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I Have Arthritis in My Spine — Is That Actually What’s Causing My Pain?

Elite Family Chiropractic Blog I Have Arthritis in My Spine — Is That Actually What’s Causing My Pain?
I Have Arthritis in My Spine — Is That Actually What’s Causing My Pain | Elite Family Chiropractic

I Have Arthritis in My Spine — Is That Actually What’s Causing My Pain?

 

“You have arthritis in your spine.”

It is one of the most common things patients hear after having an X-ray, CT scan, or MRI for neck or back pain. And understandably, many people immediately assume:

“Well, that explains why I hurt.”

But it may not. One of the most important things I explain to patients is that arthritis does not automatically equal pain.

Spinal arthritis can absolutely be painful. But degenerative changes are also extremely common in people who have no neck pain or back pain at all. The more important question is:

Is the arthritis actually causing your symptoms, or is it simply something we can see on the image?

That distinction can completely change how we approach treatment.

 

What Does “Arthritis in the Spine” Actually Mean?

When someone says you have arthritis in your spine, they are usually referring to degenerative changes involving the small joints in the back of the spine called the facet joints.

You may see terms such as:

These changes tend to become more common as we age.

But seeing arthritis on an image and proving that the arthritic joint is actually generating someone's pain are two very different things.

 

Arthritis Doesn't Always Cause Pain

This is where imaging can sometimes create confusion.

A study looking specifically at people without neck or back pain found cervical facet arthritis in approximately 33% of asymptomatic individuals and lumbar facet arthritis in approximately 37%.

The same concept has been demonstrated with other degenerative spinal findings.

A major systematic review involving 3,110 people without pain found that disc degeneration, disc bulges and other degenerative findings become increasingly common with age. For example, disc degeneration was present in an estimated 37% of asymptomatic 20-year-olds and 96% of asymptomatic 80-year-olds. The authors concluded that many degenerative imaging findings may represent normal aging and need to be interpreted in the context of the patient's clinical condition.

That does not mean arthritis or degeneration never matters.

It means:

Arthritis tells us what a joint looks like. It does not automatically tell us whether that joint is producing your pain.

 

So Why Does Arthritis Hurt in Some People?

This is where I like to explain the difference between chemical irritation and mechanical irritation.

These aren't necessarily two completely separate types of pain. In many patients, they occur together.

But understanding the difference can help explain why different treatments work for different people.

 

The Chemical Side of Pain

When a spinal joint, disc, or nerve becomes irritated, the body can produce an inflammatory response.

Inflammatory chemicals can sensitize pain-producing nerve endings, meaning it takes less mechanical stress to produce pain.

This concept is particularly well established in intervertebral disc research.

Healthy discs normally contain relatively few pain-sensing nerve fibers. During degeneration and in painful discs, researchers have found increased inflammatory signaling, increased expression of substances such as nerve growth factor (NGF), and increased growth of nociceptive nerve fibers into regions of the disc that normally contain very little innervation.

Researchers have also demonstrated higher concentrations of inflammatory mediators in painful discs and interactions between inflammatory cytokines such as TNF-alpha and IL-1β, NGF, and pain-related signaling.

For patients, we don't need to make that complicated.

The simple concept is:

An irritated tissue can become chemically sensitized.

This helps explain why treatments aimed at reducing inflammation — including anti-inflammatory medication, oral steroids or appropriately selected spinal injections — can sometimes provide significant relief.

They may reduce an important chemical component of the pain.

 

The Mechanical Side of Pain

But then we need to ask another question:

Why did that structure become irritated in the first place — and what keeps irritating it? That is the mechanical side of the equation. The spine is designed to move and distribute load through an interconnected system of:

A change in one part of that system can influence another.

For example, loss of disc height can change how loads are transmitted through the facet joints. Arthritis can change how a joint moves. Foraminal narrowing can reduce the amount of available space around a nerve. Certain positions or repetitive movements may then mechanically irritate an already sensitive structure.

This is why someone's symptoms may be highly dependent on: movement, posture, position, loading, activity or spinal mechanics.

