Spondylosis (Osteoarthritis, Degenerative Joint Disease or Wear and Tear Arthritis)

Definition

A chronic disorder characterised by osteoarthritic changes of the neck joints and narrowing of the intervertebral disk, which can occur with our without neurological symptoms.

Wear and tear is the phrase commonly associated with musculoskeletal degeneration of the body. These may include excessive loading on joints, accumulated wear and tear such as osteoarthritis, or post traumatic reactions to injuries such as fractures or dislocations. In such cases the additional stresses on tissues often cause pain and dysfunction.

Symptoms

Symptoms may include neck pain or radiating pain to the back of the head, chest, shoulders and arms and reduced range of movement. It is usually diagnosed from changes seen on X-Rays or other imaging. The problems associated with very severe degenerative changes may require medical intervention.

Evidence based summary for manual therapy

We are unaware of any randomised controlled trials investigating the chiropractic approach to cervical spondylosis or its symptomatic improvement.

However it is likely (see “Why does a joint become osteoarthritic”) that spondylosis results from chronic mechanical tension of the neck joints. There is good evidence for the benefits of chiropractic treatment of mechanical neck pain [53]. Chiropractic has also demonstrated good evidence for benefiting osteoarthritic joints in other parts of the body (hip and knee) [53].

In managing this condition we make no claims to cure or permanently alleviate symptoms. There are degrees of severity of osteoarthritis, some of which require referral to other health professionals.

Other effective non-invasive physical treatments or patient education

Why does a joint become osteoarthritic?

When a joint becomes stiff and loses its normal degree of movement, the altered movement pattern causes stress which creates damage to the cells – this is known as “Immobilisation Degeneration.” It is a similar process to the way that skin, if it is repeatedly irritated first becomes inflamed but later thickens. Wear and tear is the phrase commonly associated with this musculoskeletal degeneration of the body.

Any situation that leads to a lack of mobility can cause these degenerative changes in the musculoskeletal system [35,36,37]. These may include excessive loading on joints, conditions such as osteoarthritis, or post traumatic reactions to injuries such as fractures or dislocations. In such cases the additional stresses on tissues often cause pain and dysfunction. Complete lack of mobility is not essential for immobilisation degeneration to occur [38].

The early stages of degeneration start quickly: within a week of onset of reduced movement in a joint there is a measurable loss of proteoglycans within the joint complex and wear changes of the joint surface are measurable within 1 day to 1 week of the onset of the loss of movement [38,39]. It may however take many years to start showing up on an X-Ray.

Joints that are tight have more degenerative changes than those that are not fixed and the degree of degeneration (bone spur formation) is directly dependent on the amount of time it has been fixed [40].

Altered movements and forces on a joint, which occurs during the immobilisation process, is universally recognised as contributing to connective tissue degeneration and local changes in the chemical composition of that tissue [41]. Variations in chemical composition of degenerating connective tissues can result in mechanical failure [38].

Damage in tissues following immobilisation can be reversible upon remobilisation. The sooner the movement is restored, the more repair occurs. If the restoration of normal movement is delayed, the degeneration becomes more extensive and permanent [41, 43, 44].

Liebenson [45] lists the negative effects of immobilisation and provides references for each negative effect. In joints: shrinkage of joint capsule, increase in compressive loading, increase in contracture of the joint, increased synthesis rate of glycosamine-glycans, increase in fibrosis, irrerversible changes after 8 weeks. Ligaments: lower failure or yield point, decreased thickness of collagen fibres. Disk biochemistry: decreased oxygen, glucose, sulphate, proteoglycan content and increased lactate proliferation. Bone: Decreased bone density and eburnation (increased density and damage due to degeneration). Muscle: decreased thickening of collagen fibres, decreased oxidative potential, decreased muscle mass, decreased sarcomeres, decreased cross-sectional area, decreased mitochondrial content, increased connective tissue fibrosis, type 1 muscle atrophy, type 2 muscle atrophy, 20% of loss of muscle strength per week.

To maintain the musculoskeletal system in good health there must be weight bearing, movement and exercise.

Loss of function leads to loss of structure [46]. Animal experiments using rabbits with knee joints immobilised and splinted reported irreversible joint degeneration and osteoarthritic changes after only 2 weeks of complete immobilisation. The most obvious early changes of immobilisation was found to be reduction in mobility, which was initially reversible but after 2 weeks some range of movement was lost permanently. After 2 weeks of immobilisation, the first signs of eburnation (wearing, hardening and exposure of the bone) because of damage to the overlying cartilage was found. These are irreversible and can be identified on X-Ray as narrowing of the joint space, osteophyte (bone spur) formation and subchondral sclerosis (increased bone density beneath the cartilage). This loss of joint mobility was produced by either a single period of immobilisation of two weeks or more or repeated periods of several days of immobilisation.

Cramer and Henderson [47] found in animal experiments that in the period following immobilisation but not in controls, the spinal joints are hypomobile and their neighbours start to have too much movement. Their research shows there is a window of opportunity in the first 4 weeks, in which if the joint is released , it tends to improve.

The term arthritis covers a wide range of conditions involving damage and/or inflammation of the joints of the body. These conditions may variously involve pain, swelling or stiffness. There are over one hundred different types of arthritis and broadly, these can be categorised into inflammatory or non-inflammatory in nature. The most common is osteoarthritis, a non-inflammatory condition caused by degeneration or trauma.

Back-in-Action clinical opinion

Once identified as such, osteoarthritis can be managed by a variety of means depending upon the location and severity. The primary aim of chiropractic care is to restore mobilisation, aid repair and improve posture to reduce stress on the joints. Care options that are open to chiropractors include manual therapies (which may include chiropractic manipulation, mobilisation or massage), acupuncture, exercise, postural work, ergonomics, nutrition, lifestyle advice or orthoses. Chiropractors are qualified to diagnose this condition and determine appropriate treatment strategies for effective symptom relief and functional improvement.

In managing this condition we make no claims to cure or permanently alleviate symptoms. There are degrees of severity of osteoarthritis, some of which require referral to other health professionals.