Spinal Dysfunction

Spiney_Grey Close-UpSpinal Degeneration and Spinal Joint Dysfunction (click here to print out a pdf)Dr. William Kirkaldy-Willis, orthopedic surgeon, medical school professor, and author of the textbook, “Managing Low Back Pain,” divided the degenerative arthritic process into three phases:  Dysfunction, Instability, and Stabilization.  In the first phase–Dysfunction–the micro-traumatic, repetitive stresses and strains of life (gravity, lifting, bending, twisting, and psychological/emotional stresses) can accumulate and eventually alter the mechanics of spinal joints and cause them to malfunction–hence the term spinal joint dysfunction.  Major traumas such as car accidents or fall injuries are causative agents as well.  Dysfunction causes abnormal “wear and tear” in the posterior facet joints and the discs which can lead to microscopic tearing of muscles and ligaments.  The body responds with spasm, swelling, and eventually, scarring (the 3 S’s) as it attempts to heal.

SPINAL JOINT FIXATION:  The spasm, swelling, and scar tissue have a restrictive effect on the joints of the spine and the joints can become hypomobile—less moveable, restricted, kinked or stuck.  We call this locked-up joint a fixation.  The lack of motion in the joint is very unhealthy for the cartilage lining the joints.  Cartilage cells have no blood supply and thus, they rely on the motion of joints and the movement of synovial fluid within the joint to bring nutrients into the cells and to carry waste products away.  If these fluid dynamics are altered because of a loss of joint motion, the result is a decrease in nutrients and a build-up of waste and ultimately, the cartilage cells start to die.  This eventually leads to the more advanced and irreversible arthritic changes in the joint that are visible on x-ray.

In the dysfunction phase, the fixation is not a visible lesion that can be seen on x-ray or MRI.  Rather, it is something that is felt.  Chiropractors have been taught the art of palpation—using their hands to detect these subtle areas of restriction.

SPINAL MANIPULATION or SPINAL MANIPULATIVE THERAPY (SMT):  One of the best treatments for joint fixation is spinal manipulation, usually performed by chiropractors.  The manipulation is a gentle thrust into the area of fixation—a brief, sudden, and carefully administered “impulsion” that is given at the end of the normal passive range of motion.  The thrust has a very specific amplitude and line of drive that maximizes patient comfort and safety.  A classic example of a dysfunctional, fixed joint and one that is treated with medical manipulation under anesthesia is the Frozen Shoulder Syndrome.  Evidence-based guidelines published over the last 20 years recommend that spinal manipulative therapy be started within 1 month of the onset of symptoms.

EFFECTS of SPINAL MANIPULATION:  Manipulation of the joint helps to break up scar tissue and muscle spasm, restoring joint motion.  The pumping action can help decrease inflammation and inhibit the formation of more scar tissue.  The motion from manipulation also enhances the synovial fluid dynamics—increasing the influx of nutrients into the cartilage cells and helping with the elimination of waste products.  As a result, cartilage cell death may be inhibited and the progression of arthritis may be decreased.  Spinal manipulation is one treatment that can effect all 3 S’s—the spasm, swelling and scar tissue—that make up the pathological changes found in the dysfunctional phase of arthritis.

The most common condition that I treat is the Sacroiliac Joint Dysfunction/Piriformis Muscle Syndrome.  The SI/Piriformis Syndrome is very common in pregnant women.

Another very common area that I treat is neck pain, upper back pain, and headaches.

Disc Herniation and Summary of Spinal Degeneration

The most common areas for degeneration/dysfunction/fixation to occur (spinal and extra-spinal).

Kirkaldy-Willis, WH, Bernard, TN, “Managing Low Back Pain,” 4th edition.  Churchill Livingston, 1999.