While there is currently no proven treatment to stop or slow the progression of osteoarthritis in the spine, there are treatments to alleviate the pain and other associated symptoms, and for most people the condition will not become debilitating. Some patients with osteoarthritis have minimal or no pain, and may not need treatment. Most people who require treatment will benefit from a combination of lifestyle changes such as exercise, weight reduction, and smoking cessation. Most treatment plans for osteoarthritis focus on controlling the pain and improving the patient’s ability to function. In only the most severe cases will surgery be necessary to treat pain and disability from osteoarthritis.
Medical practitioners often refer to osteoarthritis in the spine as spinal arthritis, degenerative joint disease, or arthritis of the facet joints. Spinal arthritis is relatively common and is most likely to occur in people over age fifty. It represents an ongoing, degenerative process in the spine, and may be associated with a number of other degenerative spinal conditions. In particular, osteoarthritis is associated with degenerative discs in the spine.
Degenerative discs and osteoarthritis often occur hand in hand because the disc and facet joints (the joints in the back affected by osteoarthritis) are both part of the same three-joint complex. It is thought that degenerating discs can place undue stress on the facet joints, thus over time leading to degeneration and formation of osteoarthritis in the facet joints (also called zygapophyseal joints). This may be why the two degenerative conditions are so often seen together.
If the disc as well as the facet joints become painful as a result of degenerative changes in the spine, the condition is often called spondylosis. However, degenerative disc disease and osteoarthritis are different conditions and can occur separately: One can have degenerative discs without any facet osteoarthritis; or one can have facet osteoarthritis without degenerative discs. Osteoarthritis of the spine is unlike arthritis of the hip, knee and other joints, as the pain, aches, tiredness and stiffness does not come from just the facet joints but often also from the degenerated discs and inhibition of the spinal extensor muscles.
Most treatment plans will include a combination of non-surgical options, based on assessing several factors for the individual patient, such as: severity of the osteoarthritis, which joints are affected, nature of the symptoms, other existing medical conditions, age, occupation, lifestyle factors, and everyday activities. In cases where the patient’s osteoarthritis is causing significant pain, it is imperative to address the arthritis pain and bring it down to a manageable level in order for the patient to continue with daily activities and preferably be able to participate in a reasonable level of rehabilitation and exercise.
People with osteoarthritis often find that warmth, through warm towels or hot packs applied to the joint, or a warm bath or shower, can relieve pain and stiffness. Heat is known to help reduce inflammation and swelling in the joints and can help improve circulation. Water therapy in a heated pool or whirlpool may also help. In some cases, cold, through cold packs or a bag of ice or frozen vegetables wrapped in a towel, can relieve pain or numb the sore area. Often, applying heat for 20 minutes before doing an exercise routine or activity, and following up with applying cold to the affected area afterwards, will help alleviate activity and exercise related pain in the joints. A physican or physical therapist should be consulted to determine if heat, cold, or a combination of the two is the best treatment.
Many people with arthritis have found substantial relief from their symptoms through physical therapy and exercise. In fact, exercise is thought to be the most effective non-drug treatment for reducing pain and improving movement for people with osteoarthritis. For those with osteoarthritis, the exercises need to be done correctly to avoid causing joint pain. Specific exercises help strengthen the muscles around the joints (removing some stress from the joints), improve joint mobility and reduce joint stiffness and pain.
It has been demonstrated that back and/or neck pain inhibits extensor muscle function, and thus exercises should be focused on those particular muscles. Regular exercise also has a wide range of side benefits, as it typically improves attitude, promotes a healthy level of blood circulation, helps individuals maintain an appropriate weight, promotes endurance, provides more energy, improves sleep, and can even decrease depression.
The patient may be referred to a physical therapist or exercise trainer by his/her doctor in order to determine the appropriate amount and types of exercise. For most, it is very important to work with an appropriately trained physical therapist in order to learn how to do the exercises correctly.
For chronic symptoms or to provide relief from severe episodes of pain from osteoarthritis in the neck or lower back, manipulation (such as chiropractic or osteopathic manipulation) is recommended. The philosophy for manipulations is that joint dysfunction in the spine can produce pain, and mobilizing the spine joints through manipulations (also called adjustments) can decrease that pain.
Since osteoarthritis is a joint dysfunction, it may respond well to mobilization. Manipulation is most often performed by a chiropractor, doctor of osteopathic medicine or a properly trained and licensed physical therapist. A less forceful kind of manipulation, called traction, may also be used, e.g., gravity traction using adjusting blocks.
TENS or Transcutaneous Electrical Nerve Stimulation type of therapy uses small amounts of electricity to reduce sensitivity of nerves around the spine. The treatment has few side effects and is non-invasive; however not all patients receive pain relief. Typically, a physical therapist or a physiatrist will prescribe TENS units and instruct that patient on the proper use.
Acupuncture involves inserting ultra-fine needles at specific points on the skin. Most people report a tingling sensation, feeling relaxed or even energized. Some people have found acupuncture helpful for their osteoarthritis pain, and the NIH has found it useful as a treatment for low back pain and many other conditions including osteoarthritis.
Acupuncture is considered a safe medical treatment. For this reason, many physicians and practitioners believe that acupuncture is a beneficial treatment as an adjunct to other medical treatments, and/or as an alternative to medical treatments. In certain situations, acupuncture may be used in combination with conventional painkillers, or to replace them all together.
Patients with osteoarthritis of the spine who are overweight or obese will benefit from losing excess weight. When appropriate, weight loss can greatly reduce stress on weight-bearing joints and limit further joint injury. Weight control during middle age years can also help prevent the onset of osteoarthritis in later years. A healthy diet and regular exercise are needed to help reduce weight. A dietitian can help patients develop a healthy eating program that will help them lose excess weight and maintain the appropriate weight and mix of nutrients needed over the long term. Active exercise, which burns more calories, also assists with weight loss.
One of the most important things a patient can do is take care of oneself and adopt overall healthy lifestyle habits. Examples of specific healthy lifestyle habits include: getting proper amounts of rest, limiting alcohol and caffeine, not smoking, managing stress, and using good body mechanics for everyday activities (such as carrying a backpack instead of a purse and lifting with the legs instead of the back).
It is advisable to consult a doctor about lifestyle habits and recommendations and about programs designed to develop and reinforce these good habits. If you are experiencing back pain that might be caused by osteoarthritis, please call our office at (304) 263-4927 to schedule a consultation and begin a mufti-faceted treatment plan.