Degenerative Disc Disease and Arthritis of the Spine
There are a few different types of arthritis however, osteoarthritis is the most common and frequently referred to as just plain “arthritis”. Arthritis literally means “joint inflammation” however, the hallmark characteristic on x-ray is it’s degenerative component. Also known as degenerative joint disease (DJD for short), osteoarthritis is more likely to develop as we age. It causes pain (and sometimes swelling) in the body’s joints, such as the knees or hips.
Osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back. When focusing on these degenerative changes as they apply to the discs in the spine (or “intervertebral discs”) the term “degenerative disc disease” (or “DDD”) is used. The changes in osteoarthritis usually occur slowly over many years. As this process happens, the joints and surrounding tissues may get stiff, making pain worse. Not moving will also lead to muscles that get tight and weak, causing decreased function.
Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can directly cause weakness and pain in the arms (cervical nerve root compromise) or legs (lumbar nerve root compromise). This can be made worse by DDD, which results in less disc height and thus, less space for the nerves to occupy. This condition of nerve compromise at the spinal level is often referred to as “radiculopathy”.
Physical therapy for spinal arthritis can be multifaceted. When a patient presents with radiculopathy, reducing compression on nerve roots is priority number one. This may be accomplished through traction, stretching, joint manipulation or likely a combination of these. Almost always, improving the strength of trunk and hip muscles combined with stretching of specific muscles that contribute to spinal compression is a part of the plan. Arthritis is an ongoing condition and your PT will also teach you management strategies.
Cervical Spine Pain
Neck pain can vary greatly from person to person and may be the result of an injury or a chronic process. Daily life can contribute to neck pain in a variety of ways. Poor posture, physical demand, and stress can cause muscles to tighten and spasm. Lack of exercise, obesity and weak muscles can also place stress on the cervical spine. Mild to moderate pain of gradual onset that does not include symptoms of numbness, burning or tingling (symptoms of nerve root compromise) can usually be treated conservatively with resolution of pain in 4-6 weeks.
The cervical spine consists of 7 vertebrae from the base of the skull to the level of the shoulders. In between the vertebrae are intervertebral discs (or just simply “discs”). The discs act as shock absorbing bumpers and are composed of a tough outer layer of fibrous tissue and a soft, gel-like center. Joints, muscles and ligaments provide stability to the cervical spine while allowing for movement through a wide range of motions. The cervical vertebrae also provides bony protection for the spinal cord and nerves. The nerves that exit the cervical spine transmit nerve impulses to the shoulder, arm and hand.
Degenerative Disc Disease (DDD) in the neck can cause the discs to flatten and lose elasticity, this may predispose you to bulging or herniation of the disc. Numbness, tingling, and weakness in the arm and hand often are a result of DDD.
Several non-operative treatments are available to address DDD and neck pain. Non-operative treatment normally includes physical therapy, activity and ergonomic changes, NSAIDS, and/or injections. Physical Therapy can be helpful for treating neck pain by addressing the soft tissue surrounding the cervical spine. Stretching, dry needling and massage are used to improve flexibility and reduce muscle spasms. Scapular strengthening exercises will help improve posture and reduce stress placed on the cervical spine. Manual or mechanical traction is frequently used to alleviate compression of a pinched nerve.
Should an injury be severe enough to warrant surgery, physical therapy is usually a part of recovery to with regain strength of muscles and movement of the spine while protecting the surgical procedure.
The term “stenosis” refers to the narrowing of a hole. Spinal stenosis is a condition that occurs as the spinal canal (the hole in this case) narrows, restricting or compressing the nerve roots and/or the spinal cord (depending on the exact location of the narrowing). Spinal stenosis can be a congenital condition, with some people having a narrow spinal canal from birth. But more often, it results from degenerative changes in the spine, the wear and tear that leads to osteoarthritis of the spinal column. Thickening of a ligament in the back and bulging discs can contribute to the condition.
As mentioned elsewhere on this site “osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back. When focusing on these degenerative changes as they apply to the discs in the spine (or “intervertebral discs”) the term “degenerative disc disease” (or “DDD”) is used.” These processes often go hand-in-hand with spinal stenosis.
The narrowing of the spinal canal often happens in the lower back (lumbar spine) and neck (cervical spine) or, on rare occasion, the thoracic region of the spine (upper back). In the case of lumbar spinal stenosis, common symptoms are pain in the legs or lower back when standing or walking. Depending on the extent of your stenosis, your orthopedic doctor may suggest surgery or physical therapy, or both.
Physical therapy treatment for lumbar stenosis often involves some form of traction; seeking to decompress both the spine and impinged nerve roots. Additionally, exercises focused on trunk strength (or “core stability”), mobility, leg length and hip flexibility are generally recommended. Sometimes your PT may use various modalities to relieve pain such as (but not limited to) electric stimulation, dry needling or ultrasound.
Bulging Disc of Lumbar Spine
Bulging discs (also known as a disc protrusion) are a very common occurrence, particularly in the lumbar spine. Due to the fact that a bulging disc does not always show symptoms, many people have bulging discs without realizing it. A patient may remain asymptomatic for years and then one day experience discomfort and disability if the disc compresses an adjacent spinal nerve root (more common) or the spinal cord (less common). A disc “bulges” as the outer fibrous portion of our discs can weaken and pressure from the central core of the disc (a jelly like substance called the nucleus) can then push to the outer rim, causing the disc to bulge. If left untreated, the disc can continue to bulge until it tears and the nucleus spills out, putting pressure and chemical irritation on a nerve root, this is call as a “herniated”.
In the lower back, the damaged disc can cause pain to travel to the hips, buttocks, legs and feet. The most common spinal level for a bulging disc is seen between vertebrae L4 and L5, and (somewhat less frequently) between vertebrae L5 and S1, causing pain in the L5 nerve root distribution or S1 distribution, respectively.
A bulging disc is usually not treated surgically and physical therapy can have great success in treating this condition “while the toothpaste is still in the tube” so to speak. Apart from the active therapeutic process, patient education is of great value in treating this condition and preventing it from worsening. If they bulging disc goes untreated and progresses to herniation, therapy has less chance of success and surgery becomes more likely. Before rushing you into surgery however, your doctor may opt for an epidural steroid injection combined with physical therapy. At this point “core stability” (strengthening the trunk muscles w/o high levels of spinal movement) becomes the primary focus of physical therapy.
If a nerve or nerve root becomes damaged or compressed, patients may experience what is called radiculopathy. Radiculopathy commonly radiates into the arms or legs and can be caused by a disc herniation, arthritis, spondylolistheses, or a bone spur from osteoarthritis that is irritating the nerve.
Radiculopathy may cause symptoms such as numbness, tingling, reflex loss, and/or weakness in the legs or arms. When radiculopathy runs down into the legs it is often caused by compression of the sciatic nerve and this is referred to as sciatica or sciatic pain.
Physical therapy can help reduce the patient’s pain and decrease symptoms associated with radiculopathy utilizing various modalities such as ultrasound, electrical stimulation, myofascial release and lumbar or cervical traction. Physical therapy can help patients with radiculopathy by providing patients with strengthening exercises that will help improve stability in the muscles that surround the spine, work on any loss of muscle strength or balance deficits, as well as exercises that promote more space for the nerve root.