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Be conservative in treating arthritis in the spinal column

The problem is there is tremendous variability in physical therapy treatment approaches in the industry


Dear Colin: My neck has bothered me for about three years and my doctor and I aren’t sure why. X-rays and a MRI show “multilevel moderate arthritis” but nothing else. I’m only 54 and want to garden, play golf and tennis, but my doctor says I shouldn’t. Can physical therapy help, and if so, how? — Joan, Portland

by: SUBMITTED PHOTO - Proper technique -- When performing the seated row, start with a strong posture with head up slightly and belly drawn in (to protect lower back). End by pulling the handle back while focusing on your upper middle back muscles, not arms.

Without knowing anything else about you, research supports certain types of physical therapy for spinal arthritis (i.e., degenerative disk disease or DDD). The problem is that there’s tremendous variability in physical therapy treatment approaches depending on where you go. My advice stems from research, clinical biomechanics and patient outcomes I’ve seen over the past 12 years.

Degenerative disk disease is a condition where the fibrous discs between your vertebrae become thinner, decreasing the space between the bones. Research suggests that the risk of getting DDD increases with age, with 80 percent of people over 65 showing some form of it on X-ray. Common symptoms include pain, weakness and limb numbness/tingling, although X-ray findings don’t always correlate with symptoms, so it’s possible to have X-rays that show DDD but have no symptoms (the opposite is also possible). This likely means that other factors (e.g., muscle weakness, tightness, poor posture, obesity) can contribute to pain.

The ideal treatment for DDD is hotly debated, and there isn’t one that’s accepted as the “gold standard.” However, the consensus is that a sincere attempt at conservative therapy for three to six months should be tried before considering surgery. Key components include:

Strengthening. When carefully prescribed and 100 percent monitored by a qualified physical therapist, strengthening exercises can be effective at reducing pain and improving function in folks with DDD. For example, the seated row strengthens the entire back, which may enhance normal spinal mechanics in the neck and middle back.

Stretching. Stretching (especially the chest muscles) may reduce spinal forces and pain in people with DDD by improving posture.

Endurance exercise. For reasons still not understood, endurance exercise (e.g., walking, elliptical) can reduce pain associated with DDD.

Symptom management. Mechanical traction, manual therapy, heat/ice and physician-prescribed medication are examples of pain reduction techniques used as needed in conjunction with active therapy.

Should conservative therapy fail, surgical options may include fusion or artificial disc replacement. A fusion procedure removes damaged disc material and replaces it with bony material, followed by attachment of a metal plate for stability. A main problem with fusion is loss of spinal motion at the fused segments, subsequently leading to DDD in adjacent vertebrae. This brings us to a key benefit of the replacement option, which inserts an artificial disc in place of the collapsed disc, helping preserve spinal motion and reducing DDD risk.

Dr. Jordi Kellogg, a Portland-based neurosurgeon specializing in artificial disc replacement, says, “While the artificial disc procedure is relatively new, outcome studies suggest it is a viable alternative to fusion while dramatically improving pain and function, even in patients with severe DDD. Regardless, I always encourage patients to manage DDD conservatively before and after surgery for best results.”

And it’s important to note that trying conservative therapy applies regardless of age and health status. Spine mechanics can always improve, which may reduce pain and improve function. Just add a positive attitude and sincere desire to improve. Colin Hoobler

Colin Hoobler is a licensed physical therapist, hosts a live health segment on KGW Channel 8 and has written two books on exercise as treatment for disease and injury




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