Osteoarthritis
What
is Osteoarthritis?
Osteoarthritis is a disease which affects joints in the body. The surface of the joint is damaged and the surrounding bone grows thicker. 'Osteo' means bone and 'arthritis' means joint damage and swelling (inflammation). Other words used to describe osteoarthritis are 'osteoarthrosis', 'arthrosis' and 'degenerative joint disease'.
To understand how osteoarthritis develops, you need to know how a normal joint works (see Figure 1). A joint is where two bones meet. Most of our joints are designed to allow the bones to move only in certain directions. For example, the knee joint allows the leg to bend fully but only allows limited movement sideways.
The ends of the bones are covered by a thin layer of gristle called cartilage. This cartilage cushions the joint and spreads the forces evenly when you put pressure on the joint. The smooth, slippery cartilage surface also allows the bone ends to move freely.
The knee is the largest joint in the body, and it has extra pieces of gristle (each called a meniscus) between the cartilage layers – these are small rings of cartilage in the shape of washers.
The joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid). This fluid helps nourish the cartilage and keep it slippery. The synovium has a tough outer layer called the capsule which stops the bones moving too much.
The bones are kept firmly in place on both sides of the joint by the ligaments. These are thick, strong bands which run within or just outside the capsule. Together with the capsule, the ligaments prevent the bones moving too much or dislocating.
The tendons are strong guiders that attach the muscles to the bones either side of the joint. They also help to keep the joint in place. When a muscle contracts, it shortens and this pulls the bone and makes the joint move. Figure 2 shows what happens when a normal joint develops osteoarthritis.
When a joint develops osteoarthritis, the cartilage gradually roughens and becomes thin, and the bone underneath thickens. The bone at the edge of the joint grows outwards (this forms osteophytes or bony spurs). The synovium swells slightly and may produce extra fluid, which then makes the joint swell slightly. The capsule and ligaments slowly thicken and contract, as if they were trying to stabilise the joint as it gradually changes shape. Muscles that move the joint may weaken and become thin or wasted.
When we look at osteoarthritic joints under a microscope, we see the joint is trying to repair itself. All the tissues of the joint are more active than normal. For example, new tissue is produced to try to repair the damage, such as the osteophytes. In many cases, especially in small finger joints, the repair is successful. This explains why many people have osteoarthritis but experience few or no problems. However, sometimes the repair cannot compensate for the damage. Osteoarthritis may then seriously affect the joint, making it painful and difficult to move. This occurs particularly in large joints such as the knees and hips.
Osteoarthritis is a slow process that develops over many years. In most cases there are only small changes that affect only part of the joint. Sometimes, though, osteoarthritis can be more severe and extensive, and this is shown in Figure 3.
In severe osteoarthritis, the cartilage can become so thin that it no longer covers the thickened bone ends. The bone ends touch and start to wear away. The loss of cartilage, the wearing of bone, and the bony overgrowth at the edges can change the shape of the joint. This forces the bones out of their normal position and causes deformity.
A common complication is where chalky deposits of calcium crystals form in the cartilage (a process called calcification or chondrocalcinosis). These calcium crystals can shake loose from the cartilage, irritate the synovium and cause the joint to become hot, red and swollen (pseudogout).
What causes osteoarthritis?
Like most other conditions, there are many factors that can increase the risk of getting osteoarthritis. Usually, several of these have to be present before osteoarthritis develops. These important risk factors include the following:
Age
Osteoarthritis usually starts in the late 40s, 50s or 60s and is uncommon before the age of 40. We do not fully understand why it is more common in older people. It is probably due to several factors that accompany growing older – muscles become weaker, we put on weight, and our body is less able to heal itself.
Sex
For most joints, especially the knees and hands, osteoarthritis is more common and severe in women.
Obesity
For many people, this is an important factor in causing osteoarthritis, especially at the knee. Being overweight also increases the chances of osteoarthritis worsening once it has developed.
Joint injury
A major injury or operation on a joint may lead to osteoarthritis at that site in later life. There are some abnormalities of the joint that you can be born with or which develop when you are a child, such as Perthes' disease of the hips, which also lead to osteoarthritis in later life.
Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis. However, very hard repetitive activity may injure joints. This explains why osteoarthritis is more common in people in some physically demanding jobs, such as farmers (osteoarthritis of the hip) and professional footballers (osteoarthritis of the knee).
Heredity
There is one common form of osteoarthritis (nodal osteoarthritis) that strongly runs in families. This particularly affects the hands of middle-aged women. We do not know which inherited genes lead to nodal osteoarthritis, but we do think that a lot of genes will be involved, not just one.
In knee and hip osteoarthritis, heredity plays a smaller, though still significant, role. At these sites other risk factors such as obesity and joint injury become more important. There are some very rare but dramatic forms of osteoarthritis that start at a young age and run in families. We know these are linked with single genes that affect collagen – an essential component of cartilage.
Other types of joint disease
Sometimes osteoarthritis is caused by injury and damage from a different kind of joint disease that occurred years before. For example, people with rheumatoid arthritis can develop 'secondary' osteoarthritis in those joints in which the rheumatoid inflammation has largely burnt out but where the joint remains damaged by the disease.
Of course there must be other causes, though we do not know what they are yet. However, we know enough to correct some myths. Osteoarthritis is not caused by moderate exercise, by the weather or by a shock. It is not caused by specific items of diet, though it does not help to have poor nutrition as this is bad for muscles, cartilage and bone.
How common is osteoarthritis?
Osteoarthritis is by far the most common joint disease. Knee osteoarthritis is more common than hip osteoarthritis, but taken together they affect 10–20% of people aged over 65, becoming a major cause of pain and disability in the elderly. About 8 million people in this country are affected and about 1 million of these ask for treatment. Of the others, many never realise they have osteoarthritis, or suffer any pain, although it is very common to spot it on x-rays. Osteoarthritis occurs throughout the world, and has been common throughout history. All races are affected, though there are differences between races in how commonly the different joints are affected – for example, hip and hand osteoarthritis are common in Europeans and people of European descent but uncommon in people of Chinese and Afro-Caribbean descent.
What are the different types of osteoarthritis?
Osteoarthritis is very variable. There are many different types, affecting different joints (see Figure 4). The knees, hips, hands, spine and big toes are most often affected.
Osteoarthritis of the knee
Osteoarthritis of the knee is more common in women than men and it usually affects both knees. It causes most problems in the late 50s, 60s and 70s. Being overweight and having nodal osteoarthritis increase the risk of osteoarthritis of the knee in women. A previous sporting injury or operation (such as a cartilage being removed) are more common risks in men and may cause osteoarthritis of just one knee. Sometimes there is no obvious cause. Any pain is usually felt at the front and sides of the knee. In severe cases, the knees may become rather bent and bowed (as in Figure 5).
Osteoarthritis of the hip
Osteoarthritis of the hip affects men as much as women and often starts in the 40s, 50s and 60s. It may affect one or both hips. The risk is increased in farmers. Sometimes hip problems at birth or childhood (congenital dislocation or abnormal development such as Perthes' disease) may later lead to osteoarthritis. However, in many people there is no obvious cause.
The hip joint is below the groin, and hip pain is usually felt mainly in the front of the groin, but sometimes around the side and front of the thigh, the buttock or down to the knee (so-called radiated pain).
In severe osteoarthritis of the hip, the affected leg may get a little shorter due to the bone on either side of the joint being 'crunched up'. As mentioned above, for some unexplained reason people of Chinese and Afro-Caribbean origin rarely get osteoarthritis of the hip joint.
Osteoarthritis of the hands
Osteoarthritis of the hands usually occurs as part of nodal osteoarthritis. This mainly affects women, and often starts in the 40s and 50s, around the time of the menopause ('the change'). Most often it affects the base of the thumb and the joints at the end of the fingers. At times these joints become red, swollen and tender, especially when the condition first appears.
Gradually, over several years, firm knobbly swellings form on the back of the joints (see Figure 6). These are called Heberden's nodes after the English physician, William Heberden, who first described them. Once the Heberden's nodes are fully formed, pain and tenderness often improve. However, the base joint of the thumb may continue as a persistent problem. Although the fingers are knobbly and sometimes slightly bent, they work well and rarely cause long-term problems. However, having nodal osteoarthritis in middle age means you are more likely to develop osteoarthritis of the knee, and occasionally a few other joints, as you get into your 60s and 70s. This is why it is sometimes called 'generalised' (widespread) osteoarthritis. Nodal osteoarthritis is mainly related to genes that are inherited and so it runs in families. It is almost completely confined to white people.
Osteoarthritis of the neck and back
Osteoarthritis of the neck and back is often called spondylosis. X-rays show that it is extremely common, but it often causes no trouble, and what is seen on the x-ray bears little relationship to pain or stiffness in the spine. About half the population gets back pain from time to time, but osteoarthritis is not the most frequent cause of this.
Osteoarthritis of the foot
Osteoarthritis of the foot generally affects the joint at the base of the big toe. Eventually the toe may become stiff (hallux rigidus), which makes walking difficult, or bent (hallux valgus), which can lead to painful bunions (see Figure 7).
Osteoarthritis with crystals
Chalky deposits of calcium crystals can form in the cartilage in joints (a process called calcification or chondrocalcinosis). This calcification mainly occurs in the knee joint, especially in older people. It shows on the x-ray, and the crystals can be identified in synovial fluid which has been removed from the knee through a needle.
Because most of the crystals are made of calcium pyrophosphate, this form of osteoarthritis with crystals is often called pyrophosphate arthritis (or chronic pyrophosphate arthritis). It tends to be more severe and to progress more rapidly than osteoarthritis without crystals. Also, the crystals can cause occasional attacks of very painful swelling (pseudogout, or acute pyrophosphate arthritis).
Does osteoarthritis vary for different people?
Osteoarthritis occasionally develops in different joints from those already mentioned. Almost any joint can develop osteoarthritis, especially if it has been badly injured. Even for two people with osteoarthritis of the same joint, their osteoarthritis can affect them very differently. Some people have no problems, or just mild trouble. Pain is the main problem for some, while others find it difficult to move and use the joint. Some stay the same for years, others experience a lot of change. Osteoarthritis is so variable it is difficult to generalise. So comparing yourself to someone else with osteoarthritis will not help much.
What are the symptoms and signs of osteoarthritis?
Osteoarthritis tends to creep up on you, gradually increasing over months or years. Stiff and painful joints are the main symptoms. The pain tends to be worse on exercising the joint and at the end of the day. Stiffness after resting usually 'works off' in just a minute or two as the joint gets moving again. The joint may not move as freely or as far as normal, and often 'creaks' or 'cracks' when moved. Occasionally the joint seems to give way because of weak muscles or loss of stability. Muscle exercises can strengthen the muscle and help prevent this (exercises and other helpful hints are discussed later in this booklet).
Symptoms often vary for no obvious reason, with bad spells of a few weeks or months being broken by much better periods. Changes in the weather (especially damp and low pressure) can make joint pain worse for some people – others find it depends on how much physical activity they do.
Often the joint appears a little swollen, due to hard bony osteophytes, or extra synovial fluid (which will feel soft), while the muscles around the joint look a little thinner.
In some advanced cases, more severe and constant pain may develop and occur not only with or after exercise but even at rest or at night. Certain daily tasks and activities may then prove difficult, depending on which joint is affected. For example, osteoarthritis of the knee or hip may cause difficulties going down and up stairs, getting in or out of the car, getting up from sitting, or putting on shoes and socks. Mobility may be affected due to pain on walking. These difficulties can restrict what you can do and limit your independence.
How does the doctor diagnose osteoarthritis?
It is usually the symptoms and signs mentioned above which lead your doctor to diagnose osteoarthritis. When your joints are examined, your doctor can feel the bony swelling and creaking of the joint and see any restricted movement. Your doctor will also be looking for tenderness over the joint, and any thinning muscle, excess fluid, or instability in the joints.
What tests can show osteoarthritis?
There is no blood test for osteoarthritis, although blood tests are sometimes done to help rule out other types of arthritis. The x-ray is the most useful test to confirm osteoarthritis. Often it will show the space between the bones narrowing as the cartilage thins, and changes in the bone such as spurs. Calcification may also show up on knee x-rays. Although the x-ray helps the diagnosis, it does not predict the amount of trouble you will have. An x-ray that looks bad does not necessarily mean a lot of pain or disability.
