Osteoarthritis (OA) of the spine is a condition that usually occurs with aging and is typically diagnosed after age 50. Its causes include injury to the spine, wear and tear on the discs of the spine (often associated with obesity), or an inherited tendency to develop OA. Sometimes the cause is unknown. OA of the spine may cause pain and stiffness; and make it difficult to bend over, perform weight-bearing activities such as walking, and accomplish daily tasks such as dressing and bathing. Your physical therapist will help you manage your condition, lessen your discomfort, and get moving again.
What is Osteoarthritis of the Spine?
As we age, the discs in our spine can wear, begin to bulge, and become narrowed. These changes can put strain on the cartilage, ligaments, and joints at the involved level of the spine and may cause pain. The narrowing of the disc also results in narrowing of the space between the spinal joints, called the “facet” joints. Weight-bearing forces on the joints increase because of these disc changes. As a result, the cartilage covering the joint surface can begin to fray and wear away over time. If your cartilage wears down so that your bones begin to rub together, it can result in enlarged joints, inflammation, stiffness, and pain.
As OA of the spine progresses, your body will try to repair it by growing new bone. This bony growth is called a “bone spur.” Spur development can result in a condition known as spinal stenosis. Most often this disorder affects men and women over 50 years of age. If the spurs enlarge, they can create a narrowing of the spaces in the spine. The narrowing can involve small or large areas and can result in pressure on nerves near the involved joints, resulting in symptoms that may include pain, tingling, numbness, or burning.
How Does it Feel?
Symptoms of OA of the spine vary from person to person and can range from mild to disabling. You may not have symptoms even though the condition is present. Its onset and progression can be quite slow.
With early or mild disease, symptoms will be intermittent, or come and go. You might feel stiffness or aching after sitting a long time, on waking in the morning, or after vigorous activity. You or your family may notice changes in your posture. Some people will bend forward or shift to the side. With more advanced OA of the spine, symptoms will become more constant and tend to interfere more with your daily activity, especially with walking and standing.
Common symptoms of OA of the spine include:
- Pain in the back or neck
- Pain that is worse after prolonged inactivity, on getting up in the morning, or after physical activity
- Pain that worsens with standing and walking, and gets better with sitting or lying down
- Stiffness after prolonged inactivity, on getting up in the morning, or with movement of the involved area of the spine
- With a more advanced condition, symptoms that do not improve with rest and that interfere with sleep
- Pain, burning, or tingling sensations that spread to the shoulder or arm, or to the buttocks or leg
- Difficulty performing normal daily activities, such as dressing and bathing, as well as walking and standing as the condition progresses
- Pain caused by the weakening of muscles surrounding the joint, due to inactivity
How Is It Diagnosed?
Your physical therapist will perform a thorough evaluation and may:
- Ask specific questions about your past and current health and use of medication
- Have you complete a questionnaire about how you are functioning in your daily life
- Ask how your symptoms came about, how long you have had them, where they are located, how and when the pain occurs, and other questions, to form a clear picture of your individual situation
Your physical therapist will then conduct a physical examination and may:
- Evaluate your posture and spinal alignment, and measure the range of motion and flexibility of your spine and the extremities (arms or legs) in the involved area
- Check your nerve function with reflex, sensation, and strength testing
- Observe how you use your body for home, work, and social/leisure activities
- Check your balance to determine your risk of falling
The information learned in your evaluation will help your physical therapist prescribe a program to ease your discomfort, boost your quality of life, and get you moving your best.
Imaging tests such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) may be requested but are not necessary in every case. However, if your physical therapist suspects that your pain might be caused by an underlying condition, he or she may request testing from your physician and/or refer you to your physician for further evaluation. Your physical therapist will work with your physician to provide the best diagnosis and treatment.
How Can a Physical Therapist Help?
Your physical therapist will help you set goals to reduce your symptoms and slow the progression of the disease. You’ll learn how to safely exercise and continue to participate in your normal daily activities.
Your physical therapist can help with a variety of treatment options, including:
- Exercise: Exercise is the most important treatment to lessen your pain and improve your mobility. Your physical therapist will prescribe specific low-impact activities that will strengthen your spine, abdomen, and hip muscles—to improve your ability to stand, walk, and balance, and lower your risk of falling.
Caution: Please consult your physical therapist or doctor before starting any exercise program.
- Stretching: Your physical therapist will prescribe specific stretching exercises for your spine, arms, or legs based on the results of your initial evaluation. Obese individuals are in special need of stretching and exercises. Combined with strengthening, stretching may help slow the progression of the disease.
- Symptom management: Symptom management means learning to feel better and remain active. Sometimes people are fearful that increased activity will worsen their symptoms or increase their pain. Your physical therapist will help you learn how to be more active without worsening your symptoms. He or she will help you find your appropriate activity levels, and develop a unique program to keep you moving.
