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Seeking Alternatives for Arthritis Sufferers
Life Span--Chasing the Pain Away

By Karrie Osborn

Originally published in Massage Bodywork magazine, June/July 2005.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.


Arthritis is an insidious disease, eating its way into the joints of nearly 70 million Americans, or nearly one out of every three U.S. adults. It is considered one of our most prevalent chronic health problems, costing the economy more than $124 billion in healthcare and lost wages each year.1 One of the more unnerving aspects of this disease is the fact its prevalence has nearly doubled in the past two decades,2 adding 23 million more to its "hit list" in the past seven years alone.

Attacking men, women, and even children, arthritis can worsen with a coming storm, a less-than-healthy diet, and advancing age. The pain associated with this disease can be brutal, sometimes turning a healthy hand into a deformed, unrecognizable extremity.

Did You Know?
Even though many of us have one vision of what arthritis is, there are actually more than 100 different forms of the disease, each presenting with their own particular symptoms. While osteoarthritis and rheumatoid arthritis are the most widely recognized, here are just a few of the others:
- Bursitis
- Carpal Tunnel Syndrome
- Fibromyalgia
- Flat Feet
- Lyme Disease
- Rheumatic Fever
- Scleroderma
- Tennis Elbow
Unfortunately, one-third of us are destined to experience this disease, at least to some degree, as we move into our "golden years." While many have relied inherently on pharmaceuticals to ease arthritis pains, others have sought out more natural approaches to treat the disease.

From massage and yoga to diet and positive thinking, there are a host of therapies not traditionally associated with arthritis that can offer both temporary and lasting relief. It's important to understand how bodywork can help treat the disease and provide comfort, relief, and options to the pain-ridden client.


The 411 on Arthritis
Inflammation of the joints, stiffness, and pain are the most common symptoms of arthritis. And it's more than just one disease -- there are at least 100 variations of arthritis claiming new sufferers every day. Osteoarthritis, rheumatoid arthritis, gout, and even fibromyalgia are just a few of the arthritis heavy hitters.

Osteoarthritis is the most common type of arthritis, often associated with wear and tear on the body. This disease is degenerative and caused by the deterioration of joint cartilage, resulting in pain, swelling, and loss of movement. Repetitive stress injuries and excess body weight are considered two of the avoidable causes of osteoarthritis.

Rheumatoid arthritis (also known as rheumatism or synovitis) is an autoimmune disease affecting 1 percent of adults worldwide.3 "In rheumatoid arthritis, the immune system attacks the tissue that lines and cushions joints," says Ray Sahelian, M.D., an internationally-known specialist from Marina Del Rey, Calif. "Eventually the cartilage, bone, and ligaments of the joint erode, causing scars to form within the joint."4 But it doesn't stop at just the joints. Rheumatoid arthritis can affect the entire body, including internal organs. Women develop the disease two to three times more frequently than men, and it often first appears between the ages of 25 and 50.5

For years, those living with arthritis have sought out pharmaceutical help in dealing with the pain and inflammation. But relief from these drugs can come at a high price. Stomach irritation, peptic ulcers, and increased bleeding are just a few of the side effects of using non-steroidal anti-inflammatory medications (NSAIDS), the most common pharmaceuticals prescribed for arthritis. Despite an off-again/on-again directive reported in the news for some of the more popular drugs, recent research paints a grim picture. According to The New England Journal of Medicine, at least 16,500 deaths are caused each year by the use of NSAIDS prescribed for arthritis pain relief.6

This might be "the" motivating factor when arthritis sufferers begin seeking out better disease management solutions.


Massage for Relief
Most arthritis sufferers may not think of massage when they start to explore which complementary therapies might ease their pain. Yet, while it is doubtful an arthritic joint can "heal" completely with massage, it can feel better. And for an arthritis sufferer, "better" is a welcome word, particularly when there are no side effects involved.

According to the Arthritis Foundation, more and more doctors are recommending massage to their arthritis patients to help relieve pain and stiffness.7 With more physicians becoming massage allies, those stricken with the disease may be more accepting of touch therapies.

