Microsoft word - arthritis_guidelines

Anthony Pribila, PT, CMP, CEAS Clinic Director
“Specializing in solutions to clinical and industrial rehab challenges”
11928 Sheldon Rd. Suite 105Tampa, FL 33626813-876-8771 GUIDELINES FOR EFFECTIVE
Arthritis is an often debilitating condition affecting millions of people throughout the world. Arthritis is characterized as a progressiveinflammatory condition of the joints, which may cause pain, swelling, heat,and redness due to inflammation, infection or trauma.
These symptoms may lead to limitation of movement, joint deformation andcontractures.
Osteoarthritis is the most common noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of
the articular cartilage, hypertrophy of bone and changes in the synovial
membrane; which houses lubricating fluid of the joint. It is usually
accompanied by pain (usually before prolonged activity) and stiffness
(particularly after prolonged activity).
Billions of dollars a year are spent on the management of arthritis. There are
many companies promoting fallacious products promising relief from this
often chronic and painful condition. The following suggestions are some of
the more effective proven ways of managing various types of arthritic
Therapeutic Rehab Specialists Physical Therapy Departments
specialize in treating multiple types of arthritic conditions. Call us today at
(813) 876-8771 to find out how our effective treatment options can help you
start living a more productive life with less pain.
Physical Therapy · Comprehensive Neck/Back Evaluation & Rehabilitation · Custom Splinting ·
Musculoskeletal Pain (Bones, Joints, Muscles, Ligaments) · Sports related injuries · Work Conditioning ·
Physical Performance Evaluation · Functional Capacity Assessments (FCA) · Ergonomic Assessments
Anthony Pribila, PT, CMP,CEAS Clinic Director
 NSAIDS such as and Celebrex, have been found to be effective in decreasing arthritic pain. They are the new generation of Cox 2 enzyme inhibitors, which make them saferon the stomach. Even though they have fewer side effects on the stomach, they havebeen found to decrease blood flow to the kidneys; therefore you should be adequatelyhydrated while taking these medications.
Low doses of over the counter NSAIDS containing Ibuprofen such as (Motrin andAleve) have analgesic or (pain relieving) effects (200-400 mg), and at higher dosesanti-inflammatory effects (800-1000 mg).Warning: High doses or long term use may result in gastricbleeding.  Diffuse pain, localized stiffness, crepitus, and inflammation may be related to or aggravated by allergies to food sources including: wheat/gluten products, dairy, corn,soy, eggs, chocolate, citrus, sugars, and red meat. Nightshade family plants such aseggplant, potatoes, peppers, and tomatoes may also aggravate inflammatoryconditions. Other products to avoid are partially trans/ hydrogenated fats, sugars, andsaturated fats. Use mono saturated (olive oil) and polyunsaturated oils that resist hightemperatures for cooking. Avoid foods that irritate the gastrointestinal (GI) tract due tothe nervous system and lymphatic system lying in the (GI) tract.
 Nutritional products recommended for osteoarthritis are the herbs: curcumin/tumeric and ginger, and antioxidants. Glucosamine sulfate is an amine sugar found inglycoproteins and naturally occurring carbohydrates known as glycosaminoglycans(GAG). The supplementation of between 1500-2000 mg/day or 1000mg twice a day(BID) has been found to be beneficial in people suffering from arthritic conditions andinjuries involving the articular cartilage. Some studies have shown greatereffectiveness than Ibuprofen after 6 to 8 weeks of supplementation, and actualincreased joint space width on X-ray. It is recommended to start supplementationimmediately after an injury to the articular cartilage. Low molecular weight goodquality chondroitin sulfate is also recommended in doses up to 1200 mg/day.
Warning: Due to sugar content, Diabetics should consult their Physician prior to usage.Prostaglandins are chemicals in the body that help to control lymphocyte activity, which is a
type of white blood cell that regulates immune activity and inflammation. There are 3 types of
prostaglandins. These three groups are derived from the diet in the form of essential fatty acids.

The balance of favorable type 1 and 3 prostaglandins to unfavorable type 2 prostaglandins can
be improved by supplementing the diet with essential fatty acids such as linoleate and
linolenate. Omega 3 fatty acids, eicosapentaeonic acid (EPA), which are found in cold water
fish, and (GLA) gamma-linoleic acid are recommended. Omega 3 fatty acids are found in seeds,
nuts, flax seed oil, eggs, and fish also reduce the risk of coronary events. Flax seed oil should be
refrigerated and stored in a black bottle. It is recommended to use these fatty acids a minimum
of 3 times a week. Celadrin is a blend of fatty acids and carbons that help to relieve systemic
inflammation as well as have a beneficial effect on heart disease. Studies have shown improved
pain levels, better function, and improved ROM just 30 min. after use.

Although NSAIDS are recommended to manage inflammatory conditions, the first 24 hours
after post traumatic arthritic injuries, inflammation is essential for proper tissue healing. The
immediate use of NSAIDS may decrease prostaglandin 2 production, which may initially result
in less swelling but also decrease the strength of repairing tissue. Wait 24 hours prior to use.

