Spinal Degeneration and Dysfunction
By Mr Adam Whatley, Registered Osteopath
Specialist interest in Regenerative Medicine
Spinal degeneration or degenerative disc disease is an age-related progressive degenerative condition that happens when the spinal segments discs between of the vertebrae deteriorates or breaks down, leading to pain and poor function. pain can also be associated with weakness, numbness, and altered sensation.
It is our spinal discs between the vertebrae that pay the very important role of allowing for mobility and shock absorption. With ageing they become worn, and they no longer offer as much protection as before.
To understand and appreciate what causes spinal ageing and degenerative changes it is important to understand the basic structure of the spine.
Spinal Structure
vertebral body, discs and aligning joints. The vertebral disk so made up of fibrous tissue around the outside and a gelatinous nucleus in the inside.
Disc – 70-90 % water and is perfectly suited to deal with compression. The size of the nucleus inside the disk will ultimately dictate the mobility.
Throughout the early stages of life, the disk absorbs water through osmosis. However, there is reduced osmosis after The age of 30 which ultimately over a period of time lead to increased scar tissue (fibrosis) and progressive deformities.
Nucleus is made up of collagen, 70-90% water, proteoglycans (polysaccharides and proteins), glycosaminoglycan’s mainly chondroitin sulphate. The collagen deals with two falsies – tensile forces and compression. The outside fibres of the disc is called the annulus. More than 70% collagen is made up of the annulus and 15% in nucleus. Annulus is made up of lamina (collagen sheets). 120 degrees make up the inner fibres, and these are stiffer in nature. On top of the disc is a vertebral endplate, It is here that the disc gains nutrients and water through diffusion. The collagen fibres on the outer layer of the disc deals with more tensile forces. Movement causes diffusion through end plate, with a horizontal alignment of collagen to with stand swelling.
Spinal function
The spinal segments work with preloading of the disc, like a seesaw. Stabilising ligaments are reinforced at the back of the spine to offset over loading compressing forces on the disc. If there is an affected ligament due to many different reasons, the deeper muscles will take over in the aid to reduce compression on the disc, this can then lead to overload of the muscle tissues.
Spinal degeneration symptoms
The symptoms of spinal degenerative changes can be completely variable. Some individuals may suffer from no symptoms at all, whereas some individuals may suffer with daily excruciating pain that affects quality of life. The condition starts with spinal degeneration, but in time, symptoms can affect other parts of the body. Symptoms usually get worse with age. The discomfort can range from mild to severe and debilitating, and in some cases can lead to spinal osteoarthritis, with ongoing intermittent pain and reduced function. The most common early symptoms are usually pain and weakness.
In some cases with spinal degeneration, the pain and discomfort may radiate to the buttocks and into the legs. There may also be associated altered sensation like tingling or numbness in the legs or feet. If the damage is in the neck area (cervical spine), the pain may spread to the shoulder, arm, and hand.
Instability is also associated with spinal degenerative changes, which can leading to muscle pain or protective spasms as the body tries to stabilise the vertebrae. The individual may experience flareups of intense pain, which may be worse when sitting, bending, lifting, or twisting. Walking, lying down, and changing position may help relieve it.
Spinal degeneration causes
The spinal discs provide the padding between the vertebrae of the spine. They have an elastic structure, made of fibrocartilage tissue. As we age, repeated repetitive daily stresses on the spine and occasional injuries can damage the vertebral discs.
Changes with spinal degeneration:
Reduced disc fluid: The spinal discs of a healthy young adult consist of most water. With age, the fluid decreases, making the disc thinner. Thus, Leading to reduced function, reduced mobility and poor shock absorption.
Disc structure: Very small tears develop in the outer layer of the disc. The soft and gelatinous material in the inner part can then seep through the tears, resulting in a bulging disc. Thus, compromising function and stability.
To compensate, the spinal vertebral bodies build extra bone tissue (osteophytes, or bone spurs, small bony projections that develop along the edge of bones). This to try and better deal with compressive forces, distributing the weight over a larger surface area. These projections can press against the spinal cord or spinal nerve roots.
