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Spinal Degeneration

(Also known as Degenerative Spine, Back Arthritis, Osteoarthritis of the Spine, Spinal Arthritis, Disc Degeneration, Spinal Canal Stenosis, Vertebral Canal Stenosis, Spinal Stenosis)
What is spinal degeneration?
The spine comprises of many bones known as vertebrae each of which has a large hole in its center. Because these bones are situated on top of each other, their holes line up, forming the spinal canal. This canal provides protection and space for the spinal cord and nerves to travel from the brain to the rest of the body. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. There are also small holes on each side of the spine known as intervertebral foramen. These are located between adjacent vertebrae and allow nerves to exit the spinal canal.
Over time, wear and tear to the discs, joints and bones can occur resulting in degenerative changes to the spine. These degenerative changes may include decreased disc height, loss of joint cartilage, bony spurring (osteophytes) and thickening of bone. This condition is known as spinal degeneration. As this condition progress the spinal canal and intervertebral foramen can begin to narrow and may eventually place pressure on the spinal cord and nerves resulting in a variety of symptoms.

Signs and symptoms of spinal degeneration
Spinal degeneration is usually seen in older patients. Minor cases of degeneration may cause little or no symptoms. As the condition progresses patients may experience low back pain and stiffness. In more severe cases involving spinal cord or nerve compression, pain, pins and needles, weakness or numbness may be experienced in the lower back, legs or feet.
Patients with this condition generally experience an increase in symptoms during activities that repetitively or continuously straighten or extend the spine. Symptoms may also increase during activities that place weight on the spine (eg. lifting, prolonged standing, walking etc). Symptoms tend to ease during activities that bend the spine (e.g. sitting) or take weight off it (e.g. lying).

Diagnosis of spinal degeneration
A thorough assessment from a physician combined with appropriate investigations is usually required to diagnose spinal degeneration. An X-ray of the spine will typically demonstrate changes associated with degeneration. Other investigations such as CT scan, bone scan or MRI may also be indicated to assess the severity and to determine the exact structures that are affected.

Treatment for spinal degeneration
Patients with this condition are generally managed well with an appropriate physical therapy program. While little can be done to reverse the changes to the spine, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. This can be achieved by having regular breaks from levels of activity that increase symptoms (e.g. excessive walking, standing, lifting) with positions of comfort (e.g. sitting or lying). Activities should be balanced ideally to prevent any increase in symptoms. A gradual increase in activity and exercise can occur as guided by the treating physical therapist provided symptoms do not increase.
Alternative exercises placing minimal force through the spine should be performed to maintain fitness provided they do not increase symptoms. Better activities include cycling on a stationary bike and hydrotherapy exercises designed by a physical therapist. Patients should also perform flexibility, strengthening and core stability exercises to ensure an optimal outcome. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Physical therapy for spinal degeneration
Physical therapy treatment for patients with spinal degeneration is important to assist with pain relief, improve flexibility and strength, and to ensure an optimal outcome. This may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • mobilization
  • traction
  • dry needling
  • ice or heat treatment
  • education
  • activity modification advice
  • prescription of walking aids
  • clinical Pilates
  • hydrotherapy
  • exercises to improve flexibility, strength and core stability

Other intervention for spinal degeneration
Despite appropriate physical therapy management, some patients with spinal degeneration continue to deteriorate. When this occurs, other intervention may be required. This may include pharmaceutical intervention, corticosteroid injection, the use of supplements such as glucosamine and chondroitin, investigations such as an X-ray, CT scan, bone scan or MRI, or assessment from a specialist. The treating physical therapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically. In more severe cases of spinal degeneration involving spinal canal stenosis or nerve compression, surgery may be required to relieve the pressure on the spinal cord or nerves.