Degenerative joint disease of the lumbar spine is the most common cause of back pain that we see in our practice. As the name implies, it is the degeneration of the facet joints of the spine. Normally, the surface of these joints are lined with cartilage. But over time or previous injury, the cartilage becomes worn out and eventually, the bone of the joints are exposed. This is what doctors mean when they say, “your joint is bone on bone.” The body tries to fix this but it can not grow cartilage back. Instead, it lays down bone spurs and these end up on the edges of the joint. We ‘ll go back to this later.
As we age, our discs dry up and become thinner. This condition, by itself, does not cause the back pain. The thinning of the discs causes the intervertebral foramen to become narrower. Nerves exit through these foramina and when they become narrower, the likelihood of the nerves getting pinched increases. When nerves get pinched, that’s when pain is felt.
Going back to the bone spurs around the facet joint, these spurs cause narrowing of the intervertebral foramen as well. When you combine the presence of the bone spurs and the thinning of the discs, the foramen becomes much smaller making it really easy for the nerve to get pinched.
There are ways to mitigate this condition. In our office, we educate our patients of what I just mentioned above. We also teach them what to avoid to prevent the nerve from getting pinched. Certain movements make the foramen bigger or smaller. For example, forward bending causes the foramen to open up. Backward bending does the opposite. Side bending and twisting will also cause a change in foramen size. We have an articulated model of the spine which helps us demonstrate to our patients the change in foramen size with every movement. They can therefore mentally visualize what’s going on with their spine every time they bend or twist.
When a patient has an impinged nerve, we instruct him or her to avoid certain movements corresponding to the biomechanics of the spine. In addition, they are taught posterior pelvic tilting and abdominal strengthening exercises. Hip flexor muscles are stretched as well to minimize arching of the back. Spinal mobilization is also done to loosen up the stiff and arthritic facet joints. This is followed by gentle range of motion exercises.
Since the nerves are pinched, they are most likely inflammed and swollen. In our office, we provide our patients with modalities for inflammation. Once the inflammation and swelling go down, the nerves have more room in the foramen, making it less likely to get pinched. In our profession, the use of these modalities is becoming unpopular because health insurance companies pay very little for these. We believe in the effectiveness of these modalities and we provide them despite the low insurance reimbursement. In our office, we provide the best treatment for our patients regardless of insurance payments.
Armed with the knowledge of spinal biomechanics and corresponding precautions, our patients become pain-free and remain pain-free.
We have 2 offices to serve you. One is in Land O’ Lakes Florida and the other is in Zephyrhills Florida.
– Dino Lontoc, P.T.