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This article fully describes these conditions, and considers the usefulness of massage in reducing pain. by Ben E. Benjamin and Ruth Werner Once these conditions have become established in the body, massage generally won’t have much influence on their progression. But we can have great success in the amelioration of the pain that often accompanies both osteoporosis and rheumatoid arthritis.
Osteoporosis Definition. Osteoporosis means, literally, “porous bones.” In this condition, calcium is pulled off the bones faster than it is replaced, leaving them thinned, brittle, chalky and prone to injury. Demographics. This disease affects an estimated 25 million Americans. It affects women about five times more often than men, because women have lower bone density to begin with, and they bear children, which is an enormous drain on calcium reserves. Small-boned, thin women get it more often than others, especially those who are postmenopausal and/or anorexic. Caucasian and Asian women are most likely to develop this condition, but African-American and Hispanic women are also at risk. Although a genetic marker for osteoporosis has been identified, other risk factors are major contributors to this disease. Therefore, bone density is determined only about 60 percent by heredity, and 40 percent by controllable factors, such as diet, smoking, exercise and stress levels; chronic secretions of cortisol have been shown to be extremely destructive to bone density. Etiology. Before discussing the bones, it’s worthwhile to point out a few things about calcium. First of all, the bones are not the only part of the body that needs calcium. They happen to be a convenient storage medium, but calcium is consumed in nearly every chemical reaction that results in muscle contraction and nerve transmission. Calcium is also essential to blood clotting and pH balance. These are very important functions, and the body has a strict prioritizing system: Chemical reactions that are crucial to moment-to-moment survival are more important than maintaining the density of the vertebrae. Secondly, calcium requires an acidic stomach environment in order to be absorbed into the body. If calcium enters the body in a form that impedes its contact with hydrochloric acid (i.e., in dairy products or “calcium rich” antacids) the body may not actually be able to absorb very much of the calcium that is available. Similarly, if natural secretions of hydrochloric acid are reduced, as in postmenopausal women, there will be less access to the calcium taken in. Finally, calcium is constantly lost through sweat and urine. Some substances, specifically meat-based proteins, will cause higher levels of calcium to be excreted in urine. So although a person may take in ample supplies of calcium, she will tend to lose it if she also eats a lot of meat. This may help to explain why vegetarians have a statistically lower rate of osteoporosis than the general population, and why, although the United States is a leading consumer of milk, it is also higher in osteoporosis rates than other countries with average diets that are lower in animal proteins. Complications. Complications of osteoporosis center on pathologically weak bones. Thinned vertebrae lead to a loss of height, and the characteristic rounded “widow’s hump” of kyphosis. There can be chronic and/or acute back pain in this stage, as the vertebrae continue to degenerate. People with osteoporosis are also prone to other fractures with little or no cause. These are called spontaneous or pathological fractures. Hips, vertebrae and wrists are particularly vulnerable to breakage. And since advanced-age people are naturally low on both living osteocytes and growth hormone to induce the healing process, it is particularly difficult to recover from any injury of this severity.
Diagnosis. Osteoporosis is a virtually silent disease until it’s too late to do anything about it. In the early stages, only X-rays and bone density tests will yield any conclusive information. (See Figure 1.) In the later stages, however, the disease is often identified by compression fractures in the vertebrae. Treatment. Once osteoporosis has been identified, there are a number of treatment options available to keep it from getting worse. Among these are estrogen replacement therapy (ERT). Estrogen influences calcium absorption. Postmenopausal women secrete this hormone only in very small amounts, so replacing it can improve calcium uptake. Unfortunately, estrogen supplements are also associated with breast and uterine cancers, so ERT isn’t for everybody. Calcitonin, a man-made version of another hormone, is another option, as are biophosphates, which inhibit bone breakdown and increase bone density. Exercise is almost always a part of the osteoporosis treatment strategy. Since bone will remodel according to the stresses placed on it, weight-bearing stress will ensure that maintaining healthy mass is a high priority. For someone with this condition, exercise like gentle weight training or walking is more beneficial than cardiovascular exercises like swimming or cycling. Diet can also play an important part of dealing with osteoporosis. There are specific vitamins and other substances that may improve calcium uptake, even for postmenopausal women, but this article is not the place to discuss them. Prevention. This is a disease that is easy to prevent, feasible to slow down or halt, and often impossible to reverse. The causes of it are many and varied, but center around one main theme: The time to build up calcium reserves is in youth and early adulthood. The skeleton grows in height until about age 20, but it continues to accumulate density until about age 35. After that point it tends to progressively demineralize. Studies show that today many Americans get only half, or even less, of the recommended daily allowance of calcium; this doesn’t bode well for future osteoporosis statistics. Diet is not the only preventive measure to take against osteoporosis. Bone is living tissue that will remodel according to stresses placed upon it, and one of the best things anyone can do to prevent osteoporosis is to give the skeleton regular weight-bearing stress in the form of exercise. This makes the maintenance of bone density a high priority, and ensures the activity of osteoblasts to keep those calcium deposits coming in. Massage? In the treatment of clients with osteoporosis, the appropriateness of massage will vary from person to person. The only way massage could worsen the situation would be to exert undue mechanical force, which could lead to the possibility of fractures. On the other hand, consider the condition of the muscles of someone with osteoporosis; there’s a lot of symptomatic relief massage can offer, even if it can’t reverse the degeneration of the bone tissue. In any case, caution is the key with this condition. Don’t look for miracles; taking someone out of their pain for a few hours is miracle enough. |
