- 1008 Victoria Road West Ryde NSW 2114 Australia
- Thursday: 1:00pm – 6:00pm
By Dr Don Kim · Chiropractor & Acupuncturist · TOP Chiropractic Acupuncture, West Ryde
Arthritis is one of the most common reasons people live with daily pain — and one of the most mismanaged. Too often, the diagnosis becomes a reason to stop: stop exercising, stop treating, stop expecting improvement. Patients are told their joint is worn out, given anti-inflammatory medication, and advised to wait until they qualify for surgery.
This approach is not only unhelpful — it is clinically incorrect. The research consistently shows that appropriate exercise, joint mobilisation, and load management produce better outcomes for arthritis than medication alone. The structural changes on imaging do not determine how much pain a person experiences or how much function they can recover. What matters is what is happening around the joint — the muscles supporting it, the mechanics loading it, and the inflammatory environment maintaining it.
At TOP Chiropractic Acupuncture in West Ryde, arthritis is treated as a manageable condition, not a terminal diagnosis. We assess the full picture — which joint is affected, what is driving the load through it, what is maintaining the inflammation — and build a structured programme that reduces pain, improves function, and gives patients a realistic and achievable path forward.
Arthritis is a broad term that covers more than 100 different conditions affecting joints, surrounding tissues and connective tissue. The most common presentations we treat at TOP Chiropractic Acupuncture include:
TYPE OF ARTHRITIS | WHO IT AFFECTS | WHAT’S HAPPENING |
Osteoarthritis (OA) | Adults over 45, women post-menopause, former athletes, manual workers | The most common form of arthritis. Gradual breakdown of joint cartilage leading to pain, stiffness and reduced range of motion. Most common in the knee, hip, spine, hand and foot. OA is not simply ‘wear and tear’ — it is a complex process involving cartilage, subchondral bone, synovium and surrounding soft tissue. Many patients with significant OA on imaging have minimal symptoms. Many patients with severe pain have mild imaging changes. The load through the joint and the muscular support around it are often more important than the X-ray findings. |
Inflammatory arthritis (RA and related) | Women aged 30–60, patients with family history of autoimmune conditions | Rheumatoid arthritis and related conditions (psoriatic arthritis, ankylosing spondylitis) are immune-mediated diseases in which the immune system attacks the joint lining. Produces symmetrical joint swelling, warmth, morning stiffness lasting more than 30 minutes, and systemic symptoms including fatigue. Requires medical management for disease modification alongside conservative physical care. Manual therapy and exercise play an important role in managing symptoms and maintaining function. |
Facet joint arthritis (spinal OA) | Adults over 50, patients with chronic back or neck pain | Degenerative changes in the facet joints of the cervical, thoracic or lumbar spine. Produces local spinal pain, stiffness and restricted range of motion — often described as catching or locking. Can refer pain into the shoulder, arm, buttock or leg depending on the level affected. Frequently identified on imaging and attributed as the sole cause of pain — but facet arthritis rarely accounts for all symptoms without concurrent soft tissue and biomechanical involvement. |
Cervical spondylosis | Adults over 40, desk workers, patients with chronic neck pain | Age-related degeneration of the cervical discs and facet joints producing neck stiffness, cervicogenic headaches and, in more advanced cases, arm pain and neurological symptoms. Often detected incidentally on imaging in patients without symptoms. The presence of spondylosis does not mean the changes are causing the current pain — careful clinical assessment is required to distinguish spondylotic changes from other drivers of cervical symptoms. |
Sacroiliac joint arthritis | Women over 40, patients with seronegative spondyloarthropathy | Degeneration or inflammatory changes in the sacroiliac joint producing one-sided low back and buttock pain, particularly with prolonged standing, rolling in bed and single-leg loading. Can be associated with ankylosing spondylitis in younger patients. Distinguished from mechanical SIJ dysfunction by the presence of morning stiffness, systemic features and specific inflammatory markers on blood testing. |
Thumb CMC arthritis | Women over 45, manual workers, former racquet sport players | Degenerative changes at the carpometacarpal joint of the thumb — the joint at the base of the thumb where it meets the wrist. Produces pain and reduced pinch grip, particularly with opening jars, turning keys and sustained gripping. The most common arthritic presentation in the hand. Responds well to joint mobilisation, intrinsic strengthening and load management combined with pain-relieving acupuncture. |