Like many other chronic pain clients, arthritis sufferers may initially be apprehensive of touch. The last thing they want is to feel more pain or risk greater inflammation. That's why it's so important to fully understand arthritis clients and their conditions before beginning the work. And when you do get started, work slowly, gently, and with the utmost patience. Similar to many of your existing clients, those with arthritis need to feel a sense of trust before they're fully relaxed under your touch. Even then, the work will be challenging.

Massage therapist Chris Barrett from Weymouth, Nova Scotia, sees a lot of repetitive stress conditions in the work he does with clamdiggers and fishermen. When cases of osteoarthritis appear, he tells his clients he can't make it go away, but he can help nearby muscles relax, thereby reducing the pain.

When arthritis causes cartilage to deteriorate, Barrett says the surrounding muscles can become tight and act as a splint, thereby helping the joint function. Increasing circulation in and around the joint "increases the delivery of oxygen and nutrients, including amino acids, to rebuild tissue, as well as the removal of waste products," he says. "Passive range of motion can also help educate the body insofar as the laying down of new tissue."

From gentle stretching to vibration to friction, there are several ways to work with this type of client. However, a general caution is to avoid working directly on an actively inflamed joint.

Says Barrett, "Many of my clients who suffer from arthritis find that regular massage, which might be weekly for some and monthly for others, brings relief that lasts longer than medication and is less harmful to the body overall."

The research surrounding massage and arthritis is still sparse, but the call for more inquiry is out. In 2004, Biotone pledged $50,000 to the Touch Research Institute at the University of Miami School of Medicine to support research on the benefits of massage for the pain and disability of arthritis. This study will focus on arthritis of the hands and will examine how massage can reduce joint tenderness and improve joint mobility, grip strength, and functional ability.8

And while there still are naysayers who don't necessarily advocate massage as a treatment for arthritis, their parallel call for stress reduction makes massage therapy an obvious candidate for arthritis sufferers. "If you suffer from arthritis, you need to be especially aware of stress, since it can make it harder to manage your symptoms,"9 write the editors at Allaboutarthritis.com.


TCM, Acupuncture, and Acupressure
In the world of Traditional Chinese Medicine (TCM), arthritis is seen as a "weakness of Qi and Blood, the deficiency of Liver and Kidney essence, and the invasion of wind-cold-damp."10 Huifang Zhao, with the Samra University of Oriental Medicine in Los Angeles, says arthritis generates pathogenic heat in the joints, blocks the circulation of Qi, and creates an imbalance of Yin and Yang.11

The protocol when working from the TCM paradigm is to first determine which type of arthritis the client has. These are broken down into four categories.12 The first is Xing Bi, a "migratory" arthritis where pain moves around the body. It is caused by wind, dampness, and cold obstructing the Qi. Tong Bi is "painful" arthritis that stays in place at one or two joints and is caused by excessive cold. Zuo Bi is "fixed" arthritis identified by dampness and internal stagnation. It becomes worse on stormy days. And finally there is Re Bi, an arthritis caused by preexisting problems converted into heat. It produces swelling, tenderness, and sharp pain.13

As an adjunct element to TCM, acupuncture has become one of the most studied complementary therapies for addressing arthritis. Its goal for this disease, according to experts at Northwestern Health Sciences University, is to "stimulate, disperse, and balance the flow of energy."14

A recent study published in the Annals of Internal Medicine found that patients with arthritis of the knee had less pain and better function after receiving 23 sessions of acupuncture over a six-month period.15

For massage therapists and bodyworkers who practice acupressure, this, too, can bring relief for clients who present with arthritis. The recommended acupressure point for relieving arthritic pain in the hand, wrist, elbow, shoulder, and neck is Li 4 (although pregnant women should avoid this point because it can stimulate uterine contractions). Additional points for restoring the body's flow of Qi include Gb 41 and Gb 34.16

"Acupuncture and Oriental medicine may also provide a means of avoiding the unsettling side effects often associated with long-term use of prescription drugs," says Mark McKenzie, dean of the Northwestern Health Sciences University's Minnesota College of Acupuncture and Oriental Medicine. "Traditional Chinese medicine offers time-tested treatments that not only relieve pain, but also provide a natural approach to healthcare."17


Gentle Exercise
Not long ago experts warned arthritis sufferers to avoid exercise as it could put further stress on their already damaged weight-bearing joints. Thankfully, that recommendation has been discarded, but its ghost still lingers in the minds of some affected by the disease.