What are the prospects if I have osteoarthritis?
Osteoarthritis does not always get worse. Most people with osteoarthritis do not become severely disabled and they carry on a normal life. For many people, osteoarthritis reaches a peak a few years after the symptoms start and then either stays the same or gets a little easier. For others, one or more joints (especially a hip or knee) worsens as the years go by, and it may become painful and disabling.
Sometimes osteoarthritis gets better by itself, but this is unusual. We cannot predict the outcome in individual cases. However, there are a number of treatments that can improve symptoms, and certain changes in lifestyle can greatly reduce the risks of osteoarthritis progressing. Regular appropriate exercise, reducing stress on the joints , and maintaining an ideal weight through healthy eating will all help. So to a certain extent the person with osteoarthritis is in control of his or her own outcome.
What can I do to help myself?
Although there is no cure for osteoarthritis, there are many ways in which you can relieve your symptoms and reduce the likelihood of things progressing. Osteopaths are there to guide you, but it is important that you get to know about osteoarthritis and its treatments so you can take the lead in looking after yourself and your osteoarthritis.
Two aspects of your daily routine and lifestyle may need to be changed. These can prove more important in the long term in helping your osteoarthritis than any tablet or medication.
Reduce stress on the joints
Firstly, you can reduce the stress on painful osteoarthritic joints. This can be done in a variety of ways:
An Osteopath can teach the correct exercises, but then it is up to you to continue them as part of your daily routine, just like brushing your teeth. Appropriate exercises can be planned to fit the individual and can benefit anybody regardless of age.
Learning how to relax your muscles and get the tension out of your body can also help enormously, especially when you are in pain. Osteopaths can give you advice on how to relax, how to overcome mobility problems, how to avoid joint strain and how to cope with pain.
Will any tablets or creams help?
Painkillers often help symptoms and make it easier to get about. They do not affect the arthritis itself, but take the edge off pain and stiffness. They are best used occasionally for bad spells, or when extra exercise is likely. Never take more than the recommended dose. Paracetamol is the simplest and safest painkiller and is the best one to try first. Combined painkillers (e.g. cocodamol, codydramol) contain paracetamol and a second codeine-like drug. They may be stronger than paracetamol but are more likely to cause side-effects, such as constipation or dizziness.
Inflammation in the joint may contribute to the pain and stiffness so your doctor may prescribe a course of non-steroidal anti-inflammatory drugs (NSAIDs). These help some people more than paracetamol, but are more likely to cause side-effects such as indigestion, diarrhoea, ankle swelling and skin rashes. There is a small but significant risk of bleeding from the stomach and NSAIDs should not be given to anyone who has had stomach ulcers. A low dose of ibuprofen is the safest of these and the usual one to try first. Newer NSAIDs ('coxibs') are safer on the stomach and gut but can still cause the other side-effects of NSAIDs. 'Coxibs' have been linked with increased risks of heart attack and stroke and should not be given to people who have had either in the past, or to people with uncontrolled high blood pressure.
NSAID creams and gels often help, especially for knee and hand osteoarthritis. These are extremely safe – very little is absorbed into the bloodstream.
Capsaicin cream (made from capsicum, the pepper plant) is also an effective and safe painkiller. The first few times it is applied it may cause a warming or burning feeling, but this wears off with regular use. It needs to be regularly applied each day to be effective.
There are stronger painkillers (e.g. tramadol, nefopam, meptazinol) that may be required for people with severe pain that is unrelieved by the medications mentioned above. Unfortunately, although they are stronger painkillers they commonly have side-effects, especially nausea, dizziness and confusion, and need to be taken carefully under regular supervision from your doctor.
Because these tablets and creams work in different ways it may be useful to combine them if each seems to work but is not strong enough on its own. Your chemist can advise you and offer paracetamol, and some low-dose NSAID tablets and creams without a prescription. However, you can only get capsaicin cream, most NSAID tablets and creams, and strong combined painkillers on prescription from your doctor.
Many people try glucosamine and chondroitin tablets that they buy themselves from health food shops and chemists. These products may also be available on prescription. The reason behind their use is that joint cartilage normally contains glucosamine and chondroitin compounds and taking supplements of these natural ingredients may help improve the health of damaged osteoarthritic cartilage. Current research is trying to establish whether this is true. Nevertheless, many people report them to be effective and at least they appear to be safe, although they should not be taken by people who have an allergy to shellfish. They may need to be taken for several weeks before any pain relief is apparent. See USANA Link
How can severe osteoarthritis be treated?
Osteopathy can help reduce the symptoms of severe osteoarthritis.
Talk to your Osteopath about treatment options and advice. They should have the knowledge to give you all the help, advice and treatment you may need.
Surgery can succeed in the few cases where severe pain has developed and caused mobility to be limited in spite of other treatment. Hip replacement is very successful in bad cases. Knee replacement is now also successful in bad cases (see Figure 11). New types of surgery for knees and other joints are developing, and the success rate is improving all the time.
What if I have difficulty with containers?
If you have difficulty opening childproof bottles you can ask the pharmacist to put your drugs in a more suitable container. Apply to arc for a special request card which you can hand to your pharmacist with your prescription.
Some common questions answered
What is the difference between osteoarthritis and rheumatoid arthritis?
Rheumatoid arthritis and osteoarthritis are quite different diseases. Whereas osteoarthritis rarely occurs before the age of 40, many people develop rheumatoid arthritis in their 20s or 30s. Many joints are involved – the synovium is badly inflamed and this damages all the tissues in the joint. The affected joints are painful, often very stiff, and appear warm, tender and swollen with fluid (not with extra bone growth). Blood tests show widespread inflammation that affects the body generally, often causing anaemia, weight loss and tiredness. X-rays show that the bones are thin and eroded, rather than the bony spurs and calcification that show up in osteoarthritis.
What does the future hold?
Although osteoarthritis is often painful and upsetting, it usually does not cause crippling arthritis or severe deformity of joints. For most people it will be more of a nuisance than a major problem.
It does not lead to rheumatoid arthritis or other forms of joint disease. It will not spread all over your body. It has no link with cancer or other serious diseases.
The pain sometimes gets easier as time goes by, and most people with osteoarthritis have little disability. Try not to fear the future unnecessarily as this can be worse than the actual arthritis. People with osteoarthritis can do a lot to help themselves and often only need occasional advice from doctors and therapists. Modern medicine and surgery have much to offer, particularly for the few who do get severe joint damage.
Can any special diet help?
A large amount of research is being done on diet, nutrition and osteoarthritis. Many books, articles and advertisements claim benefits for particular diets or food supplements, but at the moment most are not supported by strong evidence.
There is, however, evidence that the supplement glucosamine can produce some improvement in osteoarthritis.
Particularly important in relation to diet is the fact that a great deal of evidence shows that being overweight increases the risk of developing osteoarthritis, especially of the knee. It also increases the risk of osteoarthritis progressing. Being overweight is also bad for your general health and increases the risk of developing heart disease, stroke and diabetes. So you should eat a balanced, healthy diet and keep your weight as close as possible to the ideal for your height and age.
Will rest or exercise help?
Joints do not wear out with normal use. In general, it is much better to use them than not to! However, you must strike a sensible balance between too much activity and too much rest. Most people with osteoarthritis find that while too much exercise worsens their pain, their joints stiffen up if kept still for too long.
For most people with osteoarthritis, the best advice is 'little and often' – a little rest, followed by a little exercise. For example, do the housework or gardening in short spells interrupted by short rests. Avoid sitting in one place for too long – get up and stretch the joints from time to time. Break up a long car journey with frequent stops to walk around.
Activities that cause severe pain afterwards are probably best avoided. If for some special reason you do need to do a lot extra, it can help to take a painkiller before you start. Even if it does cause extra pain you are unlikely to damage the joint, but your doctor or therapist will give you more advice if you are worried.
Can swimming or pool treatment help?
Swimming can be a very good way of exercising and keeping fit as it causes little pain. Water supports the body's weight so that little force goes through the joints as you exercise. Also, warm water relaxes muscles and joints and is very soothing, allowing joints to move more freely. If you have osteoarthritis of the hip or knee you may find this particularly helpful.
Prescribed exercises in a hydrotherapy pool can help get muscles and joints working better, without undue pain. Supervised swimming in natural spa waters is an ancient treatment – it is the exercise that helps rather than any healing properties of the water itself.
Will my osteoarthritis affect sex, marriage or my family?
Osteoarthritis is not catching and cannot be given to family or friends. It should not affect your marriage or partnership or your family. However, sexual intercourse may be painful, particularly for women with osteoarthritis of the hips. Using different positions can often help.
If you have nodal osteoarthritis with knobbly fingers, your children have an increased chance of developing it in their middle life. This is particularly true for girls, who have about a 30–50% chance of inheriting it from an affected mother. There is a smaller risk of passing on the tendency to develop knee osteoarthritis. No test can show whether you have inherited the tendency for nodal or knee osteoarthritis. However, if a parent has nodal or knee osteoarthritis, the children, especially the females, have an added incentive to exercise regularly and avoid getting overweight.
Does the weather really affect osteoarthritis?
Painful joints are often sensitive to the weather. They tend to feel worse when the atmospheric (barometric) pressure is falling, such as just before it rains. This helps to explain how people with osteoarthritis can predict rain, and why joint pains seem linked with the damp.
However, there is no evidence that different climates have any long-term effect on osteoarthritis or its outcome. The weather may temporarily affect symptoms but not the arthritis itself. There is no point in moving to a different area in the hope of curing osteoarthritis. Osteoarthritis occurs all over the world, in all types of climate.
Can heat help?
Warmth applied to the affected area often relieves the pain and stiffness of osteoarthritis. Heat lamps are popular, but you can get a similar effect more cheaply with hot-water bottles (be careful, though – it is easy to burn yourself with either). There are also many creams, available at the chemist, which can produce localised heat.
These measures make no long-term difference to the disease, but they can give you temporary pain relief. Used carefully they are safe and soothing.
Are manipulations or complementary medicines worth trying?
Back and neck pain are often helped by manipulation from chiropractors or osteopaths, although the use of manipulation for osteoarthritis in other areas is limited. However, many people still seek advice from these practitioners, but you should make sure that the practitioner is fully trained and registered.
'Complementary' medicines seem to help some people with osteoarthritis. A few, like acupuncture, have a proven short-term pain-relieving effect. But many do no more than produce a 'placebo' effect (as when someone receiving a simple sugar pill actually believes it is making them better). There are many good complementary practitioners, but sadly a minority seem to exploit people's suffering. We have no proof that copper bracelets or other such measures can affect osteoarthritis, but faith in them seems to help some people.
Who should I listen to?
Many well-meaning people offer advice. Magazines and the media are full of articles on arthritis and its treatment. Some offer 'new hope', others offer a special diet or medicine with 'miracle' properties. Unfortunately, there are no miracle cures or easy answers.
Keeping your spirits up
Depression, low morale and poor sleep can all make pain worse. They can all influence the way pain is experienced and lower your threshold to pain.
If someone is depressed, their pain often feels worse and they have more difficulty coping with it. They might go to their doctor and be given bigger doses of tablets to relieve that pain. But sometimes what the person needs is help for the depression and the demoralising effect of arthritis. If the depression is lifted, the pain often becomes less and the person is better able to cope with their osteoarthritis.
A positive and hopeful approach is half the battle, though this is easier said than done. Make every effort to make life fuller and more interesting than before. Your morale will drop after too much rest and inactivity, whereas hobbies and interests take your mind off your problems. Sleep is important – it is best not to take naps during the day but to save all your sleep for night-time. If you have previously enjoyed vigorous activity and sport you may have to develop less active pastimes, but there is no reason to let osteoarthritis get you down or stop you doing most everyday activities.
Glossary
Calcification – deposits of calcium crystals in soft tissues.
Capsule – the tough, fibrous sleeve around a joint. Its inner layer is the synovium.
Cartilage – strong material on bone ends that acts as a cushion. Its slippery surface allows smooth movement between bones.
Chondrocalcinosis – calcification of cartilage.
Collagen – the main substance in the white, fibrous connective tissue which is found in tendons, ligaments and cartilage. This very important protein is also found in skin and bone.
Deformity – abnormal growth or swelling of a joint.
Femur – the upper leg or thigh bone – the longest bone in the body.
Hallux rigidus – osteoarthritis of the big toe joint with a stuck, rigid toe (often painful).
