Can Chiropractors Help RA patients?
Yes, chiropractors can help by seeking to restore normal physiologic function (including immune system) and thereby help to improve the health of the individual [3]. Currently there is no effective cure (medical or complementary) for those suffering with RA however treatment may help relieve symptoms and slow the progression of the disease.
The Chiropractic Approach
Chiropractics are based on the premise that good health depends, in part, upon a normally functioning nervous system. The most delicate and important organs of the nervous system (brain and spinal cord) are encased in hard bony coverings composed of the skull and spinal vertebrae. Chiropractic health care primarily focuses on examining and evaluating the spine and pelvis to determine if any area of the spine is malfunctioning. If present these subluxations (malfunctions) may cause neurological irritation and compromise the bodies’ ability to adapt and function [3,4].
In relevance to a person suffering from rheumatoid arthritis; there is a close communication between the central nervous system and the immune system. Chiropractic seeks to optimize these interactions and traditionally have approached the spine and nervous system as key elements in maintaining overall health. Subluxations weaken your nervous system, stress the immune system, put the body in a weakened state and can set the stage for sicknesses and diseases of all kinds - rheumatoid arthritis included. Chiropractors attempt to remove these subluxations by way of an “adjustment”. An adjustment means the specific manipulation of vertebrae which have abnormal movement patterns or fail to function normally [6].
As a general rule, manipulation is avoided in joints in acute inflammation. This rule can be applied to rheumatoid arthritis in that joints that are acutely inflamed should not be manipulated. Since RA does not typically affect the sacroiliac, lumbar, or thoracic spine, manipulation can be utilized if indicated, in a non acute stage. However the cervical spine is susceptible to the same inflammatory changes as those in the arms and legs hence the cervical spine will only be adjusted if inactive RA exists [2].
Management Plan
The spinal adjustment is a predominant factor in providing chiropractic care for patients with rheumatoid arthritis. However it is not the only procedure employed in the course of care and case management. The chiropractic profession utilizes drugless therapeutics such as heat, cold, splints and exercises in the treatment of RA. Such procedures are also widely accepted in the medical field.
It is best if management of RA is approached according to the acute, subacute, and chronic (inactive) phases [2]. The goal is to provide pain relief, prevent and relieve joint contractures and to improve function.
Acute Phase – During this phase acutely inflamed rheumatoid joints need to be protected from overstretching. Inflamed soft tissue structures such as joint capsules, ligaments and tendons are vulnerable to tearing [2]. Hence the chiropractors aim would be to protect these structures by splinting the inflamed joints, which provides temporary local rest. Physical modalities such as heat and cold are also used to decrease pain and help restore function in joints. Exercises will also be prescribed to increase range of motion and strengthening of joints.
Subacute Phase – The chiropractor will suggest heat to be used prior to exercise to warm the joint and increase the extensibility of contracted soft tissues. The preferred timing for range of motion exercises is when stiffness has subsided later in the morning. The chiropractor will demonstrate various types of range of motion exercises and strengthening exercises relevant to the subacute phase. The strengthening exercises are important to restore and improve function or ability for the muscles to do work, not to build muscle size.
Chronic Phase (Inactive) – Range of motion and strengthening exercises prescribed by the chiropractor should be maintained. It is crucial that during the inactive phase that aerobic conditioning be maintained or improved. Home advice to utilize heat to warm the joints prior to exercise and ice can be used to control post exercise inflammation.
Guidance in Nutrition
Nutrition plays a vital role in the maintenance of a positive state of health and the prevention and treatment of disease. When a proper diet and nutrients are supplied to the tissues of the body, they exert powerful influences on body metabolism [3]. Dietary prevention may be possible in some individuals who appear to suffer food intolerance (allergy). Corn and wheat for example were found to possibly cause symptoms in patients with RA [1]. Dietary intervention as an adjunct to other management strategies may be useful in modifying the inflammatory response and to enhance the immune system. These include supplements such as vitamin C, copper and zinc [1]. Hence nutritional intervention in the management of RA becomes increasingly important. A chiropractor has had considerable training in nutrition and can help RA patients avoid any toxic effects of adverse interaction of improper consumption of nutritional substances.
Co-management
Chiropractors do not utilize drugs or surgery in their practices. However in the case of RA the chiropractor may recommend co-management with your medical practioner for drug intervention. Medical treatment for rheumatoid arthritis always begins with medication. In the past, pain relievers (such as nonsteroidal anti-inflammatory drugs) were often the first drugs used to treat symptoms of rheumatoid arthritis. However, other medications (disease-modifying antirheumatic drugs) that can actually slow or sometimes prevent joint destruction are now recommended early in the course of the disease. These disease-modifying antirheumatic drugs (DMARDs) can help prevent the significant joint damage that may occur in the early stages of rheumatoid arthritis [6,7].
In severe cases of rheumatoid arthritis, surgery may be considered when the joints are severely damaged, deformed, and causing extreme pain. Surgery may include total joint replacement or other techniques to improve joint function.
Last Words
Rheumatoid arthritis sufferers have a malfunctioning immune system, Chiropractic care seeks to restore normal physiological function and thereby help to improve the health of the individual. This is done by adjusting Subluxations that may weaken your nervous system, stress the immune system, put the body in a weakened state and can set the stage for sicknesses and diseases of all kinds - rheumatoid arthritis included. Or may consist of counseling the patient in areas such as nutrition, proper exercise and diet, lifestyle and general health matter. Co-management with your medical practioner should be sought for options in drugs or surgery. Chiropractic care therefore attempts to provide a “holistic” (total person) concept of health care without neglecting the RA patient of other forms of treatment.
Time for a Drink!
Ahhh…
Reference
- Jaminson Jennifer R, Dietary Intervention In Rheumatoid Arthritis, The journal of CAA, Vol 31 No.3, September 1987; 141-145.
- Bougie Jacqueline D, Rheumatoid Arthritis: Early Diagnosis And Management, Chiropractic Technique, 1993; 140-145
- Sportelli Louis, D.C, A Natural Method Of Health Care, Palmerton, 2000; 5-9.
- Gatterman Meridel I, Chiropractic Management Of Spine Related Disorders, Williams and Wilkins, 1990; 61-62.
- Rheumatoid Arthritis (RA), 2002, Arthritis Foundation.
[Accessed 19 September 2002]
- Arthritis & "Rheumatism", 2002, Dr. Mark A. Najjar, D.C. - Hazlet, NJ.
[Accessed 19 September 2002]
- Rheumatoid Arthritis, 1995-2002, Healthwise, Incorporated.
[Accessed 19 September 2002]