It is an unfortunate paradox for arthritis sufferers that while exercise is a valid component in their treatment, typical programs can be too painful to undertake. Forms of gentle exercise, such as tai chi, qigong, and yoga, can help jump-start the process, laying the groundwork for more strenuous exercise down the road. The goal here is to simply get the body moving, because for those stricken with arthritis, the cliche is especially true -- use it or lose it.

Tai chi, long known for its gentle movements and long-standing appreciation in the East, is considered an excellent way to get the arthritic body moving again. Experts recommend it, along with qigong, as a solid, physically therapeutic foundation. In a 2004 study, researchers confirmed that the gentle movement of tai chi does not aggravate the symptoms of rheumatoid arthritis and, instead, can increase range of motion for these sufferers, especially in the lower extremities.18

Yoga is another option when it comes to moving the body and keeping the joints alive. A small 1994 study published in the Journal of Rheumatology found that after a 10-week program, yoga participants had decreased their pain and tenderness and improved their range of motion.19 And, like tai chi, yoga can offer psychological benefits as it facilitates mindfulness, promotes relaxation, and opens breathing.

Another simple exercise option for arthritis patients is walking, especially water-walking in a warm pool where they receive the multiple benefits of resistance, buoyancy, and warmth.

Progressive Relaxation for Arthritis
When it comes to managing arthritic pain, releasing tension is key. Try the following simple body awareness exercise for your own therapeutic needs, and then teach it to your clients for theirs.
"Lie on your back in a quiet place. Concentrate on how your body feels, beginning with your toes. If you find any tension, try to let it go. Gradually move your focus up the length of your body, releasing tension as you go."
-- from Allaboutarthritis.com

And All the Rest
With the painful presence of arthritis ever-expanding, many have chimed in on what can be done to alleviate the disease. From foods that help keep symptoms at bay to invoking the mind as a healer, there are many tools that have benefitted some arthritis sufferers -- even though the methods may not be scientifically proven. Here are just a few:

Diet -- We know there are certain foods that affect us more negatively than others, so it's not difficult to imagine some of those same foods tipping the balance of the arthritic pain scale. Studies are starting to prove the same and even suggesting that certain lifelong dietary habits may actually reduce the risk of developing arthritis altogether.

Dr. Sahelian says diet can play a large role in pain management. Inflammation, he says, can be curbed to some degree by eating a diet rich in cold water fish and consuming red meat sparingly.20 Other recommendations to reduce inflammation include drinking green tea extract,21 having a daily dose of sour cherries,22 and enjoying a fresh papaya.23

The Arthritis Foundation says that while there isn't a magic diet for arthritis sufferers, there are certain nutritional aspects that can affect the disease. One is maintaining a diet low in saturated fats and/or vegetable oils, as they can increase the inflammatory response. Another is to be aware of any food sensitivities that can trigger symptoms or worsen existing ones.

Recent studies suggest that overall diet may play a role in whether or not a person will develop arthritis. In southern Mediterranean countries, such as Greece and Italy, where people's diets are rich in fish, fruits, vegetables, and olive oil, the incidence of rheumatoid arthritis is less severe.24 But scientists warn more research is needed to determine if the link is valid. For those who've already found pain relief by eliminating dairy and/or wheat products, cutting back on the fat, or taking refined sugars and processed foods out of their diets altogether, they already know there is a strong partnership between diet and arthritis.

Water -- According to Fereydoon Batmanghelidj, author of Your Body's Many Cries for Water, when we become dehydrated, proteins and enzymes in the body don't work as effectively as they should. "Rheumatoid joint pain is a direct signal of local water deficiency of the body,"25 he says.

Even though the debate over water intake guidelines for the general population continues, some experts say waiting for a thirst signal before drinking water is a mistake; by then, the body has already suffered at a cellular level. It's this concern that prompts experts to advise drinking at least eight 8-ounce glasses of water each day.

Positive Thinking -- Negativity is a powerful factor in health and well-being. People who are unhappy with their lot in life are often physically miserable as well. Information surrounding the mind-body-spirit triad has shown the powerful healer we all have within us. Arthritis sufferers can benefit from this tremendously as they often feel defeated by their pain and weakening mobility. Accepting the situation arthritis has presented, and being proactive in a positive course of action, can empower those dealing with arthritis and put them back in charge of their health.

