Is degeneration of your spine really the cause of your current episode of back pain, or is it simply a marker of your overall back health, independent of your day-to-day back pain?
This week we wanted to take a deep dive into arthritis of the spine, because one of the most common phrases you’ll hear when having any sort of consultation with imaging is the following:
“You’re spine is fine, you just got normal age related wear and tear.”
How should we think about degeneration in the lumbar spine?
When it comes to wear and tear in your spine it is often considered by those with back pain that this is a binary option. You either have the degeneration or you don’t, thinking of it much like pregnancy for example, you’re either pregnant, or you aren’t.
With degeneration in your spine, or any other joint for that matter, it is a scale. Having reviewed many spine and hip images over the years, we’re talking over 10,000 here, you get used to what you’re seeing. Especially when it comes to X-rays, it’s easy to forget that when the lay person first looks at some of these parts of the spine, say the L4, L5 & S1 region, it’s like looking at a cloud! The ability to draw out the detail and know what you’re looking at is often very limited. Understandably, you require a guide.
It is in imparting this information of what’s on the spinal scan, that often there is a severe failing. Being able to point out the degree of degenerative change in the spine is very important, as for many of us, the degenerative change that is in this spinal image will be both long-standing, and independent of the current episode of back pain or sciatica.
Long standing spinal degenerative change
Understanding that in order for the spine to decide to lay down extra bone (bony spurs) or change its structure, it requires years of consistent stimulation to be exerted on the tissues, which slowly lay down calcium, which hardens and becomes more bone-like.
At the same time the cartilage or discs are becoming more degraded, moving less and stiffening up, similar to a process of rusting taking place. But it’s not only the “hard tissues” that are affected, the bone and the cartilage, the ligaments, tendons, and soft tissues in general around the region of the spine affected are also undergoing changes.
Scar tissue may have formed in some of these areas from repeated insults and injuries. This has the effect of weakening their integrity and making them less competent at protecting the degenerative joints.
What is causing the pain when our spine has degeneration?
Let us begin by saying that in many cases, when you see that bony spur forming on the X-ray and slight deformity of the joint, it is mostly not the bony bits you’re seeing that are the cause of the pain. Granted, the bony spur, if moved into a specific position, might pinch a highly sensitive soft tissue, such as a spinal nerve or joint capsule, but mostly they’re just there, minding their own business. It is rather more common that the dysfunctional state of the soft tissues that regulate that joint, mentioned earlier, have been strained or damaged further, leading to a cascade of inflammation around the joint. The consequence, spinal arthritis.
For any of you that have split trousers or had to patch up some clothing, you will have experienced the consequences of “scar tissue” in a more understandable form. The fabric of your chosen garment has a smooth continuity and structure, the right amount of give and tension to prevent pressure building in any specific area. However, once split and patched, think “scar tissue”, we notice that when that same fabric is stretched, pressure builds up around the patch. At the point where there is a junction between old healthy fibers, and the new patched fibers that aren’t quite the same as the original ones, this is often the site of re-tearing in the case of your clothes. This is similar in the degenerative soft tissues around your lower back.
The tissues, be they disc fibers, smaller muscles, or other ligamentous tissues, have been routinely injured and never given enough time to fully heal, they’re riddled with scar tissue. One of the big reasons we’re so against the knee hugs is that exercises like this interfere with the healing process. It is this weak soft tissue that is re-injured and often much more likely to be the source of your pain.
The good news is, that unlike your favorite item of clothing that’s been patched up, you have the capacity to fully heal in most cases and re-integrate that “patch” into the structure of the disc that’s been injured, or ligament that has been torn. The problem is that this takes time and consistency, time scales that so frequently are not considered fully.
We’ve all been there, we heal up and are feeling better, so we stop doing our exercises, then reinjure the same area in a similar, or the same way.
When it comes to back injuries the pain goes away often when the inflammation has subsided, but healing continues to take place, remodeling of these soft tissues takes place over a long period of time, not weeks but months and often longer. In the case of most of our tissues, they’re never really fully remodeled as they are always responding to how you use your body, and growing and adapting through our entire life!
