Background The treatment of osteoarthritis (OA) of the knees and adhesive capsulitis of the shoulders (SAC) is often disappointing. Recent EULAR clinical guidlines emphasise the role of non-pharmacological treatment modalities for knee OA.1 Since 1990 some reports confirmed the benefit of chiropractic management for low back pain.2,3 The theory of the vertebrone laid by Gutzeit (1951) related vertebrogenic nerve involvement with target tissue pathology. Chiropractic method of Kasyan was devised and originally modified for the treatment of spine, shoulders and degenerative disease of the knees.4,5
Objectives To assess the results of modified Kasyan chiropractic treatment for osteoarthritis of the knee and for adhesive capsulitis of the shoulder.
Methods Twenty nine patients with symptomatic OA of the knees and 37 – with SAC (more than 50% reduction of passive movements on all directions) were referred to chiropractic clinic following failure of long term conventional therapy (physiotherapy, NSAID’s, local steroid injections). On admission very high proportion of each group (84% knees and 86% shoulder) were found to have “silent spondylosis”: L2–4 or C5-T1 tenderness, paravertebral muscle spasm, and positive X-Ray for spondylosis. None had lumbar or cervical pain. Two-three chiropractic sessions per week (15 ± 11 sessions for knee OA and 10 ± 4 – for SAC) were applied to both the relevant spine and the affected joint (combined therapy).
Results The results (in percentage of patients) are presented in the Table 1. Once a month maintenance session may be necessary to establish long term results.
Conclusion When direct therapy to knee or shoulder fails – “silent” spondylosis should be searched. Combined chiropractic therapy is highly effective in both situations.
Pendleton A, Arden N, Dougados M, et al. EULAR recommendations for the management of knee osteoarthritis (ESCITIS). Ann Rheum Dis. 2000;59:936–44
Meade TW, Dyer S, Browne W, et al. Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ 1995;311:349–51
Shekelle PG, Coulter I, Hurwitz EL, et al. Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America. Ann Intern Med. 1998;129:9–17
Kasyan N. Manual therapy for spine osteochondrosis. Moskow Medicine, 1985
Rozin A. Chiropractic management of degenerative spine disease. Rheumatic Pain Satellite Symposium, 1999, Freiburg, Germany