Osteoarthritis is a degeneration of the cartilage coating
the ends of the bones in a joint. The spine, the hips, knees,
hands or are common locations for osteoarthritis. In spinal osteoarthritis,
the smooth articular cartilage coating the facet joints of the
spine gradually deteriorates. The bones of the joints can’t move
smoothly over roughened cartilage, causing irritation and damage to the
bone. Bone spurs may form.
Degeneration is also seen in the discs between the vertebrae.
The discs lose some ability to absorb shock, as the water content
of the discs decrease and the discs decrease in height. The
degeneration of the discs between the vertebrae increases the
risk of a herniated disc.
There is not usually any inflammation in
the early stages of
osteoarthritis of the spine. In advanced cases, bits of cartilage
may break off and float around inside the joints. This can
cause irritation to the soft tissues and inflammation may
result. An x-ray can help determine if there are bone spurs
or damage to the bones.
There are varying degrees of damage in
spinal osteoarthritis, from mild cases without symptoms
or with mild back pain, to advanced cases where the bones of
the joints rub together. The amount of back pain does not
always correlate with the damage to the spine. Symptoms
may come and go for no apparent reason.
Spinal osteoarthritis can affect different
areas of the spine. The locations can vary from person to person.
The lower back is the most common location for
back pain due to spinal osteoarthritis. This is not surprising
since the lower back carries most of the weight of the body and
is the area of the body that is subject to the most mechanical
stress. Excess stress on the lower back can cause back muscle
strain and irritate spinal joints already damaged by osteoarthritis.
neck is also a common area for pain due to osteoarthritis
(also called cervical spondylosis), and holding the neck in
one position too long can trigger pain.
in the upper back, pain may flare up from slouching.
It is difficult to differentiate joint pain from muscle strain
- an activity that can irritate the joints may also be straining
the muscles, e.g. holding one position too long, poor posture.
Back pain and/or neck pain
and stiffness, especially for the first half hour in the morning.
The symptoms typically improve during the day and worsen
late in the day. In the early stages
there many be no symptoms. Many people reduce their activity
because of back pain or because they believe it will worsen spinal
osteoarthritis. As a result, the muscles that support the back
become weaker and more stress is placed on the spinal joints.
Advanced cases of spinal osteoarthriits may result in spinal
stenosis. Spinal stenosis is a compression
of the spinal cord and/or nerve roots due to narrowing of the
spinal canal. Inflammation may occur in advanced osteoarthritis,
causing a narrowing of the spinal canal. Bone spurs may also
form on the spinal joints, reducing the size of the openings
in the vertebrae and compressing the spinal nerve roots. Pressure
on nerve roots may cause pain, numbness, tingling, or weakness.
Stenosis for more information.
In advanced osteoarthritis
involving the neck area (cervical spondylosis), pressure on
nerve roots can result in muscle weakness, pain and/or numbness/tingling
in the shoulders or arms. There may be a loss of balance, headaches
at the back of the head, and neck pain/stiffness. In advanced
osteoarthriits of the lower back (lumbar spondylosis), if bone
spurs put pressure on nerve roots, pain and/or weakness/tingling/numbness
in the legs, buttocks, and sometimes feet may occur.
Strengthening Exercises to strengthen the back
and abs are helpful. Strong muscles help support the spine,
absorbing shock before it reaches the joints of the spine. Stretching
exercises can decrease stiffness
and ease back pain.
Consult your physician before starting an exercise program. See
Back Exercises for more information.
Low-impact aerobics such as walking,
swimming, or using an exercise bike or elliptical trainer
increase circulation and decrease stiffness without placing
undue stress on the spinal joints. Aerobics also help in
weight down. Keeping weight under control helps as excess
weight causes extra stress on the joints.
Warm Water Exercises: Water
supports the majority of body weight, taking stress
off the joints. Exercising in warm water has extra benefits
- warm water increases circulation, eases pain and loosens
up stiff muscles and joints, which make exercises easier
to perform. Many public swimming pools offer exercise classes
for those with osteoarthritis. See
*Do not apply heat to an inflamed area. Heat increases inflammation.
