Ginger Compress Therapy for Adults With Osteoarthritis

 

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ORIGINAL RESEARCH

Ginger compress therapy for adults with osteoarthritis Tessa Therkleson Accepted for publication 26 March 2010

Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/ onlineopen#OnlineOpen_Terms Correspondence to T. Therkle Correspondence Therkleson: son: e-mail: [email protected] Tessa Therkleson PhD RN Director of Nursing RATO Health, Lower Hutt, New Zealand

  Ginger compress compress therapy for adults with with osteoarthritis.  Journal of Advanced Nursing  66(10),  66 (10), 2225–2233. doi: 10.1111/j.1365-2 10.1111/j.1365-2648.2010.05355 648.2010.05355.x .x THERKLESON T. (2010)

Abstract Aim.   This paper is a report of a study to explicate the phenomenon of ginger compresses for people with osteoarthritis. Background.  Osteoarthritis is claimed to be the leading cause of musculoskeletal pain and disability in Western society. Management ideally combines non-pharmacologica macol ogicall strat strategies egies,, inclu including ding comp complemen lementary tary thera therapies pies and painpain-relie relieving ving medication. Ginger has been applied externally for over a thousand years in China to manage arthritis symptoms. Method.  Husserlian phenomenological methodology was used and the data were collected in 2007. Ten purposively selected adults who had suffered osteoarthritis for at least a year kept daily diaries and made drawings, and follow-up interviews and telephone conversations were conducted. Findings.   Seven Seven them themes es were identified identified in the data: (1) Medi Meditativ tative-lik e-likee stilln stillness ess and rel relaxa axatio tion n of tho though ughts; ts; (2) Con Consta stant nt pen penetr etrati ating ng war warmth mth thr throug oughou houtt the body; bod y; (3) Positive Positive cha change nge in out outloo look; k; (4) Inc Increa reased sed ene energy rgy and int intere erest st in the world; wor ld; (5) Deeply Deeply rel relaxe axed d sta state te tha thatt pro progre gresse ssed d to a grad gradual ual shift in pai pain n and increa inc reased sed int intere erest st in oth others ers;; (6) Inc Increa reased sed sup supple plenes nesss wit within hin the bod body y and (7) Moree com Mor comfor fortab table, le, flex flexibl iblee joi joint nt mob mobili ility. ty. The ess essent ential ial exp experi erienc encee of gin ginger ger compresses comp resses expo exposed sed the uniqu uniquee quali qualities ties of heat, stimu stimulatio lation, n, antianti-inflam inflammatio mation n and analg analgesia. esia. Conclusion.  Nurses could consider this therapy as part of a holistic treatment for people peop le with osteoarthritis osteoarthritis sympt symptoms. oms. Controlled Controlled resea research rch is need needed ed with larger number num berss of old older er peo people ple to exp explor loree fur furthe therr the eff effect ectss of the ginger ginger com compre press ss therapy. Keywords:  ginger compress therapy, Giorgi’s method, nursing, osteoarthritis, phenomenology

Osteoarthritis (referred to as OA) is a chronic, degenerative

in the knees, hips, spine and/or hands (Grainger & Cicuttini 2004). It is the most prevalent cause of musculoskeletal pain and dis disabi abilit lity y in old older er peo people ple in We Weste stern rn cul cultur tures es (Wa (Warsi rsi

arthritis which typically results in a thinning of joint cartilage

et al.   2003, 2003, Rah Rahman man 200 2005), 5), and its man manage agemen mentt ide ideall ally y

Introduction

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involves a multidisciplinary approach (Felson  et al.  2000b). Ginger compresses are used to manage arthritis symptoms in Chines Chi nesee fol folk k med medici icine ne (Xi (Xinan nangca gcaii 199 1998) 8) and Eur Europe opean an hospitals specializing in complementary healthcare (Eichler 1981, Fingado 2001).

Background The World Healt Health h Organ Organizati ization on decla declared red 2000 2000–2010 –2010 the Bone and Joint Decade, with one of its primary aims being the advancement of research and management of musculoskeletal disorders such as OA. Whereas OA primarily affects older people, with at least 80% of those over the age of  65 years having radio radiograph graphic ic evide evidence nce of OA, fewe fewerr than 25% are symptomatic (Felson  et al.  al.   2000a, Rahman 2005). X-rays sometimes show evidence of OA when there are no symptoms and, conversely, OA symptoms may occur when there the re is lit little tle rad radiog iograp raphic hic evi eviden dence ce of OA (Fe (Felso lson n   et al. 2000a). OA is a complex disease and joint degeneration, as observed by X-ray, results in varying degrees of pain and immobi imm obilit lity, y, wit with h oth other er fac factor torss suc such h as qua qualit lity y of lif lifee and psychosocial issues having an impact on the people with this

