Arthritis is a common and often debilitating condition that affects millions of people worldwide. If you’re one of the many individuals living with arthritis pain, you know how it can impact your daily life. Physical therapy offers effective strategies for managing and even overcoming arthritis pain. If you have arthritis in any of your hips, knees, ankles, shoulders, elbows, or hands, you’ll want to speak with a general physical therapist in a clinic near you as there are many things they can do to help you with your arthritis pain, such as pain management, improved mobility, joint protection, strength and endurance, education, and customized treatment to help you improve your functional mobility. Spine PT ONLY treats pain conditions related to the spine so in this blog, I’ll discuss arthritis of the spine and the problems with this diagnosis.
Now for the good news.
For those who have been told by their doctor that their back or neck pain is due in part to arthritis of the spine, most of you have been misdiagnosed and Spine PT can help you get out of pain.
In the last 24 years of clinical practice, the majority of my patients have been told by their doctors that arthritis, as shown in an imaging scan such as an MRI or x-ray, is a contributing factor to their pain. However, what I have experienced clinically is that this is not an accurate diagnosis. I would estimate 99.99% of my patients who come in with a diagnosis of arthritis of their spine actually just have irritated or pinched nerves that are responsible for their pain. How can I make this bold claim? Well, let’s take a look at what arthritis is and discuss what we do at Spine PT.
Arthritis is a broad term that encompasses over 100 different types of joint inflammation. The most common forms are osteoarthritis (OA) and rheumatoid arthritis (RA).
Osteoarthritis is the primary arthritis that leads people to have their hips, shoulders, and knees to be replaced. This type of arthritis is believed to have been caused by overuse or some type of trauma. The joint becomes worn down and the previously smooth cartilage, that covered the two ends of the bone and allowed for a frictionless glide as you moved the joint, deteriorates and the two bones begin rubbing against each other. This is what doctors often refer to as “bone on bone.” Eventually the smooth bone surfaces break down and become rough and pitted, making it extremely difficult and painful to move the joint.
Rheumatoid arthritis is an autoimmune disorder that causes joint inflammation. The destruction of the joints from rheumatoid arthritis is not caused from overuse of the joint but an autoimmune process where the body is attacking itself. This type of arthritis is much worse than osteoarthritis. People with RA typically have significant deformities and it is easier to visibly see that something is not normal with their joints than with someone with osteoarthritis.
Arthritis of the Spine
Why do I believe that arthritis is not causing pain in your spine when your x-ray or MRI show you have arthritis?
The root cause of pain is not easily diagnosed with x-rays or MRIs. While the MRI is great for seeing fractures, identifying tumors/cancer, and infections, finding the root cause of someone’s pain is not as obvious as we have been led to believe. Dr David Conran, MD states “There are many reasons why doctors should not make MRIs a routine order. Most importantly, research has shown that MRIs do not improve the outcomes for the majority of patients.” He emphasises that often times, the things that are being seen in the MRI are nothing more than “natural and age-related” occurances in the spine. He believes that “MRIs can over-diagnose back problems and may lead to invasive and often unnecessary treatment.”
As we age, there is normal and natural degeneration of our bodies – including the spine. These degenerative changes are not directly linked to pain. In fact, many experts feel that the diagnosis of arthritis of the spine is too easily given to patients that are seeking answers to pain. While there are instances where people do experience pain from arthritis in the spine, It is much more rare than you would expect. John Hopkins University reported that often “arthritis of the spine does not hurt or cause symptoms and nothing has to be done.”
Why then would doctors give the diagnosis of arthritis if it was not actually the cause of pain? Doctors are trying to help their patients find answers to why they are in pain. When the MRI or x-ray don’t show any obvious structural issues, but it does show some degeneration of the spine, they have no other explanation and assume the degeneration they can see must be arthritis. While this seems like a logical explanation to them, it just is not accurate.
What is causing your pain if it isn’t from arthritis?
From the many years clinical practice, I have only seen a handful of people that truly had pain from arthritis of the spine. These patients typically are in their 70’s, and 80’s, have significant changes to their spines, and are unable to stand up straight. Their spines have very little mobility and cannot move forward, backward, side to side or twist more than 10-15 degrees in any direction. Their spines have become stiff as a board and they have significant pain. While these patients can make some minor changes in increased mobility and decreased pain, they typically don’t make significant improvements.
For 99.99% of my patients that come with a diagnosis of arthritis, please know that there is hope for you to be completely pain free and back to golfing, caring for your family, work, or exercising. In fact, most all of our patients are out of pain and back to their lives within 3-6 visits.
If we aren’t treating arthritis, what are we treating? The pain people feel is from tight muscles, fascial tissue, and joints along the spine that put more stress on the nerves and cause pain.
Negative feedback loop
As a kid, it was fun to play “dog pile.” One child jumps on another child and yells “dog pile.” This signals to the other children to come and jump on the pile. The more children that pile on, the louder the bottom child is going to scream. Something similar happens with the spinal nerve roots (nerves that come off the spinal cord and go to the surrounding tissues) when they become compressed, like at the bottom of a dog pile.
As we move through our day, we may inadvertently bend, twist, or lift something too heavy that strains the tissues along the spine. We’ve all strained muscles and know it causes tightness in the muscles. If you strain the muscles along the spine and they tighten up, the tight muscles can irritate the spinal nerve roots by contributing to a narrowing of the opening from the spine where these little nerves emerge. Just like being on the bottom of a dog pile, and can’t breathe, this irritated nerve will start to scream. Well, it doesn’t actually scream but it does send a strong message into the spinal cord to let the nervous system know that it doesn’t feel safe. The spinal cord then sends a message to the muscles in the area that the nerve doesn’t feel safe. The muscles in this area tighten up to stabilize and protect the area – much the same way you would tighten your stomach if you knew someone was going to punch you in the stomach. Wait, wasn’t a tight muscle what caused the nerve to feel irritated in the first place? Yep. As the muscle tightens up to “protect” you, it further irritates the nerve and causes a stronger signal to be sent to the muscles to tighten up even more. This is what is referred to as a “negative feedback loop.” In other words, the body experiences a problem and then it’s fix to the problem, actually causes the problem to continue and make it worse.
Turning off the Pain in the Spine
To turn off the pain, we need to do something similar to a child on the bottom of a dog pile. We need to remove all the kids on top so the bottom child can breathe, stop screaming, and feel safe again. The nerve, at the bottom of this “pile,” is being restricted from the muscles and fascial tissue that tightened up to “protect” this area. If this has been going on a long time, the tight muscles and fascial tissues will eventually cause the little facet joints along the spine to tighten up as well. When these little joints tighten up, the nerve becomes more irritated. It’s a little like when we ate too much for Thanksgiving in the 80s when we didn’t have stretchy waistbands. Our stomachs were very uncomfortable until we loosened our belts, but even that wasn’t usually enough. Modern stretchy waistbands have removed a lot of the discomfort we used to feel after eating a large meal. This is where Spine PT comes in, we stretch out the muscles, fascial tissues, and joint capsules – like putting on stretchy pants, and voila, the nerve feels fabulous, and ready to go back for a second helping of pie!
Journey to a Pain-Free Life
Spine PT is all about helping people better understand how their spines work and how to stay living pain free. If you have having a lot of pain in your back or neck and have been diagnosed with arthritis pain, give us a call. You will be surprised at how quickly you are out of pain and back to the activities you love. Call (801) 709-4772 today to schedule your consultation and start your journey towards a pain-free and active life.