We have recently added some "Chiropractic" info posters to our office, which have sparked some interest among many of our patients.  In particular is the poster on Spinal Degeneration.  This poster was not meant to scare you, but educate you on the phases of spinal degeneration and the anatomic and symptom changes that occur at each phase.  Let us take a closer look

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Phase 1 or Dysfunction Phase

During phase 1, we will see the initial effects of repetitive micro trauma with minor small tears in the discs circumferential fibres localized to one side of the disc where the stress was applied, or several minor tears throughout the disc. The outer fibres of the disc have a nervous innervation resulting in the pain that occurs with these little tears or what I often refer to as disc derangement.  As these tears occur, there can be separation of the disc from it’s attachment to the bony endplate above or below the disc which compromises the discs nutritional supply and waste removal, making healing longer.  These small tears can turn into radial tears increasing the chance for disc bulge or herniation.  Symptomatically at this phase, patients may have one or few symptoms of spinal pain ranging from mild to severe depending on the structures that are involved.  

Phase 2 or Instability Phase

In this phase, there is a loss of mechanical integrity with further loss of water from the disc making tears to the outer disc easier to occur.  Further damage to the disc and to the joint complex, partial dislocation or instability will occur.  Here, symptoms may include repeated episodes of moderate to severe pain with arm or leg referral which may not have been there previously.  Instability may lead to altered movement biomechanics and thus weight may shift and be heavy on one side versus another, which leads to further progression of bone spur formation. 

Phase 3 or Stabilization Phase

During this phase, the disc space will continue to narrow and bone spurs (osteophytes) will begin to form.  Once extensive, these bone spurs can join with spurs from adjacent vertebrae forming what is known as transdiscal bridging.  Symptoms here will include significant decreases in range of motion, episodes or continuous nerve irritation resulting in numbness, tingling or referred pain, as well as postural changes.  Depending on the location of the bone spurs that form, there may be spinal canal or cord compression resulting in further changes down the spine, i.e. cervical spinal cord compression can result in single or bilateral leg numbness. 

Treatment Options

Most patients that are diagnosed with spinal degeneration, regardless of the phase they are in, most likely come in initially to have their “pain” treated.  The treatment will vary depending on the provider for whom they seek care.  Providers can include chiropractors, physiotherapists, massage therapists, family doctors, medical specialists (orthopedic surgeon, physiatrist, and neurosurgeon) or osteopathic manipulators.  Each may take their own approach to treatment which will first address helping reduce the pain, and later focus on improving movement in the spine and then working on keeping the spine mobile with proper biomechanics.  From a prevention stand point, mobility of the spine with proper postural mechanics and strength balance is key. 

As a chiropractor, we take our treatment to the level where these changes are occurring, to the joints of the spine.  Adjusting spinal joints puts motion back into restricted joints, moves the synovial fluid around to aid in nutrition of the joint, as well as help pump blood through areas that rely on motion to increase blood flow.  In addition, the nerves that innervate the joint capsule become stimulated with an adjustment, helping reduce hypertonic (tight) muscle tone and reducing pain sensation. 

If you are not moving well, seek out a provider to help you achieve your goals and start increasing your mobility.  We cannot reverse these changes once they occur, however, we can help you from progressing further. 

References:

Kimberley Middleton1 and David E. Fishcorresponding authorLumbar spondylosis: clinical presentation and treatment approaches.  Curr Rev Musculoskelet Med. 2009 Jun; 2(2): 94–104.  Published online 2009 Mar 25.