Limited resea Limited research rch has been conducted conducted on ginge gingerr appli applied ed externally, alhough it has been applied to painful joints for at least lea st a tho thousa usand nd yea years rs in anc ancien ientt Chi Chines nesee fol folk k med medici icine ne (Xinangcai 1998). Schurholz et Schurholz  et al. (1992/2002) al.  (1992/2002) in Germany carried out a pilot study in 1990 with over 300 nurses and doctors, followed by a comprehensive study between 1991 and 1992, when 800 ginger compresses were applied over the kidn ki dney ey re regio gion n to 41 pa pati tien ents ts wi with th a va vari riet ety y of he heal alth th condition cond itions. s. The ginger kidne kidney y comp compress ress (GKC) was found to be especially helpful in cases of arthritis, kidney stones, bronchitis, asthma, pneumonia and some forms of depression. A phenomenological study based in one city in New Zealand identified a positive experience for seven people with differ dif ferent ent hea health lth co condi nditio tions ns rec receiv eiving ing one GKC in pri privat vatee nursing clinics (Therkleson & Sherwood 2004). In neither of  these studies was the phenomenon of the GKC as reported by people with OA examined.

The study Aim

condition (Rosemann et (Rosemann  et al. 2006). al.  2006). Osteoarth Oste oarthritis ritis manag managemen ementt is conv conventio entionally nally conc concerned erned with wit h con contro trollin lling g sym sympto ptoms ms of pai pain n and lac lack k of mob mobili ility ty through throu gh the use of nonnon-stero steroidal idal antianti-inflam inflammato matory ry drugs (NSAIDS) and analgesics (Hunt et (Hunt  et al.   2009). These conventional medications are often rejected by people, either because of sid sidee eff effect ectss fro from m lon long-t g-term erm use or per person sonal al pre prefer feren ence ce (Felson et (Felson  et al. 2000b, al.  2000b, Fendrick & Greenberg 2009). Rheumatologists propose that management ideally combines conventionall paintiona pain-relie relieving ving medi medicatio cation n with nonnon-pharm pharmacolo acological gical strategies, such as changes in diet, exercise and the use of  natural therapies (Felson et (Felson  et al. 2000b). al.  2000b). Research shows that people with OA respond positively to heat therapy (Flusser

The aim of the study was to explicate the phenomenon of  ginger compresses for people with osteoarthritis.

et al. 2002 2002,, Canta Cantarini rini et al. 200 2007) 7) and rel relaxa axatio tion n the therap rapy y (Ga (Gay y et al. 2002, al. 2002, Baird & Sands 2006). The ginger compress, when applie app lied d ove overr the kid kidne ney y reg region ion,, com combin bines es bot both h hea heatt and relaxation therapies, with the addition of an awakening and stimulating effect (Schurholz et (Schurholz  et al. 1992/2002, al.  1992/2002, Therkleson & al.  (1992/2002) reported that Sherwood 2004). Schurholz et Schurholz  et al. (1992/2002) the gin ginger ger kid kidney ney com compre press ss was esp especi eciall ally y he helpf lpful ul for art arthri hritis tis.. Researchers have claimed that oral ginger extract can be used to manage the symptoms of arthritis, with human random contro con trolle lled d tri trials als sho showin wing g a sta statis tistic ticall ally y sign signific ificant ant red reduct uction ion of  OA sympt symptoms oms (Blid (Bliddal dal   et al.   2000, 2000, Altma Altman n & Marcu Marcussen ssen 2001, Haghighi et Haghighi  et al.  2005). However, these studies report that th at th thee hi high gh do dose se of or oral al gi ging nger er ex extr trac actt re requ quire ired d to ac achi hiev evee th thee desired response has often led to gastrointestinal complaints (Marcus & Suarez-Almazor 2001).

Giorgii (200 Giorg (2008) 8) emph emphasize asizess the importance importance of using phenomenological reduction, which includes imaginative variation and bracketing, to expose the meaning of a phenomenon from the data. Phenomenol Phenomenologica ogicall reduc reduction tion is an attit attitude ude of  mind applied in the understanding of the data to enable the researche resea rcherr to obser observe ve and identify the phen phenomen omenon on bein being g experienced free of personal biases. Bracketing is a form of  self-reflection that places the objective world in parenthesis and suspends personal biases, beliefs and opinions in order to explo ex plore re the phe phenom nomeno enon n in its tot totalit ality y (Hu (Husse sserl rl 198 1983). 3). Throughout the research process, a detailed reflective journal was used as an aid to bracketing. This journal allowed critical consciousness to enter the research process and to direct ideas back bac k to the res resear earch ch pra practi ctice. ce. Th Throu rougho ghout ut the study, study, a profes pro fessio sional nal men mentor tor pro provid vided ed per person sonal al sup suppor portt for the

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Methodology A Husserlian phenomenological approach was selected. The phenomenological approach considers human experience as its data and uses a defined process to explore these data and expose the phenomenon, that is, what is understood from the perspectiv persp ectivee of the expe experienc riencing ing partic participant ipant (Gio (Giorgi rgi 2000 2000). ). The phenomenon in this study was the GKC, and its meaning was described by ten participants in words, both verbal and written, and pictures.

