Osteoarthritis (OA) is a degenerative disease that affects the articular cartilage of the joint. As a result, there is a decrease in the joint space and an increase in boney development (commonly referred to as “bone spurs”). Onset typically takes years. Risk factors for developing OA include age, trauma, obesity and family history. It can develop in any JOINT but is most commonly seen in the knees, hips and hands. 


What does research say about exercising with arthritis?

• Exercise reduced pain, improved quality of life and increased performance in those with OA. Patients who had better outcomes were typically younger (Siew-Li Goh).
• Those who walked had less knee pain than those who didn't. The study also found that walking helped to slow the progression of OA in the knee (Lo).
• Patient outcomes were improved when exercise was combined with patient education (Goff).

What type of exercise should those with arthritis do? 

• Strength training
• Aerobics 
• Pilates
• Aquatics
• Walking

*All appeared to be helpful when performed for an hour (Raposo)


Takeaway:
Those with osteoarthritis should participate in physical activity. If pain is preventing you from exercising, try to find an activity you enjoy that causes minimal pain. If it is still challenging, reach out to a professional to create a plan to manage your pain. 

References
Goff, Anthony J., et al. "Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review." Journal of Physiotherapy 67.3 (2021): 177-189.

Lo, Grace H., et al. "Association between walking for exercise and symptomatic and structural progression in individuals with knee osteoarthritis: Data from the Osteoarthritis Initiative Cohort." Arthritis & Rheumatology 74.10 (2022): 1660-1667.

Raposo, Filipe, Marta Ramos, and Ana Lúcia Cruz. "Effects of exercise on knee osteoarthritis: A systematic review." Musculoskeletal care 19.4 (2021): 399-435.

Siew-Li Goh, Monica S.M. Persson, Joanne Stocks, Yunfei Hou, Jianhao Lin, Michelle C. Hall, Michael Doherty, Weiya Zhang,Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis, Annals of Physical and Rehabilitation Medicine,Volume 62, Issue 5, 2019,

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Inflammation is the body's immune response to an irritant (Informedhealth). White blood cells migrate into the tissues in an effort to “protect” the body from the irritant. Inflammation is categorized as acute or chronic. For an acute period of time inflammation is beneficial, however, chronic inflammation becomes harmful.

How does inflammation cause pain?
During the inflammatory process chemical mediators are released to signal white blood cells to the area. White blood cells release a byproduct that affects the nerves in the area to tell the brain that there is pain. For a short time, this is a protective mechanism. If a body part is injured, reducing movement decreases any further damage. However, long term inflammation to the body is very damaging (Omoigui).

Causes of inflammation: 

• Table Sugar (Havard Health).​
• Ultra-processed foods
• Alcohol
• High fat
• High intensity exercise
• Visceral fat (Kolb). 

*People at higher risk of increased dietary inflammation: male, older, post-menopausal women, those with higher BMI, and those with more body fat.

Ways to reduce inflammation:
Specific foods

• Fatty fish like tuna, salmon, sardines 
• Fruits & vegetables
• Walnuts & almonds
• Flax seeds
• High protein, high fiber, complex carbohydrate foods that help to slow digestion 
• (Havard Health)

Exercise

• Moderate intensity exercise. 
• Walking 

Sleep 

• Sleep promotes recovery and allows the body time to heal from stress. 
• Regulating your circadian rhythm 

Supplements

• Turmeric
• Omega-3 
• Vitamin C
• Zinc

Takeaway:
Inflammation is inevitable, and for short periods of time it is important and beneficial. The problem occurs when inflammation goes uncontrolled for extended periods of time. Take small steps each day to reduce inflammatory habits in your lifestyle. 

Resources 
Foods that fight inflammation - Harvard Health

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. What is an inflammation? 2010 Nov 23 [Updated 2018 Feb 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279298/

Kolb, H. Obese visceral fat tissue inflammation: from protective to detrimental?. BMC Med 20, 494 (2022). https://doi.org/10.1186/s12916-022-02672-y

Omoigui S. The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3 - inflammatory profile of pain syndromes. Med Hypotheses. 2007;69(6):1169-78. doi: 10.1016/j.mehy.2007.06.033. Epub 2007 Aug 28. PMID: 17728071; PMCID: PMC2771434.

