Carl Pelletier

Osteopathy

Affected population and risk factors
Coxarthrosis affects both men and women and its prevalence increases with age, with a more feminine recrudescence after 55 years of age.

xx
It affects more than 45% of the Canadian population aged 65 and over (2) and, according to Health Canada, the majority of the population before the age of 70. In Canada, the average age at diagnosis is 50.4 years (3). Because of its high incidence, it is a major medical concern with high social and economic costs.

Despite being the second most disabling disease (4), there is no cure for OA, but it can be prevented and its consequences limited.

The risk factors are age, gender and hormonal factors (osteoarthritis being more frequent in women and also often more severe), overweight, sedentary lifestyle, heredity, injuries and complications secondary to other pathologies, such as diabetes (5-6). Coxarthrosis frequently develops in cases of overweight leading to increased stress on the joint, or repeated micro-trauma in occupational or sports activities. Inadequate postural adaptations may also increase the risk.

Mechanisms
The causes of coxarthrosis are still unknown, but the process of installation is explained by the simultaneous damage of 3 tissues, i.e., the progressive deterioration of the cartilage, the inflammation of the synovium and the thickening of the bone (7). Although it is recognized as a non-inflammatory disease, some research shows the presence of inflammatory blood markers without other signs of inflammation (8).

Symptoms
Coxarthrosis may remain asymptomatic for a long time. Its characteristic symptoms are pain and joint stiffness that can lead to decreased physical function, especially walking ability. Clinically, there is crackling, joint limitation or locking, pain on mobilization and palpation, the appearance of bony prominences, and loss of joint alignment to joint deformity. Internal rotation of the hip is often the most limited and painful parameter (9).

Diagnosis
The diagnosis is made radiologically, by X-ray or MRI, after clinical evaluation. The severity of the pathology is graded into four stages, indicating its degree of progression (10). There is often a clear dichotomy between the intensity of the reported pain and the radiological stage. For example, some people with stage 4 coxarthrosis have few symptoms, while others with stage 1 have severe and disabling pain.

Treatment
Treatment for hip OA includes manual therapies, pharmacological approaches and surgical approaches. The traditional approaches consist of prescribing analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) in the first instance, corticosteroid infiltration under scopy in the second instance, and in some cases in the very advanced stages, hip replacement surgery is proposed.

xx
Despite the prevalence of coxarthrosis, few clinical studies have been carried out to date in manual therapies.

xx
However, recent studies have shown encouraging clinical results in reducing pain and increasing physical capacity. The techniques used vary and include the use of thrust, mobilizations, joint pumping, tissue tensioning, massage, lymphatic treatment and cranial work. All studies and guidelines less than ten years old suggest the addition of home exercises to accompany therapy.

Osteoarthritis and osteopathy
Osteopathy cannot make osteoarthritis disappear, but it can contribute to slowing down its evolution and reducing pain. Based on the body's ability to self-regulate when in balance, the osteopath will work to maintain hip mobility by eliminating restrictions and areas of excessive pressure on the joint, to maximize vascular and nerve supply and tissue flexibility to the entire area (11, 13). This is accomplished by treating not only the hip, but also the body as a whole, ensuring adequate vitality, absence of facial or musculoskeletal restrictions, and proper postural balance.

 

Osteoarthritis and osteopathy
Osteopathy cannot make osteoarthritis disappear, but it can contribute to slow down its evolution and to reduce the pain. Based on the body's ability to self-regulate when in balance, the osteopath will work to maintain hip mobility by eliminating restrictions and areas of excessive pressure on the joint, to maximize vascular and nerve supply and tissue flexibility to the entire area (11, 13). This is accomplished by treating not only the hip, but also the body as a whole, ensuring adequate vitality, absence of facial or musculoskeletal restrictions, and proper postural balance.

Based on one of the founding principles of osteopathy that good blood supply and drainage are fundamental to healing, the osteopath may also provide treatment with a specific lymphatic focus (12) or, as Jardine et al. (2012), balance diaphragmatic and abdominopelvic tensions with the goal of decreasing superficial resistance of the femoral artery, in order to increase vascular supply to the lower extremity to improve its physiology and mobility (13).

xx
The more balance and joint mobility are preserved, the more the effects of osteoarthritis will be slowed down, which is why prompt management is crucial.

Carl Pelletier, Osteopath in NDG
xx
Sources

(1) Jotanovic, Mihelic, Gulan, Sestan and Dembic, 2015. (2) MacDonald, Sanmartin, Langlois, and Marshall, 2014. (3) MacDonald et al. 2014. (4) Janani, Nassar, Rachidi, and Mkinsi 2013. (5) Health Canada, 2008. (6) Jotanovic et al. 2015. (7) Janani et al. 2013. (8) Jotanovic et al., 2015. (9) Jotanovic et al., 2015. (10) Jotanovic et al., 2015. (11) Williams, 2008. (12) Gagné, 2016. (13) Jardine et al., 2012.