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Ginger compress therapy for osteoarthr osteoarthritis itis

resear earche cher, r, and two aca acade demic mic sup superv erviso isors rs ass assist isted ed in the res design and explication process.

Ethical considerations

Participants

The study was approved by the appropriate ethics committees. Ten Regis Registered tered Nurses, educated educated in ginge gingerr comp compress ress therapy, delivered the treatment and monitored participants’ condition.

A sample of ten consenting adults over 45 years, who had been diagnosed with symptomatic osteoarthritis for at least 1 year, was purpo purposively sively selec selected. ted. Osteo Osteoarthr arthritis itis was confirme fir med d by XX-ra ray y an and d co comp mple leti tion on of th thee Sh Shor ortt Ar Arth thri riti tiss Assessment Scale (Wolfe et (Wolfe  et al. 2004). al.  2004). The health assessment excluded rheumatoid arthritis, fibromyalgia, cancer and other seriou ser iouss con condit dition ions, s, and tho those se tak taking ing cor cortic ticost ostero eroids ids.. In phenomenological research the sample size must be sufficient to understand the phenomenon (Giorgi 1997). Ten participants ensured that an in-depth profile of the experience was gained that represented the core themes and enabled understanding of the phenomenon of the GKC.

Application of the ginger kidney compress The participants were offered the GKC by doctors and nurses in five separate primary healthcare clinics in New Zealand and Australia. The nurses applied the GKC daily for seven consec con secuti utive ve day dayss acc accord ording ing to a defi defined ned pro proced cedure ure and protocol proto col as clari clarified fied by Schu Schurholz rholz   et al.   (1992/2002). (1992/2002). The GKC GK C co comp mpri rise sed d a co cott tton on cl clot oth h so soak aked ed in a ho hott gi ging nger er infusion and applied for 30 minutes over the kidney region, followed by a 20-minute rest. During the GKC, participants rested supine in a comfortably warm and quiet place.

Data collection The data were collected over a 9-month period in 2007 from four sources: sources: (1) written diaries daily describing describing the GKC experience; (2) coloured human diagrams on which participants indicated warmth as red, cold as blue and sensations as yellow; (3) interviews within one week of the treatment; and (4) two follo follow-up w-up telephone telephone conv conversati ersations ons afte afterr the inter inter-view vi ew.. Th Thee pr prim imar ary y qu ques esti tion on as aske ked d in th thee di diar arie iess an and d interviews was the same for all participants: ‘What was your experi exp erienc encee of the GK GKC?’ C?’ Dur During ing the int interv erview iews, s, fur furthe therr supple sup plemen mentar tary y que questi stions ons wer weree use used d as pro prompt mpts, s, suc such h as: ‘Could you tell me more about that?’ and ‘Could you describe how that made you feel?’ The in-depth, open-ended interviews vie ws co cond nduc ucte ted d 1 we week ek af afte terr th thee tr trea eatm tmen entt to took ok 40 40– – 80 minutes and took place in participants’ own homes. The data obtained were rich and varied. As Giorgi (1997) claims, written and coloured descriptions are brief and organized, whereas where as inter interviews views are gene generous, rous, disor disorganiz ganized ed and spon spontataneous.   2010

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Data explication Explicati Explic ation on of the dat data a was sys system temati aticc and fol follow lowed ed six clearly defined steps as adapted by Schweitzer (1983, 1998) from fro m Gio Giorgi rgi (19 (1971, 71, 198 1985, 5, 199 1997). 7). The These se ste steps ps we were: re: (1) holist hol istic ic gras grasp p of all the data; (2) de delin lineat eation ion of dat data a int into o discrete meaning units in the participants’ language, with the development of individual participant profiles; (3) amalgamation and codi coding ng of all parti participan cipantt data; (4) inte interrogat rrogation ion of  the amalgamated coded data and consideration of emerging themes the mes in the res resear earche cher’s r’s lan langua guage; ge; (5) des descri cripti ption on and discussion of themes; and (6) succinct summary of themes to isolate the phenomenon of the GKC for people with OA. The software tool, NVIVO  7 (Richards 2005, 2006), was used to facilitate management and analysis of the data.

Rigour A phen phenomen omenologi ological cal stanc stancee was adop adopted, ted, which invol involved ved transparent bracketing and a systematic, explicit process in making decisions throughout the research process. Data were obtained in a variety of ways and were visible and accessible to others. The use of NVIVO   7 software enabled memos of  thought thou ght proc processes esses and creat creative ive imaginings to be recor recorded ded alongside along side the analys analysis. is. In analys analysing ing the data, expe experienc rienced ed Husser Hus serlia lian n phe phenom nomeno enolog logist istss wer weree inv involv olved ed in off offeri ering ng critique and guidance.