Hallux valgus – osteoarthritis of the big toe joint with angulation of the toe.
Heberden's nodes – firm swellings of the end joints of fingers, often painless when fully formed – the hallmark of nodal osteoarthritis.
Ligaments – tough, fibrous bands anchoring the bones on either side of a joint and holding the joint together.
Menisci (singular meniscus) – free rings of cartilage, like washers, lying between the cartilage-covered bones in the knee. Each knee has an inside (medial) and an outside (lateral) meniscus.
Nodal osteoarthritis – a form of osteoarthritis that often runs in families, characterised by knobbly finger swellings (Heberden's nodes) and a tendency to get osteoarthritis at several sites (especially knees, big toes).
Osteophytes – overgrowth of new bone around the sides of osteoarthritis joints, also known as 'spurs'.
Patella – the kneecap, a small bone that helps the front thigh muscles work the knee.
Perthes' disease – inflammation at the head of the thigh bone (femur) which causes pain and limping, usually in boys aged 5–10 years. It can restrict blood supply to the bone leading to poor growth and deformity and can cause osteoarthritis to develop in later life.
Pseudogout – a sudden attack of a hot, painful, very swollen, red joint, caused by calcium crystals in the joint (mainly the knee).
Pyrophosphate arthritis – a type of osteoarthritis in which crystals of calcium pyrophosphate form in a joint (see calcification and chondrocalcinosis). The crystals can cause pseudogout.
Radiated pain – pain that is felt some way away from the joint causing the trouble (for example, pain in the thigh and knee from an osteoarthritic hip).
Spondylosis – osteoarthritis of small joints in the neck and back – commonly present in all of us, often without causing any symptoms.
Synovial fluid – the fluid produced by the synovium to nourish and lubricate the joint.
Synovium – the capsule's inner layer that produces synovial fluid.
Tendons – strong fibrous 'guiders' or cords that anchor muscles to bone.
Tibia – the lower leg or shin bone – the second largest bone in the body.
Osteoarthritis is a disease which affects joints in the body. The surface of the joint is damaged and the surrounding bone grows thicker. 'Osteo' means bone and 'arthritis' means joint damage and swelling (inflammation). Other words used to describe osteoarthritis are 'osteoarthrosis', 'arthrosis' and 'degenerative joint disease'.
To understand how osteoarthritis develops, you need to know how a normal joint works (see Figure 1). A joint is where two bones meet. Most of our joints are designed to allow the bones to move only in certain directions. For example, the knee joint allows the leg to bend fully but only allows limited movement sideways.
The ends of the bones are covered by a thin layer of gristle called cartilage. This cartilage cushions the joint and spreads the forces evenly when you put pressure on the joint. The smooth, slippery cartilage surface also allows the bone ends to move freely.
The knee is the largest joint in the body, and it has extra pieces of gristle (each called a meniscus) between the cartilage layers – these are small rings of cartilage in the shape of washers.
The joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid). This fluid helps nourish the cartilage and keep it slippery. The synovium has a tough outer layer called the capsule which stops the bones moving too much.
The bones are kept firmly in place on both sides of the joint by the ligaments. These are thick, strong bands which run within or just outside the capsule. Together with the capsule, the ligaments prevent the bones moving too much or dislocating.
The tendons are strong guiders that attach the muscles to the bones either side of the joint. They also help to keep the joint in place. When a muscle contracts, it shortens and this pulls the bone and makes the joint move. Figure 2 shows what happens when a normal joint develops osteoarthritis.
When a joint develops osteoarthritis, the cartilage gradually roughens and becomes thin, and the bone underneath thickens. The bone at the edge of the joint grows outwards (this forms osteophytes or bony spurs). The synovium swells slightly and may produce extra fluid, which then makes the joint swell slightly. The capsule and ligaments slowly thicken and contract, as if they were trying to stabilise the joint as it gradually changes shape. Muscles that move the joint may weaken and become thin or wasted.
When we look at osteoarthritic joints under a microscope, we see the joint is trying to repair itself. All the tissues of the joint are more active than normal. For example, new tissue is produced to try to repair the damage, such as the osteophytes. In many cases, especially in small finger joints, the repair is successful. This explains why many people have osteoarthritis but experience few or no problems. However, sometimes the repair cannot compensate for the damage. Osteoarthritis may then seriously affect the joint, making it painful and difficult to move. This occurs particularly in large joints such as the knees and hips.
Osteoarthritis is a slow process that develops over many years. In most cases there are only small changes that affect only part of the joint. Sometimes, though, osteoarthritis can be more severe and extensive, and this is shown in Figure 3.
In severe osteoarthritis, the cartilage can become so thin that it no longer covers the thickened bone ends. The bone ends touch and start to wear away. The loss of cartilage, the wearing of bone, and the bony overgrowth at the edges can change the shape of the joint. This forces the bones out of their normal position and causes deformity.
A common complication is where chalky deposits of calcium crystals form in the cartilage (a process called calcification or chondrocalcinosis). These calcium crystals can shake loose from the cartilage, irritate the synovium and cause the joint to become hot, red and swollen (pseudogout).
What causes osteoarthritis?
Like most other conditions, there are many factors that can increase the risk of getting osteoarthritis. Usually, several of these have to be present before osteoarthritis develops. These important risk factors include the following:
Age
Osteoarthritis usually starts in the late 40s, 50s or 60s and is uncommon before the age of 40. We do not fully understand why it is more common in older people. It is probably due to several factors that accompany growing older – muscles become weaker, we put on weight, and our body is less able to heal itself.
Sex
For most joints, especially the knees and hands, osteoarthritis is more common and severe in women.
Obesity
For many people, this is an important factor in causing osteoarthritis, especially at the knee. Being overweight also increases the chances of osteoarthritis worsening once it has developed.
Joint injury
A major injury or operation on a joint may lead to osteoarthritis at that site in later life. There are some abnormalities of the joint that you can be born with or which develop when you are a child, such as Perthes' disease of the hips, which also lead to osteoarthritis in later life.
Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis. However, very hard repetitive activity may injure joints. This explains why osteoarthritis is more common in people in some physically demanding jobs, such as farmers (osteoarthritis of the hip) and professional footballers (osteoarthritis of the knee).
Heredity
There is one common form of osteoarthritis (nodal osteoarthritis) that strongly runs in families. This particularly affects the hands of middle-aged women. We do not know which inherited genes lead to nodal osteoarthritis, but we do think that a lot of genes will be involved, not just one.
In knee and hip osteoarthritis, heredity plays a smaller, though still significant, role. At these sites other risk factors such as obesity and joint injury become more important. There are some very rare but dramatic forms of osteoarthritis that start at a young age and run in families. We know these are linked with single genes that affect collagen – an essential component of cartilage.
Other types of joint disease
Sometimes osteoarthritis is caused by injury and damage from a different kind of joint disease that occurred years before. For example, people with rheumatoid arthritis can develop 'secondary' osteoarthritis in those joints in which the rheumatoid inflammation has largely burnt out but where the joint remains damaged by the disease.
Of course there must be other causes, though we do not know what they are yet. However, we know enough to correct some myths. Osteoarthritis is not caused by moderate exercise, by the weather or by a shock. It is not caused by specific items of diet, though it does not help to have poor nutrition as this is bad for muscles, cartilage and bone.
How common is osteoarthritis?
Osteoarthritis is by far the most common joint disease. Knee osteoarthritis is more common than hip osteoarthritis, but taken together they affect 10–20% of people aged over 65, becoming a major cause of pain and disability in the elderly. About 8 million people in this country are affected and about 1 million of these ask for treatment. Of the others, many never realise they have osteoarthritis, or suffer any pain, although it is very common to spot it on x-rays. Osteoarthritis occurs throughout the world, and has been common throughout history. All races are affected, though there are differences between races in how commonly the different joints are affected – for example, hip and hand osteoarthritis are common in Europeans and people of European descent but uncommon in people of Chinese and Afro-Caribbean descent.
What are the different types of osteoarthritis?
Osteoarthritis is very variable. There are many different types, affecting different joints (see Figure 4). The knees, hips, hands, spine and big toes are most often affected.
Osteoarthritis of the knee
Osteoarthritis of the knee is more common in women than men and it usually affects both knees. It causes most problems in the late 50s, 60s and 70s. Being overweight and having nodal osteoarthritis increase the risk of osteoarthritis of the knee in women. A previous sporting injury or operation (such as a cartilage being removed) are more common risks in men and may cause osteoarthritis of just one knee. Sometimes there is no obvious cause. Any pain is usually felt at the front and sides of the knee. In severe cases, the knees may become rather bent and bowed (as in Figure 5).
Osteoarthritis of the hip
Osteoarthritis of the hip affects men as much as women and often starts in the 40s, 50s and 60s. It may affect one or both hips. The risk is increased in farmers. Sometimes hip problems at birth or childhood (congenital dislocation or abnormal development such as Perthes' disease) may later lead to osteoarthritis. However, in many people there is no obvious cause.
The hip joint is below the groin, and hip pain is usually felt mainly in the front of the groin, but sometimes around the side and front of the thigh, the buttock or down to the knee (so-called radiated pain).
In severe osteoarthritis of the hip, the affected leg may get a little shorter due to the bone on either side of the joint being 'crunched up'. As mentioned above, for some unexplained reason people of Chinese and Afro-Caribbean origin rarely get osteoarthritis of the hip joint.
Osteoarthritis of the hands
Osteoarthritis of the hands usually occurs as part of nodal osteoarthritis. This mainly affects women, and often starts in the 40s and 50s, around the time of the menopause ('the change'). Most often it affects the base of the thumb and the joints at the end of the fingers. At times these joints become red, swollen and tender, especially when the condition first appears.
Gradually, over several years, firm knobbly swellings form on the back of the joints (see Figure 6). These are called Heberden's nodes after the English physician, William Heberden, who first described them. Once the Heberden's nodes are fully formed, pain and tenderness often improve. However, the base joint of the thumb may continue as a persistent problem. Although the fingers are knobbly and sometimes slightly bent, they work well and rarely cause long-term problems. However, having nodal osteoarthritis in middle age means you are more likely to develop osteoarthritis of the knee, and occasionally a few other joints, as you get into your 60s and 70s. This is why it is sometimes called 'generalised' (widespread) osteoarthritis. Nodal osteoarthritis is mainly related to genes that are inherited and so it runs in families. It is almost completely confined to white people.
Osteoarthritis of the neck and back
Osteoarthritis of the neck and back is often called spondylosis. X-rays show that it is extremely common, but it often causes no trouble, and what is seen on the x-ray bears little relationship to pain or stiffness in the spine. About half the population gets back pain from time to time, but osteoarthritis is not the most frequent cause of this.
Osteoarthritis of the foot
Osteoarthritis of the foot generally affects the joint at the base of the big toe. Eventually the toe may become stiff (hallux rigidus), which makes walking difficult, or bent (hallux valgus), which can lead to painful bunions (see Figure 7).
Osteoarthritis with crystals
Chalky deposits of calcium crystals can form in the cartilage in joints (a process called calcification or chondrocalcinosis). This calcification mainly occurs in the knee joint, especially in older people. It shows on the x-ray, and the crystals can be identified in synovial fluid which has been removed from the knee through a needle.
Because most of the crystals are made of calcium pyrophosphate, this form of osteoarthritis with crystals is often called pyrophosphate arthritis (or chronic pyrophosphate arthritis). It tends to be more severe and to progress more rapidly than osteoarthritis without crystals. Also, the crystals can cause occasional attacks of very painful swelling (pseudogout, or acute pyrophosphate arthritis).
Does osteoarthritis vary for different people?
Osteoarthritis occasionally develops in different joints from those already mentioned. Almost any joint can develop osteoarthritis, especially if it has been badly injured. Even for two people with osteoarthritis of the same joint, their osteoarthritis can affect them very differently. Some people have no problems, or just mild trouble. Pain is the main problem for some, while others find it difficult to move and use the joint. Some stay the same for years, others experience a lot of change. Osteoarthritis is so variable it is difficult to generalise. So comparing yourself to someone else with osteoarthritis will not help much.
What are the symptoms and signs of osteoarthritis?
