Sunday, August 26, 2012


Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

I hate to be the bearer of bad news but realistically, you need to know this: There is no cure for osteoarthritis of the spine, the most common cause of chronic low back pain.  Your lumbar spine is a weight bearing structure, similar to your knees, your hips, and ankles.  (Reminder, this discussion has very little to do with your neck or thoracic spine; they have different purposes.)

There are some blogs and websites that insist you can "rebuild" your back.  That's not possible for people with osteoarthritis.  People with sprains and strains that have not progressed to osteoarthritis can "rebuild" or strengthen their back.  There are ways of decreasing pain and cutting down on re-injuries, too.  However, the only person who could "rebuild" an osteoarthritic back would be a surgeon, and he is only resurfacing or remodeling.  The structure is what it is.

Osteoarthritis is the chronic degeneration of the structures that make up the spinal column: mainly the discs, the cartilage, and the ligaments.  The discs dehydrate and collapse; the cartilage cracks and breaks down; the ligaments become stiff and less flexible.  Even without external factors caused by overwork, this process is related to aging.  Until someone comes up with a fool proof method of reversing aging, osteoarthritis will not be reversible.

I'll use the knee as an example of a weight bearing joint.  The same things I will mention here apply to the hips, lower back, and ankles.

There aren't many people claiming they can rebuild your knees, although doing so may be easier for the surgeons than rebuilding your back.  A serious knee injury, say a torn ACL (anterior cruciate ligament), leads invariably to osteoarthritis of the knee.  This is true whether the ACL is reconstructed or not.  The osteoarthritis (degeneration of the cartilage, collapse of the joint space, loss of flexibility of the ligaments) is inevitable.  The time it takes to degenerate can be affected by life style, however.  Serious injury makes the joint too mobile, allowing structures to move too far stressing other structures, leading to premature aging.

At age 19, I had my right knee severely damaged playing spring football in college.  I tore the MCL (medial collateral ligament), the medial meniscus (cartilage), and the ACL.  In 1967, they didn't surgically repair ACLs like they do today.  They did remove the damaged cartilage, however.  MCLs heal on their own; they have good blood supply.  ACLs do not heal, having poor blood supply.  The orthopedic surgeon told me that I didn't need an ACL.  As long as I kept my quadriceps muscles strong, he said, my knee would function normally.  I believed him and I spent a lot of time exercising my legs.  I had some problems, but overall, my knee has served me well.  It has been essentially pain free for 45 years.  I played soccer until I was 45.  At 65, I continue to run 5-8 miles twice a week.  However, if you x-ray my knee, it looks like it should hurt a lot.  I have bone spurs, a flattened joint, and nearly bone on bone collapse of the joint space -- a typical severe osteoarthritis x-ray.

Exercise of joints with osteoarthritis is important.  This is true for backs, hips, knees, and ankles.  Motion is the lotion, as one neurosurgeon I met told me.  Under-exercise and over-exercise can lead to more degeneration and pain.  When an ACL is repaired, the athlete can continue to exercise.  His knee joint will still develop osteoarthritis, but more slowly than if he stopped exercising.  When you suffer a back injury, motion is an important part of recovering, and keeping the muscles strong in your abdomen and back help protect you from further injury.  Gradual onset of osteoarthritis is almost inevitable with a severe injury, but moderate exercise delays the progression.  So, even if osteoarthritis can't be cured, it can be delayed and the pain minimized.  Being active is important.

In addition to being active, decreasing the load your lower spine has to bear also slows the progression of osteoarthritis.  So if you are overweight, losing weight helps your back.  Avoid lifting very heavy objects.

Osteoarthritis is a chronic, progressive medical condition with no cure.  That does not mean having this disease is a death sentence.  Many people live very well with it.  It's not reversible, but you can slow its progression if you remain active.  To minimize discomfort lose weight and don't overdo it. 

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