Osteoarthritis : Degenerative Spinal Joint Disease
Osteoarthritis is a disease of
the joints. Also know as degenerative joint disease, it is the most
common form of arthritis, affecting more than 20 million American
adults. It should not be confused with rheumatoid arthritis, which
is not the same as osteoarthritis. Osteoarthritis is caused by a
breakdown of cartilage, the substance that provides a cushion
between the bones of the joints. Healthy cartilage allows bones to
glide over one another and acts as a shock absorber during physical
movement. In osteoarthritis, the cartilage breaks down and wears
away. This causes the bones under the cartilage to rub together,
causing pain, swelling and loss of motion of the joint.
What Causes Osteoarthritis?
Most cases of osteoarthritis have no known cause. Risk factors
Signs and Symptoms of Osteoarthritis
- Age - osteoarthritis affects more people over the age of 45
- Female - osteoarthritis is more common in women than in men
- Certain hereditary conditions such as defective cartilage and
- Joint injuries caused by sports, work-related activity or
- Diseases that affect the structure and function of cartilage,
such as rheumatoid arthritis, hemochromatosis (a metabolic
disorder), Paget's disease and gout
Osteoarthritis usually begins slowly. Early in the disease, joints
may ache after physical work or exercise. Often the pain of early
osteoarthritis fades and then returns over time, especially if the
affected joint is overused. Other symptoms may include :
Osteoarthritis : Commonly Affected Joints
Which joints are affected by Osteoarthritis?
- Swelling or tenderness in one or more joints, especially
before or during a change in the weather
- Loss of flexibility of a joint
- Stiffness after getting out of bed
- A crunching feeling or sound of bone rubbing on bone
- Bony lumps on the joints of the fingers or the base of the
- Steady or intermittent pain in a joint (although not everyone
with osteoarthritis has pain)
Osteoarthritis can occur in any joint but most often occurs in the
spine, hips, knees or hands.
How do I know if I have Osteoarthritis?
Stiffness and pain in the neck or in the lower back can result
from osteoarthritis of the spine. Weakness or numbness of the
arms or legs can also result. Some people feel better when they
sleep on a firm mattress or sit using back support pillows.
Others find help from heat treatment or an exercise program to
strengthen the back and abdominal muscles. In severe cases,
surgery to reduce pain and help restore function may be
Osteoarthritis in the hip can cause pain, stiffness and severe
disability. People may feel the pain in their hips, groin, inner
thigh or knees. Osteoarthritis in the hip may limit moving and
bending. This can make daily activities such as dressing and
foot care difficult. Walking aids (such as canes and walkers),
medication, and exercise can help relieve pain and improve
motion. If the pain is severe and not helped by other methods,
hip replacement surgery may be necessary.
The knees are the body's primary weight-bearing joints. For
this reason, they are among the joints most commonly affected by
osteoarthritis. They may be stiff, swollen, and painful, making
it hard to walk, climb, get in and out of chairs and use
bathtubs. If not treated, osteoarthritis in the knees can lead
to disability. Medications, losing weight, exercise, and walking
aids can reduce pain and disability. In severe cases, knee
replacement surgery may be necessary.
In osteoarthritis of the hands, small, bony knobs appear on the
end joints of the fingers. They are called Heberden's nodes.
Similar knobs, called Bouchard's nodes, can appear on the middle
joints of the fingers. Fingers can become enlarged and gnarled,
and may ache or be stiff and numb. The base of the thumb joint
is also commonly affected by osteoarthritis. Medications,
splints or heat treatment can usually help osteoarthritis in the
No single test can diagnose osteoarthritis. However, if you are
experiencing any of the symptoms listed above, see your doctor. Most
doctors use a combination of tools to determine if you have
osteoarthritis, including :
Your doctor will begin by asking you to describe any symptoms
you are having and how they have changed over time. Tell your
doctor about any pain, stiffness, or decreased joint function
you are experiencing and how it is affecting your daily life.
Also talk to your doctor about how you have been treating these
symptoms. Be sure to also tell your doctor about any other
medical problems you have and if you are taking any medications.
- Physical Examination
After talking with you about your symptoms, your doctor will
examine you by checking your reflexes and muscle strength. Your
doctor may also ask you to walk and bend to observe your
Since there is no single test for osteoarthritis, your doctor
may need to do a variety of tests including x-rays of your
joints to see if there has been any cartilage loss, bone damage
or bone spurs. Other tests may include blood tests and a test
called "joint aspiration" where fluid is drawn from
the joint to be examined.
It is usually not difficult to tell if a patient has
osteoarthritis. It is more difficult to tell if the disease is
causing the symptoms. Osteoarthritis is so common, especially in
older people, that other conditions may play a role in the symptoms.
Your doctor will try to find out what is causing the symptoms and
rule out any other health problems you may have.
