525-34.

    Poulsen E, Hartvigsen J, Christensen HW, Roos EM, Vach W, Overgaard S. Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip.A proof of principle three-arm parallel group randomized clinical trial. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. Jun 20 2013 Jun 21. doi:pii: S1063-4584(13)00845-5. 10.1016/j.joca.2013.06.009.

    Brantingham JW, Parkin Smith, Cassa T, et al. Full kinetic chain manual and manipulative therapy plus exercise compared with targeted manual and manipulative therapy plus exercise for symptomatic osteoarthritis of the hip – a randomized controlled trial. Arch Phys Med Rehabil. 2012 93(2):259-67.

    Hoeksma HL, Dekker J, Ronday HK, et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Rheum. Oct 15 2004;51(5):722-9.

    Vaarbakken K, Ljunggren AE. Superior effect of forceful compared with standard traction mobilizations in hip disability? Adv Physiother. Sep 2007;9(3):117-128

    Note: all above did HVLA Grade 5 thrust manipulation to the hip except Vaarbakken and Ljunggren who actually did long sets of many repetitions of very strong oscillating grade 4 (I would suggest that grade 4++ per Maitland is what was applied as I read what vaarbakken and Ljunggren did) axial elongation mobilization of the hip. French et al., whose RCT I will describe below also used mobilization but of much lesser grades and force. Otherwise all others used Grade 5 thrust manipulation (what most DCs think of has an “adjustment” but they all deviate some from each other and, some of the RCTs are very similar to each other).

    Abbott et al and Poulsen et al had impressive results that were still significant and at one year follow up (with WOMAC and HOOS outcome and other secondary measures). Brantingham et al and Hoeskma et al had impressive results that lasted 3 months and 5 months respectively (respectively with WOMAC and a Likert Functional Scale (for Hip OA) and with respectively patient satisfaction scales (aka Global Rating of Change measures). They all used Valid and Reliable outcome measures.

    The only (and 6th, large RCT) that did not show that manipulative therapy helped was:

    French HP, Cusack T, Brennan A, et al. Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial. Archives of physical medicine and rehabilitation. Feb 2013;94(2):302-14.

    However, French et al 2013 RCT used much less force and almost exclusively only light grade II and III mobilizations of the hip (all others almost exclusively used Grade 5 HVLA thrust manipulation. With French et al., at the end of an 18 week trial there was no difference between Manual Therapy + exercise versus exercise alone (Using WOMAC).

    Although it is an older, small, & a humble RCT – it should be noted that Brantingham et al did an RCT for Hip OA in 2003 predating Hoeksma et al 2004.

    Brantingham J, Williams A, Parkin-Smith G, Weston P, Wood T. A controlled, prospective pilot study into the possible effects of chiropractic manipulation in the treatment of osteoarthritis of the hip. Euro J Chiropr. 2003;51:149-66.

    Beyond this there are reviews (Hoskins et al 2006) and systematic reviews (Brantingham et al 2012) and Bronfort 2010 that also document Case Reports and Series and RCTs of chiropractic treatment of Hip OA and Disability. The meta-analyses and systematic reviews of Hochberg et al (for the American College of Rheumatology now suggest Manual or Manipulative Therapy as a treatment for hip OA; the ACR for the first time ever by this august association!

    From some of these reviews many well done prospective case series and reports are summarized – all from peer reviewed literature (MacDonald et al 2006, Brantingham et al 2010, Brantingham et al 2010, de Luca et al 2010, and support the growing evidence base of RCTs – see below:

    MacDonald C, Whitman J, Cleland J, Smith M, Hoeksma H. Clinical outcomes following manual physical therapy and exercise for hip osteoarthritis: A case series J Orthop Sports Phys Ther. Aug 2006;36(8):588-599.

    Brantingham JW, Globe G, Cassa T, et al. A single-group pre-test post-test design using full kinetic chain manipulative therapy with rehabilitation in the treatment of 18 patients with hip osteoarthritis. J Manipulative Physiol Ther. July/August 2010;33(6):445-457.

