A Physical Therapy Guide to Osteoarthritis of the Spine

Spine pain is a particularly common complaint in the United States. At some point in their lives, up to 80% of people¹ experience pain in their neck or back region.

Osteoarthritis of the spine is a frequent diagnosis. The good news is that many of those with osteoarthritis of the spine have no symptoms or problems whatsoever. Others with symptoms can turn to conservative, non-invasive, strategies to manage their pain successfully.

It is understandable to feel overwhelmed by neck or back pain, particularly when the pain is severe and interferes with your life. Working with a trusted movement expert—such as a CityPT physical therapist—can give you the confidence that you know how to keep your spine healthy as you age.

For those who are experiencing pain or other symptoms from osteoarthritis of the spine, most can manage their condition conservatively — without surgery.

Table of Contents

• Understanding Osteoarthritis of the Spine
• Symptoms of Osteoarthritis of the Spine
• What are Common Risk Factors for Osteoarthritis of the Spine?
• Diagnosing Osteoarthritis of the Spine
• What to Expect from Physical Therapy
• What If Conservative Treatment Doesn't Work?
• Preventing Osteoarthritis of the Spine
• Is It Time to Seek Treatment?

Understanding Osteoarthritis of the Spine

Your entire spine consists of a set of small bones, called vertebrae. There are three main sections of vertebrae in your spine, all working together to allow you to turn, bend, and extend:

• Cervical, or neck region
• Thoracic, or mid-back
• Lumbar, or lower back

Below the lumbar spine, at the level of the pelvis, is the sacrum. Below the sacrum is the coccyx, known by most people as the tailbone. The sacrum and coccyx each consist of a set of fused vertebrae which do not move.

Anatomy of Your Spinal Joints

You have three joints between each vertebrae:

• One intervertebral joint between the main bodies of the vertebrae, in the front part of your spine, separated by a strong, flexible disc, called an intervertebral disc.
• Two facet joints in the back part of your spinal column — one on the left, and one on the right. These are sometimes called zygapophyseal or apophyseal joints. These joints are synovial joints, similar to your knee or knuckles. The surfaces are covered with cartilage and the entire joint is surrounded by a membrane.

The joints in your spine are reinforced by sturdy bands of ligament and muscle. This trio of joints works perfectly together to bend, twist, and extend in virtually any direction you choose. This could include turning to reach something behind you in the car, crouching to tie your shoe, or rolling over in bed to reach something on the nightstand.

While the intervertebral joint carries most of the weight of your body from the segments above, the facet joints also play a role in weight-bearing.

Other Spine Structures

Your spinal cord runs vertically through a series of openings in the back part of each vertebra. A pair of small nerves or "nerve roots" exit the spinal cord between each vertebrae, with the facet joints forming an arch around the nerve. These nerves control motor function and send information to your brain about sensations in that region of the body.

The static position and available movement of your spine joints can influence how these neural tissues function.

Age-Related Changes in Your Spinal Joints

When we age, we naturally tend lose some of the height in our spinal discs. This condition is referred to as degenerative disc disease.

Changes in disc height may provoke irritation to the facet joints adjacent to that disc. Chronic irritation can result in arthritic changes to the cartilage in the facet joint. These cartilage changes would appear in an x-ray as a narrowing of the space inside the facet joint.

Along with arthritis in the facet joint, you may also develop some changes in the vertebrae themselves, such as changes in the quality of the bone below the cartilage, or the development of bone spurs — also called osteophytes. When bone changes become severe enough they are called spinal stenosis.

The most common areas for developing osteoarthritis of the spine are in the cervical spine and the lumbar spine. It is also possible to develop arthritis at the sacroiliac joint, where the pelvis and sacrum meet. You may see these joints as a pair of "dimples" on either side of the lower back.

Symptoms of Osteoarthritis of the Spine

Osteoarthritis of the spine is commonly asymptomatic.² Some people do have symptoms coinciding with these spine changes, such as:

• A feeling of pain or stiffness along the spine
• Pain that responds to activity — perhaps worse after prolonged inactivity, when getting up in the morning, or with exercise or physical activity
• Pain that responds to position — for example, it is worse with things like standing or walking, or better with sitting or lying down
• Pain or sensory changes, such as numbness or tingling, into the arm or leg
• Weakness in the affected limb

When the symptoms extend into your limb, this likely indicates irritation to the nerve adjacent to that disc. Rarely, people experience compression to the spinal cord severe enough to prevent walking and other functions of the lower body.