Findings Seven themes were identified, representing the core experience for the participants. For all participants except one, the change cha ngess we were re pre presen sentt for at lea least st a mon month th fol follow lowing ing the treatment. This one exception was conscious of the changes during each GKC yet suffered extreme pain, which necessitated tat ed opi opiate ate med medica icatio tion n and a joi joint nt rep replac laceme ement nt wit within hin 4 weeks of the treatment.

Theme 1: Meditative-like stillness and relaxation of  thoughts Participantss expe Participant experienc rienced ed warm warmth th build building ing up in the body body,, which initially spread from the mid-point of the back to the  

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head, d, act activa ivatin ting g a sen sense se of med medita itativ tive-l e-like ike sti stilln llness ess and hea relaxation relax ation of thou thoughts. ghts. This chang changed ed ment mental al state allowed the opportunity opportunity to posit positively ively reconsider reconsider chall challenge engess in life, eventuall even tually y arous arousing ing an inne innerr state of peac peacee and calm. This theme included the features of warmth, relaxation, peace, peac e, calm and comf comfort ort in assoc association iation with parti participan cipants’ ts’ thought thou ght proc processes esses.. In a warm warm,, comf comfortab ortable le and semisemi-dozi dozing ng place, pla ce, the they y rea reasse ssesse ssed d and rel releas eased ed men mental tal wo worrie rriess and tensions, which led to overall calm and composure: I am sure many times when the nurse came in I just didn’t want to come back into the world, you know, you just wanted to stay there where your body was so lovely and comfy; it was perfect.

Picturesq Pictur esque ue wor words ds wer weree use used d to des descri cribe be the som somew ewhat hat dreamy experience: It was cosy and warm and I felt like I was floating on a cloud.

Prior to the treatment, there had been a tendency to hurry and panic through life, whereas during the GKC a space of  tranquillity replaced that of general tension:

It did just seem to spread; my back got warm then it was sort of as if  my whole nervous system was saying, ‘This is really nice, I’ll have some as well’. It spread down both legs and arms, that lovely warmth was so good.

Warmth Warm th in incr crea ease sed d in th thee jo join ints ts an and d th thee me meta tabo boli licc an and d excretory excr etory organs, with a corre correspon sponding ding positive effect on excre ex cretio tion n and dig digest estion ion.. Dep Depend ending ing on the par partic ticipa ipant’ nt’ss constitution, the warmth seemed to be directed to where it was most beneficial and was perceived as activated by the ginger, with words such as hot, spicy, prickly, itchy, tingly, glowing and fuzzy used. The increased bodily warmth led to a sense of deep relaxation, allowing release of bodily tensions: You are relaxed and if you are relaxed it doesn’t matter what you are doing you just get on with it and don’t think about it. If you are in pain and you can’t get up from sitting down or anything the brain takes tak es over and tells you there is an obstructi obstruction. on. I fel feltt a gre greate aterr freedom once I got off the table and was warmed up.

Whilst these reports were subjective, a common picture of  freedo fre edom m and pos positi itivit vity y eme emerge rged d as the OA obs obstru tructi ction on shi shifte fted. d.

From the rushing in and everything being so outwardly alert and living on nerves, I came to a much more peaceful, relaxing situation.

Theme 3: Positive change in outlook In th this is pe peac acef eful ul pl plac ace, e, wh whil ilee to tota tally lly pr pres esen ent, t, th thee mi mind nd experienced a profound state of stillness. Issues in life that had been disturbing were met with inner serenity. In warmth and an d co comf mfor ort, t, OA no mo more re fe feat atur ured ed an and d li life fe co coul uld d be considered with renewed understanding.

Theme 2: Constant penetrating body warmth throughout the body Participants experienced constant penetrating warmth, which gradually increased in intensity and radiated throughout the body, from the mid-back to the head then extending to the feet, hand feet, handss and inner body, activ activating ating an overa overall ll physi physical cal warmth and relaxation. The second theme amalgamated the features of warmth and relaxation. Following every GKC, participant’s coloured warmth on a human diagram using red, which intensified on the back and extended to include the feet, hands and OA joints. Participants initially indicated cold feet and OA joints by colouring them blue and/or describing this: I haven’t experienced that warmth before, you sort of feel penetrating warmth that was getting into your bones; it wasn’t surface warmth. You know how you stand in front of a fire and get warm and as soon as you move away it’s gone, well this is constant.

