Manual Therapies for Arthritis Pain

In addition to medical management, there are a variety of manual (hands-on) therapies that some people find helpful in managing their arthritis symptoms. Two of the more common treatments include manual manipulation, which is often referred to as chiropractic care, and massage therapy.

Chiropractic Treatment

Manual manipulation, which is commonly provided by chiropractors, has existed for thousands of years. Today, chiropractors are licensed health care professionals who concentrate on diagnosing and treating neuromuscular and skeletal disorders. They use manual adjustment or manipulation and/or mobilization of the spine rather than surgery or medication.

See Other Specialists for Arthritis Treatment

Chiropractors originally based their practice on the beliefs that:

• Biomechanical and structural problems in the spine can affect the nervous system.
• By restoring the structural integrity of the spine, chiropractic treatment can reduce pressure on sensitive neurological tissue, improving an individual’s health.

Today, chiropractic care has evolved as a science with many studies supporting it to be as or more effective in both patient satisfying results and cost containment when compared to pharmaceutical as well as other forms of health care.¹Muller R, Giles LGF. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther 2005;1(28):3-11. Chiropractors have become an integral part in pain management, frequently working side-by-side with medical doctors, physical therapists, and others in a group or multidisciplinary setting.²Sarnat RL, Winterstein J, Cambron JA. Clinical utilization and cost outcomes from an integrative medicine independent physician association: An additional 3-year update. J Manipulative Physiol Ther 2007 (May);4(30):263-269.^,

While some people with arthritis say they benefit from chiropractic manipulation, certain types of manipulation such as the commonly employed “high velocity low amplitude” (HVLA) thrust manipulation can carry serious risks for certain people, such as those with active, inflammatory rheumatoid arthritis and those experiencing certain stages of ankylosing spondylitis. Practitioners can use lower-force techniques to reduce the likelihood or risk of serious side effects.

See What Is Ankylosing Spondylitis?

Because of the risks associated with manual manipulation, patients are advised to consult with their rheumatologists or other physicians (who have expertise with their form of arthritis) prior to undergoing treatment. In fact, one way to find a skilled and experienced chiropractor or manual manipulation health professional is to ask for a physician referral from the medical specialist who is managing the patient's arthritis.

Similar to chiropractors, osteopathic physicians are specially trained in providing manual manipulation. Physiatrists or other health providers may also be trained in manual manipulation.

Massage Therapy

A licensed physical therapist or masseuse can use massage techniques to manipulate muscles, skin, and tendons. There are several types of massage, including:

• Trigger point massage relieves tight areas within muscle and other tissues that cause pain in other parts of the body. (For example, tight muscles in the neck can cause referred pain in the arm.)
• Deep tissue massage uses slow movements and applies heavy, concentrated pressure to affect the muscles and fascia located well below the skin’s surface.
• Swedish massage is considered traditional massage, and it is meant to promote blood circulation and relaxation.

There is no definitive research on massage and arthritis pain, but the studies that do exist seem to show short-term benefits.⁴Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Archives of Internal Medicine. 2006; 166(22):2533– 2538.10.1001/archinte.166.22.2533 [PubMed: 17159021]^,5Yip YB, Tam AC. An experimental study on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-severe knee pain among the elderly in Hong Kong. Complementary Therapies in Medicine. 2008; 16(3):131–138.10.1016/j.ctim.2007.12.003 [PubMed: 18534325] As of this writing, there are no research studies examining the long-term affects of massage on arthritis.⁶Shengelia R, Parker SJ, Ballin M, George T, Reid MC. Complementary therapies for osteoarthritis: are they effective? Pain Manag Nurs. 2013 Dec;14(4):e274-88. doi: 10.1016/j.pmn.2012.01.001. Epub 2012 Mar 21. Review. PubMed PMID: 24315281; PubMed Central PMCID: PMC3857560.