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Tuesday, 12 January 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Osteoarthritis: Treatment In herbal and traditional Chinese medicine - The alternative natural treatment

Kyle J. Norton (Scholar, Master of Nutrients, All right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia



                       Osteoarthritis


Osteoarthritis (OA), a form of arthritis, is defined as a condition of as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone. University of Porto Medical School indicated that one must understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints(3).
The characteristics of osteoarthritis are aching pain(5), stiffness(6), or difficulty of moving the joint or joints(7). The pain usually gets worse in change of weather, at night and in the advanced diseases, the pain can occur even at rest(8). Today management of osteoarthritis (OA) focuses on pain relief and improved physical function through pharmacological, non pharmacological, and surgical treatments(4).


                                    The Treatment

B. In herbal  and traditional Chinese medicine perspective
B.7. The alternative natural treatment 
Beside suggesting certain herbal medicine for treatment of osteoarthritis, modern herbal and TCM medicine doctors may also combine other natural treatment for alleviating symptoms of the disease
1. Use Ice or Heat Therapies therapy
Ice therapy such as repeated, rather than continuous, ice applications may be considered as an effective treatment for some patient with osteoarthritis(380) as it reduces swelling and pain(380), if the therapy is applied correctly to avoid side effects, and prevent possible further injury, but according to Dr. Mac Auley DC. as the therapy has shown to impair reflex activity and motor function  up to 30 following treatment.(378). The doctor also said that guidance on the duration, frequency, or length of ice treatment may be depending on the particular ice therapy, injury location, or severity(379). Heat therapy has shown to loosen tissues and relax stiff joints may also benefits to some patient of osteoartritis(381). According to the study by University of Haifathermal and athermal short-wave diathermyhave shown effectively for the management of knee osteoarthritis(382).

2. Acupuncture
The most oldest form of medical treatment in traditional Chinese medicine has been known for its function in relief pain(383) and functional limitation(384) for chronic patient, including patient with moderate or severe chronic knee pain(383), peripheral joint osteoarthritis(384) and hip osteoarthritis(385) with many different techniques, such as acupuncture techniques, moxibustion, transcutaneous electrical nerve stimulation(392).
In pain management, acupuncture is found to significant reduce pain intensity, improve functional mobility and quality of life in patient with osteoarthritis (386). According to the University of York, in patient with knee osteoarthritis, in a systematic review with network meta-analysis, indicated that
acupuncture is considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term, but due to poor quality of the study(387), larger sample size and multi sample studies are necessary to confirm this claim.
Dr. Vas J. and Dr..White A said "... optimal results from acupuncture treatment for osteoarthritis of the knee may involve: climatic factors, particularly high temperature; high expectations of patients; minimum of four needles; electroacupuncture rather than manual acupuncture, and particularly, strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments"(388)

3. Massage Therapy
Massage therapy has been used in traditional Chinese medicine over thousands of year for treatment of osteoarthritis (OA)(392)(389), especially for OA patient for short-term pain relief(389). In a sixty-eight adults with radiographically confirmed OA, massage therapy seems to be most efficacious relief pain, stiffness, and improve physical function limitation for patient OA of the knee(390).
According to the joint study by the University Medical Center and Avans University of Applied Scienc, in a systematic review of randomised clinical trials, said that there is a evidence indicated that massage improves function in the short term compared to no treatment in people with knee arthritis(391)

4. Spa therapy
Spa therapy may be one the effective technique for treatment of lower back pain, according to some studies(392)(393)9394). In patient with rheumatoid arthritis, spa therapy showed to relief symptoms of pain, stiffness and mobility(395). According to the joint study by the  University of Siena and Spa Centre of Fonteverde Natural Spa Resort, the clinical trials conducted exhibited the support of spa therapy on pain, function and quality of life in hand OA(396), if used conjunction with the application of thermal treatments(396). In patient with knee osteoarthritis, especially in European countries, although the spa treatment is still the subject of debate, the existence of data of some clinical trials suggested a beneficial effect of spa therapy on pain, function and quality of life in knee OA if the treatment cover the duration from six to nine months(397).
In the study conducted by the University of Siena, Viale Bracci, spa therapy showed effectively in modified plasma levels of leptin and adiponectin of which are, important mediators of cartilage metabolism and related to the development of knee osteoarthritis(398)

5. Hydrotherapy
Hydrotherapy, using water for the treatment of disease has shown some beneficiary for treating pain in patient with lower back pain(399), joint hemorrhages(400) and multiple sclerosis(401). In patient with knee osteoarthritis, water therapy reduced knee pain and increased knee function in participants with knee OA as effectively as conventional based therapy(402).
In a randomized controlled trial conducted among 152 older persons with chronic symptomatic hip or knee OA by the University of Sydney, hydrotherapy or Tai Chi classes showed to enhance large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA(403).
In lower limb osteoarthritis, the study of 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA suggested that water exercise induced significantly reduction in pain and improvement in physical function of the participants after 1 year with a favourable cost--benefit outcome(404).
Unfortunately, the water gym study conducted by the Universidade Estadual Paulista Júlio Mesquita Filho, showed no beneficiary in improving symptoms of individuals with knee OA(405).