Walking. Yes, it's that simple. With step counters becoming more popular, recent research shows that ALL causes of mortality were reduced in those who walked more (Jayedi). Step intensity did not make a difference (Saint-Maurice PF). 

The risk of cardiovascular disease and dysglycemia were both shown to be reduced in those who took more steps each day (Hall KS). 

The average American takes around 5,000 steps per day (Liu Y). The higher the number, the lower the risk of mortality. So how do you get moving more?

1. Make a goal
   1. Decide how many steps you would like to get each day
   2. Decide how often you want to move
2. Make a plan to reach that goal
   1. Take breaks from the computer every hour
   2. March in place
   3. Take the stairs
   4. Park far away
3. Make it a family activity
   1. Take the kids out for a walk
   2. Walk the dog
   3. Challenge friends to join in

Take away:
Walking is a great way to improve your overall health. If you are having pain that is preventing you from doing an activity, come get it checked out. Challenge yourself today to see how many steps you can get….if it's less than 5,000, think of ways you can do more!

P.S. don’t cheat and put the step counter on the dog…you know who you are. 

Step counters

1. Fitbit: Fitbit Official Site for Activity Trackers & More
2. Alexa watch: Amazon.com: Alexa Smart Watch for Women, Alexa Built-in, RERE Fitness Tracker for Blood Oxygen, Heart Rate, Sleep Monitor, 1.69 inch Smartwatch for Android and iPhone, 5ATM Waterproof, 10 Day Battery Life, Pink : Sports & Outdoors

References

Hall KS, Hyde ET, Bassett DR, Carlson SA, Carnethon MR, Ekelund U, Evenson KR, Galuska DA, Kraus WE, Lee IM, Matthews CE, Omura JD, Paluch AE, Thomas WI, Fulton JE. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act. 2020 Jun 20;17(1):78. doi: 10.1186/s12966-020-00978-9. PMID: 32563261; PMCID: PMC7305604.

Jayedi A, Gohari A, Shab-Bidar S. Daily Step Count and All-Cause Mortality: A Dose-Response Meta-analysis of Prospective Cohort Studies. Sports Med. 2022 Jan;52(1):89-99. doi: 10.1007/s40279-021-01536-4. Epub 2021 Aug 21. PMID: 34417979.

Liu Y, Sun Z, Wang X, Chen T, Yang C. Dose-response association between the daily step count and all-cause mortality: A systematic review and meta-analysis. J Sports Sci. 2022 Aug;40(15):1678-1687. doi: 10.1080/02640414.2022.2099186. Epub 2022 Jul 12. PMID: 35819337.

Saint-Maurice PF, Troiano RP, Bassett DR Jr, Graubard BI, Carlson SA, Shiroma EJ, Fulton JE, Matthews CE. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. 2020 Mar 24;323(12):1151-1160. doi: 10.1001/jama.2020.1382. PMID: 32207799; PMCID: PMC7093766.

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Every chiropractic office is different. Many "old school" chiropractors will still take x-rays of every single patient. I do not. If after doing a history and exam I feel you need to get imaging done to help us formulate a better treatment plan, then I will refer you out to have those images taken. 
Reasons I may order imaging:

• To rule in/out a fracture
• Your symptoms and exam do not match up
• You have an underlying medical condition
• To measure a progressive scoliosis 
• You have not responded to conservative treatment 
• You exhibit any of the following "Ottawa rules" (1)
• You have progressive muscle weakness
• You were involved in some type of accident

Reasons I would NOT order imaging:

• To draw lines on it and scare you into thinking you need a $2000 treatment plan

There is a time and place for imaging. Typically, it's not needed on the first visit. If someone takes images of your spine, ask them why they need to take the images, ask them to describe everything they see and WHAT IT MEANS. 

If my patient walks in with an imaging report, the first thing I do is sit down with them and go over what all those words mean and what we do from there. 

