Physiotherapist
Degenerative spinal disease is a general term for wear and tear in the structures that make up the spine. This can occur in the cervical, thoracic or lumbar regions. Just because someone has degnerative changes on x-ray doesn't mean they have pain.
Degeneration is a natural part of aging and over time all people will exhibit changes. The important thing to consider is what movementsor positions make you feel better and conversely what movements or positions make you feel worse.
A trained McKenzie physiotherapist will be able to assess you area of pain and determine what's the one or two key exercises that will help you take control of your pain rather than your pain controling you.
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Degeneration of the lumbar spine is a normai change as we age, but becomes significant when their are associated Modic changes.
Modic changes are simply-put bone marrow swelling of the adjacent bodies of the spinal bones, and as a result a strong inflammatory pattern occurs- symptoms of this are felt as severe night pain and morning stiffness in the back- a T2 weighted MRI is currently the only way to confirm this. The bone marrown inflammation does burn out, but can take 18-24 months in the worst case
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Although there is a common trend that the older we get, the more degeneration is present; there may be other factors at play which may speed up this degenerative change.
Several studies (1-6) suggest that a reduction in the normal motion of a joint known as hypomobility (a joint that isn't moving enough) results in time-dependent degenerative changes. And as Sandr McFaul noted, degeneration does not always lead to pain, however from our clinical experience it is found that increased degenerative change reduced the degree of function available for the spine. Symptoms such as stiffness, or being less flexible are common concerns.
Other studies suggest that degenerative joint changes may be due to traumas to the joint surface (7,8). Indeed James Schomburgks comment of inflammation and Modic changes would support this. These may be large traumas such as a heavy fall or accident, or multiple smaller traumas such as repeditive strain injuries.
As Chiropratcors, we are interested in the health of the spine. We therefore aim to have the spine functioning at it's best. There are some small trials to suggest that when this is the case, there is a decreased risk of degenerative change (see references below).
1. Cramer et al., Degenerative changes following spinal fixation in a small animal model. J Manip Physiol Ther 2004 (Mar); 27(3): 141-154
2. Kirkaldy-Willis WH. Managing Low Back Pain. 2nd ed. New York: Churchill Livingstone, 1978.
3. Evans EB, Eggers GWN, Butler JK, and Blumel J. Experimental immobilization and remobilization of rat knee joints. J Bone and Joint Surg 1960; 42A: 737.
4.Hall MC. Cartilage changes after experimental immobilization of the knee joint of the young rat. J Bone and Joint Surg 1963; 45A: 36.
5. Troyer H. The effect of short term immobilization on the rabbit knee joint cartilage: A histochemical study. Clin Orthop 1975; 107: 249.
6. Mooney V, and Ferguson A. The influence of immobilization and motion on the formation of fibrocartilage in the repair granuloma after joint resection in the rabbit. J Bone and Joint Surg 1966; 48A: 1145
7.Gelber et al., Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Int Medicine 2000 (Sep5); 133 (5): 321-328
8. Roos et al., Osteoarthritis after meniscectomy; prevalence of radiographic changes after twenty one years compared with matched controls. Arthritis Rheum 1998; 41 (4) Apr: 687-93
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