Pain Management -- According to the editors at Allaboutarthritis.com, there are several avenues to take when it comes to finding a personally viable way of handling the pain. In the same vein as positive thinking, distraction or redirection of thoughts is one way to ease the mind out from under the fog of pain. Since our brains like to focus on one thing at a time, they say, redirecting thoughts and/or actual activity to something we enjoy can provide some relief.

Mindfulness, meditation, and imagery are other ways of "distracting" the brain from the incessant pain.

As the next wave of baby boomers find themselves subject to the painful jaws of arthritis, and as more research directs a focus on arthritis treatments outside of the pharmaceutical realm, we are sure to find better answers to the debilitating effects of arthritis. Until then, listen carefully and patiently to your clients and find ways to help them take charge of their symptoms.


Karrie Osborn is contributing editor to Massage Bodywork magazine.


References
1 The Facts about Arthritis. Arthritis Foundation. Available at www.arthritis.org/resources. Accessed February 2005.
2 Ibid.
3 Sahelian, R. Rheumatoid Arthritis. Available at www.raysahe lian.com/rheumatoidarthritis.html. Accessed February 2005.
4 Ibid.
5 Ibid.
6 Wolfe, MM., et al. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs.The New England Journal of Medicine. 1999; 340 (24): 1888-1899.
7 Alternative Therapies. Arthritis Foundation. Available at www.arthritis.org/conditions/alttherapies/common_therapies.asp. Accessed February 2005.
8 Biotone Pledges $50,000 to Support Touch Research Institute Arthritis Study. Aug. 12, 2004 press release.
9 Stress and Arthritis Pain. Available at www.allaboutarthritis .com/AllAboutArthritis/layoutTemplates/html/en/contentdisplay/ document/condition/arthritis/generalArticle/arthritis_pain_stress.htm. Accessed February 2005.
10 Zhao, H. The clinical and experimental research of rheumatoid arthritis treated with Chinese medicine. Samra University of Oriental Medicine. Available at www.samra.edu/ medicine/med3.html. Accessed February 2005.
11 Ibid.
12 Types of Arthritis from Oriental Medicine Perspective. Available at www.holistic-online.com/Remedies/Arthritis/arth_
oriental_medicine.htm
. Accessed February 2005.
13 Ibid.
14 Oriental Medicine May Ease Pain of Arthritis, press release from Northwestern Health Sciences University. Available at www.nwhealth.edu/nwtoday/healthnews /arthritis.html. Accessed February 2005.
15 Berman, B., et al. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee. Annals of Internal Medicine. 2004 Dec; (141) 12: 901-910.
16 Available at www.holistic-online.com/Remedies/Arthritis/ arth_RA_acupressure.htm. Accessed February 2005.
17 Northwestern Health Sciences University. Available at www.nwhealth.edu/nwtoday/healthnews/arthritis.html. Accessed February 2005.
18 Tai Chi for Treating Rheumatoid Arthritis. Cochrane Database Syst Rev. 2004; (3):CD004849.
19 Haslock, I., et al. Measuring the Effects of Yoga in Rheumatoid Arthritis. British Journal of Rheumatology. 1994; 33: 787-788.
20 Sahelian, R. Rheumatoid Arthritis. Available at www.raysahe lian.com/rheumatoidarthritis.html. Accessed February 2005.
21 Ibid.
22 Drinking Tart Cherry Juice: Does it really help arthritis pain? Available at www.allaboutarthritis.com/AllAboutArthritis/layout Templates/html/en/contentdisplay/document/condition/arthritis/
clinicalNews/tart_cherry_juice.htm
. Accessed February 2005.
23 Martin, R and Romano, K. Preventing and Reversing Arthritis Naturally. Healing Arts Press, (Rochester), 2000, 81.
24 Does diet have a role in the etiology of rheumatoid arthritis? Proc Nutr Soc. 2004 Feb;63(1):137-43.
25 Batmanghelidj, F. How to Deal with Back Pain and Rheumatoid Joint Pain, Global Health Solutions (Falls Church, Va.) 1991, 52.






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