Knee OA | Adults over 55, overweight patients, previous knee injury or surgery | Medial compartment knee OA is the most common arthritic presentation in the lower limb. Produces medial knee pain and stiffness with loading — particularly stairs, prolonged walking and rising from a chair. Often attributed solely to the joint changes on X-ray, but the quadriceps strength deficit, hip abductor weakness and gait mechanics around the knee are consistently more modifiable and more important for functional outcomes than the cartilage changes themselves. |
Inflammatory flare on chronic OA | Any patient with pre-existing OA after overuse, injury or illness | Chronic OA can undergo acute inflammatory episodes — joint swelling, increased warmth and pain disproportionate to baseline — from activity overload, joint trauma or systemic illness. Distinguishing an acute OA flare from gout, septic arthritis or inflammatory arthritis is clinically important. Treatment during a flare focuses on settling inflammation before returning to loading programmes. |
⚠️ New or acutely worsening joint pain with significant swelling, heat, redness or systemic symptoms such as fever should be assessed medically before beginning conservative treatment. These features may indicate gout, septic arthritis or an acute inflammatory flare requiring urgent investigation and management. |
One of the most important things to understand about arthritis — particularly osteoarthritis — is that the pain is not simply caused by the structural changes in the joint. If that were true, the level of pain would directly correlate with the degree of change on imaging. It does not.
Research consistently shows that a significant proportion of people with severe OA changes on X-ray or MRI have no pain at all — and a significant proportion of people with severe pain have mild imaging changes. What determines the pain experience is far more complex: the muscular support around the joint, the load distribution through it, the neurological sensitisation of the surrounding tissue, and the inflammatory environment being maintained by biomechanical or systemic factors.
This means that treatment directed only at the arthritic joint — without addressing the muscles that support it, the mechanics that load it, and the chain above and below it — consistently produces incomplete outcomes. The following chain framework illustrates how arthritis at any joint is influenced by structures beyond that joint.
The load from above Every arthritic joint receives its load from the structures above it. A knee with medial compartment OA is loaded by the hip abductors, the lumbar spine and the pelvis. If the hip abductors are weak, the knee collapses into adduction with every step, concentrating load on the medial compartment where the arthritis is. If the lumbar spine is restricted and pelvic alignment is altered, the load asymmetry into the knee increases further. Treating the knee without restoring hip abductor strength and lumbar mechanics means treating the symptom while the cause continues. | The joint itself Arthritic joints respond to mobilisation. The research shows that manual therapy directed at arthritic joints — gentle, graded mobilisation within comfortable range — reduces pain and improves function through mechanisms including fluid exchange in the joint, nociceptive inhibition and restoration of accessory joint movement that passive stretching cannot achieve. This applies to knee OA, hip OA, spinal facet arthritis and thumb CMC arthritis equally. Avoiding the joint entirely is not a neutral decision — it progressively reduces the joint’s capacity to tolerate load. | The mechanics from below For lower limb arthritis, what happens below the affected joint determines how load is distributed through it. A knee with medial compartment OA in a patient with bilateral foot pronation is receiving asymmetric compressive load from the ground up with every step. A hip with OA in a patient with ankle restriction is being forced into compensatory external rotation during gait. Addressing the lower limb mechanics from the foot upward is not peripheral to the arthritis management — it is central to it. |
What makes our approach different is that we do not just treat the arthritic joint — we assess the full biomechanical picture. Who is loading the joint from above? What mechanics are driving load from below? What inflammatory drivers are maintaining the sensitisation? Addressing these factors alongside the joint itself is what produces meaningful, lasting improvements in an arthritic patient — not just temporary symptom relief. |
In practice, the most common arthritic presentations — and the contributing factors that make them worse — include:
Knee OA with quadriceps deficit | The most consistent finding in knee OA is not the cartilage loss — it is the quadriceps weakness that accompanies it. Quadriceps function directly controls load on the medial compartment: weak quads increase joint loading with every step, particularly on stairs and slopes. The research is unambiguous: quadriceps strengthening is the most effective single intervention for knee OA pain and function, superior to anti-inflammatory medication for long-term outcomes. Yet the majority of patients with knee OA have never been through a structured quadriceps strengthening programme before seeking surgery. We build one from the first session. |
Hip OA with glute and gait pattern | Hip OA is accompanied by a predictable pattern of muscle dysfunction: the gluteus medius and hip external rotators weaken, the hip flexors tighten, and the patient develops an antalgic gait that further concentrates load on the arthritic segment. Many patients with hip OA also have lumbar restriction that limits normal gait extension, forcing the hip to compensate. Restoring hip abductor strength, lumbar mobility and gait pattern is consistently more effective than passive treatment of the hip joint alone. We address all three simultaneously. |
Spinal facet arthritis with chronic stiffness | Facet joint arthritis in the lumbar or cervical spine produces a characteristic pattern of morning stiffness that eases with activity, then worsens again with prolonged loading. Patients often describe it as ‘seizing up’ overnight and needing time to loosen. Spinal facet arthritis responds well to graded mobilisation and manipulation — both of which have strong evidence in this population — combined with core stability and postural endurance exercises that reduce the daily load the facet joints are absorbing. Medication alone does not address the mechanical component. |
Inflammatory arthritis on a background of deconditioning | Patients with RA and related conditions often develop significant deconditioning from years of reduced activity due to pain and fatigue. The resulting muscle weakness, poor joint stability and reduced cardiovascular capacity amplify the pain experience and the functional limitations beyond what the disease alone produces. Exercise is now classified as a first-line treatment for inflammatory arthritis — not something to be avoided. Structured, graded exercise in collaboration with rheumatological management consistently improves pain, fatigue and function. We design the programme around the patient’s current capacity and progress systematically. |
Every arthritic patient begins with a thorough assessment — identifying which joints are affected, the degree of functional impairment, the muscular and biomechanical contributors, and any systemic or inflammatory features that require medical co-management. Treatment is structured around what the assessment finds, not applied as a standard protocol.
Our approach combines four elements — each targeting a different layer of the problem, in a sequence that makes each one more effective.
Acupuncture Provides meaningful pain relief in arthritic presentations through central and peripheral pain inhibition mechanisms. Reduces the neurological sensitisation that amplifies arthritis pain beyond the structural changes alone. Effective for knee OA, hip OA, spinal facet arthritis and hand and thumb arthritis. Multiple high-quality trials support acupuncture for osteoarthritis pain — it is not placebo, and its effects are clinically meaningful. | Chiropractic mobilisation Graded joint mobilisation directed at the arthritic joint and the structures loading it from above and below. For spinal arthritis, gentle mobilisation and manipulation reduce stiffness, restore accessory movement and reduce pain through neurophysiological mechanisms that are distinct from and additive to exercise benefits. For peripheral joint arthritis, mobilisation is combined with attention to the full lower or upper limb chain that is concentrating load on the affected joint. |
Soft tissue therapy Release of the muscle tension that builds around arthritic joints in response to pain and guarding. The quadriceps inhibition pattern in knee OA, the hip flexor tightening in hip OA, the deep cervical muscle guarding in cervical spondylosis — these are maintained by the pain response and amplify the load on the arthritic joint. Releasing them reduces joint load and improves the patient’s ability to engage in the strengthening programme. | Acupuncture for inflammation Targeted acupuncture to the joint and periarticular structures has local anti-inflammatory effects through neuropeptide modulation. In acute inflammatory episodes on a background of chronic OA, acupuncture provides a clinically meaningful reduction in joint inflammation and pain within 24 to 48 hours — creating a window where active rehabilitation can resume. Particularly useful when an acute flare has interrupted the loading programme. |