Osteoarthritis tends to creep up on you, gradually increasing over months or years. Stiff and painful joints are the main symptoms. The pain tends to be worse on exercising the joint and at the end of the day. Stiffness after resting usually 'works off' in just a minute or two as the joint gets moving again. The joint may not move as freely or as far as normal, and often 'creaks' or 'cracks' when moved. Occasionally the joint seems to give way because of weak muscles or loss of stability. Muscle exercises can strengthen the muscle and help prevent this (exercises and other helpful hints are discussed later in this booklet).
Symptoms often vary for no obvious reason, with bad spells of a few weeks or months being broken by much better periods. Changes in the weather (especially damp and low pressure) can make joint pain worse for some people – others find it depends on how much physical activity they do.
Often the joint appears a little swollen, due to hard bony osteophytes, or extra synovial fluid (which will feel soft), while the muscles around the joint look a little thinner.
In some advanced cases, more severe and constant pain may develop and occur not only with or after exercise but even at rest or at night. Certain daily tasks and activities may then prove difficult, depending on which joint is affected. For example, osteoarthritis of the knee or hip may cause difficulties going down and up stairs, getting in or out of the car, getting up from sitting, or putting on shoes and socks. Mobility may be affected due to pain on walking. These difficulties can restrict what you can do and limit your independence.
How does the doctor diagnose osteoarthritis?
It is usually the symptoms and signs mentioned above which lead your doctor to diagnose osteoarthritis. When your joints are examined, your doctor can feel the bony swelling and creaking of the joint and see any restricted movement. Your doctor will also be looking for tenderness over the joint, and any thinning muscle, excess fluid, or instability in the joints.
What tests can show osteoarthritis?
There is no blood test for osteoarthritis, although blood tests are sometimes done to help rule out other types of arthritis. The x-ray is the most useful test to confirm osteoarthritis. Often it will show the space between the bones narrowing as the cartilage thins, and changes in the bone such as spurs. Calcification may also show up on knee x-rays. Although the x-ray helps the diagnosis, it does not predict the amount of trouble you will have. An x-ray that looks bad does not necessarily mean a lot of pain or disability.
What are the prospects if I have osteoarthritis?
Osteoarthritis does not always get worse. Most people with osteoarthritis do not become severely disabled and they carry on a normal life. For many people, osteoarthritis reaches a peak a few years after the symptoms start and then either stays the same or gets a little easier. For others, one or more joints (especially a hip or knee) worsens as the years go by, and it may become painful and disabling.
Sometimes osteoarthritis gets better by itself, but this is unusual. We cannot predict the outcome in individual cases. However, there are a number of treatments that can improve symptoms, and certain changes in lifestyle can greatly reduce the risks of osteoarthritis progressing. Regular appropriate exercise, reducing stress on the joints , and maintaining an ideal weight through healthy eating will all help. So to a certain extent the person with osteoarthritis is in control of his or her own outcome.
What can I do to help myself?
Although there is no cure for osteoarthritis, there are many ways in which you can relieve your symptoms and reduce the likelihood of things progressing. Osteopaths are there to guide you, but it is important that you get to know about osteoarthritis and its treatments so you can take the lead in looking after yourself and your osteoarthritis.
Two aspects of your daily routine and lifestyle may need to be changed. These can prove more important in the long term in helping your osteoarthritis than any tablet or medication.
Reduce stress on the joints
Firstly, you can reduce the stress on painful osteoarthritic joints. This can be done in a variety of ways:
- Keep to your ideal weight. If you are overweight, losing even a few pounds will reduce the stress on your hips, knees and feet. Regaining your ideal weight is extremely important for your joints, but is difficult and you need to be determined. Combining regular exercise with a diet is often better than dieting alone. 'Dieting' means altering your eating habits forever, not just for a few months.
- Pace your activities through the day. Spread physically hard jobs (such as housework, mowing the lawn) at intervals through the day, rather than tackling them all at once.
- Wear shoes with thick soft soles that act as shock absorbers for your feet, knees, hips and back. Trainers with 'air' soles are ideal, but many fashion shoes now use these soles. For women it is also important to have flat heels. Raised heels alter the angle of the knee and hip and put additional strain on these joints.
- Use a walking stick to reduce the weight and stress on a painful hip or knee. A therapist or doctor can advise on the correct length of the stick and how to use it properly.
- Protect your joints. Avoid unnecessary activities that put a lot of strain on your joints. Think of modifying your home, car or workplace to minimise unnecessary stresses. If you find it hard to cope at home, an occupational therapist can give you advice on ways to protect your joints and improve the amount you can do.
- Activity and exercise
An Osteopath can teach the correct exercises, but then it is up to you to continue them as part of your daily routine, just like brushing your teeth. Appropriate exercises can be planned to fit the individual and can benefit anybody regardless of age.
Learning how to relax your muscles and get the tension out of your body can also help enormously, especially when you are in pain. Osteopaths can give you advice on how to relax, how to overcome mobility problems, how to avoid joint strain and how to cope with pain.
Will any tablets or creams help?
Painkillers often help symptoms and make it easier to get about. They do not affect the arthritis itself, but take the edge off pain and stiffness. They are best used occasionally for bad spells, or when extra exercise is likely. Never take more than the recommended dose. Paracetamol is the simplest and safest painkiller and is the best one to try first. Combined painkillers (e.g. cocodamol, codydramol) contain paracetamol and a second codeine-like drug. They may be stronger than paracetamol but are more likely to cause side-effects, such as constipation or dizziness.
Inflammation in the joint may contribute to the pain and stiffness so your doctor may prescribe a course of non-steroidal anti-inflammatory drugs (NSAIDs). These help some people more than paracetamol, but are more likely to cause side-effects such as indigestion, diarrhoea, ankle swelling and skin rashes. There is a small but significant risk of bleeding from the stomach and NSAIDs should not be given to anyone who has had stomach ulcers. A low dose of ibuprofen is the safest of these and the usual one to try first. Newer NSAIDs ('coxibs') are safer on the stomach and gut but can still cause the other side-effects of NSAIDs. 'Coxibs' have been linked with increased risks of heart attack and stroke and should not be given to people who have had either in the past, or to people with uncontrolled high blood pressure.
NSAID creams and gels often help, especially for knee and hand osteoarthritis. These are extremely safe – very little is absorbed into the bloodstream.
Capsaicin cream (made from capsicum, the pepper plant) is also an effective and safe painkiller. The first few times it is applied it may cause a warming or burning feeling, but this wears off with regular use. It needs to be regularly applied each day to be effective.
There are stronger painkillers (e.g. tramadol, nefopam, meptazinol) that may be required for people with severe pain that is unrelieved by the medications mentioned above. Unfortunately, although they are stronger painkillers they commonly have side-effects, especially nausea, dizziness and confusion, and need to be taken carefully under regular supervision from your doctor.
Because these tablets and creams work in different ways it may be useful to combine them if each seems to work but is not strong enough on its own. Your chemist can advise you and offer paracetamol, and some low-dose NSAID tablets and creams without a prescription. However, you can only get capsaicin cream, most NSAID tablets and creams, and strong combined painkillers on prescription from your doctor.
Many people try glucosamine and chondroitin tablets that they buy themselves from health food shops and chemists. These products may also be available on prescription. The reason behind their use is that joint cartilage normally contains glucosamine and chondroitin compounds and taking supplements of these natural ingredients may help improve the health of damaged osteoarthritic cartilage. Current research is trying to establish whether this is true. Nevertheless, many people report them to be effective and at least they appear to be safe, although they should not be taken by people who have an allergy to shellfish. They may need to be taken for several weeks before any pain relief is apparent. See USANA Link
How can severe osteoarthritis be treated?
Osteopathy can help reduce the symptoms of severe osteoarthritis.
Talk to your Osteopath about treatment options and advice. They should have the knowledge to give you all the help, advice and treatment you may need.
Surgery can succeed in the few cases where severe pain has developed and caused mobility to be limited in spite of other treatment. Hip replacement is very successful in bad cases. Knee replacement is now also successful in bad cases (see Figure 11). New types of surgery for knees and other joints are developing, and the success rate is improving all the time.
What if I have difficulty with containers?
If you have difficulty opening childproof bottles you can ask the pharmacist to put your drugs in a more suitable container. Apply to arc for a special request card which you can hand to your pharmacist with your prescription.
Some common questions answered
What is the difference between osteoarthritis and rheumatoid arthritis?
Rheumatoid arthritis and osteoarthritis are quite different diseases. Whereas osteoarthritis rarely occurs before the age of 40, many people develop rheumatoid arthritis in their 20s or 30s. Many joints are involved – the synovium is badly inflamed and this damages all the tissues in the joint. The affected joints are painful, often very stiff, and appear warm, tender and swollen with fluid (not with extra bone growth). Blood tests show widespread inflammation that affects the body generally, often causing anaemia, weight loss and tiredness. X-rays show that the bones are thin and eroded, rather than the bony spurs and calcification that show up in osteoarthritis.
What does the future hold?
Although osteoarthritis is often painful and upsetting, it usually does not cause crippling arthritis or severe deformity of joints. For most people it will be more of a nuisance than a major problem.
It does not lead to rheumatoid arthritis or other forms of joint disease. It will not spread all over your body. It has no link with cancer or other serious diseases.
The pain sometimes gets easier as time goes by, and most people with osteoarthritis have little disability. Try not to fear the future unnecessarily as this can be worse than the actual arthritis. People with osteoarthritis can do a lot to help themselves and often only need occasional advice from doctors and therapists. Modern medicine and surgery have much to offer, particularly for the few who do get severe joint damage.
Can any special diet help?
A large amount of research is being done on diet, nutrition and osteoarthritis. Many books, articles and advertisements claim benefits for particular diets or food supplements, but at the moment most are not supported by strong evidence.
There is, however, evidence that the supplement glucosamine can produce some improvement in osteoarthritis.
Particularly important in relation to diet is the fact that a great deal of evidence shows that being overweight increases the risk of developing osteoarthritis, especially of the knee. It also increases the risk of osteoarthritis progressing. Being overweight is also bad for your general health and increases the risk of developing heart disease, stroke and diabetes. So you should eat a balanced, healthy diet and keep your weight as close as possible to the ideal for your height and age.
Will rest or exercise help?
Joints do not wear out with normal use. In general, it is much better to use them than not to! However, you must strike a sensible balance between too much activity and too much rest. Most people with osteoarthritis find that while too much exercise worsens their pain, their joints stiffen up if kept still for too long.
For most people with osteoarthritis, the best advice is 'little and often' – a little rest, followed by a little exercise. For example, do the housework or gardening in short spells interrupted by short rests. Avoid sitting in one place for too long – get up and stretch the joints from time to time. Break up a long car journey with frequent stops to walk around.
Activities that cause severe pain afterwards are probably best avoided. If for some special reason you do need to do a lot extra, it can help to take a painkiller before you start. Even if it does cause extra pain you are unlikely to damage the joint, but your doctor or therapist will give you more advice if you are worried.
Can swimming or pool treatment help?
Swimming can be a very good way of exercising and keeping fit as it causes little pain. Water supports the body's weight so that little force goes through the joints as you exercise. Also, warm water relaxes muscles and joints and is very soothing, allowing joints to move more freely. If you have osteoarthritis of the hip or knee you may find this particularly helpful.
Prescribed exercises in a hydrotherapy pool can help get muscles and joints working better, without undue pain. Supervised swimming in natural spa waters is an ancient treatment – it is the exercise that helps rather than any healing properties of the water itself.
Will my osteoarthritis affect sex, marriage or my family?
Osteoarthritis is not catching and cannot be given to family or friends. It should not affect your marriage or partnership or your family. However, sexual intercourse may be painful, particularly for women with osteoarthritis of the hips. Using different positions can often help.
If you have nodal osteoarthritis with knobbly fingers, your children have an increased chance of developing it in their middle life. This is particularly true for girls, who have about a 30–50% chance of inheriting it from an affected mother. There is a smaller risk of passing on the tendency to develop knee osteoarthritis. No test can show whether you have inherited the tendency for nodal or knee osteoarthritis. However, if a parent has nodal or knee osteoarthritis, the children, especially the females, have an added incentive to exercise regularly and avoid getting overweight.
Does the weather really affect osteoarthritis?
Painful joints are often sensitive to the weather. They tend to feel worse when the atmospheric (barometric) pressure is falling, such as just before it rains. This helps to explain how people with osteoarthritis can predict rain, and why joint pains seem linked with the damp.
