Dr. Gary Barone

The Lesser-Known Benefit of the Adjustment

Of all the reasons to visit a chiropractor regularly, one of the most compelling is to prevent osteoarthritis in the spinal joints. Unfortunately for the public, it is not well-known that chiropractic care can play a significant role in preventing this debilitating degeneration of the joints. In this article, I will discuss how osteoarthritis forms, how it differs from systemic arthritis like rheumatoid arthritis, and why chiropractic is essential to prevent osteoarthritis even if you stretch, exercise and take supplements.

How does osteoarthritis form?

Joints are very complex structures. There are a few different types of joints, but today, I will discuss synovial joints. They occur between two bones and have a smooth cartilage layer enclosed in a fluid-filled capsule. Your fingers each have three synovial joints, while your thumb has two. Your hip joint is also an example of a large synovial joint.

How many synovial joints are in the spine?

There are approximately 92 synovial joints along the spine. Two vertebral facet joints between each pair of 24 vertebrae constitute 48 synovial joints, and there are two costal facet joints at 20 of the 24 ribs (T1-10) and one on each side of two vertebrae (T11-12), for a total of 92.

Synovial fluid is more than a lubricant. It acts as a delivery system for nutrients to cartilage. Unlike muscle and bone, which use blood vessels to deliver nutrients, smooth cartilage has no blood vessels and relies on the movement of synovial fluid. Nutrients enter the synovial fluid via the synovial membrane (lining).

When joints stop moving, the flow of the synovial fluid stagnates, and the joint begins to degenerate. Thus begins the slow process of degeneration. This process of degeneration is well documented, with research extending over forty years.

What happens during degeneration?

After only 30 days of not moving, articular cartilage begins to become irregular on a microscopic level. In addition, the joint capsule becomes infiltrated by thick collagen fibres. These fibres become the framework for the gradual deposit of calcium, a process called ossification. Over the years, these ossifications or osteophytes will eventually bridge the joint’s gap until the joint fuses and the joint dries up completely. This photo shows models of progressing stages of degeneration in the spine.

Can you feel this happening?

No. If a joint is stiff for 30 days, collagen fibres thicken in the capsule, and cartilage degenerates. You can’t feel this initial stage of arthritis. Once it has progressed for several years, it is typical to start to feel stiffness in the morning that subsides with movement. Over time, the symptoms become more severe and constant. However, a skilled chiropractor can detect the early signs of joint restriction using palpation and instruments.

How can you prevent osteoarthritis?

Chiropractors are optimally skilled at checking the movement, alignment, and texture of joints and muscles and restoring them to normal. They can find joints vulnerable to degeneration before they develop osteoarthritis. Once a joint is moving, nutrients can flow in the synovial fluid. It is still possible to get osteoarthritis due to insufficient availability of nutrients in the body or from sudden injury. Still, you need movement to keep joints healthy; regular adjustments are essential.

Can you reverse osteoarthritis?

Soft tissues can heal, but once osteophytes form and the bone changes shape, it is not reversible. The good news is that it may be possible to prevent osteoarthritis from worsening in the affected joints, and we can also help maintain good health in the other joints of the spine.

Can stretching and exercise prevent osteoarthritis?

Stretching or exercising does not work in your spine because you can compensate by moving the joints around the stiff joint. Although stretching and exercise are essential, they will only prevent arthritis in those moving joints, leaving the stiff joints vulnerable to degeneration.

Can I adjust my own spine?

Absolutely not! Although it is easy to make cracking noises, that does not mean you have made a proper adjustment. Even a chiropractor can’t adjust his own spine.

Chiropractors spend seven years in school learning the anatomy, biomechanics, and skills needed to perform spinal adjustments. Adjusting the spine is a complex skill that only another chiropractor can perform.

Attempting to adjust your own spine would result in continued degeneration, instability, and possible significant injury. The same goes for having an unskilled person attempt to adjust you.

Similarly, it would be dangerous if an untrained person attempted to use a scalpel to perform surgery. It would not have the benefits of surgery because the scalpel and blood do not heal the patient; the surgeon uses his or her skill to do so.

Likewise, the chiropractor’s expertise, not the cracking noise, heals the patient. Sorry to gross you out with that analogy.

Do other professionals prevent osteoarthritis?

To prevent osteoarthritis, you must check all the spinal joints at least once a month. However, most practitioners, such as physiotherapists and osteopaths, do not typically desire to do this. Even some chiropractors have given up trying to educate patients about preventive wellness care, fearing pushback from skeptical patients.

From a business perspective, all practitioners, including chiropractors, can still live well off patients who visit only when they are in pain. They are, after all, the clear majority. Conversely, from an ethical perspective, chiropractors at least should make some effort to educate people about preventing problems from occurring.

Imagine if your dentist didn’t tell you that periodic cleanings prevent cavities and tooth decay. You would suffer, and they would continue profiting from your crowns, fillings, and root canals. I am grateful for the dental industry’s efforts to educate the public about this preventive strategy and wish for the same level of education about chiropractic care for preventing osteoarthritis.