And this is where conservative mechanical treatment, including chiropractic care, may play a role.

 

Where Chiropractic Care Fits

If you are looking for a chiropractor for spinal arthritis, it is important to understand what chiropractic care can — and cannot — do. Chiropractic treatment does not remove arthritis, make an osteophyte disappear, or turn an arthritic joint back into a 20-year-old joint. That isn’t the goal.

It does not make an osteophyte disappear or turn an arthritic joint back into a 20-year-old joint.

That isn't the goal.

The goal is to determine whether there is a mechanical component contributing to the patient's symptoms and, when appropriate, improve how the spine moves and tolerates load.

Depending on the patient's condition, conservative care may include:

Sometimes the chemical component is dominant. Sometimes the mechanical component is dominant. And quite often, both are present.

For example, an injection may successfully decrease inflammation around an irritated structure, while addressing the mechanical environment may help reduce the repetitive irritation that contributed to the problem.

That is why I don't see chiropractic care, physical therapy, medication, injections and spine specialists as competing approaches.

They address different pieces of the same problem.

 

How Do We Know if Your Arthritis Is Actually Causing Your Pain?

This is where a good spine evaluation becomes important. We don't diagnose a pain generator based on one sentence in an X-ray or MRI report. Instead, we try to determine whether several pieces of the puzzle line up.

1. Where is the arthritis?

Is it cervical or lumbar?

Which levels are involved?

Are the changes primarily in the facet joints, discs, neural foramina or somewhere else?

 

2. Does it match where you hurt?

An abnormality at one level doesn't necessarily explain pain occurring somewhere completely different.

 

3. What movements reproduce your symptoms?

Does extension hurt?

Rotation?

Sitting?

Standing?

Walking?

Bending?

Mechanical behavior can provide valuable information about which structures may be involved.

 

4. Are nerves involved?

Pain extending into an arm or leg, numbness, tingling, weakness or changes in reflexes may suggest something more than isolated arthritis.

 

5. What else is on the imaging?

A patient may have arthritis but also have:

The most obvious finding isn't necessarily the most important one.

 

6. Does everything correlate?

Ultimately, imaging should support the clinical picture — not replace it.

The spine contains many structures capable of generating pain, including the discs, joints, nerves, muscles and ligaments. Research into discogenic pain demonstrates this same fundamental principle: structural abnormalities become clinically meaningful when pain-sensitive tissue is actually being mechanically or chemically irritated.

 

Your X-Ray Is Part of the Story — Not the Entire Story

If you've been told that your neck pain or back pain is simply because you have arthritis, don't panic. And don't ignore the finding either. Put it into context. Arthritis may be an important part of your problem.

It may be contributing to altered mechanics.

It may be associated with inflammation.

It may be narrowing the space around a nerve.

Or it may simply be an age-related finding that has very little to do with why you currently hurt.

The goal of a thorough spine evaluation is to figure out which findings actually matter.

At Elite Family Chiropractic in Charleston, SC, our approach is not simply to look at an X-ray and treat every abnormality we see. We combine your history, examination, neurological findings, biomechanics and imaging to better understand what may actually be generating your symptoms.

Sometimes that means chiropractic care. Sometimes it means combining conservative care with another provider. And sometimes the appropriate answer is a referral to pain management, orthopedics or neurosurgery.

The goal isn't to treat your arthritis. The goal is to understand why you hurt — and determine the most appropriate way to help you.

 

Author
Elite Family Chiropractic - Chiropractor Charleston, SC Brad Gorski DC, FSBT At Elite Family Chiropractic in Charleston, South Carolina, Dr. Brad Gorski is a top-ranked chiropractor offering effective treatment options for back pain, knee pain, neck and shoulder pain, sciatica, migraines, pinched nerves, herniated discs, and more. Dr. Gorski received his Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, Iowa in 2008. He has completed extensive post-graduate training, becoming qualified in Hospital Based Spine Care, MRI Interpretation Review, and Trauma while also completing a Fellowship in Spinal Biomechanics and Trauma. He provides chiropractic care and helps his patients achieve their goal of optimum health and wellness.

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