However, there is no evidence that different climates have any long-term effect on osteoarthritis or its outcome. The weather may temporarily affect symptoms but not the arthritis itself. There is no point in moving to a different area in the hope of curing osteoarthritis. Osteoarthritis occurs all over the world, in all types of climate.
Can heat help?
Warmth applied to the affected area often relieves the pain and stiffness of osteoarthritis. Heat lamps are popular, but you can get a similar effect more cheaply with hot-water bottles (be careful, though – it is easy to burn yourself with either). There are also many creams, available at the chemist, which can produce localised heat.
These measures make no long-term difference to the disease, but they can give you temporary pain relief. Used carefully they are safe and soothing.
Are manipulations or complementary medicines worth trying?
Back and neck pain are often helped by manipulation from chiropractors or osteopaths, although the use of manipulation for osteoarthritis in other areas is limited. However, many people still seek advice from these practitioners, but you should make sure that the practitioner is fully trained and registered.
'Complementary' medicines seem to help some people with osteoarthritis. A few, like acupuncture, have a proven short-term pain-relieving effect. But many do no more than produce a 'placebo' effect (as when someone receiving a simple sugar pill actually believes it is making them better). There are many good complementary practitioners, but sadly a minority seem to exploit people's suffering. We have no proof that copper bracelets or other such measures can affect osteoarthritis, but faith in them seems to help some people.
Who should I listen to?
Many well-meaning people offer advice. Magazines and the media are full of articles on arthritis and its treatment. Some offer 'new hope', others offer a special diet or medicine with 'miracle' properties. Unfortunately, there are no miracle cures or easy answers.
Keeping your spirits up
Depression, low morale and poor sleep can all make pain worse. They can all influence the way pain is experienced and lower your threshold to pain.
If someone is depressed, their pain often feels worse and they have more difficulty coping with it. They might go to their doctor and be given bigger doses of tablets to relieve that pain. But sometimes what the person needs is help for the depression and the demoralising effect of arthritis. If the depression is lifted, the pain often becomes less and the person is better able to cope with their osteoarthritis.
A positive and hopeful approach is half the battle, though this is easier said than done. Make every effort to make life fuller and more interesting than before. Your morale will drop after too much rest and inactivity, whereas hobbies and interests take your mind off your problems. Sleep is important – it is best not to take naps during the day but to save all your sleep for night-time. If you have previously enjoyed vigorous activity and sport you may have to develop less active pastimes, but there is no reason to let osteoarthritis get you down or stop you doing most everyday activities.
Glossary
Calcification – deposits of calcium crystals in soft tissues.
Capsule – the tough, fibrous sleeve around a joint. Its inner layer is the synovium.
Cartilage – strong material on bone ends that acts as a cushion. Its slippery surface allows smooth movement between bones.
Chondrocalcinosis – calcification of cartilage.
Collagen – the main substance in the white, fibrous connective tissue which is found in tendons, ligaments and cartilage. This very important protein is also found in skin and bone.
Deformity – abnormal growth or swelling of a joint.
Femur – the upper leg or thigh bone – the longest bone in the body.
Hallux rigidus – osteoarthritis of the big toe joint with a stuck, rigid toe (often painful).
Hallux valgus – osteoarthritis of the big toe joint with angulation of the toe.
Heberden's nodes – firm swellings of the end joints of fingers, often painless when fully formed – the hallmark of nodal osteoarthritis.
Ligaments – tough, fibrous bands anchoring the bones on either side of a joint and holding the joint together.
Menisci (singular meniscus) – free rings of cartilage, like washers, lying between the cartilage-covered bones in the knee. Each knee has an inside (medial) and an outside (lateral) meniscus.
Nodal osteoarthritis – a form of osteoarthritis that often runs in families, characterised by knobbly finger swellings (Heberden's nodes) and a tendency to get osteoarthritis at several sites (especially knees, big toes).
Osteophytes – overgrowth of new bone around the sides of osteoarthritis joints, also known as 'spurs'.
Patella – the kneecap, a small bone that helps the front thigh muscles work the knee.
Perthes' disease – inflammation at the head of the thigh bone (femur) which causes pain and limping, usually in boys aged 5–10 years. It can restrict blood supply to the bone leading to poor growth and deformity and can cause osteoarthritis to develop in later life.
Pseudogout – a sudden attack of a hot, painful, very swollen, red joint, caused by calcium crystals in the joint (mainly the knee).
Pyrophosphate arthritis – a type of osteoarthritis in which crystals of calcium pyrophosphate form in a joint (see calcification and chondrocalcinosis). The crystals can cause pseudogout.
Radiated pain – pain that is felt some way away from the joint causing the trouble (for example, pain in the thigh and knee from an osteoarthritic hip).
Spondylosis – osteoarthritis of small joints in the neck and back – commonly present in all of us, often without causing any symptoms.
Synovial fluid – the fluid produced by the synovium to nourish and lubricate the joint.
Synovium – the capsule's inner layer that produces synovial fluid.
Tendons – strong fibrous 'guiders' or cords that anchor muscles to bone.
Tibia – the lower leg or shin bone – the second largest bone in the body.
Sciatica
What is Sciatica?
Sciatica is a pain that runs along the sciatic nerve, a large nerve extending from the lower back and down the back of each leg. Sciatica is a common kind of back pain. Although sciatica can be very painful, it is rare for the disorder to cause permanent nerve damage. Most sciatica pain syndromes result from inflammation and will usually get better within a few weeks.
What are the symptoms of Sciatica?
• Pain in the rear or leg that is worse when sitting • Burning or tingling down the leg • Weakness, numbness or difficulty moving the leg or foot • A constant pain on one side of the rear • A shooting pain that makes it difficult to stand up
Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse.
What causes Sciatica?
Any condition that causes irritation to the sciatic nerve can cause the pain associated with sciatica. In many cases, sciatica is caused by pressure on the sciatic nerve from a herniated disc (also called a slipped disc or ruptured disc). Additional common causes of sciatica include:
• lumbar spinal stenosis (narrowing of spinal canal in the lower back) • degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae) • spondylolisthesis (a condition in which one vertebra slips forward over another one) • pregnancy
Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
How is Sciatica diagnosed?
In diagnosing sciatica, an Osteopath will take your medical history and perform an examination of the back, hips, and legs in order to test for strength, flexibility, sensation, and reflexes. Other tests may include:
• X-rays • MRI scans • CT scans • Nerve conduction studies –In these tests, an electrical current is passed through a nerve to determine the health or disease of that nerve.
How is Sciatica treated?
Treatment for sciatica focuses on relieving pressure and inflammation. Typical sciatica treatments include:
Gentle Spinal mobilisation of the lower lumbar spine and releasing of muscle spasm.
Traction of Lumbar spine manually and gently articulating the affected joints.
Rehabilitation exercises.
Medical treatments for sciatica (such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, oral steroids, or epidural steroid injections) help to relieve inflammation.
Osteopathy usually starts after adequate pain control and has an essential role both for the acute episode as well as long term avoidance of further episodes.
Surgery for sciatica may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments, patients should seek immediate medical attention with any symptoms of progressive lower extremity weakness, loss of bladder or bowel control.
Frozen Shoulder
Frozen
Shoulder (Adhesive Capsulitis)
There is great variation in the severity and length of symptoms. Untreated, on average the symptoms last 12-18 months in total before going. In some cases it is much less than this. In a minority of cases, symptoms last for several years.
Who gets frozen shoulder?
Frozen shoulder affects about 1 in 50 adults at some stage in their life. It most commonly occurs in people aged between 40 and 60. It is more common in people who have diabetes. Either shoulder can be affected but most commonly it is the non-dominant shoulder. That is, the left shoulder in a right handed person. In about 1 in 5 cases the condition also develops in the other shoulder at some stage. Frozen shoulder is not a form of arthritis, and other joints are not affected.
What causes frozen shoulder?
The cause is not clear. It is thought that some scar tissue forms in the shoulder capsule. The capsule is a thin tissue that covers and protects the shoulder joint. The scar tissue may cause the capsule to thicken, contract, and limit the movement of the shoulder. The reason why the scar tissue forms is not known.
A frozen shoulder occasionally follows a shoulder injury, but this is not usual and most cases occur for no apparent reason.
What are the treatment options for frozen shoulder?
The aim of treatment is to ease pain and stiffness, and to keep the range of shoulder movement as good as possible whilst waiting for the condition to clear. One or more of the following may be advised to help ease and prevent symptoms.
Osteopathy Many people are referred to an Osteopath who can give expert advice on the best exercises to use as well as improving movement and pain relief. Also, they may try other pain relieving techniques such as heat, cold, etc.Most patients that Osteopaths treat find that the pain is greatly relieved by treatment and it is often wise to get regularly seen in the early stages and as the shoulder "thaws out" the patient is put on very useful rehabilitation exercises.
Anti-inflammatory painkillers For example, ibuprofen, diclofenac, naproxen, etc. One of these drugs is commonly prescribed to ease pain. There are many different brands. Therefore, if one does not suit, another may be fine. Side-effects sometimes occur with anti-inflammatory painkillers. Always read the leaflet that comes with the drug packet for a full list of cautions and possible side-effects.
Ordinary painkillersParacetamol or codeine may be an option if anti-inflammatory painkillers do not suit. These do not have any anti-inflammatory action, but are good painkillers. Constipation is a common side-effect from codeine. You can take painkillers in addition to other treatments.
Shoulder exercisesThese are commonly advised. The aim is to keep the shoulder from 'stiffening up', and to keep movement as full as possible. For most benefit, it is important to do the exercises regularly, as instructed by a doctor or physiotherapist.
A steroid injection An injection into, or near to, the shoulder joint brings relief of symptoms for several weeks in some cases. Steroids reduce inflammation. It is not a 'cure' as symptoms tend to gradually return, and the actual procedure can be very painful., but many people welcome the relief that a steroid injection can bring.
|
Frozen
shoulder is a condition where a shoulder
becomes very painful and stiff. Movements of
the shoulder become reduced, sometimes
completley 'frozen'. It is thought to be due to
scar-like tissue forming in the shoulder
capsule. Without treatment, symptoms usually go
but this may take up to 18 months in really
stubborn cases. Various treatments are used to
ease pain and improve the movement of the
shoulder.
|
What
are the symptoms of frozen
shoulder?
The typical symptoms are pain, stiffness, and
limitation in the range of movement of a shoulder.
The symptoms typically have three phases.
- Phase one - the 'freezing', painful phase. This typically lasts 2-4 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night, and when lying on the affected side.
- Phase two - the 'frozen', stiff phase. This typically lasts 4-6 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.
- Phase three - the 'thawing', recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement gradually returns to normal, or near normal.
There is great variation in the severity and length of symptoms. Untreated, on average the symptoms last 12-18 months in total before going. In some cases it is much less than this. In a minority of cases, symptoms last for several years.
Who gets frozen shoulder?
Frozen shoulder affects about 1 in 50 adults at some stage in their life. It most commonly occurs in people aged between 40 and 60. It is more common in people who have diabetes. Either shoulder can be affected but most commonly it is the non-dominant shoulder. That is, the left shoulder in a right handed person. In about 1 in 5 cases the condition also develops in the other shoulder at some stage. Frozen shoulder is not a form of arthritis, and other joints are not affected.
What causes frozen shoulder?
The cause is not clear. It is thought that some scar tissue forms in the shoulder capsule. The capsule is a thin tissue that covers and protects the shoulder joint. The scar tissue may cause the capsule to thicken, contract, and limit the movement of the shoulder. The reason why the scar tissue forms is not known.
A frozen shoulder occasionally follows a shoulder injury, but this is not usual and most cases occur for no apparent reason.
What are the treatment options for frozen shoulder?
The aim of treatment is to ease pain and stiffness, and to keep the range of shoulder movement as good as possible whilst waiting for the condition to clear. One or more of the following may be advised to help ease and prevent symptoms.
Osteopathy Many people are referred to an Osteopath who can give expert advice on the best exercises to use as well as improving movement and pain relief. Also, they may try other pain relieving techniques such as heat, cold, etc.Most patients that Osteopaths treat find that the pain is greatly relieved by treatment and it is often wise to get regularly seen in the early stages and as the shoulder "thaws out" the patient is put on very useful rehabilitation exercises.
Anti-inflammatory painkillers For example, ibuprofen, diclofenac, naproxen, etc. One of these drugs is commonly prescribed to ease pain. There are many different brands. Therefore, if one does not suit, another may be fine. Side-effects sometimes occur with anti-inflammatory painkillers. Always read the leaflet that comes with the drug packet for a full list of cautions and possible side-effects.