- Daily activity training: Your physical therapist can teach you how to get in and out of bed, in and out of the bathtub, or out of a chair, and how to bend and walk with more ease.
- Use of modalities: Treatment “modalities” such as heat or ice may be used to help manage your symptoms.
- Manual therapy: Your physical therapist may use gentle hands-on techniques (manual therapy) to help improve your spinal flexibility and ease stiffness.
- Balance and walking training: Exercises and instruction may be used to improve your balance safely, and reduce your risk of falls.
- Specialized braces or taping: Your physical therapist may use taping or specialized braces to help support your joints. Back bracing is used most in more advanced conditions.
- Weight control: If you are obese, you are likely to have more spinal impairment in your upper back. Your physical therapist can help you improve your activity levels, and refer you to nutritional experts.
Remember, all cases of OA of the spine are different. Your physical therapist will choose the best treatment options for you based on his or her evaluation of your specific problem.
The predominant treatment for OA of the spine is non-surgical. However, symptoms that interfere with bowel or bladder function and cause problems with the nervous system may require surgery.
Immediately after surgery, a physical therapist will visit you in the hospital to help you get out of bed and walk, and possibly use a cane or walker for safety. When adequate healing has occurred, you may be sent for outpatient physical therapy to continue to improve your walking, and to progress your exercise program.
Can this Injury or Condition be Prevented?
OA occurs as you age, but is not a direct result of getting older. There are many factors that put you at risk of developing OA, including your family history. Other factors include previous injury, heavy use of your spine over a period of time, and obesity.
If you are obese, you have a higher likelihood of having OA in the spine. Weight loss is important to lower joint stress, and possibly prevent the onset of OA. If you already have OA, weight loss may prevent worsening of the condition. Exercise and increasing your physical function along with dietary modifications can also decrease your pain.
Prevention of injuries, especially sports injuries, may prevent the onset of OA. It is important to perform your physical activities or exercises to the point of fatigue, but not to force yourself beyond that point. Regular conditioning and strengthening exercises will improve the ability of your muscles to work, easing the stress on your joints.
Real Life Experiences
Mary is a 50-year-old office worker. She has recently noticed that when she gets up from her chair at coffee-break time, her back feels stiff, and she is slow to get up and move. She feels a little aching in her back, but it gets better after she walks a bit. More and more she notices aching in her back at the end of her workday. She discusses this with her friend Sue, and wonders if it is happening because she has gained a little weight. The next day, Mary notices pain and stiffness when she gets up in the morning. Sue suggests she see a physical therapist.
On her first visit, Mary’s physical therapist reviews her medical history and asks her questions about her symptoms. She then observes Mary’s posture and tests her physical strength; flexibility; the range of motion of her back, arms, and legs; and her spinal joint mobility. Walking tests show Mary is taking shorter steps and can’t walk as fast as others in her age group, and balance testing shows a mild loss of balance as she walks.
Mary’s physical therapist notes that the pain and stiffness she is experiencing is consistent with OA of the spine. She prescribes treatment to improve Mary’s flexibility and strength, to better support her spinal and hip joints, and improve her posture. She also prescribes balance and walking exercises to improve Mary’s walking patterns. Over several visits, Mary receives treatment that includes manual therapy, stretching, and strengthening exercises for her hip and trunk muscles, and walking balance exercises. Her physical therapist also encourages her to walk an average of 2.5 hours a week. Mary performs her exercises every day at home.
She also learns how to arrange her office and home environments to reduce stress and strain on her spine. She changes her chair at work, and has arranged her desk and computer so she is not leaning forward as much.
On her last visit, Mary’s physical therapist measures an improvement in her posture, back range of motion, and hip and trunk strength. Her walking pattern and speed, and balance, are now within normal limits. Much of the time, Mary feels no symptoms. She intends to continue her exercise program to stay in shape, and to help prevent any worsening of her OA of the spine.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and clinical experience to treat OA of the spine. However, you may want to consider:
- A physical therapist who has treated people with OA of the spine. Some physical therapists have a practice with an orthopedic or geriatric focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or geriatric physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists that have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you’re looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with OA of the spine.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.
The following articles provide some of the best scientific evidence related to physical therapy treatment of hip osteoarthritis and hip replacement. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Vismara L, Menegoni F, Zaina F, et al. Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. J Neuroeng Rehabil. 2010;7:3. Free Article.
Kalichman L, Li L, Kim DH, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila, Pa 1976). 2008;33:2560-2565. Free Article.
US Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: US Dept of Health and Human Services, Office of the Surgeon General; 2001.
National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Spinal stenosis.
Arthritis Foundation. Disease center.
Arthritis Foundation. ArthritisToday.
US Department of Health and Human Services. Physical activity guidelines for Americans.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Acknowledgements: Mary Kay Zane, PT, OCS