Anthony Pribila, PT, CMP, CEAS Clinic Director
 Methylsulfonylmethane (MSN) is a naturally occurring compound containing sulfur, which with less than 1000 mg doses can partially offset the loss of sulfur occurring inosteoarthritic patients taking pain medications. In higher doses it can have analgesiceffects.
 Fibromyalgia is a type of inflammatory condition characterized by widespread pain in the joints, muscles, tendons and other soft tissues causing chronic pain and tendernessfor over 3 months in 11 of 18 tender points. Symptoms may be magnified by stressand poor digestion. Sufferers are recommended to eat natural organic foods anddecrease toxins in the body and environment, such as avoiding perfume productsaround the house, in clothes and on the skin. Drink filtered water but avoid drinkingout of thin plastic bottled water due to plastic chemicals possibly contaminating water;especially when left in heat.
 Immobilization leads to stiffness and a decrease in the quality of joint, ligament and cartilage tissue. Exercise helps to decrease pain in local and general inflammatorydisorders as well as improve cartilage nourishment. Strength training exercise helps inretaining body mass, decrease risk of falls and injuries in addition to increasing GrowthHormone (GH) release which helps improve muscle mass, and decrease effects ofaging such as wrinkles and sagging skin.
 If your having problems exercising due to daily fatigue unrelated to sleep deprivation you may want to consider taking supplements such as CO Q10 (100-300 mg/ day), L-carnitine (500-1000 mg 3x/day) and NADH (active coenzyme form of vitamin B3 (10mg/day). Other B vitamins are also recommended to decrease plasma levels of theamino acid homocystine (tHcy) which irritates blood vessels if >10 µml/L. High levelsof (tHcy) cause inflammation, atherosclerosis, and coronary heart disease.
Niacinamide another form of vitamin B3 which is important in carbohydratemetabolism. It is recommended to take up to 500 mg 3x a day with N-Acetyl Cysteinewhich is an amino acid found in food that helps break down mucus. When combinedthey help provide relief from inflammatory conditions.
Other often recommended dietary supplements include Boswella, a type of herb used to
decrease inflammation. Rosemary contains four anti-inflammatory substances: Carnosol,
Oleanolic acid, Rosmarinic acid, and Ursolic acid. Carnosol acts on the same anti-inflammatory
pathways as both steroids and aspirin, Oleanolic acid has been marketed as an antioxidant in
China, Rosmarinic acid acts as an anti-inflammatory, and Ursolic acid, which makes up about
four percent of the plant by weight, has been shown to have antiarthritic effects in animal trials.

Alfalfa contains organic minerals such as calcium, magnesium, phosphorus, and potassium and
almost all known vitamins, as well as being very high in chlorophyll, which is a diuretic. Most
herbs with a diuretic action will help in some way, significantly or insignificantly, with
conditions like arthritis. Putting it simply, they help to flush out the system, or detoxify.
Drinking water will have much the same effect.

The use of protease enzymes such as (trypsin, chymotrypsin, bromelain, and papain) are
recommended to be taken between meals.
Anthony Pribila, PT, CMP, CEAS Clinic Director
 Among the multiple well know health risks of smoking, the impairment of microcirculation is something especially detrimental to the healing process of post-surgical patients or post traumatic arthritic conditions.
 Prolotherapy is the injection of a solution into ligaments or a tendon, which is performed by a Physician to promote stability in hyper mobile or unstable joints. Itworks by increasing blood supply and nutrients to the tissue and stimulates tissue repairdecreasing tissue laxity. The average number of treatments for an area are 4-6.
Prolotherapy can be effective in treating low back, shoulder, knee, and sacroiliacdysfunction.
 A synovial fluid analogue called Synvisc or Hyalgan can also be performed 1x a week for 3 weeks and has been found to be effective in reducing pain in hip and kneearthritic sufferers for up to 9 months. Synvisc also known as Hyaluronate which is asodium derivative substance from Hyaluronan. It’s a substance found in synovial fluidwhich when injected into the knee acts like your own joint fluid which helps lubricateand cushion joints.
 Post injury or surgery, vitamin C and zinc are recommended to promote tissue healing.
Levels of vitamin C rise in healing tissue and return to normal after it is healed. Zinc isone of the oldest agents that can help promote wound healing. There areapproximately 200 zinc-requiring enzymes in the body, such as DNA polymerasewhich is needed for cell regeneration during healing.
 Diseases modifying anti-rheumatic drugs (DMARDS) have been shown to be beneficial in decreasing the cause of Rheumatoid Arthritis as well as symptomatic benefit. The benefitis slow usually 4-16 weeks. These drugs may have side effects which should bemonitored by the patient’  STEP (Scientific Therapeutic Exercise Program) consists of forces of compression, decompression and gliding which is designed to stimulate cartilage healing by usinghigh repetitions (20-30), low resistive exercise for 4-5 sets a day. Beginners may wantto start with lower repetitions until form improves.
 Physical Therapy has many worthwhile options in treating a variety of arthritic conditions.
Electric stimulation or (TENS) and laser therapy have been found to be beneficial ingiving pain relief. Therapeutic strengthening and stretching exercise have been found tobe beneficial in granting pain relief. Exercise can also result in weight loss which willdecrease pressure on weight bearing joints. Resting splints can also be used to decreasepain with activity but do not improve function, grip strength or dexterity. Joint tractionand gentle mobilization of stiff joints may improve mobility and nourish joints. AquaticTherapy is a fabulous way for arthritic sufferers to exercise in a safe comfortable andnearly weightless environment. Buoyancy of the water helps to unload the joints and thewarm water helps improve circulation and decrease spasms.
Note: The above mentioned guidelines are meant as a source of information only. If you are suffering from health problems please
consult your Physician before beginning medication, or initiating an exercise or nutrition program.


Microsoft word - teleseminar transcript from dec. 10 2012 draft.docx

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