Isometric loading The starting point for all arthritic exercise programmes — particularly in patients with significant pain on movement. Sustained muscle contractions without joint motion reduce pain through central inhibition and begin the process of muscle recruitment without provoking joint symptoms. Quadriceps isometric holds for knee OA, glute holds for hip OA, deep neck flexor holds for cervical spondylosis. The load is set to produce mild muscle fatigue without joint pain. | Progressive strengthening Once isometric loading is tolerated, progressive strengthening through range rebuilds the muscular support that reduces joint load with every step. For knee OA: wall slides, step-ups, straight leg raises progressing to squats. For hip OA: isometric glute med holds progressing to side-lying abduction, standing hip abduction, single-leg press. For spinal arthritis: dead bugs, bird-dogs, cat-cow progressing to loaded extensions. Each programme is specific to the arthritic joint and the patient’s functional level. | Functional and lifestyle return The ultimate goal is not pain-free performance in clinic — it is function in daily life. Stair climbing, prolonged walking, gardening, returning to sport or recreation. The final phase of the exercise programme replicates the functional demands the patient has lost and progresses those systematically. Activity modification is included: which activities protect the joint, which are beneficial, which should be modified and how. |
The evidence for exercise in arthritis is overwhelming and consistently misrepresented to patients. Here is what the research actually shows:
For knee osteoarthritis, structured exercise produces pain and function outcomes equivalent to, or superior to, non-steroidal anti-inflammatory medication. The Cochrane reviews are unambiguous: land-based exercise reduces pain and improves physical function in adults with knee OA, with benefits that persist after the programme ends.
For hip osteoarthritis, exercise therapy produces clinically meaningful improvements in pain and function. Manual therapy combined with exercise produces superior outcomes to either intervention alone.
For inflammatory arthritis including rheumatoid arthritis, exercise — including resistance training — is safe, does not worsen disease activity, and consistently improves strength, cardiovascular fitness, fatigue and quality of life. The old advice to rest inflamed joints has been replaced by evidence-based exercise guidelines that recommend structured activity as part of standard management.
For spinal OA and cervical spondylosis, manual therapy combined with exercise produces superior short and long-term outcomes to either exercise alone or medication alone.
Exercise is medicine for arthritis. Not a complement to real treatment — the treatment itself. The type of exercise matters, the dose matters, and the progression matters. A structured programme built around the specific joint affected, the patient’s current capacity, and the biomechanical contributors is what the evidence supports. Generic advice to ‘stay active’ without a programme is not sufficient and rarely produces meaningful change. |
Medication, injections and surgery all have a role in arthritis management — but that role is as part of a broader strategy, not as a standalone solution.
Anti-inflammatory medication (NSAIDs) reduces arthritic pain effectively in the short term. For chronic arthritis, the long-term risk profile of regular NSAID use — gastrointestinal, cardiovascular and renal — means it is most appropriately used for acute flares rather than as the primary ongoing management strategy.
Cortisone injections provide meaningful short-term pain relief for arthritic joints and are most useful when pain is severe enough to prevent participation in a loading programme. The evidence on repeated cortisone injection into OA joints is less favourable — some studies suggest accelerated cartilage loss with repeated injections. A cortisone injection used to create a treatment window for rehabilitation is appropriate. Repeated injections without a concurrent loading programme are not.
Joint replacement surgery produces excellent outcomes for carefully selected patients with severe OA who have exhausted conservative management. It is not the only option for patients with advanced OA, and the outcomes of surgery are improved by pre-operative strengthening and post-operative rehabilitation. Many patients referred for surgery have not been through a structured conservative programme — and a significant proportion improve sufficiently that surgery is deferred or no longer desired.
At TOP Chiropractic Acupuncture, we work alongside GPs, rheumatologists and orthopaedic surgeons. We manage what conservative treatment can manage, refer when specialist input is needed, and communicate with the treating medical team where co-management is appropriate.