Heat and warmth flowed through the body, extending out to the periphery: 2228

 

Participants experienced a positive shift in thinking, with a subseq sub sequen uentt ch chang angee in out outloo look. k. Pas Pastt mem memori ories, es, of fam family ily,, friends and health were awoken and met with fresh insight and acceptance, leading to renewed interest and confidence in relationships with others. During the GKC there was a warming and loosening of  thought processes. Consciousness shifted from the present to the past and on into the future, with an internal reliving of  experiences with others: Thoughts at the start were all the external things that I have to think about ab out in the day day;; th thes esee qui quick ckly ly dis disapp appea eared red.. I co coul uld d al alig ign n my thoughts in whatever way I wanted to in daydreaming.

Participant musings after the GKCs revealed an underlying regret for losses of the past, such as physical agility, nurture and relationships with family and friends. Living with OA was frustrating and caused loss of freedom: I experienced OA as a disability; like having to get by with a broken part, yet 7 years ago I could hardly keep my feet on the ground and I would run everywh everywhere. ere.

As participants reminisced, they became increasingly aware of the significance of others, with an inner ordering and shift in understanding: My father died at my age, crippled with OA; in fact my mother became confused and thought I was her husband at one stage.   2010

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Perceptions changed as memories from the past were awoken in the present. Thinking that had been closed, even limited, became clearer and more outward looking: Some of my family members, they probably didn’t know the extent of  my disability. Because there is nothing much you can do about it if  you keep going on about it. I wasn’t actually hiding it; I was just not sharing with anyone. Now I have done a lot of talking to friends and people I have met.

Following the treat Following treatment ment,, parti participan cipants ts desc described ribed a chang changee from being reserved and reticent to having more meaningful social soc ial int intera eracti ction, on, wit with h inc increa reased sed int intere erest st in how oth others ers managed a disability such as OA.

Theme 4: Increased energy and interest in the world Following Follow ing the GKC GKC,, par partic ticipa ipants nts fel feltt awa awake ke and ali alive, ve, arousi aro using ng bot both h ne new w and rej rejuve uvenat nated ed int intere erests sts in wor worldl ldly y activities. Incr In crea ease sed d fo focu cuss at wo work rk an and d ho home me me mean antt th that at no mo more re we were re thoughts being dissipated; rather, thinking was more alive: This week I feel things are flowing, I am going back to a creative style that I thought I had lost in my work; there is more movement in my head and thinking.

Whilst receiving daily GKCs meant a busy week for participants, there was no mention of fatigue; rather, life took on a fresh vigour: After the compress I wake up feeling awesome, awesome, awake and alive. I get on with the day and find my thinking is wide awake. It’s like a buzz and I am off to work sparking.

Participants’ Participant s’ lighte lightening ning in think thinking ing and increase in ener energy gy stimulated stimu lated more open openness ness towa towards rds the world world.. Energ Energized ized,, focused mental processes enabled tasks, such as completing a

Ginger compress therapy for osteoarthr osteoarthritis itis

Theme 5: Deeply relaxed state that progressed to a gradual shift in pain and increased interest in others Participants experienced a gradual shift of pain as the inner body progressively progressively warmed and relaxed, allowing a sense of  emotional freedom which resulted in a new-found willingness to sha share re the their ir pri privat vatee wor world ld wit with h fam family ily,, fri friend endss andcolle andcolleagu agues. es. During the first GKCs, low-level physical irritations and discomforts were accentuated, with old injuries surfacing: Every day as I lay down the right side of the back became quite tense. I didn’t have a sore back when I lay down; it was like the experience of an old pain or tension.

The warmth of the GKC infiltrated and penetrated the body, activating a sense of opening and relaxing, with a gradual release of tension and pain: It’s the warmth that goes through the body from those compresses that causes the relaxation. Whatever the ginger does from then on, when you are relaxed it is able to do its thing.

The extreme chronic pain shifted during the later GKCs as participants relaxed totally: I was totally relaxed with the GKC; a time free of pain, great.

They contemplated the changed experience and described an association between warmth, relaxation and movement. As they warmed and relaxed there was an overall release from fr om di disc scom omfo fort rtss of th thee pa past st – ph phys ysic ical al,, me ment ntal al an and d emot em otio iona nal. l. Fo Foll llow owin ing g th thee tr trea eatm tmen ent, t, a ne new w at atti titu tude de of  optimi opt imism, sm, eve even n pla playfu yfulne lness, ss, was evi eviden dentt as par partic ticipa ipants nts smil sm iled ed an and d jo joke ked. d. Wi With th a tw twin inkl klee in hi hiss ey eye, e, th thee ol olde dest st participant said: I came home and my wife ran a mile – not really!

