Osteoarthritis

osteoarthritis degeneration back painDegeneration of the spine is a prevalent problem that generally advances with age, though is not always restricted to the elderly1.

The presence of osteoarthritis is not always consistent with pain either. While progressive joint failure may cause pain and disability, approximately 50% of people with osteoarthritic changes don’t have any symptoms2. This is known as the “structure-symptom discord”.

How the spine degenerates and how pain is experienced is multifactorial. Firstly, osteoarthritis begins when there is an imbalance of mechanical load that exceeds the limit of what joint tissues can handle. Bony changes and inflammation cause dysfunction and instability of the joints. Secondly, changes to the nervous system occur around the spine, then spinal cord, and finally brain. How people move starts to change; muscle strength changes; and finally sensory awareness of their body changes. When these systems break down, the person experiences persistent pain (Fig. 1).

biopsychosocial model structure symptom_550

Figure 1. Biospsychosocial model depicting the relation of structural pathology to the experience of pain

How such dramatic alterations in shape of the spine occur over time (Fig. 2) is primarily due to a decrease in nutrition to the discs between the vertebrae3. The primary source of nutrition for the intervertebral discs are the end plates of the vertebrae. As degeneration progresses, fissures, cracks, clefts and fractures occur in the end plates, resulting in them thinning and water volume being lost from within the disc. This reduces disc height, misaligning mechanical forces and changing the shape of the spine (Fig. 3). As a consequence, more stress and strain is placed on the joints of the spine creating back pain. Long term pain can lead to more permanent, dysfunctional changes in the central nervous system ■

spinal degeneration disc compression_550

Figure 2. Spinewave case example of degeneration of the lumbar spine over 23 years resulting in scoliosis to the right and persistent low back pain

disc degeneration

Figure 3. Qualitative stress distribution across vertebral end plate for normal and degenerated intervertebral disc under pure compressive and eccentric compressive loading

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This can’t be good for you – Part 6

25 year old patient presents with migraine.

harrington rods B

harrington rods A

See also: This can’t be good for you Part 1 | Part 2 | Part 3 | Part 4 | Part 5

Scoliosis

“I was truly shocked when I saw the x rays but it certainly explained my problems.”

So often I’ve heard from clients that a therapist of some description has run their fingers down their spine and told them they have scoliosis. This is not how you define scoliosis. It’s defined by x ray only and the curvature has to be more than 10 degrees.

Spinal fusion started becoming popular in the 1900s. And then by the mid-1900s Harrington rods were introduced by Paul Harrington. In all this time, cutting the spine open and fusing bones together still seems like the logical first step to people with back pain – costing ACC hundreds of thousand of dollars every year – even in light of the spine being the key signalling device for the central nervous system to maintain harmony within the body. Some research has even suggested that scoliosis might manifest itself due to lesions in the posterior columns of the nervous system during the early years. This central nervous system dysfunction was hypothesised to be a decreased vibratory sensation1,4. So as a side note: Adjust the child.

For the brain to be aware of its internal and external environment, and to lead adequate self-directed healing, the spine needs to be mobile.

The risks of surgery become quite overwhelming: Neurological damage, loss of normal spine function, additional strain on unfused vertebrae, excruciating post-surgical pain (sometimes only a year down the track), infection, and in the instance of scoliosis, further curvature progression. Due to these complications, re-operation is necessary, sometimes referred to as reconstructive, re-corrective, revision, or salvage surgery. Complication rates vary, but failure of fusion has been found in more than 50% of treated patients and among 25 adult patients, 40% required salvage surgery2. What we know now, from a patient’s perspective at least, is the preferred plan of action would likely be avoiding unnecessary risk, i.e. avoiding surgery (or keep it as the final option) once all conservative measures have failed.

While mechanical medicine was making its surgical advances in the 1950s, so too was chiropractic. The developer of chiropractic after his father, BJ Palmer, reported on a case of scoliosis in 1951 amongst his extensive plethora of research. BJ Palmer also had at that time, the biggest collection of pathological and anomolous bones in the world. BJ reported 4,392 total specimens, containing 13,697 skeletal elements. It was estimated that these 4,392 specimens represented approximately 3,000 persons. BJ Palmer assembled the Osteological Studio in a room for student study. Even then, the collection was known to the professors of anatomy in many of the nearby state medical colleges. These specimens were available to them and were often studied by them to better qualify them for carrying on their lecture work in their own classes. Read more


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