Osteoarthritis : Treatment Options
Treatment of Osteoarthritis
Even though there is no cure for osteoarthritis, its symptoms can
be treated. Osteoarthritis treatment generally includes the
- Pain Control
Many different medications can be used to control pain,
including corticosteroids and non-steroidal anti-inflammatory
drugs (NSAIDs). If NSAIDs do not provide relief to inflamed
joints, glucocorticoids (an injection) may be used. For mild
pain without inflammation, acetaminophen or aspirin may be used.
Non-drug treatments may provide temporary pain relief and
include hot/cold therapy, acupuncture and herbal remedies.
Exercise to improve flexibility and improve muscle strength.
Regular exercise can also improve your mood and outlook,
decrease pain, improve your heart and blood flow and maintain
- Weight Control
Maintaining an acceptable body weight will help prevent extra
stress on weight-bearing joints.
- Spine Surgery
Spine surgery (in severe cases) may be necessary to relieve
chronic pain in damaged joints.
One of the most important things you can do is to take care of
yourself and adopt healthy lifestyle habits. People with
osteoarthritis can enjoy good health despite having this disease.
Research shows that patients who take part in their own care report
less pain and make fewer doctor visits. They also enjoy a better
quality of life. The best way to start is what you are doing right
now - learning as much as you can about osteoarthritis. Talk to your
doctor about programs that you can join that are designed to help
you manage your condition and develop a healthy lifestyle.
than 60% of the UK population reports regular back pain, amounting
to around 100 million days a year of lost working time. A bad back
can be the bane of your life. Everyday tasks can result in agony and
there's no quick-fix solution. But if you suffer from back pain,
you're certainly not alone. Back pain affects 28.3 million Brits,
according to a recent survey. Celebrity sufferers include Sean
Connery, Emma Thompson and Michael Caine.
Three in five adults in the UK admit to suffering from an
occasional aching back and slouching in chairs has been named as the
number one cause, according to mattress company Relaxsan. "The
tragedy is that this is the UK's leading cause of disability, and
even more disturbing is that recent research is showing back pain is
increasingly prevalent among children," says Barrie Savory,
"Current statistics from the Department of Health indicate
that back pain is costing British industry £5 billion a year in
lost production through absenteeism - and the National Health
Service £481 million a year in treating it."
Types of Back Pain
In 95% of cases, the cause is linked to the way the bones,
ligaments and muscles of the back work together. Pain is often based
in the lumbar region (lower back), and will come and go at different
times depending on different levels of activity.
Simple back pain triggers include poor posture, lack of exercise,
sleeping on a mattress that doesn't provide enough back support or a
trip or fall. Other causes of back problems are much less common.
Nerve root pain is the cause in less than 5% of people. The pain is
usually caused when a vertebral disc becomes displaced or bulges out
from its normal position, putting pressure on the nerve root. This
is called a slipped disc.
Lifting heavy objects may trigger a nasty twinge in your back but
surprisingly most backache is actually caused by doing nothing at
all. Savory continues: "The biggest factor behind back pain is
the fact we're too sedentary. Our creature comforts - the bed, the
soft armchair, the car, the office desk and the computer - are the
very instruments of our torture. Our backs have become weaker and
weaker as we've become more sedentary."
Unfortunately, once you've experienced back pain you may well be
prone to more problems, Savory adds. "Disc problems at the base
of the spine are one of the most common back injuries. Recurrent
episodic lower back pain is down to an instability between vertebrae
and vertebrae, where the disk has lost its fluid content and can
effectively 'wobble' about. Once you've got a degree of instability,
unless you do an enormous amount of core muscle strength exercises
to regain it, you'll always be vulnerable."
If you suffer from recurrent back pain it's wise to seek advice
from an expert. Back pain can be treated in many ways, including
physiotherapy, osteopathy and chiropractic treatment. "All of
these have an input in helping to restore the back to normal but
much of it is down to self-help and prevention," Savory says.
"We are all dealing with the same body - its structure and
function remain the same; it's only our approaches to its management
that are different."
Prevention is better than cure and back pain can be kept at bay
with a few simple changes. "Don't let yourself be a victim of
your surroundings. The invisible enemy - the desk and computer -
programme you into a shape and before you know it you're suffering
with back pain and need a lot of treatment to try and change it,"
He has these tips to help you wave goodbye to a bad back:
Walk more and try to do a spot of daily exercise. You don't need to
join a gym; get off one bus stop early, run up a flight of stairs or
balance on one leg while you're trying to clean your teeth. Sitting
just loses muscle tone.
- Pilates is recommended for strengthening core muscles. Yoga
can over-stretch and does not give the same degree of muscle
- Get out of 'desk mode'. Every time you get up from sitting,
deliberately put your hands behind the back, make your shoulder
blades meet at the back so you open the front of the chest and
hold for five seconds. Effectively you're coming out of 'desk
mode' and into an upright posture.
- Spend time on shoulder shrugging sessions when you're sitting
for long periods of time. This gets blood supply moving and
relieves tension at the top of the shoulders.
- Find a mattress that gives support. Don't go for super-hard
mattresses but ones with a soft top surface that's firm enough
to hold you.