Social Soc ially, ly, the there re was a loo loosen sening ing in rel relati ating ng to oth others ers,, wit with h

meal, class lesson or creative artwork, to be accomplished in a more organized fashion. During and following the treatment, men t, par partic ticipa ipants nts beg began an to con consid sider er new ide ideas, as, suc such h as travelling travel ling out of town, walking up hills and subt subtly ly chang changing ing work processes. After the GKCs, there were suggestions of  person per sonal al gro growth wth,, wit with h wor words ds suc such h as spr spring ing,, but butter terfly, fly, freedom and release being used:

increased willingness to share inner needs:

After the week’s course I spread my wings free and remained flying

Theme 6: Increased suppleness within the body

for about 4 days. I still have increased energy in my thinking and I feel positiv positive. e.

Participants’ thinking that was previously confused was, after the treatment, attended with enthusiasm and creativity. An attitu att itude de of pos positi itivit vity y and hop hopee was evi eviden dentt as the they y mad madee plans into the future.   2010

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Now I just say ‘yes please’. I haven’t been good at asking for help and accepting the fact that people are now opening doors for me.

Participantss expre Participant expressed ssed an overa overall ll chan change ge in emot emotional ional being as they related to others with a new-found sense of openness.

Participantss expe Participant experienc rienced ed incre increased ased suppl supplenes enesss in the body body,, which facilitated mobility, posture and breathing and positively influenced social opportunities. Mobility was the most frequently discussed aspect of the OA experience. Initially, movement was difficult, especially where the OA joint was involved. Participants had a tendency  

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dist stan ance ce th them emse selv lves es fr from om th thee OA ex expe peri rien ence ce,, wi with th to di subsequent loss of body awareness:

had influenced feelings of self-esteem and independence, but this changed as many former tasks were attempted:

I am not inclined to be self aware of my foot and stuff like that;

There are certain movements in a cultural performance that means I

people will see me limping around but I am so busy I am not aware

have to swivel and now I am swivelling without even thinking about

whether it is hurting or whether I am cold or hot, basically I am just

it, which I couldn’t do before. I have more flexibility and mobility in

too busy to be aware.

my hip.

During the GKCs, the physical body became suppler as tense, contracted muscles and joints relaxed and loosened:

Participa Partic ipants nts we were re awa aware re of a boo boost st in ene energy, rgy, which was manifested initially in the desire to mobilize after each GKC and continued to carrying out increasing activities through the day:

My whole leg is freer, I can get in and out of the car easily, easily, I don’ don’tt have to lift my leg. When I get out of bed I can walk straight straight away away without a pause and I think I am beginning to stand more evenly.

The increased flexibility was also evident in improved posture and more comfortable breathing: Now I am standing up straight without even thinking about it. My posturehas post urehas imp improve roved d defin definite itely.Also ly.Also I can’ can’tt getover tha thatt bre breathi athing ng last night, I thought my breathing was so easy; I took a deep breath in and

I felt as though I was slightly rejuvenated, with more energy; this continued through to going to bed.

During Durin g and aft after er the tre treatm atment ent,, the inc increa reased sed ene energy rgy and renew ren ewed ed joi joint nt mob mobili ility ty all allow owed ed inv involv olveme ement nt in for former mer enjoyable recreational activities, such as gardening, travelling and walking.

out and found it was a real flow, where before it was very shallow. shallow.

Increased mobility enabled improved interaction with others, such as visits to family and friends: By the end of the second second compress compress I did think think som someth ething ing was happening. I walked up the road to my friend. It doesn’t sound far three doors up the road– but when you have a problem like this it is like a mile.

During Durin g the GKC GKCs, s, as mob mobili ility ty and pos postur turee imp improv roved, ed, the sense sen se of sel selff in rel relati ation on to oth others ers changed changed and soc social ial life became re-enlivened. Previous social isolation was replaced with enthusiasm to contact and/or visit others.

Theme 7: More comfortable and flexible joint mobility Participants experienced more comfortable and flexible joint mobility mobilit y and inc increa reased sed phy physic sical al ene energy rgy,, whi which ch ena enable bled d renewed participation in worldly activities. This theme amalgamated the features of relaxation, freedom do m an and d mo mobi bilit lity. y. Du Durin ring g th thee tr trea eatm tmen ent, t, wa warm rmth th an and d relaxation increased their mobility: I felt the warmth in my hands and there was more movement in the

Meaning of ginger compress Thesee seven interpretive Thes interpretive themes themes of the expe experienc riencee of a serie seriess of GKCs were further explored to expose the meaning of the GKC GK C for pe peopl oplee wit with h OA. Th Three ree ess essent ential ial the themes mes wer weree identified, which summarize the phenomenon of the GKC: •   Warmth penetrated through through the entire self, activating deep deep relaxation. •   Total relaxation relaxation of the self enabled release release of tensi tension on and improved receptivity towards others. •   Inte Interest rest in the outer world increased increased as the self felt more mobile and energized. The findings revealed that during the GKCs people with OA expe experienc rienced ed prolo prolonged, nged, concentrated concentrated warmth on the lumbar region, and the opportunity to rest in a warm, quiet, comfortable place that allowed them to be totally present, while the while their ir bod bodily ily ten tensio sions ns dim dimini inishe shed. d. Gin Ginger ger’s ’s uni unique que qualities quali ties of heat, stimu stimulatio lation, n, vital vitality, ity, antianti-inflam inflammatio mation n and analgesia aided the participants in this moment, activating a temporary detachment from the stress and pain of living with OA and allowing an opening out towards the world and others.

hands; the warmth sort of feeds through the arms.

