Back pain is surrounded by myths which often cloud simple facts. People with back pain are often told is that “it is just wear-and-tear and you’ll have to put up with it” or “it’s probably arthritis. What do you expect at your age”. This is not very helpful and often is plain wrong.
Many back sufferers are unclear if it is arthritis or not and what the best treatments and self-help strategies are. The surprising news is that arthritis is not as important as a cause of back pain as we once thought.
What is arthritis of the spine?
When people say arthritis of the spine they are mainly talking about osteoarthritis. This is the most common sort and occurs in almost everyone as we get older. There are characteristic changes to the discs, vertebrae and spinal joints. The first sign on an X-ray or MRI scan is a loss of fluid from the jelly in the centre of the discs, especially of the lower lumbar spine. The discs then lose height and in the advanced stages can almost disappear. This is why we get shorter as we get older. The spine responds to these changes by growing bony spurs to buttress the ageing discs which give the spine a bumpy shape on X-ray and other imaging. The discs in the lower back carry the most load so this is probably why they have these changes first.
The spinal joints are prone to osteoarthritis too. First the non-slip surface of the cartilage covering the bones gets roughened and pitted as it wears a bit. The joint may make more noise as it moves so you may hear more clicks and crunching sounds. Sometimes it sounds like grit in the joint although this is rarely painful. In the advanced stages extra bone growth occurs here too and this can be seen as bony spurs on imaging. The range of movement of the joint decreases and this leads to loss of flexibility as we get older.
Arthritis does not cause more back pain
The good news is that as horrible as these changes appear they have not been shown to cause an increase in back pain. Imaging of people with back pain shows that they have the same levels of osteoarthritis in the back as people of the same age without back pain. So what is going on?
It is likely that arthritis in the spine does not cause pain directly. It may, however, make it more likely that spinal joints will lock up and this can cause pain. As locking of the spinal joints is a common cause of back – so-called facet joint syndrome- it seems that the effect of osteoarthritis is lost in the frequently occurring condition. Spinal manipulation and mobilisation by our chiropractors and physiotherapists unlock the joints that cause the pain and is an effective treatment for most back pain.
There is one a rare side effect of osteoarthritis where the bony spurs get so big that they press on the nerves. If they press on the nerves that go down the leg it can cause sciatica symptoms. If compression occurs around the spinal cord this can cause a condition called spinal stenosis. Then pain and numbness can occur in both legs especially after walking a short distance. Manual treatment and exercises can help but surgery is rare but sometimes necessary.
In addition to osteoarthritis there are many other sorts of arthritis. This includes rheumatoid arthritis which is an aggressive, auto-immune disease in which inflammatory changes attack the spine and other joints. Fortunately it is an unlikely cause of back pain. The other significant but also rare form of spinal arthritis is ankylosing spondylitis. This is also an inflammatory disease which is more common in men and causes progressive spinal stiffness and pain. Both rheumatoid arthritis and ankylosing spondylitis are diagnosed with a blood test and can be treated with medication. If we think you may have this sort of condition we will refer you back to your GP.
If you would like a free consultation to find out if arthritis might be contributing to your back pain then give us a call or book online above.
Spine (Phila Pa 1976). 2008 Nov 1;33(23):2560-5. doi: 10.1097/BRS.0b013e318184ef95.
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