Arthritis and Back Treatment Osteoarthritis (OA), Degenerative Joint Disease (DJD), degenerative arthritis, osteophytes, arthrosis, spondylosis, hypertrophy, sclerosis, stenosis, sciatica, desiccation - and several other scary terms, all boil down to a single word - arthritis.
There are over 100 different forms of arthritis. The word comes from the Greek "arthro" for joint and the suffix "itis" indicating in pathology an inflammatory condition (bronchitis; gastritis; neuritis, etc. ). So, arthritis means an inflamed joint. Inflammation itself is part of the complex biological response of vascular tissues evolved to help begin the healing process of any irritated or injured tissue, specifically by increased movement of white blood cells from the blood into the injured area. Regardless of the type of arthritis, the common symptoms for all arthritic disorders include varying levels of pain, swelling, and stiffness of the involved joints.
Diagnosis and treatment of a painful, swollen, and stiff joint depends upon its etiology (cause, origin). Rheumatoid arthritis is a disorder in which the body's own immune system starts to attack and destroy body tissues, not only the bone cells of the joints but also many other parts of the body. Gouty arthritis is a metabolic disorder resulting in a deposition of uric acid crystals into the joint causing inflammation typically of the first metatarsal or big toe joint. Even syphilis, a highly infectious bacterial STD, results in arthritic damage to joints in its later stages. Of course the treatment of each of these differs because immune system disorders, metabolic disorders, and infections are different causes, and there are many other types and causes of arthritis. However, the most common form of arthritis is osteoarthritis which is sometimes referred to as "wear and tear" arthritis - a mechanical disorder, also requiring a different treatment. Any joint of the body is potentially subject to abnormal, repetitive, or excessive mechanical stress (injury) that could result in wear and tear to the cartilage and bone, although the weight bearing joints of the spine, hip, and knee are stressed most and are therefore most common. Osteoarthritis (OA) is also known as degenerative arthritis or Degenerative Joint Disease (DJD). When applied to the spine, use of these terms generally implies multiple osteoarthritic changes found at multiple vertebral levels.
It is easy to presume that if the bones are "catching" or "rubbing wrong" or any of the myriad of other phrases that patients use to describe the wear and tear they feel upon these joints that eventually the bone would wear down or wear away but, in fact, under mechanical stress the opposite occurs. Remember, bone is living tissue and like other living tissue such as the skin on the palm of a hand, for instance, it will build up when mechanically stressed. A buildup of skin cells we call a callous. Abnormal or excessive mechanical stress to bone causes it to respond in the same way as does skin - an initial inflammatory response followed by metabolic repair and a buildup of bone cells. A buildup of bone cells is called a bone spur or osteophyte. What confuses this issue is that arthritis (joint pain, swelling, and stiffness) caused by many immune disorders, metabolic disorders, and infectious diseases more often results in the net destruction of existing bone cells, not the formation of additional bone cells as occurs with mechanical stress. Regardless of the pathogenesis (cause) the resultant pain, swelling, and stiffness feel the same.
Obviously, a single bone cell or a single calcium molecule cannot be detected by x-ray but as the buildup progresses an area of density which shows up on x-ray as a bright whiteness is visible. Early on this is termed sclerosis (hardening), and is the same root word from which we get arteriosclerosis or hardening of the arteries, but later as these calcium molecules continue to accumulate they eventually become numerous enough to form visible bone spurs or osteophytes. This buildup of bone where joints meet such as the facets at the back of the vertebra is termed arthrosis, and where ligament attaches to bone spondylosis. Often the supporting ligaments of the involved joints are themselves being stressed and rather than getting weaker as one might at first suppose they actually get stronger by the multiplication of these cells too which is called hypertrophy. All this is triggered by the inflammatory response resulting in varying levels of pain, swelling, and stiffness of the involved joints. Many different names that all boil down to a single word - arthritis, from the same cause - mechanical stress.
From Bad to Worse
Normal motion of the joint has already been restricted and is further inhibited by the patient's reluctance to force into motion (exercise) an already painful joint. Together this has a devastating effect on the spinal discs that depend upon normal motion which acts as a pumping action to circulate fluid through them. Less motion equals less pumping and the result is an insidious (gradual) drying out (desiccation) of the intervertebral disc(s). As the disc gets dryer and dryer it soon begins to lose height resulting in the vertebrae becoming closer together. A dry, thin disc can no longer adequately do its job of absorbing shock and allowing proper motion of the spinal segments compounding the stress upon the joint and accelerating the degenerative process. The space lost due to the thinning disc added to the thickening ligaments (hypertrophy) and growing calcium deposits results in a narrowing of the channels through which pass the spinal cord (in the central canal) and from which the spinal nerve roots exit (from the neural foramen). This narrowing is called spinal stenosis.
Before long the dry, brittle outside fibers (annular fibers) of the disc weaken and tear (annular tear) permitting the inside (nucleus) of the disc to bulge out (herniate or protrude) into the already narrowed channels resulting in nerve root compression (a pinched nerve). And now, there is not only pain, swelling, and stiffness of the involved spinal joints but also pain along the course of the pinched nerve (radiculopathy, neuritis, sciatica).
Spinal Decompression Treatment
In the past, a patient suffering from this degenerative process was usually given pain medications or injections, instructed to refrain from physical activities, referred for physical therapy, and when they weren't progressing they were sent for spinal surgery or simply told to learn to live with it. Since 2001 when the FDA finally approved non-surgical spinal decompression therapy, there is new hope for those who suffer from degenerative joint diseases. Spinal Decompression Therapy is a non-invasive, non-surgical treatment performed on a special, computer controlled table similar in some ways to an ordinary traction table. A single disc level is isolated and by utilizing specific traction and relaxation cycles throughout the treatment, along with proper positioning, negative pressure can actually be created within the disc. It works by gently separating the offending disc 5 to 7 millimeters creating negative pressure (or a vacuum) inside the disc to pull water, oxygen, and nutrients into the disc, thereby re-hydrating a degenerated disc and bringing in the nutrients needed to heal the torn fibers and halt the degenerative process. As the disc is re-hydrated the shock absorbing properties are restored and the stress on the joint is reduced and the inflammation subsides. Many times much of the lost height can be restored as well. Now a normal life can be resumed.
Dr. Michael L. Hall, D.C. practices at Triangle Disc Care in Raleigh, North Carolina specializing in Spinal Decompression for the treatment of acute and chronic neck pain and back pain due to herniated, degenerated discs. This is a conservative procedure for patients suffering with bulging or herniated discs, degenerative disc disease, posterior facet syndrome, sciatica, failed back surgery syndrome, and non-specified mechanical low back or neck pain.