There was a definite consciousness that the warmth spreading andpenetrat andpenet rating ing theinner bod body y eas eased ed thejoint thejointss aff affec ected ted by OA: Having warmed up you are relaxed and moving freer; there is no question about that.

The sco scope pe of wh what at was pos possib sible le inc increa reased sed as par partic ticipa ipants nts attempte atte mpted d a wide widerr range of activ activities ities.. Previo Previous us restr restrictio ictions ns 2230

 

Discussion Study limitations This study exposed the essence of the phenomenon of the GKC GK C fo forr pe peop ople le wi with th OA by ex expl plor orin ing g th thee su subj bjec ecti tive ve exper ex perien iences ces of ten par partic ticipa ipants nts.. Wh Whils ilstt ten par partic ticipa ipants nts ensured that an in-depth profile of the experience was gained,   2010

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What is already known about this topic •

•

  Osteoarthr Osteoarthritis itis is the most common common form of  musculosk musc uloskeleta eletall pain and disab disability ility in olde olderr adult adultss in Western society.   People with osteoarthritis suffer a variety of  symptoms, including pain, psychological distress, social isolation and general inability to cope.

•

  Management of osteoarthritis ideally involves both both conventional pain-relieving medication and nonpharmacologic strategies, such as ginger compress therapy.

What this paper adds •

•

•

  The essential experience experience of ginger compresses compresses exposed the unique qualities of heat, stimulation, antiinflammation and analgesia.   Seven interpretive themes themes of the experience of a series of ginger kidney compresses were identified.   From these seven themes, three essential essential themes were identified which summarize the phenomenon of the ginger kidney compress: warmth penetrated through the entire self, activating deep relaxation, total relaxation relax ation of the self enabl enabled ed release of tensi tension on and improved receptivity towards others. Additionally, interest in the outer world increased as the self felt more mobile and energized.

Implications Implic ations for pract practice ice and/o and/orr policy •

•

  Ginger compress therapy therapy should be considered considered as a viable non-invasive option by nurses caring for people with osteoarthritis.   Further controlled research on ginger compress compress therapy is need therapy needed ed with large largerr numb numbers ers of the elderly suffering from osteoarthritis.

any conclusions drawn are too specific to be generalizable. This study was not intended to support statistically based generaliza gener alizations tions,, and and furth further er resea research rch with more parti participan cipants ts is needed. Additionally, only participants from New Zealand and Australia were included. Whilst no core differences were found between these two cultures, further research in these and other cultures would be worthwhile.

Experiences of ginger kidney compresses The participants, as others with OA, suffered psychological distress, cognitive impairment, social isolation and a general   2010

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Ginger compress therapy for osteoarthr osteoarthritis itis

