Spondylosis


Symptoms

Spondylosis is the medical name for spinal osteoarthritis.

The symptoms can range from mild to severe and, if neglected, can become chronic or even disabling. They vary depending on the region of the spine which is affected, but generally cause pain that varies from day to day.

The pain is often worse on one side of your body.

The pain is relieved by rest although there may be stiffness first thing in the morning and often the problem is made worse by prolonged sitting or standing in one position.

You may have pain in other areas of your body - typically fingers, hips or knees.

There may be radiating pain causing headache or pain across your shoulders and down your arms from cervical (neck) spondylosis or over your buttocks and down your legs from lumbar (low back) spondylosis.  Sometimes these same areas may feel weak or tingling.  Lumbar spondylosis may cause sciatica due to irritation of the nerve roots that emerge from the spinal cord at the level of the spondylosis, causing pain to refer to the buttock, groin or hamstring region.  In other cases, the pain may be felt in the front of the thighs.

There may be pain on any movement of your neck or back, but often the worst pain is leaning backwards or side-bending.

If the spondylosis has progressed to cause Spinal Stenosis then there may be more severe nerve pain and weakness.

The diagnosis can usually be made based on the history of the condition, and the presence of the signs and symptoms listed above. If there is any doubt, or if the pain does not resolve with treatment, it may be necessary to have an x-ray of the spine and blood tests. A CT scan or MRI scan may also show the problem.

Treatment

Acute spondylosis:  The nearby muscles may tend to spasm. Alternate hot and cold compresses can help to ease the spasms and reduce the inflammation around the joint. Avoid over-working the back for several days but do try to continue with as near to normal activities particularly walking to keep the area actively healing. See also Spinal Facet Joint Syndrome.

It is important to keep the region warm to relieve back pain and muscle spasm, but preferably using clothing, a pad or pillow avoiding hot water bottles or similar as these tend to cause congestion of the area.

Rest, non-steroidal anti-inflammatory (NSAIDs) drugs e.g. paracetamol, aspirin or ibuprofen should help to relieve the pain. Occasionally, your doctor may prescribe a low dose of amitriptyline at night to relieve the pain or gabapentin to relieve associated nerve pain.

Massage may help to ease the pain but care should be taken not to relax the surrounding muscles too quickly as this may lead to more severe reflex spasms as the back is attempting to protect the joints form further injury. 

Gentle osteopathic mobilisations help to clear the inflammation from the joints and ease the tenderness. 

Chronic Spondylosis: A warm shower or bath, especially with Epsom salts will help to ease the stiffness. See the Hydrotherapy page. Again refrain from painful activities but do keep on the move.  Once the joint inflammation has resolved or the muscles are supporting correctly, the pain may disappear entirely.

Memory tape strapping or a Back Brace can provide reassurance and support to the lower back. However it is very important to try to rebuild your own muscular support and not to rely on external devices.

Rehabilitation & Protecting Your Back

Poor posture plays a major role in the development of Spondylosis.

Prolonged sitting and bending postures, where the lumbar spine is 'flexed' should be avoided as they increase the pressure on the discs. This can lead to disc degeneration and a loss of disc height. As the discs shrink the facet joints come into contact with each other and start to bear weight. This is not what they are designed to do.

In order to avoid disc degeneration, and excessive loading of the facet joints, it is important to take better care of back posture. An understanding of good posture is necessary to achieve this.

Viewed from the side, the spine consists of a series of curves that increase the load-carrying capability of the spine compared to if the spine was just straight.

The lumbar part of the spine consists of a forward curve and as long as this is maintained, posture will be reasonably good. It is important that this improved posture is maintained during all activities, particularly when sitting for long periods - slumping should be avoided.

A Lumbar Roll placed at the bottom of the back or a Seating Support can be effective when sitting.

