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Osteoarthritis in the Lumbar Spine

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Almost every movement you perform involves your joints. Walking, running, typing, and lifting are just a few of the common things people do that would be impossible without joints. To prevent our bones from wearing down during these movements, our joints rely on cartilage, a spongy tissue that helps to cushion the friction between connecting bones. Without it, everyday activities would be painful.

Osteoarthritis (OA) is a degenerative joint disease that causes this cartilage to break down and become rough and flaky, making movement in the affected area difficult. OA usually occurs in weight-bearing joints, like the hips or the knees, which support the body. However, any joint can become affected. In fact, OA can occur in several joints at the same time. It's possible, for example, to have pain in one knee and not the other, and at the same time have pain in the shoulder or the ankle.

Patients with OA often report having mild pain, morning stiffness and limited movement in the affected joint. The pain tends to come in bouts, with particularly painful periods followed by periods of relief. Patients usually report the most discomfort at night and after extensive use of the affected joint. Some patients also complain of a complete loss of motion in certain areas, although this is rare.

No one knows for sure what causes OA, but age and obesity seem to play a role. Almost everyone experiences some changes in their joints by the age of 40, and although few people show any symptoms, OA occurs most often in those who are middle-aged and older. Obesity also increases the risk of becoming affected as extra weight puts more stress on joints.

While there's no cure for OA, your healthcare practitioner can implement a management plan that prevents its progression, promotes joint health and relieves pain. By seeing your healthcare practitioner and adopting lifestyle changes, you can reduce the condition's debilitating effects.

Anatomy

If you don't have osteoarthritis (OA) in your elbow or knee, bending your arm or leg probably doesn't hurt. That's partly because of the protective tissues that cushion the joints. Cartilage, which coats the end of the bones, and synovium, a membrane that lines the joint, form a pillow between connecting bones that provides flexibility and support.

Cartilage is composed almost entirely of water -- nearly 85% in young adults and about 70% in older adults. Two components of cartilage, proteoglycans and collagen, help to bind the water to form a flexible, supportive mesh. The synovium surrounds this mesh and provides lubrication and nutrients.

Osteoarthritis (OA) occurs when the body loses proteoglycans and other important components of cartilage, causing the cartilage to break down. As the condition progresses, significant amounts of cartilage are destroyed, leaving the ends of bones in joints unprotected. To replace the cartilage, the body reacts by producing new bone, which helps stabilize the joints. Unlike cartilage, however, bone isn't flexible, making the joints sore and stiff.

Although the exact cause of OA is unknown, it's considered to be age-related. The older you are, the greater your risk of becoming affected. Studies also reveal, however, that osteoarthritic cartilage has a different chemical makeup than the cartilage in unaffected older people, pointing to factors unrelated to age. These may include muscle weakness, genetics, obesity, previous joint trauma and anatomical abnormalities that can place stress on joints.

Chiropractic Care

If your chiropractor diagnoses you with osteoarthritis (OA), he or she will devise a management plan that may include spinal manipulative therapy, also known as adjustment, heat therapy, various types of electrical therapy and exercise.

To perform an adjustment, your chiropractor will use his or her hands or a device called an activator tool to apply a thrust to affected joints, ensuring that they're moving properly. This helps to keep surrounding cartilage healthy, as well as to ensure that nearby muscles, ligaments, tissues and nerves are functioning at their best.

Because cartilage can be so worn in patients with OA, however, adjustments can only serve to maintain the condition of affected joints and prevent them from getting worse. The damage cannot be reversed. Nonetheless, patients undergoing chiropractic adjustment report having more comfort and a greater range of motion.

To further improve your joints' movement, your chiropractor may also use a technique called mobilization, which involves moving joints through their full range of motion. This helps for two reasons. First, patients with OA often have a buildup of chemical irritants, like prostaglandins, accumulating in the joint. Mobilization causes an influx of fresh circulation to wash away these irritants, reducing pain. Second, mobilizations get joints moving again. This movement promotes flexibility, strengthens weak muscles and prevents further deterioration in the joints' movement.

Your chiropractor may also recommend you apply a heat application to sore body parts, which can bring some relief. While heat can exacerbate inflammation that accompanies acute conditions, it is very helpful for long-term conditions like OA. Heat increases tissue stretch and elasticity, helps relax muscles and helps relieve joint stiffness.

Physiotherapeutic devices, like ultrasound, can also reduce pain and promote healing. Ultrasound works by delivering high-frequency sound waves through the skin, deep into the tissue beneath. This increases blood flow and helps promote healing, which helps patients with OA to maintain and possibly produce cartilage.

In order to keep your joints healthy you also need to move them. Long periods of inactivity can make them stiffen, leading to muscle weakening and atrophy (shrinkage). Your chiropractor may advise several types of strengthening, stretching and aerobic exercises to help keep your joints in top condition. These will increase muscle strength and endurance, as well as promote your overall health.

Lastly, pay close attention to your diet. Eating healthy, low-fat meals is a great way to start losing weight, which will decrease stress on your joints. Also, consider taking some nutritional supplements, like vitamin E, vitamin C and glucosamine sulfate. In a clinical trial testing the effectiveness of vitamin E, which promotes the body's production of cartilage, patients taking the supplement demonstrated significant improvement. Vitamin C has also demonstrated a positive effect, as it's another vitamin that helps in the formation of cartilage.

Recent studies also show that glucosamine sulfate is helpful for patients with OA, as it provides the building blocks from which the body creates the cushioning components of cartilage, like synovial fluid. Glucosamine sulfate also has some anti-inflammatory properties, which means it not only helps in the formation and repair of cartilage, but prevents cartilage from further destruction.

For many patients, this conservative chiropractic care is effective. But if your pain and disability are severe, your chiropractor may refer you to a medical doctor for additional treatment, while continuing to provide chiropractic care. One treatment available to medical doctors is joint replacement surgery, which generally has good outcomes. In less severe cases, medical doctors may recommend anti-inflammatory drugs.




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