Understanding Spinal Arthritis: Latest Evidence on Pathology and Treatment
osteopath Ginger Short giving hands on relief for neck pain
Arthritis of the spine, or spinal arthritis, is a common condition that can lead to back and neck pain, stiffness, and discomfort, especially as we age. It refers to inflammation in the joints of the spine, which can cause a range of symptoms that affect day-to-day life. While the term “arthritis” is often associated with wear and tear, there are different types that affect the spine, each with its own causes and treatments. This post explores the different types of spinal arthritis, the latest understanding of the pathology, and the best conservative (non-surgical) treatment options—focusing the most common cause of arthritis that we see, osteoarthritis (OA).
Types of Spinal Arthritis
There are several types of arthritis that can affect the spine, each with different underlying causes and treatments.
Osteoarthritis (OA): This is the most common type of arthritis and results from the degeneration of cartilage between the joints over time. In the spine, it typically affects the facet joints (the joints in between each vertebrae), causing pain, stiffness, and decreased mobility.
Rheumatoid Arthritis (RA): This is an autoimmune condition where the body’s immune system attacks the joints, including those in the spine. RA often affects the upper part of the spine (cervical spine) and can lead to significant inflammation and pain. RA will generally present with other symptoms and areas of the body affected as well as the spine and diagnosis often involved blood tests.
Ankylosing Spondylitis (AS): This is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints (where the spine meets the pelvis). Over time, AS can lead to the fusion of spinal vertebrae, reducing flexibility and mobility.
Psoriatic Arthritis: Linked with the skin condition psoriasis, psoriatic arthritis can also affect the spine, leading to joint pain, swelling, and stiffness.
Pathology of Spinal Osteoarthritis (OA)
In osteoarthritis of the spine, the protective cartilage between the facet joints wears down over time. This breakdown can lead to pain, stiffness, and the formation of bone spurs (osteophytes), which can sometimes narrow the amount of space that our nerves have. Spinal OA usually progresses slowly, with symptoms becoming more pronounced as the cartilage continues to deteriorate.
Current research shows that OA isn’t just about "wear and tear"—there’s also an inflammatory component, even in what we think of as “non-inflammatory” arthritis like OA. Low-grade inflammation within the joint can contribute to the breakdown of cartilage and the thickening of the joint capsule. This combination of mechanical stress and inflammation is now seen as central to the progression of spinal OA. If pain and stiffness over a long period of time results in decreased movement, then subsequently we see a loss in strength of the surrounding muscles, further impacting on the ability to complete daily activities.
Latest Evidence on Treatment: Conservative Management for OA
Conservative management focuses on non-surgical interventions that aim to manage symptoms, improve function, and slow the progression of osteoarthritis. Here’s what the latest evidence says about the best ways to manage spinal OA conservatively:
1. Exercise Therapy
Exercise is one of the most effective treatments for spinal OA, and it’s backed by strong evidence. Regular physical activity can help strengthen the muscles that support the spine, improve flexibility, and reduce stiffness. Types of exercise that are particularly helpful include:
Strengthening exercises: Building up the core muscles (abdominals, back, and hips) provides better support for the spine and reduces pressure on the joints.
Aerobic exercises: Low-impact activities like walking, swimming, or cycling help maintain joint health and improve overall fitness without putting too much strain on the spine. If you feel good doing higher impact exercises then continue this too.
Stretching and flexibility exercises: These help maintain range of motion and reduce stiffness in the spine.
Studies show that a well-rounded exercise program can improve both pain and function in people with spinal OA . Our Exercise Physiologist as well as our osteos and physios are all experienced at exercise prescription. A tailored exercise program and understanding ways to use exercises for pain relief can be a great strategy to self manage your OA.
2. Manual Therapy: physio, osteo & remedial massage
Working with a physio or osteo can be beneficial, as we can design a personalised exercise program and use manual therapy techniques to help reduce pain and improve mobility. We can also guide you on movement postures and ergonomic modifications to reduce stress on the spine during daily activities if these are problematic. Hands on techniques can often be one tool in your toolbox of strategies to decrease pain and stiffness associated with OA, particularly if you are sensitive to the side effects of anti-inflammatory or pain relieving medication.
3. Weight Management
Maintaining a healthy weight is crucial for managing spinal OA. Excess weight increases the load on the spine, which can accelerate the breakdown of cartilage and worsen symptoms. Even a modest weight loss may help reduce pain and improve mobility .
4. Medications
While medications don’t address the underlying cause of OA, they can help manage symptoms. Common options include:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These help reduce inflammation and pain. However, long-term use can come with side effects like stomach issues, so they’re usually recommended for short-term use during flare-ups. There are particular types of medications that your doctor may prescribe for longer term use.
Topical creams: Creams containing NSAIDs or capsaicin can be applied directly to the skin over the painful area and may provide localised relief without the systemic side effects of oral medications.
5. Heat and Cold Therapy
Applying heat or cold packs can help manage the pain and stiffness associated with spinal OA. Heat therapy (like a warm compress) is useful for loosening stiff joints and muscles, while cold therapy (such as ice packs) can reduce inflammation after activities. If you respond well to heat then you may also find warm water in the form of hydrotherapy helpful.
6. Cognitive Behavioural Therapy (CBT)
Living with chronic pain can take a toll on mental health, and the mind-body connection plays a role in how we experience pain. CBT is a type of therapy that helps patients manage the psychological aspects of chronic pain. By changing negative thought patterns and coping strategies, CBT can help reduce the perception of pain and improve quality of life. We think that the way someone explains your joint pain to you is really important. Unhelpful thought patterns can ramp up the brain’s protective mechanisms and reinforce fear and avoidance of movement. You can read more about our approach to chronic pain here
7. Supplements
While the evidence is mixed, some people with spinal OA find relief from supplements like glucosamine and chondroitin, which are thought to support joint health. Fish oil, rich in omega-3 fatty acids, may also help reduce inflammation in some individuals. There is also emerging evidence suggesting that undenatured type II collagen may be helpful in cartilage repair and preservation in early knee OA, resulting in pain relief and improved function. While we wait for more conclusive evidence, our advice is generally to use supplements as one possible strategy within the wide variety of treatment options available for OA.
The Bottom Line
Spinal arthritis, particularly osteoarthritis, can be a source of pain and disability, but with the right management strategies, it’s possible to maintain mobility and reduce symptoms. The latest evidence supports a conservative approach focusing on exercise, physical therapy, weight management, and pain-relieving strategies like medication and manual therapy. If you’d like a tailored exercise program to address your OA, please book in with one of our physios or our Exercise Physiologist. If you would like to trial manual therapy as part of your treatment approach, please choose a physio or osteo. You can book online here
References:
Glyn-Jones, S., Palmer, A. J. R., Agricola, R., Price, A. J., Vincent, T. L., Weinans, H., & Carr, A. J. (2015). Osteoarthritis. The Lancet, 386(9991), 376-387.
Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet, 393(10182), 1745-1759.
Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., ... & Tugwell, P. (2008). OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 16(2), 137-162.
Kumar P, Bansal P, Rajnish RK, Sharma S, Dhillon MS, Patel S, Kumar V. Efficacy of undenatured collagen in knee osteoarthritis: review of the literature with limited meta-analysis. Am J Transl Res. 2023 Sep 15;15(9):5545-5555. PMID: 37854210; PMCID: PMC10579002.