Risk factors
Age is the biggest risk factor, but some other factors can speed up the process of degeneration Like:
obesity
repetitive trauma
strenuous work
smoking/poor health
injury/trauma
Treatment options for spinal degeneration and back pain
treatment options are in most cases primarily dealt with conservative management. These treatment options of them include mobility exercises, strengthening exercises, physical therapy, manual therapy, osteopathy, advice on posture and lifting. Further treatments may include anti-inflammatory medications, losing weight, spinal injections, and surgery.
Spinal injections are often used using an anti-inflammatory and a local anaesthetic. These are called facet joint injections or epidural injections. They can provide effective pain relief, However, pain relief is often short lived. Further regenerative treatments are now frequently used aimed at restoring and facilitating healing and repair of damage tissue. Common treatments used within regenerative medicine often include platelet rich plasma (PRP) treatment. PRP treatment has been found to provide better long-term outcomes with reduced side-effects.
SPINAL DYSFUNCTION & PAIN
Causes of dysfunction
Increased flexion (bending) force in spine – picking up a weight
Ligamentous laxity (pregnancy, steroids)
Poor posture (reduced normal spinal curvature)
Weak core muscle
Increased compressive forces
Trauma
Muscle imbalances
Structural imbalances
Increased hysteresis
Important differentials
Ankylosing spondylitis
Spondylolisthesis
Tumour
Aortic aneurysm
Visceral referal
Spinal stenosis
Cauda equine.
At the back of the spine you have articulating joints that facilitate mobility. These are called facet joints. These joints also work in a harmonious balance with the spinal discs. Dehydration of the disc can lead to facet impaction from reduced mobility ultimately causing increased joint friction and progressive degradation over time.
How spinal discs become vulnerable
1) Genetic mutations (predisposition)
2) Non-enzymatic glycation (cells get broken down faster)
3) structural damage to disc or endplate
Presupposing factors
Reduced disc blood supply
Proteoglycan degeneration (reduced nutrition and hydrophilic nature)
Water loss, hydrostatic pressure loss, loss of disc absorption, dehydration and weakening of the annulus (reduced pre-load and increased neutral zone)
Spinal Aging and Degeneration
General:
- Reduced tissue flexibility
- Muscle strengthen decreases
- Less motor control
- Wider base of support due to the longer postural response
- More wear at lower lumbar spine L3/4/5, flat spines have more wear throughout and more server. - Less trabecular and cortical bone – which reduces the ability to absorb compression.
Acute and chronic low back pain
Pain can either build up very quickly or slowly over lots of different periods. The common scenario involves an individual going through prolonged periods of minor disc trauma. The internal fibres of the spinal disc are actually non-pain sensitive, meaning one is unlikely to know about the disc trauma. However, this disc trauma will still result in mechanical consequences which lead to the dull non-specific lower back pain.
Scenario – low-grade trauma from gardening and then one puts the achy back down to increased physical activity. However this prolonged low-grade trauma can result in disc inflammation. This can then build up, and cause nerve root irritation. Alternatively, internal fibres of the dsic can become damaged due to prolonged rotation trauma and this can either results in this bulging or worst case scenario information to get internal area of the disc.
In very acute cases it can often be ligamentous trauma due to heavy lifting in poor posture for example. This ligamentous trauma then can result in increased segmental Instability that then results in disc bulging due to reduced disc restraints.
GET IN TOUCH TO FIND OUT MORE OR SCHEDULE A FREE CONSULTATION
Don’t let back pain, joint damage, sports injuries or arthritis get in the way of allowing you to do what you want. Schedule a consultation at Dynamic Osteopaths & Regenerative Medicine today, and let us treat your injury, provide pain relief and get you back to your full and active lifestyle. We have clinics operating out of Solihull (Henley-In-Arden), Birmingham (Harborne/Edgbaston) & Bromsgrove (Barnt Green).
Call us today 01564 330773
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