Apply heat for 20 - 30 minutes at a time, waiting at least an
hour between each application to prevent overheating of tissues.
Moist heat penetrates
the tissues more quickly, and penetrates more deeply than dry
*Do not use rubs and heat at the same time as a burn may occur.
Ice wrapped in a cloth can be applied after exercise if back
pain flares up. (Don’t leave ice on for over 20 minutes
to avoid frostbite).
Ice may be reapplied every one to four hours. Applying a wet towel
between the skin and the ice pack will allow the cold to penetrate
more deeply. If back pain continues over a couple of days, take
a break from exercising. Resume exercising once the pain has
subsided. If back pain doesn’t
subside over a few days, consult your doctor.
Analgesics such as Tylenol or anti-inflammatory
such as Aspirin are good for minor pain. Aspirin is also an
anti-inflammatory. Taking an anti-inflammatory medication
may be helpful. Sometimes taking an anti-inflammatory before
exercise can help prevent or reduce post-exercise pain. Consult
your doctor on the use of anti-inflammatory medications. Over
use of anti-inflammatory medications may cause stomach ulcers,
so don’t overdo it. See
Osteoarthritis Medications page.
Supplements for Osteoarthritis:
Glucosamine and Chondroitin, MSM,
and omega-3 fatty acids are commonly used supplements for the pain
and inflammation of osteoarthritis. See
Osteoarthritis Supplements page.
Deep-Heating rubs applied to the skin can relieve back pain by
increasing blood flow to the area. This causes a sensation
of warmth, which is both soothing and a distraction from the
Topical capsaicin cream: Capsaicin is an extract from red chili
peppers that reduces a substance in the nerve endings that transmit
pain to the brain. It can take several weeks to obtain the full
Some prescription topical creams contain an
NSAID that is absorbed through your skin directly to the area
where it is needed. This minimizes the amount of drug that gets
into the bloodstream and lessens the chance of side effects from
the medication. If you are taking oral NSAID's for spinal osteoarthritis
you may have to reduce the dosage of your medication.
In severe cases, where inflammation is involved, injections
of corticosteroids into spinal joints (facet joints) or an epidural
injection (an injection into the epidural space of the spinal
cord) can bring down inflammation for quick pain relief. An local
anesthetic is also sometimes injected.
Conservative treatments usually relieve the symptoms of spinal
osteroarthritis. When surgery is performed, it is almost always
Emergency surgery, though rare, may be needed if there is severe
neurological impairment (great difficulty in walking or there is
a sudden loss of bladder or bowel function) due to severe compression
of the spinal cord or nerve roots. See
Surgery may be performed to remove bone
spurs, shave damaged cartilage, etc. Sometimes this can be accomplished
with arthroscopic surgery. Arthroscopic surgery is non-invasive
surgery where a camera attached to video monitor is inserted
through a small incision. It is usually performed on an outpatient
Fusing the vertebrae together
to stabilize the neck is sometimes done in severe cases of
There are many complementary
treatments for used to reduce pain. These treatments are
used in addition to standard medical treatments, not in place
of them. Not all people will have the same results with any
treatment (standard or complementary) -even people with
the same condition. Acupuncture and massage
examples of popular complementary treatments. TENS is
effective for some people.
Adequate Back Support:
A firm or medium-firm mattress can be helpful,
especially if the pain is in the lower back. Too soft of a mattress
causes the lower back to sink into the mattress and can
irritate the spinal joints; too firm of
a mattress can cause pressure points, and reduce circulation.
There needs to be enough cushioning to let your body sink into
it a bit and to distribute your weight evenly. A good quality
piece of foam placed on top of a mattress can help.
a chair that reclines slightly shifts your weight onto the backrest
of the chair, which takes
some of the pressure off of the discs and spinal joints and
allows your back muscles to relax.
Fortunately, the majority of cases of spinal osteoarthritis
(spondylosis) are mild and do not lead to serious complications. There
are many causes of back pain. Never attempt to diagnose yourself.
Always seek a proper diagnosis from a qualified physician.
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