Recently I have seen a lot of cases of hip osteoarthritis. Although osteopathy can be advantageous in the early stages, the late stage mainly involves osteopathic pain management until an orthopaedic intervention has begun.
The process.
The basics of osteoarthritis are the breakdown of bone cartilage, leading to a cascade of inflammation and deterioration.
The bone cartilage, called hyaline cartilage, is the most frictionless substance on earth. Therefore, it allows excellent gliding within the joint of articulating bones.
Typically, a fibrous capsule covers these joints with a layer of synovium, which keeps the fluid within the joint clean and healthy. The synovium has Type A cells that clean the debris within the synovial fluid and Type B cells that produce the components of the synovial fluid.
The fibrous capsule and synovium are rich in blood supply, nerves and lymphatic.
The synovial fluid and articular cartilage help lubricate the joint.
In osteoarthritis, there is a progressive loss of articular cartilage. As a result, the articular cartilage breaks down and reduces the joint space. In addition, friction starts to develop, which generates inflammation and triggers pain in the nerve supply of the synovium.
Maintaining the health of the cartilage is the chondrocyte's job. The chondrocytes are in a gelatin complex that contains type 2 collagen and proteoglycans (water absorbing). This gelatin complex provides cartilage elasticity and high tensile strength, allowing weight distribution throughout the joint and the underlying bone to absorb shock.
The chondrocyte's job is to balance cartilage breakdown by releasing degradative enzymes and producing cartilage by releasing synthetic enzymes.
In osteoarthritis, there is an increased production of the degradative enzyme.
What causes this increase in the degradative enzyme?
For this, we have to look at the risk factors:
Age - the cartilage is being broken down over time
Inflammation - by environmental changes or a lifestyle of poor diet and lack of exercise.
Joint injury - Clients with a history of injury, tear, and fractures are all predisposed to osteoarthritis. But, again, it could be related to inflammatory factors.
In a desk-based profession, abnormal mechanical stress - such as repetitive activity in an awkward position or chronic postural fatigue.
Neurological factors - where the joint cannot be mechanics are unstable and cause abnormal mechanical stress that can lead to inflammation.
Obesity - creating joints to be loaded beyond their capabilities.
And other mechanisms such as genetics and drugs.
Whatever the mechanism initiated the articular damage, the chondrocytes react by producing more type 2 collagen and proteoglycans. Unfortunately, the chondrocytes are not metabolic active (no blood supply), so they get tired and die over time.
When chondrocytes die, the articular cartilage loses there elasticity and begins to flake into the joint.
Type A cells in the synovium attempt to remove this flaking of the cartilage, which stimulates an immune response, which produces an inflammatory response.
As the osteoarthritis advances, cracks start to appear in the articular cartilage, and the synovial fluid enters the cracks, causing a further breakdown of articular cartilage - debris - inflammation.
A point reaches where there is no articular cartilage and is left with bone rubbing against bone.
When there is no or minimal cartilage, the joint tries stabilising itself by producing a bony outgrowth called osteophyte or spur. In advanced osteophyte formation, we can see visible deformity to the joint.
Care pathways.
For osteopathic management, an early stage is best, encouraging good fluid flow within the joint. Then, increasing the range of movement within the joint, working throughout the chain reaction of the body to reduce pressure on an affected joint. Finally, the management is through manual therapy and exercise.
In late-stage osteoarthritis, osteopathy can help pain management but may require medical and surgical intervention.