When we neglect those degenerative joints in our spine and stop our rehab, we rob the body of the stimulation required from our regular resistance based exercises. This stimulation is what drives the remodeling process and helps us re-integrate the “patch” back into the tissues.
You’ve experienced this already though.
Everyone reading this will have cut their hand, knee or elbow at some point in life, and it has been sore. And over a few days a good scab forms, and then it stops being painful.
BUT IT IS STILL WEAK & DAMAGED!
Over time however, the scar tissue of the scab is processed and reprocessed and goes through the healing and remodeling process, and heals completely. The difference and challenge with your back and the joints that may well be degenerative, is that it is more difficult to allow it to heal as we use our back every day, no matter what we do.
What should I do if I have degeneration in my spine
Acknowledge firstly, that if you’ve got degenerative changes in your spine, you have been doing things incorrectly for a long time. Yes. Even if the pain has only been there in recent months or weeks. If you’re to have a lasting solution you cannot ignore this. You need to know that to the degree the degeneration is more or less severe around the spine, you may have something called stenosis too. This sounds scary but it just means “less space”. The implication is that there is less space for inflammation to build up, meaning if you have a minor injury to that vulnerable scar tissue we mentioned earlier, the inflammatory reaction is more likely to result in severe symptoms than in someone with more space – no stenosis.
Think of it like this. If your lounge gets a leak they have a nice big bucket to place under the leak, you won’t notice it’s such a problem. But if your kitchen gets that same leak and waters dripping and all you have is an espresso cup you’re going to be in trouble pretty quickly. This example could literally be segments of your spine next to one another, just like rooms in the house, the health of one segment is frequently at odds with other segments in your spine, and other joints in your body.
If you can understand & accept this, then the natural next step is easy.
To the degree you have degenerative change in your spine in a more severe manner, you must work proportionally to increase your strength, competence, hip flexibility and all round spinal control. This is to say, irrespective of your age, work to be stronger than the average person, have better hip flexibility to compensate when moving, and improved control and stability at the level of the spine.
These changes won’t reverse the X-ray changes we see in terms of the bony spurs, but they protect that joint and form armor around that region of the body so it is much more resilient, so the soft tissue health has improved and you ultimately are more healthy, mobile and free going forwards.
One afterthought on “age appropriate wear and tear”
Clinically we’ve seen many X-rays, MRI’s and reports, from people of all ages. The number of times someone in their 20’s and someone in their 50’s who have more or less identical X-ray images, have both had “normal age appropriate wear and tear” on the accompanying report is astounding.
That is to say that if you presented both X-rays with no other data they could pass off as in the same spinal condition! Yet both are “age appropriate wear and tear”.
Don’t let comments like this affect you, they have little impact on what you need to do to get your back in shape!
Comment of the week – Helen
“Went shopping yesterday and had to keep asking for 10’s instead of 12’s…”
3 Ways You Can Fix Back Pain From Spine Arthritis
- Focus on building stability
Gaining control of your spine’s neutral position is a vital skill allowing for you to maintain the position of the spine and pelvis in spite of forces acting on your body, pulling you off balance. The corset of muscles around your trunk section can stabilise the spine as a whole and therefore compensate for the weak or degenerate links in the chain. This is especially important in the early days to help reduce the frequency of relapses.
- Be proactive when you try new things
Whether it’s a new activity, a new intensity, or an out of the ordinary venture, whenever you’ve used your body in one of these different ways, follow the practices we teach in Phase 1 and be proactive that day. Do not wait for your your back to be sore before you do your lower body stretching, towel and ice. Do it right away after said activity, or at very least, as soon as you get home. This will help you reduce the likelihood and severity of a reaction the next morning!
- Be stronger than the average!
Know that life tests us and our body. Build the strength in your core, back and legs to allow for you to effortlessly take on life’s challenges. The result here will be that it will be ever more unlikely that you’ll be faced with a strain your body cannot handle, and in the unlikely event that you are challenged sufficiently and fail, your recovery will be that much faster.
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