    Brantingham JW, Globe G, Cassa T, et al. A single-group pre-test post-test design using full kinetic chain manipulative therapy with rehabilitation in the treatment of 27 patients with hip osteoarthritis J Amer Chiropr Assoc. August 2010;47(6):8-26.

    de Luca K, Pollard H, Brantingham J, Globe G, Cassa T. Chiropractic management of the kinetic chain for the treatment of hip osteoarthritis: an Australian case series. J Manipulative Physiol Ther. Jul-Aug 2010;33(6):474-479.

    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. July – August 2010;33(6):438-444.

    Pollard H, Ward G. A study of two stretching techniques for improving hip flexion range of motion. Journal of manipulative and physiological therapeutics. Sep 1997;20(7):443-447.

    Vaux P. Hip osteoarthritis: a chiropractic approach Euro J Chiropr 1998;46(1):17-22.

    Pollard H, Hoskins W, Schmerl M. The use of hip manipulation in the management of acetabular labrum injury. Chiropr J Aust. 2007;37:49-56.

    And it is continuing (another Physical Therapy Case Series):

    Hando BR, Gill NW, Walker MJ, Garber M. Short- and long-term clinical outcomes following a standardized protocol of orthopedic manual physical therapy and exercise in individuals with osteoarthritis of the hip: a case series. The Journal of manual & manipulative therapy. Nov 2012;20(4):192-200.

    So DCs, this is an unprecedented, but time sensitive chance to help a huge and growing population of older baby boomers and others (per the US and developed nations demographics) that suffer Osteoarthritis of the Hip and I believe, even to begin to become a part of medicine – not “apart” from medicine. So please, either learn the best treatments using thrust manipulation and multimodal care from purchasing:

    1. The individual papers above and/or get prepared by going to
    2. http://www.jamesbrantingham.com where you can obtaining an e book that summarizes all the RCTs, studies and research above on Hip OA at
    3. http://www.jamesbrantingham.com.

    James W. Brantingham DC, PhD
    Faculty of Health Sciences, Murdoch University, Murdoch,
    Western Australia

    Formerly:

    Director of Research & Associate Professor – Cleveland Chiropractic College Los Angeles California (from about 2005-2011)

  • Dear DCs,

    In the comments I just made, I made one mistake in paragraph 5 the correction should read:

    This is a crucial time and there is a vacuum because arthroscopic surgery for hip OA has not been demonstrated to be better than placebo in many well designed methodologically strong RCTs (I am talking about “debridement and lavage” or arthroscopic surgery not arthroplasty or total joint hip joint replacement) see below:

    (in the blog the mistake read I am not talking about “debridement and lavage”…). The word “not” should have been removed in front of “talking” at (I am…talking about…).

    Arthroscopy has been shown to not be better than placebo as I documented in Hochberg et al., and Zhang et al., but here is more evidence that this is correct (from my book):

    32. Moseley JB, Jr., Wray NP, Kuykendall D, Willis K, Landon G. Arthroscopic treatment of osteoarthritis of the knee: a prospective, randomized, placebo-controlled trial. Results of a pilot study. The American journal of sports medicine. Jan-Feb 1996;24(1):28-34.

    33. Moseley J, O’Malley K, Petersen N, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88.

    34. Nutton RW. Is arthroscopic surgery a beneficial treatment for knee osteoarthritis? Nat Clin Pract Rheumatol. Mar 2009;5(3):122-123.

    35. Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 2008(1):CD005118.

    36. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. Sep 11 2008;359(11):1097-1107.

    37. Wilson AS, Cui Q. Current concepts in management of femoroacetabular impingement. World J Orthop. Dec 18 2012;3(12):204-211.

    38. Clohisy JC, Baca G, Beaule PE, et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. The American journal of sports medicine. Jun 2013;41(6):1348-1356.

    39. Hunt D, Prather H, Harris Hayes M, Clohisy JC. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM & R : the journal of injury, function, and rehabilitation. Jul 2012;4(7):479-487.

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