Spinal Osteoarthritis

Written by Rebecca Parsons

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What is spinal osteoarthritis?

Osteoarthritis (OA) is also known as degenerative joint disease. It is a condition in which the cartilage that protects the bony surfaces degenerates or wears down. Spinal osteoarthritis occurs when this happens in the back, most commonly the lower back or neck within the facet joints. In conjunction with the degeneration of cartilage, in osteoarthritis you can also develop bone spurs or osteophytes.

What are the symptoms of spinal osteoarthritis?

Patients with spinal OA often present with stiffness in the neck or back. This stiffness is usually worse in the morning, tends to ease as you start to move around but can worsen towards the end of the day. This stiffness can be due to build up of fluid in the joint but can also be as a result of loss of joint flexibility. Most patients describe the pain as ‘aching’ in character and can be a steady or intermittent pain.

There is often a localised tenderness around the joint when provoked and this can be aggravated by certain movements (usually sitting upright and standing) and tends to ease while lying down. Occasionally with movements some crunching or grinding can be heard this is known as crepitus.

In more advanced cases, it isn’t uncommon to have weakness or numbness in your arms or legs due to the bone spurs and osteophytes putting pressure on the nerves that leave the spinal column.

In most cases people experience very little interference with being able to continue in their day to day lives. If the physical effects begin to affect activities it is good to seek assistance from a trained professional.

What are the common causes of spinal osteoarthritis?

Spinal osteoarthritis can occur as part of normal age related changes in the body. A younger person is more likely to be diagnosed with spinal OA following injury or trauma to the spine previously in their life or as a result of a genetic defect involving cartilage

In those younger than 45, spinal OA is more common in men and post 45 it is more common in women.

There are a few factors that can increase your likelihood of getting spinal OA. These include:

  • Obesity
  • Family history of osteoarthritis
  • Having an occupation involving repetitive joint movements, especially with load.
  • Genetic birth defects of the joints or cartilage.

How is spinal osteoarthritis diagnosed?

Spinal OA can often be diagnosed with a full case history and physical exam specifically assessing pain and tenderness at certain points and restriction of movement in a particular area. In advanced cases a neurological exam of limbs may be conducted to assess any changes in reflexes, sensation and muscular weakness in the arms or legs.

Further tests may be required to assist in the diagnosis:

  • X-Ray – this allows the medical professional to ascertain if there is any loss of cartilage, bone spurs or damage to the bone. However it is often missed in the early stages of OA.
  • Blood tests – these can be used to rule out alternative diagnosis for your symptoms rather than rule in spinal OA.
  • MRI – this allows more insight into the soft tissues of the back such as the discs and can aid in diagnosis also.
  • Joint aspiration – this is occasionally done to collect fluid from the joint to rule out an infectious cause of pain.

What are the treatment options for spinal osteoarthritis?

Most treatments for spinal osteoarthritis are to assist in relieving symptoms and increase function.

Usually this can include:

  • Exercise to increase flexibility and range of movement, aerobic exercise to improve blood flow and strengthening exercise to increase the support of the muscles surrounding the spine.
  • Massage to reduce overt muscle tension which can cause some of the painful symptoms such as compensatory muscular spasms.
  • Acupuncture – there is limited evidence that suggests acupuncture can help with OA pain and back pain, but anecdotal evidence suggests that may be beneficial.
  • Heat or cold compress.
  • TENS (transcutaneous electrical nerve stimulation) machine that emits small electrical pulses into the area.
  • Nutritional supplements – turmeric, omega-3 fatty acids, glucosamine vitamin D, ginger and chondroitin sulfate are commonly suggested for OA, however more research is needed to back up the claims. Supplements are generally considered safe however side-effects although uncommon can occur so speak to your pharmacist before trying.
  • Medication: Acetaminophen and NSAIDS (non-steroidal anti-inflammatory drugs)
  • Topical treatments: sprays, creams and gels that you can apply locally to the area to reduce inflammation.
  • Osteopathy and Physiotherapy treatment will aim to increase the quality and quantity of movement of the spinal joints. Soft tissue techniques will also be used to help stimulate and relax surrounding muscle tissues. Your manual therapist will also prescribe an individualised and guided exercise programme to strengthen the core muscles which in turn will help provide support for your back.
  • Surgery – only ever considered in cases where the bladder or bowel function is impaired or the nervous system is in danger of becoming damaged or walking becomes difficult.

Contrary to old school belief; bed rest and back splinting/bracing is not recommended in this case. Keeping as relatively active as you can is key!

How long does spinal osteoarthritis last?

There isn’t a cure for spinal OA and once the changes have occurred they aren’t reversible. Hence once you are experiencing symptoms, goals of treatment are to relieve pain and improve joint mobility. However with the correct treatment and exercises programme the extent to which the osteoarthritis progresses can be managed.

Can spinal osteoarthritis be prevented?

You are more likely to suffer from spinal OA from being overweight and those in sports or jobs that put repetitive stress through joints in the spine. Therefore it can be helped by maintaining within a normal weight range, making sure you get regular treatment for any injuries and check-ups for optimum spinal health if you have a job that puts repetitive stress through your body or you play high impact sports.

What are the best exercises for spinal osteoarthritis*?

Pelvic Tilt. Lie on the floor with your knees bent and arms by your sides. Brace your core ( imagine someone tightening a belt around your waist a few notches). ilt your pelvis towards your head and hold for 5 seconds. Then tilt the other way and hold for 5 seconds. Repeat this 10-15 times

Shoulder Bridge. Lie on your back with your knees bent and arms by your sides. Squeeze your buttocks in slightly and then gradually push your hips up towards the ceiling (making sure that the level of your hips isn’t above your shoulders. Hold this for 8-10 seconds. Slowly lower to the starting position. Repeat this 10-15 times.

Low back twist. Lie on your back with your knees bent and your feet flat on the floor. Place a small cushion between your knees and bring your hands out by your side at a 45 degree angle, palms facing up. Slowly rock your knees from side to side. As you progress let your knees get lower to the ground. You should start to feel a gentle stretch in your side body. Repeat 10-15 times.

*It is recommended to get the go ahead from your GP, osteopath or physiotherapist before trying out any of these exercises.

Do I need to see my local GP or go to the hospital?

You may need to see your GP for severe symptoms of OA however most people experience mild symptoms and discomfort.

If you experience progressive symptoms, fever, redness/swelling in the area, a change in bowel or bladder habits and neurological symptoms (numbness or weakness) in one or both legs in combination with lower back pain, it is recommended you get this checked out as a matter of urgency on the same day by either your GP or at your local walk in centre.

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