6. Tai Chi
Tai chi, an ancient form of mind-body exercise or technique used in Chinese with meditative movements that promote balance and healing of the mind and body induced mental concentration, physical balance, muscle relaxation, and relaxed breathing(406).
In chronic diseases, such as osteoarthritis, Tai Chi improve physical performance(408), such as walking distance (6MWD) and knee extensor strength and pain(408) and stiffness of patient with osteoarthritis(407) and knee osteoarthritis(408)(409).
In the assessing  the effectiveness of Tai Chi for knee osteoarthritis, conducted by Tufts University School of Medicine, Tai Chi therapy improved WOMAC pain(411) and stiffness scores, physical(411) and lower-extremity function, knee proprioception, ect., after 12, 24 and 48 weeks(410).

7. Yoga
An ancient form of medical technique originated from India, is become a popular multimodal mind-body exercise in the Western world for promoted flexibility, strength, endurance, and balance(412). According to the study by the University of Minnesota, Minneapolis (CC, JFW), Yoga 45 to 90 mins per session for 6 to 12 wks, reduced pain, stiffness, and swelling, inpatient with osteoarthritis of the knees(413) or osteoarthritis but the study showed an inconclusive outcome on physical function and psychosocial well-being(412).

8. Chiropractic
 Chiropractic is one the alternative therapy for diagnosis and treatment of Musculoskeletal disorders (MSDs), including osteoarthritis. It is one the primary care of hip osteoarthritis in Denmark(425)
According to the Cleveland Chiropractic College, chiropractic increased range of motion, improved balance and gait speed, and decreased disability after a 12-week course in a 70 year old geriatric patient with left hip pain, a history of repetitive falls, poor balance, myofascial dysfunction, and hip osteoarthritis(424) of that may contribute to a conservative management options for patient with hip osteoarthritis(426).
Chiropractic management showed to decreased WOMAC scores and increases in hip range of motion in patient of hip osteoarthritis, according to the study by Autralia(427) and may provide a short-term benefit to relieve hip pain for patients with hip osteoarthritis waiting for hip surgery(428), according to the report of Scandinavian College of Chiropractic. 
Used in conjunction with heat, chiropractic spinal manipulation,showed more effective for the treatment of low back pain in patient of osteoarthritis (OA) in comparison of the application of moist heat or chiropractic spinal manipulation alone(429).

9. Chinese Herbal Bath Therapy
Chinese herbal bath therapy (CHBT) has been used traditionally for its effects on analgesics and anti-inflammation against pain, especially for patient with knee osteoarthritis(495). According to the joint study by  reviewed of a total of 529 abstracts identified from 7 English
and Chinese databases conducted by the Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Tufts University and Tufts University School of Medicine, the therapy effectively reduced pain, improved physical performance, and wellness in comparison to  standard western treatment with little or no adverse effects(496).

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References
(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
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(376) Management of Osteoarthritis with Avocado/Soybean Unsaponifiables by Christiansen BA1, Bhatti S2, Goudarzi R3, Emami S4.(PubMed)
(377) Avocado/soybean unsaponifiables prevent the inhibitory effect of osteoarthritic subchondral osteoblasts on aggrecan and type II collagen synthesis by chondrocytes by Henrotin YE1, Deberg MA, Crielaard JM, Piccardi N, Msika P, Sanchez C.(PubMed)
(378) Ice therapy: how good is the evidence? by Mac Auley DC1.(PubMed)
(379) Do textbooks agree on their advice on ice? by MacAuley D1.(PubMed)
(380) Should I use heat or ice to ease knee pain from osteoarthritis?[No authors listed](PubMed)
(381) Osteoarthritis-dependent changes in antinociceptive action of Nav1.7 and Nav1.8 sodium channel blockers: An in vivo electrophysiological study in the rat by Rahman W1, Dickenson AH2(PubMed)
(382) Effectiveness of thermal and athermal short-wave diathermy for the management of knee osteoarthritis: a systematic review and meta-analysis by Laufer Y1, Dar G.(PubMed)
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(386) Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. by Manyanga T1, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, Shay BL.(PubMed)
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(416) Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms by Therkleson T1(PubMed)
(417) Zucapsaicin(Wikipedia)
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(422) Osteoarthritis: physical medicine and rehabilitation--nonpharmacological management.
Stemberger R1, Kerschan-Schindl K.(PubMed)
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(496) Chinese Herbal Bath Therapy for the Treatment of Knee Osteoarthritis: Meta-Analysis of Randomized Controlled Trials by Chen B1, Zhan H1, Chung M2, Lin X1, Zhang M1, Pang J1, Wang C3.(PubMed)