Spinal Disc Degeneration

Osteoarthritic and spondylitic arthritis of the lumbar spine, showing degeneration of the intervertebral disc between the L3 and L4 vertebrae, spondylitic arthritis between the L4 and L5 vertebrae (in which encroachment on the intervertebral foramen compresses the spinal nerve), and an osteoarthritic facet joint.

As chiropractors we commonly find spinal disc degeneration as a complicating factor in the spine and spine related conditions that our patients have. Almost always these patients are older, 45 years old and up, and they believe that spinal disc degeneration is a byproduct of age. Patients think that they should have “arthritis” because they are older. The reality of the situation, though, is that age is not the most significant variable for the presence of arthritis. Since it takes time for degeneration to progress, age is only a factor because we typically do not see arthritis on advanced imaging until later in life. Injuries that damage joints and the supporting soft tissue may accelerate the degenerative process, this is why we sometimes arthritic change in patients even in their late 20’s or early 30’s.  It is not age, or even an injury alone which causes arthritis but an increase in joint loading. kinetic-chain

Joints are designed to move but they also have to bear a load. When a joint is in it’s normal and healthy position it can move and weight bear properly. Outside of a joint’s normal and proper position it cannot perform it’s movement properly and it cannot properly handle the loading it is meant to. The easiest joint to describe this on is the knee, because many Americans are familiar with knee arthritis. The knee joint basically has two joints to it, there is a medial and lateral aspect. The medial aspect of the knee most commonly is the part of the knee that becomes painful with degeneration. A common issue associated with the knee is a fallen arch in the foot. As your arch falls your knee turns in resulting in an increase in loading to the medial aspect of the joint. Due to the increase in loading, not only will this joint become more difficult and even painful to move but also the joint surface will breakdown which is what we call arthritis.  knee OAOsteoarthritis is how the body responds to an increased load across a joint surface, the cartilage breaks down and there is increased bone growth to fuse the joint together. Our bodies do this on a cellular level and is influence by expression or inhibition of genes. Regarding spinal disc degeneration there is actually death of spinal disc tissue that takes place under increased loading. This 2000 study measured that sustained loading on the spinal discs results in cellular death and a progression of disc degeneration. The authors noted that as the load and duration of the load increased so did the degeneration. This 2007 study also found that sustained loading on a spinal disc stimulated degeneration but these authors found that dynamic loading, (loading and unloading a joint continuously,) actually has more of a healing affect on a spinal disc. So not all loading has the same affect on a spinal joint, anyway, but sustained or static loading stimulates the degenerative process while loading/unloading a spinal disc is healthy for it. What does loading/unloading look like, movement. Movement is good for the body, static postures are not. Don’t sit still OR stand still for too long, both will result in static loading and possibly spinal disc degeneration. lumbar spine

Spinal disc degeneration occurs in response to an increase in loading on a spinal joint, this loading alters the way the cells function causing them to undergo early apoptosis. Apoptosis is programmed cell death, remember that from biology class? Cells have a life cycle and will die with age, in the spinal discs an increase in loading forces the cell to die prematurely. Over time, enough cells die without being replaced, the spinal disc looses it’s height and bone spurs grow in an effort to fuse the joint to make it stronger to support the increase in load. Age is only a component because this process takes time, if degeneration was age dependent we would be able to predict how much arthritis at what age. Instead we have seen patients as young as 30 with signs of spinal degeneration and patients as old as 99 with no signs of spinal degeneration.

Altered joint loading in the spine is due to poor posture and poor spinal alignment. Our spine should be straight from the front and we have normal curves that should be present from the side. Any deviation from the normal will result in an increase in loading in the spinal joints and strain in the supporting muscles and ligaments. In the short term our bodies can adapt to it but over the long term that loading will contribute to stiff joints, tight muscles and spinal degeneration. What is interesting is that spinal arthritis, or spinal degeneration, does not correlate well to pain. What that means is you can have spinal disc degeneration but no pain associated with it but it doesn’t mean you won’t have pain at some time. As the degenerative process progresses, though, this will contribute to pain, sciatica, carpal tunnel syndrome, tingling/numbness in the extremities, and reduced or loss of motor control of the extremities.

PostureWThere has been no reported cases of spinal degeneration being reversed. So if you already have some amount of spinal disc degeneration it is very unlikely it will ever be reversed. The issue then is what to do to keep it from getting worse. If you don’t want to have any spinal arthritis including spinal disc degeneration the prevention is the same as the treatment for those who already have it. This is to measure your posture and the structure of your spine and compare to established normal data to start. Then to engage in a care plan of restoring your posture and spinal alignment towards the normal values.  In our office we used tested protocols to successfully restore postures spinal alignment. The research into these protocols tells us that by restoring posture and spinal alignment not only do we get a more permanent resolution of symptoms but there are measurable improvements in body functioning that are possible as well. By restoring posture and spinal alignment we restore the normal joint loading and can slow or even stop the degenerative process. If you have significant spinal disc degeneration, because that involves joint derangement, there is a limitation to how close to normal we can restore a patients posture and structure. In our view, though, any improvement towards normal is a good thing for the patients long term health and function.

Spinal disc degeneration isn’t a “life sentence” of progressive pain and future loss of function. You should also not expect to have arthritis in any joint just because you are getting older. Osteoarthritis at any joint is due to mechanical loading, most commonly caused by a deviation from the normal posture OR chronic repetitive motion of a joint like the shoulder. We should strive to maintain proper posture throughout our life to give ourselves the best chance of no developing any joint pain or loss of joint function. When we loose that proper posture and alignment it is important to engage in a program to restore it and sometimes it isn’t as easy as doing a few exercises. If you want to find out if your chronic spine or joint pain is correctable, give our office a call for a consultation and evaluation.

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Posted in Back Pain, Wellness

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