inability to cope inability cope.. Two phenomenolog phenomenological ical resea researche rchers rs have described the experience of living with OA of the knee: one found a sense of lost control and independence as a result of the constant disability disability (Keys (Keysor or   et al.   1998), 1998), whi while le the other described a sense of learned helplessness, with a loss of self confidence, confidence, past physi physical cal agility and social inte integragraal.  2003, tion (Maly & Krupa 2007). Three trials (Blouin et (Blouin  et al. 2003, Mouchnino   et al.   2005, Dohre Dohrenbusc nbusch h   et al.   2008) 2008) hav havee shown sho wn tha thatt chr chroni onicc pai pain n in pat patien ients ts wit with h OA res result ulted ed in disturbanc distu rbances es in cogn cognitive itive func function tion and psych psychologi ological cal well well-being. The present participants’ experiences suggest an association of the GKC with relaxation and heat therapies. Research on heat and relaxation therapies has shown positive effects in the management management OA symptoms. RCTs using topical compresses of hot therapeutic mud on joints affected by OA have al.  2002, been found effective at Italian spa clinics (Flusser et (Flusser  et al. 2002, Cantarini et Cantarini  et al.   2007, Odabasi et Odabasi  et al.   2008). Verhagen et Verhagen  et al. (2007), in a systematic review of seven RCTs for patients with OA receiving spa therapy, suggested this as an effective treatment for OA symptoms. Deep relaxation therapies, such as hypno hypnotic tic relax relaxation ation and mindf mindfulnes ulnesss medi meditatio tation, n, have been use been used d eff effect ective ively ly to man manage age sel self-p f-perc ercept eption ion of OA symptoms (Gay et (Gay  et al.  2002, Baird & Sands 2006). Morone and an d Gr Grec eco o (2 (200 007) 7) is a st stru ruct ctur ured ed re revi view ew of re rela laxa xati tion on therapies that reported their positive effect in the management of OA pain and discomfort. The present findings suggest that participants’ experience of OA was typical, and that their responses to the GKC were compar com parabl ablee to tho those se of peo people ple wit with h OA rec receiv eiving ing dee deep p relaxation relax ation and heat therapies. therapies. The findings extend understan st andi ding ng of th thee GK GKC C fo forr pe peop ople le wi with th OA an and d su sugg gges estt possibilitie possib ilitiess for futu future re treat treatment ment and manag managemen ementt of this condition. The following recommendations are made in relation to the three essential themes: •   Given that warmth penetrated penetrated through the entire self, activating deep relaxation, the GKC is recommended as a non-invasive form of thermotherapy for OA. The GKC is especially beneficial for those with cold limbs and/or sensitivity sitivi ty to the cold. of the self (mental, physical and •   Given that total relaxation of emotional) enabled release of tensions and improved receptivity towards others, the GKC is recommended for people who tend to be intellectually preoccupied, fixed in habits, anxious, depressed, depressed, introspective, introspective, socially restrained, restrained, and/or tend to stiffen, tense, contract and/or hold their breath when moving. •   Give Given n that interest interest in the outer outer world increased increased as the person felt more mobile and energetic, the GKC is  

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suggested for those with OA, who are tired and lack the stamina to be involved in outside activities. Research Rese arch invol involving ving wellwell-desig designed ned cont controlle rolled d studi studies es or trials is warra warranted nted.. Possib Possibilitie ilitiess for future research on this topic are vast as the GKC treatment is largely unexplored. For example, it is possible that the chemical components of  ging gi nger er ac acti tive vely ly co cont ntrib ribut utee to th thee wa warm rmth th,, re rela laxa xati tion on,, stim st imul ulat ator ory, y, an anti ti-i -infl nflam amma mato tory ry an and d an anal alge gesi sicc ef effe fect ct.. Resear Res earch ch usi using ng tra transd nsderm ermal al del delive ivery ry of gin ginger ger,, in com combibination nat ion wit with h hea heatt pac packs, ks, mig might ht imp improv rovee man manage agemen mentt of  OA.. Re OA Rese sear arch ch ex expl plor orin ing g th thee im impa pact ct of th thee GK GKC C on larger lar ger pop popula ulatio tions ns of old older er peo people ple wit with h OA, esp especi eciall ally y thos th osee wi with th me ment ntal al he heal alth th is issu sues es,, wo woul uld d be va valu luab able le.. Additionally, increased understanding of the characteristics of ol olde derr pe peop ople le wi with th asy asymp mpto toma mati ticc OA co coul uld d he help lp to iden id enti tify fy th thee ch chara aract cter eris isti tics cs an and/ d/or or co copi ping ng sk skill illss th that at people develop to manage the damage to joints caused by OA. Conventional management of OA using anti-inflammatory drugs and analgesics is often an unsatisfactory answer due to side effects and/or patie patient nt comp complianc liancee issue issues, s, whe whereas reas the GKC treatment offers hope and a brighter future for those living with OA. Healt Healthcare hcare providers providers shou should ld cons consider ider the GKC GK C as pa part rt of ho holi list stic ic tr trea eatm tmen entt fo forr pe peop ople le wi with th OA symptoms.

Acknowledgements Appreciation Appreciati on is exte extended nded to: Anth Anthropos roposophic ophic Nurses and Docto Do ctors rs in New Zea Zealan land, d, Aus Austra tralia, lia, Eur Europe ope and Uni United ted Kingdom for both practical and personal support throughout this research. My academic colleagues in the phenomenology group at Edith Cowan University (ECU), Western Australia, Austr alia, especially especially Dr Trish Sherw Sherwood, ood, for her stimulating, chall challengin enging g and suppo supportive rtive enco encourage uragement ment these past years.

Funding Grants Gran ts fo forr th this is Ph PhD D re rese sear arch ch we were re re rece ceiv ived ed fr from om Th Thee Australian government, through an Australian Post-graduate Award;; ECU, Western Australia, through a PostAward Post-gradu graduate ate Exce Ex cell llen ence ce Aw Awar ard; d; Ma Mahl hlee-St Stif iftu tung ng Gm GmbH bH,, St Stut uttg tgar art, t, Germany, Germ any, through funding the ten nurses; and Phytomed Medicinal Herbs Ltd, New Zealand, through donating the organic ground ginger.

Conflict Confli ct of intere interest st No conflict of interest has been declared by the author. 2232

 

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