Ordinary painkillersParacetamol or codeine may be an option if anti-inflammatory painkillers do not suit. These do not have any anti-inflammatory action, but are good painkillers. Constipation is a common side-effect from codeine. You can take painkillers in addition to other treatments.
Shoulder exercisesThese are commonly advised. The aim is to keep the shoulder from 'stiffening up', and to keep movement as full as possible. For most benefit, it is important to do the exercises regularly, as instructed by a doctor or physiotherapist.
A steroid injection An injection into, or near to, the shoulder joint brings relief of symptoms for several weeks in some cases. Steroids reduce inflammation. It is not a 'cure' as symptoms tend to gradually return, and the actual procedure can be very painful., but many people welcome the relief that a steroid injection can bring.
Osteoporosis
What is osteoporosis?
Osteoporosis literally means ‘porous bones’. Our bones are made up of a thick outer shell and a strong inner honeycomb mesh of tiny struts of bone.
Osteoporosis means some of these struts become thin or break. This makes the bone more fragile and prone to break. It often remains undetected until the time of this first broken bone.
Broken wrists, hips and spinal bones are the most common fractures in people with osteoporosis.
What causes osteoporosis?
Two types of cells are constantly at work in our bones.
One set builds up new bone while another set break down old bone. Up to our mid-20s the construction cells work harder building strength into our skeleton.
From our 40s onwards, the demolition cells overtake and our bones gradually lose their density as a natural part of ageing.
One in two women and one in five men over the age of 50 in the UK will break a bone, mainly because of osteoporosis. Exactly why this happens is still not fully understood. Research continues to build up a picture of the factors that influence our bones.
Who is at risk?
Our bone health is largely down to the genes we inherit from our parents.
But there are other factors that can put people at greater risk:
Women if they have had an early menopause or hysterectomy (before the age of 45)
If you have low levels of testosterone (known as hypogonadism)
People who have broken a bone after only a minor trauma (called a fragility fracture)
People who take Steroids (for conditions such as asthma or arthritis)
People with a family history of osteoporosis, particularly if your mother has broken her hip
People with medical conditions which affect the absorption of foods, such as Crohn’s disease, coeliac disease or ulcerative colitis
People with medical conditions which leave them immobile for a long time
People who drink excessive amounts of alcohol
People who smoke
Women who are underweight or have developed an eating disorder
Osteoporosis can also affect children and young people and pregnant women. However, these conditions are extremely rare.
I think I might be at risk. Can I be tested for osteoporosis?
You cannot see or feel your bones getting thinner. Many people are unaware of any problems until they break a bone or start to lose height.
If you think you are at risk then discuss it further with your GP. You may need a special scan which measures bone density, called a dual energy x-ray absorptiometry (DXA) scan. It is a simple, painless procedure and is recommended for those people considered at high risk of breaking a bone because of osteoporosis.
Osteoporosis diagnosed on a bone density scan does not always mean you have a high risk of breaking a bone at the time of the scan so a drug treatment is not always necessary or appropriate. Other factors, such as your age, will need to be taken into account.
If you have broken a bone because of osteoporosis there are a range of drug treatments. These will help to reduce your risk of breaking another bone. The way you live your life can also help.
Osteoporosis literally means ‘porous bones’. Our bones are made up of a thick outer shell and a strong inner honeycomb mesh of tiny struts of bone.
Osteoporosis means some of these struts become thin or break. This makes the bone more fragile and prone to break. It often remains undetected until the time of this first broken bone.
Broken wrists, hips and spinal bones are the most common fractures in people with osteoporosis.
What causes osteoporosis?
Two types of cells are constantly at work in our bones.
One set builds up new bone while another set break down old bone. Up to our mid-20s the construction cells work harder building strength into our skeleton.
From our 40s onwards, the demolition cells overtake and our bones gradually lose their density as a natural part of ageing.
One in two women and one in five men over the age of 50 in the UK will break a bone, mainly because of osteoporosis. Exactly why this happens is still not fully understood. Research continues to build up a picture of the factors that influence our bones.
Who is at risk?
Our bone health is largely down to the genes we inherit from our parents.
But there are other factors that can put people at greater risk:
Women if they have had an early menopause or hysterectomy (before the age of 45)
If you have low levels of testosterone (known as hypogonadism)
People who have broken a bone after only a minor trauma (called a fragility fracture)
People who take Steroids (for conditions such as asthma or arthritis)
People with a family history of osteoporosis, particularly if your mother has broken her hip
People with medical conditions which affect the absorption of foods, such as Crohn’s disease, coeliac disease or ulcerative colitis
People with medical conditions which leave them immobile for a long time
People who drink excessive amounts of alcohol
People who smoke
Women who are underweight or have developed an eating disorder
Osteoporosis can also affect children and young people and pregnant women. However, these conditions are extremely rare.
I think I might be at risk. Can I be tested for osteoporosis?
You cannot see or feel your bones getting thinner. Many people are unaware of any problems until they break a bone or start to lose height.
If you think you are at risk then discuss it further with your GP. You may need a special scan which measures bone density, called a dual energy x-ray absorptiometry (DXA) scan. It is a simple, painless procedure and is recommended for those people considered at high risk of breaking a bone because of osteoporosis.
Osteoporosis diagnosed on a bone density scan does not always mean you have a high risk of breaking a bone at the time of the scan so a drug treatment is not always necessary or appropriate. Other factors, such as your age, will need to be taken into account.
If you have broken a bone because of osteoporosis there are a range of drug treatments. These will help to reduce your risk of breaking another bone. The way you live your life can also help.
Low Back Pain
OSTEOPATHIC
INFORMATION SERVICE
OSTEOPATHY: Back Pain
Lower back pain has reached epidemic proportions in the western world. Research
shows that 60% of the UK’s population will suffer from it at some stage during their lives.
Back pain responds well to osteopathic treatment – reducing pain and restoring mobility
and quality of life.
What is Osteopathy?
• Osteopathy recognises that much of the pain and disability we suffer stems from
abnormalities in our body’s structure and function.
• Osteopaths diagnose and treat problems with muscles, ligaments, nerves and
joints to help the body’s natural healing ability.
• Treatment involves gentle, manual techniques – easing pain, reducing swelling
and improving mobility. Often, this involves manipulation which can result in an
audible ‘crack’ which is simply the sound of gas bubbles popping in the fluid of
the joints.
• Osteopathy does not involve the use of drugs or surgery.
The scourge of back pain
• Lower back pain now affects two-thirds of the adult population of the UK; it is the
nation’s leading cause of disability.
• Four out of five people will suffer back pain lasting more than a day at some point
in their lives.
• Over £480 million a year is spent on services used by sufferers of back pain,
including 14 million GP consultations, seven million therapy sessions and
800,000 hospital beds.
• Back pain is very common in children. Around 50% of children in Europe
experience back pain at some time.
• Back problems and repetitive strain injuries cost British industry £5 billion each
year.
• Doctors write 55 million prescriptions for painkillers each year.
Back pain – causes and effects
The trouble with back pain is that it can do more than just give you a pain in the back. It
can create difficulties with walking, sitting, bending and lifting and can even lead to
depression and incontinence. It can also be the cause of pain in the buttocks, groin or
legs (commonly called sciatica), in the head, neck, shoulders and arms. It can also be
one of the effects of hip, knee and foot problems.
Back pain can result from bad posture, a sudden jerky movement, a lumpy mattress or
poor lifting techniques. It can also be caused by injury in a work place, by a sports
accident or by muscular spasms. It often occurs during pregnancy or, because of
decreased flexibility, as people get older.
There are also many diseases and pathological conditions that can lead to back pain.
These include abdominal or pelvic disease, anxiety, arthritis, cervical or lumbar
spondylosis, dermatological problems, kidney disease, rheumatic conditions, tumours
and scoliosis.
Our modern, sedentary lifestyles have a profound effect on the development of back
pain; indeed one of the most effective ways of preventing it is simply to stay active.
An average adult in the UK spends at least two hours a day in front of a computer
screen or television set, and back problems can be triggered if they don’t sit properly.
In an age of mobile phones and computer games, such troubles are increasingly
inflicting children of school age as well.
Osteopathy and the treatment of back pain
Osteopathic treatment is often the most effective first line of attack in correcting
problems caused by back pain. Speedy access to osteopathic care for acute patients
often averts the possibility of conditions becoming chronic.
By correcting any underlying mechanical disturbances in the musculo-skeletal system,
osteopaths can greatly relieve pain and distress, minimise dependency on drugs and
slash the cost of treatment for side effects.
Osteopathic treatment often negates the need for further medical investigation or
surgery, although osteopaths are skilled in diagnosing problems that require such
investigation or treatment.
Back problems account for over 50% of the cases osteopaths see.
Visiting an osteopath
On your first visit, and before examination begins, the osteopath will discuss and record
your medical history in detail. You will then normally be asked to remove some of your
clothing so that a series of observations and biomechanical assessments can be made.
The osteopath will then apply a highly developed sense of touch to identify points of
weakness or excessive strain throughout the body. Further investigations may include
an x-ray or blood test. This will allow a full diagnosis of the problem and will enable the
osteopath to tailor a treatment plan to your needs.
Your osteopath should make you feel at ease and tell you what is happening throughout
your consultation. You should ask questions if you have any concerns. If further medical
treatment is needed the osteopath may contact your doctor, with your permission.
How much does osteopathy cost?
You do not need a referral from a GP to see an osteopath. The majority of osteopaths
work in private practice, so you may choose to approach a practitioner directly and pay
for treatment. Fees range from £25 to £50 and above for a single session, depending
upon the location of the practice and experience of the osteopath. Typically between
two and six treatment sessions are needed, though this varies according to the severity
of the problem.
An increasing number of osteopaths work alongside GPs, so it may be possible for your
doctor to refer you to an osteopath on the NHS. It may also be possible to claim for a
course of osteopathy if you have private health insurance policy. Check with your
insurance provider to confirm the available level of cover and to find out whether you
require a referral from a GP or specialist. All insurance companies have help lines to
explain your benefits and methods of claiming.
Ten top tips for back care
1. For back pain, better to see your osteopath sooner than later.
2. Take regular exercise – your osteopath can say what’s right for you.
3. Hours in one position can cause problems – avoid computer ‘hump’.
4. During repetitive tasks, vary your rhythm and take frequent breaks.
5. Adjust car seats and on long journeys, take regular breaks to stretch.
6. Pace yourself with heavy work such as gardening – don’t risk a disc!
7. Watch children’s posture – they shouldn’t carry bags on one shoulder or spend
too long at a computer without breaks.
8. During pregnancy, osteopathy can help your body adjust to changes.
9. Avoid strain when lifting, particularly small children and shopping.
10. Your bed could be part of the problem. Seek osteopathic advice on choosing a
new one.
Osteopathy and patient protection
Patients consulting an osteopath have the same safeguards and rights as when
consulting a doctor or dentist. Osteopathy is an established system of diagnosis and
treatment, recognised by the British Medical Association as a distinct clinical discipline.
Under the Osteopaths Act of 1993, osteopathy was accorded statutory recognition, and
the title “osteopath” protected by law. In the UK it is now a criminal offence to describe
oneself as an osteopath unless registered with the General Osteopathic Council
(GOsC).
The GOsC regulates, promotes and develops the profession, maintaining a Statutory
Register of those entitled to practise. Practitioners on the Register meet the highest
standards of safety and competency. They have provided proof of good health, good
character and have professional indemnity insurance.
Osteopathic training is demanding and lengthy, and a recognised qualification is only
available from osteopathic educational institutions accredited by the GOsC. Trainee
osteopaths study anatomy, physiology, pathology, biomechanics and clinical methods
during a four or five year honours degree programme. Such wide-ranging medical
training gives osteopaths the skills to diagnose conditions when osteopathic treatment is
not advisable, and the patient must be referred to a GP for further investigation.
Osteopaths are committed to a programme of continuing professional development.
You can obtain details of an osteopath’s registration by telephoning the GOsC on 020
7357 6655.
Finding an osteopath near you
To find an osteopath near you, details are available in Thomson and Yellow Pages directories.