Please note: a new or recent onset of low back pain with severe loss of function in the legs or bowel/bladder, loss of sensation in the genital area, or loss of sexual function could be indicative of a medical emergency.

If you are experiencing these symptoms, seek emergency care.

What are Common Risk Factors for Osteoarthritis of the Spine?

Osteoarthritis of the spine is a common condition, which increases in frequency with age. Aside from the normal aging process, people with other comorbidities may be at a higher risk for osteoarthritis of the spine:

• History of a prior spinal surgery, such as a spinal fusion, in an adjacent spinal level
• History of disc degeneration
• History of vascular disease, as measured by abdominal aortic calcification
• Obesity, more so for lumbar spine than cervical spine³

A person's sex does not seem to be related to development of this condition.

Diagnosing Osteoarthritis of the Spine

As mentioned above, many people likely do not even realize they have age-related facet joint changes, as they may have no symptoms or other limitations in their daily life.

An X-ray or MRI showing osteophytes or the presence of joint space narrowing would confirm the diagnosis for symptomatic people. Often, imaging only occurs if someone does not improve with conservative treatment.

At your first meeting with your clinician — whether that is a physician, a doctor of physical therapy, or another licensed healthcare professional — they will ask you specific questions to determine whether urgent imaging would be recommended to check for more serious issues. However, absent any red flags for serious pathology, an imaging study or diagnosis is not required to begin pain-relieving treatment.

What to Expect from Physical Therapy

The most important thing for your physical therapist to understand is what your pain and symptoms prevent you from doing. Do you feel the pain primarily while walking and standing? Do you feel relief with sitting? Do you feel pain when turning your head while driving? Is it mostly at work, when performing your job-related tasks?

Understanding this will help drive the treatment that is most meaningful for you.

Your CityPT therapist will create a customized treatment plan for you based on what they observe about your strength and movement, as well as what you tell them at your initial evaluation.

Treatment will vary depending on your symptoms and goals but could include any of the following:

• Education about your condition: Which may include suggestions for sleep positions or advice about applying ice or heat. Your physical therapist will also work with you to address some of the underlying factors that may be contributing to your pain, such as regular exercise, stress, or smoking.
• Symptom-reducing treatments: Generally a combination of gentle exercises⁴ and hands-on manual treatments to help decrease the severity of pain around your spine, as well as to decrease the symptoms which extend into your limbs.⁵
• Treatments to improve your range of motion: Limited range of motion may contribute to uncomfortable feelings of stiffness with your daily activities. Again, this is typically treated with a combination of exercise and manual therapy. Spine and trunk exercises can help your body remember how to move in a smooth, easy manner.
• Addressing adjacent body regions: Often strengthening or improving function in nearby body regions — such as your hips for your low back, or your upper back and shoulders for your neck — can help promote functional movement in the spine itself.
• Return to desired activity level: Whether that is sport, occupation, or recreational activities, your physical therapist will help you develop and implement a plan so that you have the strength, flexibility, and endurance required by your activity.

What If Conservative Treatment Doesn't Work?

If you are not seeing improvement with conservative management, such as exercise and physical therapy, you may wish to explore further alternatives, such as:

• Spinal injection
• Spinal fusion
• Other spinal surgery such as laminectomy or facetectomy
• Medial branch blocks or radiofrequency facet denervation

Some of these alternatives are only appropriate for certain people and symptoms. When considering any elective surgery, is important to discuss the risks and benefits of each option with your care team to determine the best path for you.

Preventing Osteoarthritis of the Spine

As discussed, there are several factors which may put you at risk for developing osteoarthritis of the spine. Many of these factors are not things we can change. However, there is a lot we can do to keep our spines — and bodies — strong and functional with age.

• Quit smoking to promote improved blood flow to your spine.
• Work with your care team to manage cardiovascular conditions.
• Boost metabolism by focusing on eating wholesome and nutritious foods.
• Get enough sleep and manage stress for overall health and injury prevention.
• Engage in regular physical activity, which may contribute to the health and resilience of the spinal discs.⁶

Is It Time to Seek Treatment?

If you are currently dealing with neck or back pain and feel overwhelmed about where to begin, you would benefit from working with a CityPT physical therapist. This is true whether you have a diagnosis of osteoarthritis of the spine or you just want to feel and move better.

Reach out to one of our CityPT specialists to get moving and return to wellness.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

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