Date of Award

8-1-2000

Degree Type

Restricted Access Professional Report

Degree Name

Master of Public Health

Field of Study

Clinical Research and Education: Osteopathic Manipulative Medicine

Department

School of Public Health

Abstract

Osteoarthritis (OA) is the most prevalent form of arthritis in the United States. Of those 65 to 74 years old, 18 per 100 women and 8 out of 100 men will experience OA of the knee. (Towheed and Hochberg, 1997) The Center for Disease Control and Prevention (CDC) reported a high prevalence for disability for person > 65 years. Arthritis or rheumatism accounts for 7.2 million (17.1%) people ranking above back problems and heart disease. (CDC, 1994) The Framingham epidemiologic study of knee osteoarthritis estimated a 27% prevalence for those 44% of those >80 years. Nelson, Naimark, Anderson, Kazis, Castell & Meenan, 1987) This study uses the principles of Osteopathy to treat OA for the elderly as osteopathic manipulative treatment (OMT) specifically addresses the symptoms and signs of OA. The typical symptom of OA is pain stiffness “in and around a joint accompanied by limitation of function.” (Klippel, 1997) Pain from OA may originate from “periostitis at sites of bony remodeling; subchondral microfractures; irritation of sensory nerve endings in the synovium from osteophytes; periarticular muscle spasm; bony angina due to decreased blood flow and/or elevated intraosseous pressure; and synovial inflammation accompanied by release of prostaglandins, leukotrienes, and other cytokine.” (Klippel, 1997) Other symptoms include morning stiffness, gel phenomenon, buckling/instability. The signs of OA are bony enlargements, limitation of range of motion, crepitus, tenderness on pressure, pain, join effusion, malalignment and/or joint deformity. (Hazzard, 1999) Most often, pain and limitation of movement from OA cause signficiant changes in lifestyle for the older adult; functional independence is adversely affected. Decreased functional independence that affects the quality of life makes this the most debilitating illness in the 65 and older population. Studies have shown that patients with osteoarthritis of the hip and knee have comparable number of days with restricted activity as patients rheumatoid arthritis. (Towheed, 1997; Holman & Lorig, 1997). Treatment goals for managing osteoarthritic patients is to control pain subsequently minimizing functional limitation and disability. (Hazzard, 1999) To treat the above dysfunction, current treatments for OA include pharmacologic agents such as NSAIDs, analgesics, intra-articular steroid injections, topical analgesics; glucosamine sulfate and hyaluronic acid; nonpharmacologic measures include weight reduction, therapeutic ultrasound, acupuncture, transcutaneous electrical nerve simulation (TENS), physical therapy, pulsed electrical stimulation, orthotics, hydrotherapy, self management courses, and support groups. (Womheim, 1996; Zizic, 1995; Creamer, 1997; & McNoll, 199*) The primary objective of pharmacologic treatments is to decrease pain resulting in an increased functional capacity and improved quality of life. There are side effects and limitations to pharmacologic regimens. For example, the usage of NSAIDs in the treatment of the elderly can result in gastrointestinal bleeding. (McNoll, 1998) Non-pharmacologic treatments are viable alternatives in treating osteoarthritis; osteopathic manipulative treatment is such an alternative. A primary osteopathic principle dictates that structure and function are reciprocally inter-related. Any change from the “normal” is called somatic dysfunction. Specifically, somatic dysfunction is the altered or impaired function of related components of the somatic (body framework) system-skeletal, arthrodial, and myofascial structures and related vascular, lymphatic, and neural elements. (Greenman, 1989) OMT is used to return the body to its normal state by increasing symmetry and motion thereby improving body balance and reducing inflammation and pain by increasing fluid flow. When considering the physiological causes for OA of the knee coupled with the side effects from pharmacological treatment, health care providers must consider alternative treatments. The principles of osteopathy provide a logical spring board to meet that challenge. This present study provides a preliminary understanding of the efficacy of OMT for OA of the knee.

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