Alternatively contact the GOsC directly at:
Osteopathy House
176 Tower Bridge Road
London SE1 3LU
Tel: 020 7357 6655
Email: info@osteopathy.org.uk
www.osteopathy.org.uk
Further information
This leaflet is one of a series of information leaflets for the public. Please contact us for copies
of the following:
• Osteopathy: An introduction to Osteopathy and the GOsC
• Osteopathy: Arthritis
• Osteopathy: Babies and children
• Osteopathy: Choosing a Bed and choosing a bed
• Osteopathy: Driving
• Osteopathy: Pain Relief
• Osteopathy: Pregnancy
• Osteopathy: Sports
• Osteopathy: Work Strain
For further information and lists of local practitioners please contact the Osteopathic
Information Service, General Osteopathic Council, Osteopathy House, 176 Tower Bridge Road,
London, SE1 3LU. Telephone number 0207 357 6655 or alternatively use our searchable
database on www.osteopathy.org.uk
OSTEOPATHY: Back Pain
Lower back pain has reached epidemic proportions in the western world. Research
shows that 60% of the UK’s population will suffer from it at some stage during their lives.
Back pain responds well to osteopathic treatment – reducing pain and restoring mobility
and quality of life.
What is Osteopathy?
• Osteopathy recognises that much of the pain and disability we suffer stems from
abnormalities in our body’s structure and function.
• Osteopaths diagnose and treat problems with muscles, ligaments, nerves and
joints to help the body’s natural healing ability.
• Treatment involves gentle, manual techniques – easing pain, reducing swelling
and improving mobility. Often, this involves manipulation which can result in an
audible ‘crack’ which is simply the sound of gas bubbles popping in the fluid of
the joints.
• Osteopathy does not involve the use of drugs or surgery.
The scourge of back pain
• Lower back pain now affects two-thirds of the adult population of the UK; it is the
nation’s leading cause of disability.
• Four out of five people will suffer back pain lasting more than a day at some point
in their lives.
• Over £480 million a year is spent on services used by sufferers of back pain,
including 14 million GP consultations, seven million therapy sessions and
800,000 hospital beds.
• Back pain is very common in children. Around 50% of children in Europe
experience back pain at some time.
• Back problems and repetitive strain injuries cost British industry £5 billion each
year.
• Doctors write 55 million prescriptions for painkillers each year.
Back pain – causes and effects
The trouble with back pain is that it can do more than just give you a pain in the back. It
can create difficulties with walking, sitting, bending and lifting and can even lead to
depression and incontinence. It can also be the cause of pain in the buttocks, groin or
legs (commonly called sciatica), in the head, neck, shoulders and arms. It can also be
one of the effects of hip, knee and foot problems.
Back pain can result from bad posture, a sudden jerky movement, a lumpy mattress or
poor lifting techniques. It can also be caused by injury in a work place, by a sports
accident or by muscular spasms. It often occurs during pregnancy or, because of
decreased flexibility, as people get older.
There are also many diseases and pathological conditions that can lead to back pain.
These include abdominal or pelvic disease, anxiety, arthritis, cervical or lumbar
spondylosis, dermatological problems, kidney disease, rheumatic conditions, tumours
and scoliosis.
Our modern, sedentary lifestyles have a profound effect on the development of back
pain; indeed one of the most effective ways of preventing it is simply to stay active.
An average adult in the UK spends at least two hours a day in front of a computer
screen or television set, and back problems can be triggered if they don’t sit properly.
In an age of mobile phones and computer games, such troubles are increasingly
inflicting children of school age as well.
Osteopathy and the treatment of back pain
Osteopathic treatment is often the most effective first line of attack in correcting
problems caused by back pain. Speedy access to osteopathic care for acute patients
often averts the possibility of conditions becoming chronic.
By correcting any underlying mechanical disturbances in the musculo-skeletal system,
osteopaths can greatly relieve pain and distress, minimise dependency on drugs and
slash the cost of treatment for side effects.
Osteopathic treatment often negates the need for further medical investigation or
surgery, although osteopaths are skilled in diagnosing problems that require such
investigation or treatment.
Back problems account for over 50% of the cases osteopaths see.
Visiting an osteopath
On your first visit, and before examination begins, the osteopath will discuss and record
your medical history in detail. You will then normally be asked to remove some of your
clothing so that a series of observations and biomechanical assessments can be made.
The osteopath will then apply a highly developed sense of touch to identify points of
weakness or excessive strain throughout the body. Further investigations may include
an x-ray or blood test. This will allow a full diagnosis of the problem and will enable the
osteopath to tailor a treatment plan to your needs.
Your osteopath should make you feel at ease and tell you what is happening throughout
your consultation. You should ask questions if you have any concerns. If further medical
treatment is needed the osteopath may contact your doctor, with your permission.
How much does osteopathy cost?
You do not need a referral from a GP to see an osteopath. The majority of osteopaths
work in private practice, so you may choose to approach a practitioner directly and pay
for treatment. Fees range from £25 to £50 and above for a single session, depending
upon the location of the practice and experience of the osteopath. Typically between
two and six treatment sessions are needed, though this varies according to the severity
of the problem.
An increasing number of osteopaths work alongside GPs, so it may be possible for your
doctor to refer you to an osteopath on the NHS. It may also be possible to claim for a
course of osteopathy if you have private health insurance policy. Check with your
insurance provider to confirm the available level of cover and to find out whether you
require a referral from a GP or specialist. All insurance companies have help lines to
explain your benefits and methods of claiming.
Ten top tips for back care
1. For back pain, better to see your osteopath sooner than later.
2. Take regular exercise – your osteopath can say what’s right for you.
3. Hours in one position can cause problems – avoid computer ‘hump’.
4. During repetitive tasks, vary your rhythm and take frequent breaks.
5. Adjust car seats and on long journeys, take regular breaks to stretch.
6. Pace yourself with heavy work such as gardening – don’t risk a disc!
7. Watch children’s posture – they shouldn’t carry bags on one shoulder or spend
too long at a computer without breaks.
8. During pregnancy, osteopathy can help your body adjust to changes.
9. Avoid strain when lifting, particularly small children and shopping.
10. Your bed could be part of the problem. Seek osteopathic advice on choosing a
new one.
Osteopathy and patient protection
Patients consulting an osteopath have the same safeguards and rights as when
consulting a doctor or dentist. Osteopathy is an established system of diagnosis and
treatment, recognised by the British Medical Association as a distinct clinical discipline.
Under the Osteopaths Act of 1993, osteopathy was accorded statutory recognition, and
the title “osteopath” protected by law. In the UK it is now a criminal offence to describe
oneself as an osteopath unless registered with the General Osteopathic Council
(GOsC).
The GOsC regulates, promotes and develops the profession, maintaining a Statutory
Register of those entitled to practise. Practitioners on the Register meet the highest
standards of safety and competency. They have provided proof of good health, good
character and have professional indemnity insurance.
Osteopathic training is demanding and lengthy, and a recognised qualification is only
available from osteopathic educational institutions accredited by the GOsC. Trainee
osteopaths study anatomy, physiology, pathology, biomechanics and clinical methods
during a four or five year honours degree programme. Such wide-ranging medical
training gives osteopaths the skills to diagnose conditions when osteopathic treatment is
not advisable, and the patient must be referred to a GP for further investigation.
Osteopaths are committed to a programme of continuing professional development.
You can obtain details of an osteopath’s registration by telephoning the GOsC on 020
7357 6655.
Finding an osteopath near you
To find an osteopath near you, details are available in Thomson and Yellow Pages directories.
Alternatively contact the GOsC directly at:
Osteopathy House
176 Tower Bridge Road
London SE1 3LU
Tel: 020 7357 6655
Email: info@osteopathy.org.uk
www.osteopathy.org.uk
Further information
This leaflet is one of a series of information leaflets for the public. Please contact us for copies
of the following:
• Osteopathy: An introduction to Osteopathy and the GOsC
• Osteopathy: Arthritis
• Osteopathy: Babies and children
• Osteopathy: Choosing a Bed and choosing a bed
• Osteopathy: Driving
• Osteopathy: Pain Relief
• Osteopathy: Pregnancy
• Osteopathy: Sports
• Osteopathy: Work Strain
For further information and lists of local practitioners please contact the Osteopathic
Information Service, General Osteopathic Council, Osteopathy House, 176 Tower Bridge Road,
London, SE1 3LU. Telephone number 0207 357 6655 or alternatively use our searchable
database on www.osteopathy.org.uk
Sports Injuries
OSTEOPATHY: Sports
Osteopathy is a natural approach to healthcare and an ideal treatment for most sports injuries.
Sports injuries treated by osteopaths
Whether you’re an enthusiastic amateur or an elite professional, an osteopath can help with the
prevention and treatment of common sporting injuries.
Pains and strains:
• low back pain (with or without sciatica).
• muscle and ligament injuries.
• knee pain (including lack of mobility and degenerative conditions).
• shoulder, elbow and wrist injuries.
• foot and ankle complaints.
Functional complaints:
• reduced joint flexibility (e.g. suffered by golfers who can’t rotate as well as they used to).
• mechanical limitations (e.g. suffered by gymnasts having difficulty in doing full “splits”).
Injuries caused by overuse:
• tennis and golfer’s elbow.
• jumper’s knee.
• tenosynovitis and tendonitis.
Recurrent injuries.
What is osteopathy?
• Osteopathy recognises that much of the pain and disability we suffer stems from
abnormalities in our body’s structure and function.
• Osteopaths diagnose and treat problems with muscles, ligaments, nerves and joints to
help the body’s natural healing ability.
• Treatment involves gentle, manual techniques – easing pain, reducing swelling and
improving mobility. Often, this involves manipulation which can result in an audible
‘crack’ which is simply the sound of gas bubbles popping in the fluid of the joints.
• Osteopathy does not involve the use of drugs or surgery.
Visiting an osteopath
On your first visit, and before examination begins, the osteopath will discuss and record your
medical history in detail. You will then normally be asked to remove some of your clothing so
that a series of observations and biomechanical assessments can be made.
The osteopath will then apply a highly developed sense of touch to identify points of weakness
or excessive strain throughout the body. Further investigations may include an x-ray or blood
test. This will allow a full diagnosis of the problem and will enable the osteopath to tailor a
treatment plan to your needs.
Your osteopath should make you feel at ease and tell you what is happening throughout your
consultation. You should ask questions if you have any concerns. If further medical treatment is
needed the osteopath may contact your doctor, with your permission.
How much does osteopathy cost?
You do not need a referral from a GP to see an osteopath. The majority of osteopaths work in
private practice so you may choose to approach a practitioner directly and pay for treatment.
Fees range from £25 to £50 and above for a single session, depending upon the location of the
practice and experience of the osteopath. Typically between two and six treatment sessions are
needed, though this varies according to the severity of the problem.
An increasing number of osteopaths work alongside GPs, so it may be possible for your doctor
to refer you to an osteopath on the NHS. It may also be possible to claim for a course of
osteopathy if you have private health insurance policy. Check with your insurance provider to
confirm the available level of cover and to find out whether you require a referral from a GP or
specialist. All insurance companies have help lines to explain your benefits and methods of
claiming.
Osteopathy in action
A man in his late fifties, running at senior club level, had a calf injury in his right leg. After
assessment by a variety of therapists he consulted an osteopath who discovered that the problem had
been caused by a change of job two years previously. The man’s new job required a lot of standing up,
and examination revealed his tendency to stand with his right leg slightly bent. As a result the calf
muscle had started to shorten on the right hand side. Osteopathic treatment helped him to stand with a
straight posture, reducing the tension in the right calf. A stretching routine was then prescribed and
recovery from the injury was quickly achieved.
A forty year old woman, playing badminton and tennis at county level, had been suffering from severe
tennis elbow for six months. She was concerned that the worsening pain would force her to give up her
sport. Her osteopath discovered that her spine allowed little rotation, and that her shoulder muscles
were unusually tight. He treated her neck (from where the nerve supply to the elbow arises), and
worked on her shoulder and upper back mobility. This approach reduced the demands on her elbow.
Free of pain, and benefiting from greater mobility, she recovered from the injury and was able to play
more powerful tennis and badminton shots than ever before.
