Hip and Knee Osteoarthritis Guideline for Nonsurgical Management
Hello, I'm Norman Swan. Welcome to this programon the new guidelines for the nonsurgical managementof hip and knee osteoarthritis. It's a timely program, as we're broadcastingduring Arthritis Awareness Week. Arthritis, as you know, is a major causeof disability and chronic pain. There's around 100 different formsof arthritis, and osteoarthritis is the most common.
This program is the thirdin a series of four on the musculoskeletal guidelines that have been developedby the Royal Australian College of GPs and approved by the NH and MRC. This program will cover the diagnosisof osteoarthritis and discuss recommendednonpharmacological and pharmacological interventions in a multidisciplinaryprimary healthcare setting.
As always,you'll find a number of resources available on the Rural Health EducationFoundation's website: Let's meet our panel. Geoff McColl is a rheumatologistand professor of Medical Education and Trainingat the University of Melbourne. Welcome, Geoff. Thank you, Norman. Geoff is the current president ofthe Australian Rheumatology Association and was part of the working partydeveloping this guideline.
Rana Hinman is a physiotherapistand senior lecturer in the University of Melbourne Schoolof Health Sciences. Welcome, Rana. Rana has particular expertisein evaluating conservative treatments for osteoarthritis, and was alsoa member of the working party. Michael Yellandis a general practitioner and associate professorof Primary Health Care at Griffith University in Queensland.Welcome, Michael. His teaching and research interestsfocus on evidencebased diagnosis
and the treatmentof musculoskeletal pain. And David Ng, who's a pharmacist and director of the South Australianand Northern Territory Branch of the Pharmaceutical Societyof Australia. Welcome, David. Thank you, Norman. From the home of fish oil. That's correct. We'll talk about fish oil later to see whether or not it'sthe magic panacea for osteoarthritis.
Many myths about osteoarthritis,Geoffreyé There are many myths, Norman. Probably the best place to start is that this is an illness that you acquireas you grow old that you can do nothing about. You're just going to creak your wayto the wall at the bottom of the garden. Absolutely. There's a certain acceptancethat this is the way it will be. NORMAN:Are you telling me it's reversibleé
How to Treat Osteoarthritis
My name is Troy Giles. I am a ofChiropractic and a Natural Internist. Today I want to talk to you a little bit about osteoarthritis,or degenerative arthritis. A picture of that on this slick is pretty cool. I am going toshow you this. This actually just sticks to the wall. See thaté That is really cool. Osteoarthritisis a degenerative arthritis, where the joint actually starts to decay, usually from trauma,or from overuse. Osteoarthritis is that of old age, if you will. However, it can startin the our younger ages as well. Trauma, in the form of football injuries, or slips andfalls, or car accidents, injure a usually healthy, normal cartilage. When that becomesinjured, then there are different inflammatory
states. Chemicals that are released withinour body that start to irritate and cause inflammation, trying to heal the area. Butgenerally speaking it creates weakness and overall degeneration, where this cartilagehere, starts to wear down and become like this, to where you have bone on bone and justwhere all that good cartilaginous tissue has been lost and irritated and degenerated. Soin the spine it looks similar to this. This is where the disc space is that holds thosevertebrae apart. It starts to degenerate. Over time the disc space diminishes and nowthe hole that used to be there, that used to be open, that would allow the nerve rootor part of the spine. Lets say this rod is
a spinal cord and it runs down the centerof the vertebrae. At various areas there are places where nerve roots actually exit thespine and go out and go to an organ. When this joint space here becomes diminished ordegenerated, the actual hole starts to diminish and now you are having inflammatory statesand inflamation and degeneration of the nerve root as well. So now you start to have organdisfunction. You start to have pain in the joints, down the legs and so forth. That isthe reason why people come in and see me generally. Chiropractically speaking it is because ofthe pain. Now on xray, of an actual person here, you can see that this space here, thisdark space, so this space here, this space
is diminished. You can see the front and youcan see the that there is a bone spur off the front, one here off the back as well.That is degeneration. More than likely, she was in a whiplash injury. In fact, she was.This area here became irritated. It became inflamed and started to degenerate. The veryexact same thing that has happened over her. Over time these will start to degenerate.The s and orthopedists around here in Bountiful have seen some amazing things aseither over use or traumatic. I would suggest always traumatic is what starts the inflammationand then the inflammation many times does not go away. Because of the amount of sugarsthat we eat, sugar is inflammatory and it
continues that process moving and degenerating.So the idea is to be able to stop that. We do that through chiropractic adjusting. Wedo that through the changing of the diet, taking specific nutrients that will help.I have just brought on a supplement here called Arthroben. Arthroben helps to give nutrientsand it is a powder that we give the patient, that they take every day that will actuallyhelp to repair and start to strengthen, shutting down the inflammation and giving specificnutrients to the joint capsule, to start to repair those joint surfaces, so they can becomestronger again. Same thing in the spine. We want to be able to do that. So we want toget a better position. Let me just take you
over here for a minute. I want to show youthis space. Each nerve root, I have explained this before, but each nerve root exits thevertebrae and runs down to an organ. So if we touch, for example, C7, you can see howthe energy passes down the arms. So many times patients come in and they say quot;Hey, I havegot numbness and tingling in my hands.quot; Well, we can do a nerve conduction velocity testto find out if these nerves are being affected anywhere down the vertebrae, or we can lookat it and see what is happening. Is there space between the vertebrae where these nerveroots are being irritated and shutting down the energyé What's more important to me isthe pain that the patient is having is not