Most arthritic presentations can be comprehensively assessed and managed in clinic. Where further investigation is indicated — to confirm diagnosis, exclude other pathology, or guide treatment decisions — we recommend specific investigations based on the clinical picture.
Blood testing is indicated where inflammatory arthritis is suspected — elevated CRP, ESR and rheumatoid factor or anti-CCP antibodies are the primary markers. HLA-B27 testing is relevant where ankylosing spondylitis is considered. These are requested through the patient’s GP.
Imaging decisions are based on what the clinical assessment cannot determine rather than requested routinely. X-ray provides the baseline structural assessment for OA. MRI is indicated where soft tissue, ligamentous or inflammatory joint pathology is suspected beyond what clinical examination can confirm. Ultrasound is used for peripheral joint effusion assessment and guided injection planning.
Referral to rheumatology is recommended when inflammatory arthritis is suspected, when the clinical presentation is atypical, or when systemic features are present. Referral to orthopaedics is discussed when conservative management has been comprehensively delivered and the patient’s functional limitations warrant surgical consideration.
At the end of your treatment plan, we perform a full re-examination — retesting everything from your first visit and comparing the results side by side. This gives you a clear, objective picture of how much you have improved.
There is no guesswork and no vague ‘how do you feel’ — we measure your joint range of motion, your muscle strength, your functional capacity (sit-to-stand, step count, walking tolerance), your pain levels with specific activities, and where questionnaire outcomes were completed at baseline, your DASH, NDI or KOOS score. Those results determine whether you are progressing as expected, need adjustment to the programme, or require specialist referral. The numbers make the decision.
Chiropractic Joint mobilisation to reduce stiffness and restore movement. Chain mechanics above and below the arthritic joint. Spinal alignment and load distribution. Evidence-based for spinal and peripheral joint OA combined with exercise. | Acupuncture Pain modulation through central and peripheral mechanisms. Periarticular inflammation reduction. Muscle guarding release. Multiple systematic reviews support acupuncture for OA pain reduction beyond placebo effect. | Exercise programme Isometric loading progressing to strengthening. Specific to the affected joint and contributing muscles. The most evidence-supported intervention for arthritis of any joint. Dose and progression matter — not generic movement advice. | Co-management Liaison with GP, rheumatologist and orthopaedic surgeon where indicated. Referral for blood testing, imaging and specialist opinion. Pre- and post-operative rehabilitation for joint replacement patients. |
⚠️ Arthritic pain that is rapidly worsening, associated with systemic symptoms (fever, unexplained weight loss, significant fatigue), or affecting multiple new joints simultaneously warrants urgent medical assessment to exclude inflammatory arthritis, infection, malignancy and other serious systemic conditions before conservative management is commenced or continued. |
Book an assessment at TOP Chiropractic Acupuncture if you are experiencing:
Joint stiffness in the morning that eases with activity — in the spine, hips, knees, hands or feet Joint pain with specific movements or loading that is limiting your daily activities A diagnosis of osteoarthritis with no structured exercise programme in place Knee or hip pain that worsens on stairs, prolonged walking or rising from a chair Neck or back stiffness attributed to spondylosis or facet arthritis that is not improving Hand, thumb or wrist arthritis affecting grip and daily tasks Inflammatory arthritis managed with medication but with persistent pain, fatigue or deconditioning You have been told surgery is the next step but want to explore conservative management first |
Dr Don Kim is a dual-qualified chiropractor and acupuncturist at TOP Chiropractic Acupuncture in West Ryde. He holds a Masters of Chiropractic, Bachelor of Chinese Medicine and Bachelor of Acupuncture, and has been treating arthritic and degenerative joint conditions since establishing the clinic in 2016. His patient caseload includes adults with knee and hip OA managing their condition conservatively, patients with spinal spondylosis and facet arthritis, patients with inflammatory arthritis seeking conservative support alongside medical management, and patients preparing for or recovering from joint replacement surgery. The common thread is that structured, evidence-based conservative care consistently produces meaningful improvements in pain and function — and that arthritis is a condition to be managed well, not accepted passively.