A 16 year old footballer, representing his county several times at U18 level, complained of
recurrent hamstring injuries and right-sided low back pain over the past two years. This was
despite of rest, various treatments and specialists’ opinions where because of unequal leg
lengths a heel raise had been recommended, but more widespread symptoms had been
created as a result. An osteopath’s opinion was sought and was able to demonstrate that very
unusually because of sport, a ‘protective scoliosis’ had already started to become semi-
permanent. Thus the heel raise had forced additional stress which the spine was unable to
compensate for. Treatment to enable the spine to re-align itself was carried out and a steadily
increasing height of heel raise was gradually introduced. Exercises to maintain the developing
flexibility helped to maintain the change. Resolution of the back problem also led (as
anticipated) to a curtailment of recurrent hamstring injuries.
Osteopathy and patient protection
Patients consulting an osteopath have the same safeguards and rights as when consulting a
doctor or dentist. Osteopathy is an established system of diagnosis and treatment, recognised
by the British Medical Association as a distinct clinical discipline.
Under the Osteopaths Act of 1993, osteopathy was accorded statutory recognition, and the title
“osteopath” protected by law. In the UK it is now a criminal offence to describe oneself as an
osteopath unless registered with the General Osteopathic Council (GOsC).
The GOsC regulates, promotes and develops the profession, maintaining a Statutory Register
of those entitled to practise. Practitioners on the Register meet the highest standards of safety
and competency. They have provided proof of good health, good character and have
professional indemnity insurance.
Osteopathic training is demanding and lengthy, and a recognised qualification is only available
from osteopathic educational institutions accredited by the GOsC. Trainee osteopaths study
anatomy, physiology, pathology, biomechanics and clinical methods during a four or five year
honours degree programme. Such wide-ranging medical training gives osteopaths the skills to
diagnose conditions when osteopathic treatment is not advisable and the patient must be
referred to a GP for further investigation.
Osteopaths are committed to a programme of Continuing Professional Development.
You can obtain details of an osteopath’s registration by telephoning the GOsC on
020 7357 6655.
A healthy sporting life
If you’re taking up a new sporting activity, you should seek the advice of a coach, trainer or instructor,
and ask for an appropriate training programme for your age, experience and fitness.
With injuries, especially those to legs or arms, always remember the word PRICED:
Prevent injuries by preparing thoroughly. You should always warm up and stretch before exercise,
and warm down and stretch afterwards.
Rest after injury, and give your body time to recover.
Ice should be placed on the injured area as quickly as possible.
Compress the injured area to prevent swelling. Strapping or taping should always be carried out by a
qualified person.
Elevate the injured part of the body in order to encourage blood and oxygen to flow to the joints and
tissues. This helps the body to heal itself.
Diagnosis should be obtained from a medical expert if you are concerned about the severity of an
injury.
Finding an osteopath near you
To find an osteopath near you details are available in Thomson and Yellow Pages directories.
Alternatively contact the GOsC directly at:
Osteopathy House
176 Tower Bridge Road
London SE1 3LU
Tel: 020 7357 6655
Email: info@osteopathy.org.uk
www.osteopathy.org.uk
Osteopaths specialising in the treatment of sports injuries have formed the Osteopathic Sports Care
Association, which can be contacted on 0870 601 0037.
Further information
This leaflet is one of a series of information leaflets for the public. Please contact us for copies of the
following:
• Osteopathy: An introduction to Osteopathy and the GOsC
• Osteopathy: Arthritis
• Osteopathy: Babies and children
• Osteopathy: Back Pain
• Osteopathy: Choosing a Bed and choosing a bed
• Osteopathy: Driving
• Osteopathy: Pain Relief
• Osteopathy: Pregnancy
• Osteopathy: Work Strain
For further information and lists of local practitioners please contact the Osteopathic
Information Service, General Osteopathic Council, Osteopathy House, 176 Tower
Bridge Road, London, SE1 3LU. Telephone number 0207 357 6655 or alternatively use
our searchable database on www.osteopathy.org.uk
Babies and Children
OSTEOPATHY: Babies and children
Osteopathy is an effective and natural approach to healthcare for all life stages. Osteopaths
treat babies and children for a variety of common complaints, and to ensure healthy postural
development.
Can osteopathy help my child?
Problems often suffered by babies:
• crying and irritability, especially when lying down.
• feeding difficulties.
• sickness, colic and wind.
• sleep disturbances.
Problems often suffered by older children:
• musculo-skeletal problems.
• susceptibility to infections and a depleted immune system.
• ear infection, sometimes with a loss of hearing and ‘glue ear’.
• sinus and dental problems, with a constantly blocked or runny nose.
• behavioural problems and learning difficulties, including poor concentration, fidgeting,
difficulty in sitting still and hyperactivity.
• headache, other aches and pains.
• asthma and vulnerability to chest infections.
What is osteopathy?
• Osteopathy recognises that much of the pain and disability we suffer stems from
abnormalities in our body’s structure and function.
• Osteopaths diagnose and treat problems with muscles, ligaments, nerves and joints to
help the body’s natural healing ability.
• Treatment involves gentle, manual techniques - easing pain, reducing swelling and
improving mobility. Often, this involves manipulation which can result in an audible
‘crack’ which is simply the sound of gas bubbles popping in the fluid of the joints.
• Osteopathy does not involve the use of drugs or surgery.
Could my child suffer an adverse reaction to osteopathy?
Often, after treatment, the baby or child is very relaxed and sleeps well. Others have a burst of
energy, and then have a good night’s sleep. Occasionally children feel unsettled, but this is a
temporary situation that happens when mechanical changes are occurring, and only lasts for a
day or two.
At what age should my child be treated?
Children of any age can benefit from osteopathy. It is never too early to start, and for best
results treatment should begin before the age of five. Early treatment reduces hindrances to
growth and limits the severity of any developing learning difficulty.
Osteopathy for babies and toddlers
Many of the problems that babies and children suffer are caused before, during and immediately
after birth, and the child may be left with uncomfortable stresses within its head and body.
These stresses can lead to problems such as suckling and latching-on difficulties, irritability,
colic, wind and disturbed sleep patterns. Toddlers may suffer from difficulties with mobility and
play, and they may sit, crawl and walk early, seeking movement to relieve physical discomfort.
Sleep patterns are disturbed, teething may be uncomfortable and head banging or pulling at the
hair may occur.
Osteopathic treatment can bring about significant improvement in these cases, and has
particular success in treating the problems suffered by premature babies. These babies
inevitably suffer stresses and trauma during birth and then further stress from the equipment
that needs to be used to stabilise their condition.
Osteopathy for children and teenagers
Distortions to the head can continue to hinder the growth and development of a child’s brain as
it grows older. The child’s behaviour may be volatile, and they may have problems with co-
ordination and physical development. They may be vulnerable to chronic ear infections, glue
ear, headaches, growing pains and stomach aches. They may be habitual mouth breathers, and
suffer from developmental problems such as dyslexia, dyspraxia and attention deficit and
hyperactivity disorder (ADHD). The child's posture may suffer too, with the head being held on
one side, or one shoulder held higher than the other.
During the teenage years, the body frame undergoes a number of changes. Problems may
occur because of an exaggerated spinal curve or because of mechanical changes that occur
through osteochondritis – a self-limiting condition that causes a distortion of the bone. Other
problems are caused by sporting and recreational activities that carry the risk of sprains and
strains.
If these problems are left undiagnosed and untreated they can worsen in later life. Osteopaths
can help the body frame adjust to the postural demands made on it. By analysing, treating and
managing problems associated with growth, osteopaths make a major contribution to ensuring
that young people stay fit and healthy.
Osteopathy in action
Alex is a boy of 12 who suffered from regular and severe headaches, causing him to miss at
least a day a week from school. Medication helped to reduce the
intensity but not the frequency of the headaches. On examination by an osteopath, Alex's
posture was found to be the primary cause of the headaches. He had flat feet and his knees
were locked back and held together. He had relatively weak abdominal muscles and stronger
back muscles, and threw his weight forward into a sway-back posture. Osteopathic treatment
helped improve and develop his posture so that it would support him as he grew. Alex now
suffers only occasional headaches, which don’t usually require medication or time off school.
Alice is two and until recently suffered from hearing loss. She consistently failed hearing tests
from the age of eight months and suffered from nasal congestion. Osteopathic examination
found tightness through the base of her skull, face and upper cervical spine. This was leading to
a reduction of drainage of the naso-pharynx and poor functioning of the Eustachian tube.
Osteopathic treatment reduced this compression and improved the mechanical functioning of
the upper neck. Alice's hearing improved significantly after only two treatment sessions.
Baby James cried all the time. He was constantly hungry but couldn’t feed for more than a few
minutes without getting distressed. His birth had been easy but very fast, causing his head to be
cone-shaped and the area around his right eye to be bruised. An osteopath found that James
couldn’t move his jaw in a correct manner as there was restriction of the temporal bone and
cranial base. This meant that he couldn’t open his mouth wide enough to latch on or suckle
effectively. Treatment to the base of his head allowed the jaw joint to move in the correct way.
There was immediate improvement after the first treatment session, and James was feeding
easily after the second.
Visiting an osteopath
On your first visit, and before examination begins, the osteopath will discuss and record your
child’s medical history in detail. You will then normally be asked to remove some of your child’s
clothing so that a series of observations and biomechanical assessments can be made. This
will allow a full diagnosis of the problem and will enable the osteopath to tailor a treatment plan
to your child’s needs.
The osteopath will then apply a highly developed sense of touch to identify points of weakness
or excessive strain throughout the body. Further investigations may include an x-ray or blood
test.
Your osteopath should make your child feel at ease and tell you what is happening throughout
your consultation. You should ask questions if you have any concerns. If further medical
treatment is needed the osteopath may contact your doctor, with your permission.
How much does osteopathy cost?
You do not need a referral from a GP to see an osteopath. The majority of osteopaths work in
private practice so you may choose to approach a practitioner directly and pay for treatment.
Fees range from £25 to £50 and above for a single session, depending upon the location of the
practice and experience of the osteopath. Typically between two and six treatment sessions are
needed, though this varies according to the age of the child and severity of the problem.
An increasing number of osteopaths work alongside GPs, so it may be possible for your doctor
to refer your child to an osteopath on the NHS. It may also be possible to claim for a course of
osteopathy if you have private health insurance policy. Check with your insurance provider to
confirm the available level of cover and to find out whether you require a referral from a GP or
specialist. All insurance companies have help lines to explain your benefits and methods of
claiming.
Osteopathy and patient protection
Patients consulting an osteopath have the same safeguards and rights as when consulting a
doctor or dentist. Osteopathy is an established system of diagnosis and treatment, recognised
by the British Medical Association as a distinct clinical discipline.
Under the Osteopaths Act of 1993, osteopathy was accorded statutory recognition, and the title
“osteopath” protected by law. In the UK it is now a criminal offence to describe oneself as an
osteopath unless registered with the General Osteopathic Council (GOsC).
The GOsC regulates, promotes and develops the profession, maintaining a Statutory Register
of those entitled to practise. Practitioners on the Register meet the highest standards of safety
and competency. They have provided proof of good health, good character and have
professional indemnity insurance.
Osteopathic training is demanding and lengthy, and a recognised qualification is only available
from osteopathic educational institutions accredited by the GOsC. Trainee osteopaths study
anatomy, physiology, pathology, biomechanics and clinical methods during a four or five year
honours degree programme. Such wide-ranging medical training gives osteopaths the skills to
diagnose conditions when osteopathic treatment is not advisable, and the patient must be
referred to a GP for further investigation.
NCT Classes
Early Days Courses
Whether motherhood turns out to be a breeze or a howling gale, NCT Early Days courses provide a space every week for you to come and talk about how you are doing in a supportive group environment.
We will explore the following topics over six weeks:
Redland courses are on Tuesday mornings 11am-1pm.
Yate courses are on Wednesday afternoons 3-5pm starting on 21st January.
These groups are for mums and babies from newborn to about 6 months.
Early Days courses are £60 and are also available at concessionary rates.
For more information and to book, contact Sarah Baker (email bookings3e@nct.org.uk or phone 0844 243 6946).
Whether motherhood turns out to be a breeze or a howling gale, NCT Early Days courses provide a space every week for you to come and talk about how you are doing in a supportive group environment.
We will explore the following topics over six weeks:
Redland courses are on Tuesday mornings 11am-1pm.
Yate courses are on Wednesday afternoons 3-5pm starting on 21st January.
These groups are for mums and babies from newborn to about 6 months.
Early Days courses are £60 and are also available at concessionary rates.
For more information and to book, contact Sarah Baker (email bookings3e@nct.org.uk or phone 0844 243 6946).