In the long term, good posture is maintained by increasing the muscular stability of the spine. The osteopath will identify muscles that have become over-stretched or shortened, weak or tense and can then teach a range of exercises and techniques that will help to stabilise the back, including improving abdominal, pelvic floor and back strength. For more information please call or ask in the clinic or visit www.back-stability.co.uk.

Prognosis

Regular maintenance treatment may be helpful to maintain mobility and strength.

However, where there is persistent pain originating from a facet joint problem, an injection of long acting local anaesthetic and anti-inflammatory corticosteroid into the facet joint may be effective in relieving symptoms and, if successful, it confirms the diagnosis.

In order for this approach to work the injection is best done by a Consultant Radiologist under an image intensifier. This device allows the doctor to see exactly where the injection is going. This approach can give very good pain relief, but the effects may wear off after a while and of course there can be unwanted side-effects from the steroid including softening and weakening of the ligaments and cartilage. It may be necessary to repeat the procedure at a later date.

About Spondylosis

Spondylosis is often unfortunately just another part of getting older!  It means degeneration of the spine from wear and tear, but not everyone will have symptoms as a result of spondylosis.

You will only feel pain if there is irritation or inflammation of a potentially painful structure e.g. if the cartilage wears out and bone rubs on bone, if the muscles or ligament are irritated or if the nearby nerves are pinched or rubbed.  Once the joint inflammation has resolved or the muscles are supporting correctly, the pain may disappear entirely.

Spondy means spine; losis means problem. Spondylosis, then, is a problem with your spine, but doctors today use it to specifically mean arthritis in the spine.

As we get older, our bodies tend to wear out—no surprise there. Years of use and overuse can cause parts of the spine, especially the joints, ligaments, and intervertebral discs, to change and not work as well.

However, ageing is an individual process. Just as some people go grey earlier, some people will feel the effects (mostly pain) of their ageing spine earlier. In fact, some people may not have much pain ever. It all depends on how the parts of your spine are changing and if those changes are affecting the spinal cord or spinal nerves. You will only feel pain if the inflammation

Your spinal joints are covered by cartilage, which protects your bones as you move. Without cartilage, your bones would rub together-very painful. Unfortunately, your cartilage can be affected by general wear and tear on your spine, and it can wear away. That's when bony spurs (osteophytes) can form as your body attempts to repair itself.

Causes of Spondylosis

Spondylosis is a common cause of back pain. A severe acute episode of spondylotic pain may be due to sudden movement, which traumatises the facet joint. More often, spondylosis is chronic in nature - that is, the underlying cause is due to long term changes in the facet joint that are often associated with repeated injuries and degenerative disc disease.

Lack of stability of your back due to poor muscle strength allows too much movement to occur at the joints (hypermobility).

Hypermobility causes changes in your spine. It tries to stop the movement with the growth of small bony elements called bony spurs (osteophytes). Unfortunately, the bone spurs sometimes pinch nerve structures and cause pain. The bone spurs can narrow the space for the spinal cord and nerves—that disorder is called spinal stenosis. Degenerative disc disease won't cause spinal stenosis in everyone, but it's something you should be aware of if you have spondylosis.

Your genes can also cause spondylosis. You may be pre-disposed to excessive joint and disc wear and tear, so if someone in your family has or had spondylosis, you may also develop back or neck pain related to spondylosis.

Finally, the way you're living could lead to spondylosis. Smoking, for example, adversely affects your discs and can cause them to degenerate faster. Smoking actually decreases the amount of water in your discs, and water is part of what helps your discs absorb movement. With less water content, your intervertebral discs can wear out sooner.

Poor posture where the back is in one position for along period (usually flexed forward) e.g. sitting slumped or bending whilst working or gardening may cause the back muscles to become excessively tired and the ligaments close to the spondylotic facet joint to become stretched.

Spondylosis makes the facet joints more vulnerable to injury than usual, so when you try to stand up straight, the muscles do not behave properly, the facet joint may not straighten correctly into their proper position and become ‘nipped’ or ‘locked’.



 
Spondylosis

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