- Warm-wrap therapy - a form of heat therapy to relieve pain
caused by muscle spasms in the lower back - is an effective
treatment, according to new research.
Taj Medical Group provide an all inclusive package comprising
specific X-rays, MRI scans, tests and investigations for determining
the root cause of your back ache, including 2 nights fully inclusive
stay (for you and a companion) followed by consultation with our
Spinal Surgeons in India for £395 - for more details - Back
Ache Investigation Package.
|What is Lower
Low back pain (LBP) is often described as sudden, sharp,
persistent, or dull pain felt below the waist. LBP is very common
and affects the majority of people at some point during their life.
Low back pain is most commonly caused by muscle strain associated
with heavy physical work, lifting or forceful movement, bending or
twisting, awkward positions, or standing in one position too long.
Any of these movements can exacerbate a prior or existing back
Other conditions that can cause low back pain include spinal
stenosis, arthritis (osteoarthritis), spinal infection
(osteomyelitis), spinal tumors (benign and malignant),
spondylolisthesis, and vertebral fractures (e.g. burst fracture).
Low back pain is either acute or chronic. Acute LBP may begin
suddenly with intense pain usually lasting less than 3 months.
Chronic pain is persistent long-term pain, sometimes lasting
throughout life. Even chronic pain may present episodes of acute
Other symptoms include localized pain in a specific area of the low
back, general aching, and/or pain that radiates into the low back,
buttocks, and leg(s). Sometimes pain is accompanied by neurologic
symptoms such as numbness, tingling, or weakness.
Neurologic symptoms requiring immediate medical attention include
bowel or bladder dysfunction, groin or leg weakness or numbness,
severe symptoms that do not subside after a few days, or pain
prohibiting everyday activities.
Low Back Pain : Diagnosis
Pain felt in the low back (lumbar spine) is not always indicative
of a spinal problem. A thorough physical and neurologic assessment
may reveal the cause of the low back pain. The physical examination
begins with the patient's current condition and medical history.
Range of Motion
The patient's range of spinal motion is evaluated while standing
straight, bending forward, and to the side. Asymmetry, posture, and
leg length is noted. Methodical palpation of the spine can reveal
muscle spasm, possible bony displacement, and tender points.
Abdominal palpation is performed to determine if the cause of low
back pain is possibly organ related (e.g. pancreas).
The neurologic assessment evaluates weakness, absence of reflexes,
tingling, burning, pain, diminished function, and other signs that
may indicate nerve involvement. In some cases electrodiagnostic
studies such as electromyography (EMG) or nerve conduction velocity
(NCV) are performed to confirm a diagnosis or localize the site of
If infection, malignancy, fracture, or other risk factors are
suspected, routine lab tests may be ordered. These tests may include
complete blood count (CBC), erythrocyte sedimentation (ESR), and
Plain radiographs (x-rays), CT Scan, and/or MRI studies are
performed when fracture or neurologic dysfunction is suspected. An
MRI represents the gold standard in imaging today. An MRI renders
high-resolution images of spinal tissues such as the spinal cord and
intervertebral discs. X-rays are still the imaging methods of choice
to study the bony elements in the low back.
The results of the physical and neurologic examinations combined
with test results are carefully evaluated to confirm a diagnosis.
Most patients with low back pain (lumbar spine) are treated without
surgery. A conventional treatment plan may include bed rest for a
day or two combined with medication to reduce inflammation and pain.
Medications recommended by the physician are based on the patient's
medical condition, age, other drugs the patient currently takes, and
The first choice for pain relief is often nonsteroidal
anti-inflammatory drugs (NSAIDs). These drugs should be taken with
food to prevent stomach upset and stomach bleeding. Muscle relaxants
may provide relief from muscle spasm but are actually benign
sedatives, which often cause drowsiness. Narcotic pain relievers are
prescribed for use during the acute phase.
Physical therapy (PT) is started as soon as the patient can
tolerate activity. A managed PT program can help build muscle
strength, flexibility, improve mobility, coordination, stability,
balance, and promotes relaxation. Patients who participate in a
structured physical therapy program often progress to wellness more
rapidly than those who do not. This includes low back maintenance
through a home exercise program developed for the patient by the
PT may include ice therapy to slow nerve conduction thereby
decreasing inflammation and pain. Heat treatments may be used to
accelerate soft tissue repair. Heat increases blood flow and speeds
up the metabolic rate to assist healing. Heat also helps decrease
muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a
treatment used to deliver heat deep into soft tissues. Sometimes a
heat treatment is given prior to a session of therapeutic exercise.
Seldom is surgery required to treat low back pain. Surgery may be
considered if the patient is experiencing bowel or bladder
dysfunction, increased nerve impairment, progressive weakness,
incapacitating pain, or spinal instability. The surgical procedure
depends on the diagnosis or the cause of low back pain.
First and foremost, follow the treatment plan outlined by the
physician and physical therapist. To enhance recovery from surgery,
an episode of low back pain, or to help prevent future exacerbation
try to maintain good posture, be consistent in a home exercise
program, and eat sensibly to maintain proper body weight.