Invisible Benefits of Wellness Care

There are also benefits to the chiropractor for preventive care, which affect the cost to the patient. Preventive care is typically much easier and more enjoyable than acute care. Acute care visits are usually longer and require more physical and mental work. I spend much more time explaining issues, managing patient emotions, conversing with other doctors, and sometimes dealing with ICBC and WCB during acute care visits. Wellness care is much more relaxing and positive for the doctor and the patients.

Acute care visits raise the overall cost of care for everybody, while preventive care lowers the overall cost per office visit. Indeed, if we lived in a predominantly wellness-oriented culture, visit fees would be drastically lower.

Although it is an honour to help you when you are in pain, I much prefer to see you healthy, help you reach perfect spinal health and prevent future problems.

About Rheumatoid Arthritis

This is a common question among patients that I often forget to mention. It is such a different problem that it borders on changing the subject altogether. However, since it is in many of your minds, it is necessary to explain it briefly.

Rheumatoid arthritis is a systemic problem with the immune system that causes the degeneration of virtually all joints simultaneously. Conversely, osteoarthritis only occurs in one damaged area because of a movement problem. Because of this difference, they have different rationales for care.

Patients with rheumatoid arthritis can still visit the chiropractor. The visits are modified based on your condition and may still help by maintaining normal movement and reducing overall stress, which may reduce the likelihood of flare-ups. Assisting a patient with RA is drastically different and could be the topic of another article.

Supplements for Osteoarthritis

Supplements such as glucosamine sulphate have been shown to regenerate cartilage. They enter the synovial fluid via the bloodstream. Once in the synovial fluid, joint movement is essential for cartilage to receive the nutrients from the supplement.

Conversely, even when all your joints are moving, a nutritional deficiency can contribute to the erosion of your bones and cartilage. Similarly, problems can occur if you don’t get enough exercise to stimulate your joints and muscles.

So you can see that stretching, exercise, and supplements are important but do not preclude the necessity of checking and maintaining normal movement in every joint of the body with regular chiropractic visits.

How often should I visit the chiropractor?

Research has shown that degeneration begins after one month of reduced joint movement. For this reason, chiropractors generally recommend visiting at least once per month. However, this is a minimum, and most patients who are proactive about their health will visit more frequently if they are financially capable.

Research has shown that patients who visit every two weeks will see a gradual improvement of mild symptoms over the course of a year.

More severe problems will improve much more quickly if you visit a chiropractor two or three times per week, a typical recommendation in the initial stages of care.

How often do chiropractors check their families?

Chiropractors recommend monthly wellness care to patients but typically check their children, husbands, and wives at least once weekly. Chiropractors can detect issues before they become painful. They understand the profound effect they can have on the quality of their family’s life and will at least intend to check their family as much as possible.

Most chiropractors will happily recount the story of holding their baby for the first time and immediately checking their upper cervical spine while the baby is only seconds old. Chiropractors know that the birth process can be stressful for the baby.

Understand that cost is not a factor for chiropractors, and the cost/benefit ratio for weekly family care may not be as beneficial for a paying patient. The point is, however, that in a perfect world, your family would benefit from weekly care. Discuss with your chiropractor what care suits your family members best.

How often do athletes get checked?

Professional sports teams often have a chiropractor on staff. Players can visit their chiropractor weekly to enhance their body’s function or more frequently if they have a specific issue.

Many athletes have visited me weekly in the off-season or hired their own chiropractors for themselves and their families. Most athletes recognize that if they can prevent problems and extend their career by one or two years, this will be a significant return on their investment both financially and in quality of life.

How often should children be checked?

Children have problems, too. 30% of children get back pain every year. The use of devices has increased the likelihood of osteoarthritis in children. I have seen one case of osteoarthritis in a child that was 11 years old. In short, monthly care is still advisable for infants and children.

Eighty percent of babies are born with significant problems in the spine or skull that cranial chiropractic can correct. Furthermore, it is important to monitor for changes in developmental milestones such as lifting the head, rolling over, sitting up, crawling, and walking. Needs change as toddlers begin to play sports and sit at desks at school.

In short, the same rules apply to kids as adults. Chiropractors recommend monthly care for children.

Does it cost more to prevent osteoarthritis?

Chiropractic care is safe, regulated, and is one of the most affordable types of health care, even when patients have to pay out-of-pocket. The Manga Report, a famous study from Ontario in the 1990s, indicated that the provincial health care program would save billions if it fully covered chiropractic.

Some metrics classify back pain as the most costly problem in Canada and the United States. It results in billions of dollars in lost revenue and is one of the leading causes of opiate addiction. The mismanagement of back care results in billions of dollars spent unnecessarily and millions of people suffering unnecessarily.

Individuals who visit chiropractors regularly take 85% fewer medications, spend 40% less on health care overall, and have a better quality of life.

So let me ask you this: Are you so rich that you can afford the luxury of not preventing a problem that could result in suffering, unnecessary surgery, added expense, drug addiction and lost work?

The most valuable thing you can do for yourself and your children is commit to visiting a chiropractor at least once per month. It will be a shift that helps you and your family live a naturally optimal life.

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