It is important to note that imaging will show structural changes, pain is not always caused by a structural problem. A systematic review showed that 37% of 20-year-olds and 96% of 80-year-olds have disc degeneration in the form of a disc bulge or disc protrusion WITHOUT ANY SYMPTOMS (2)! Another study showed that only 3-4% of people with a disc herniation or stenosis were symptomatic (3). 

Soooo what does all that mean? It means your imaging could look "terrible" and you could have no pain/symptoms at all OR your imaging could look "normal" and you could have a lot of pain/symptoms. 

Take away. Sometimes imaging is necessary. If you have imaging taken, be sure someone takes the time to explain it to you. Otherwise, conservative treatment such as chiropractic care or physical therapy should be your first step in dealing with pain. 

Reference:
1. Ottawa ankle rules | Radiology Reference Article | Radiopaedia.org
2.Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
3. Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging

The pelvic floor is a group of muscles that sits within the pelvis. They are "bowl-shaped" and work to support our lower organs. The urethra, vagina and rectum all pass through the pelvic floor. This is why the pelvic floor can play a role in causing bladder leaking, discomfort during intercourse, constipation, diarrhea and uterine prolapse. The muscle strength and resting muscle tone can either help or hinder these conditions. 

Naturally, the pelvic floor and the diaphragm work together. It is when these two muscles groups become out of sync that problems "don't resolve on their own." 

Sneezing is a great example of when these two muscles don't work together. A sneeze is a forced exhale, during exhalation the diaphragm and pelvic floor should both rise. However, if pressure is forced downward, it can result in bladder leaking. 

Pressure management is the key to a healthy pelvic floor. 

Hands down I would tell you that if you could only afford one item it would be a kettlebell. If you are not familiar with a kettlebell, it is one of the most functional pieces of fitness equipment.

Pros
The kettlebell can be used for activities that mimic everyday actions like carrying a bag of groceries, lifting a kid, putting things on a high shelf. With a barbell you are limited to training in one plane of motion, this increases the risk of injury when you go to do things outside of the plane you trained in. The kettlebell does not have this limitation. It allows you to train in multiple planes of motion. Better for long-term training, thus further reducing the risk of injury because it does not allow you to advance quickly before moving up to the next bell. Research shows that inactive adults were able to improve their grip strength with kettlebell training; grip strength is an important indicator of longevity (1).

Cons
Kettlebells can only be loaded so much. For those whose goals involve heavy weights, a barbell would be better. Typically, kettlebell training will recommend you stick with the same weight until you master that weight. 

Fitness is not a race. It is a lifestyle. Everyone has a different goal. If yours is to improve or maintain your health, then a kettlebell would be the perfect addition to your home gym. The kettlebell offers long term training with reduced risk of injury due to the style of training. 

To learn more about Kettlebell training click the link below:
Beginners, START HERE | StrongFirst

Where to purchase a Kettlebell:
Kettlebells: The Perfect Full-body Workout with One Handy Tool (titan.fitness)

References:
1. https://doi.org/10.1186/s12877-022-02958-z

Hey, everyone! Welcome to the "Feeling Crabby" blog where we will dive into different health conditions and learn holistic approaches to treatment. For those of you who don't know me, my name is Dr. Harmon. I am a chiropractor in Galveston, TX. I love living on the island...as my friends at the Galveston Island Running company would say, "Aloha spirit without the price tag". My patients here definitely have that attitude....they often ask me what time I want to come to work when we schedule a follow-up visit. It throws me off every time and I love it. You will not find a better group of people. 

My partner Marc and I have 3 girls! Yes, 3 girls. They are 13, 2 and 1...we have so many emotions in this house on a daily basis, if I get to work and you see my eye twitching...you know why! Our oldest is going through the "I'm-too-cool-for-you" phase, the 2-year-old is the sweetest girl who loves to talk, and the baby has the best dance moves out of everyone!

I've gotten asked several times why I named my practice "Crabby Chiropractic". My partner Marc and I were having an argument one morning and I told him he was being "crabby". The name just stuck. I figured it was appropriate because we are on the beach and when people are in pain, they aren't the happiest. My patients can't help but smile when they walk in the door and giggle when they say they feel "crabby today". 

Feel free to post comments or questions below. If you have an idea for a blog post add it to the comments!