Regenerative

As a chiropractor, I commonly see people with complaints of neck and back pain. Usually I’ll take a set of x-rays to assess what their spine looks like, and sadly, I often have to tell them that they have some degree of spinal degeneration. Spinal degeneration presents as thinning of the cartilaginous disc between the vertebrae (called “degenerative disc disease”) as well as the formation of osteophytes, or bone spurs, along the edges of the bones. This process can occur at any joint, but is particularly troublesome in the spine, due to all of the neurological structures it can interfere with. While we don’t want degeneration anywhere in our bodies, joints like hips, knees, and shoulders can be replaced, if necessary. However, we only get one spine, and so we must take extra care of it throughout our lives.

The spine consists of 24 vertebral bones (plus the sacrum and coccyx) connected by 48 separate “facet” joints. These are the joints where Degenerative Joint Disease is most commonly found. In general “Degenerative Joint Disease,” or DJD, is a gradual process that involves the wearing down of structures that make up a joint. This can happen anywhere in the skeletal system that has suffered a trauma or undergone too much “wear and tear.” This is why it will be frequently be found on one side of the body. For instance, if someone tends to put more weight on their right leg, the right hip and knee will likely degenerate faster. This is unlike an inflammatory joint disease, like Rheumatoid Arthritis (RA), that will occur on both sides of the body to multiple joints.

While conditions like RA tend to be genetically inherited, structural degeneration can happen to anyone, which is why it’s the leading cause of joint pain in adults. Since DJD tends to get worse as people age, it is generally thought that this is just a normal aging process. However, after learning about joint structure and function through school, research and clinical experiences, I believe that aging is more correlated than causative, and that to an extent, degeneration is common, but not normal.

When told “getting old” is to blame, people are disempowered. After all, we can’t do anything about aging.

As a practitioner who mainly works with joints, hearing that they get unhealthy because of aging is like telling a dentist that people get cavities due to old age. Of course there are some genetic conditions that cause people to have weaker joint structure. Certain things truly are out of our control, such as the fact that the more years we live, the more likely our joints will be subjected to stressors and wear. Yet there are some things we can do to keep our joints healthier. Here are 5 things you can do to defy aging and keep your joints young!

• Move more often

This may seem like an obvious thing to do.  After all, staying active is a vital part of most health advice.  Yet if we specifically consider the structure and physiology of joints, we can better appreciate how important movement is.

Joints are where bones connect and allow our skeletal structure to move.  In the body, there are 3 types of joints, fibrous (non-moveable), cartilaginous (slightly moveable) and synovial (freely moveable).  The spine is composed of vertebral bones connected by discs (cartilaginous joints) and facets (synovial joints).  The synovial “facet” joints are what allow our spines to bend and twist, while the cartilaginous discs provide stability and cushioning from impact and gravity.  Each spinal facet joint is encased by a fibrous capsule lined with a membrane called, “synovium,” that produces “synovial fluid.”  This fluid lubricates the joint and reduces friction between the articular cartilage, which lines the bone.  It also supplies oxygen, nutrients and removes carbon dioxide and metabolic waste.  Just like the oil in a car engine, this fluid needs to be routinely replenished. To ensure this, within the articular cartilage there is a reserve of synovial fluid that gets mechanically squeezed out during movement. T

his is why it is so important to move!  Moving joints in their full range of motion is the most effective way to get fresh synovial fluid.

To use a quote I heard in a yoga class, “Movement is life, and motion is like lotion.”  Speaking of yoga, I often recommend to patients that they begin a yoga practice.  Certainly any consistent stretching routine will be of great benefit, but in my experience, yoga is one of the most effective ways to move and stretch the entire body.  It also helps improve one’s body awareness, so imbalances can be found.  Like I tell my patients, yoga and stretching are like brushing and flossing, and I’m like the dentist.  If they don’t want to see me as often, get brushing!

• See a musculoskeletal specialist, such as a chiropractor, physical therapist or orthopedist, to assess your spinal joint movement.

With an understanding of joint structure and movement, we now have to consider the fact that some of our joints may become restricted or stuck over time.  These restrictions can be due to trauma, such as a car accident or sporting injury, or to consistent, little microtraumas, like sleeping in an odd position every night or constantly looking down at smart phone devices.  Even emotional and chemical stressors can contribute to loss of mobility by increasing tension in the body.  While these joint restrictions may be quite small, they can lead to very big problems over time.

In a 2004 study from the Journal of Manipulative and Physiological Therapeutics, researchers studied “Degenerative Changes Following Spinal Fixation in a Small Animal Model.”  While I am not a fan of animal testing, the study did reveal significant findings.  In a sample size of 87 (23 control animals and 64 fixation animals), they compared changes found in vertebral segments that were fixed (hypomobile) with changes in adjacent nonfixed vertebral segments.  They found that fixed segments had more degenerative changes than freely moveable segments, and that osteophyte (bone spur) formation and articular surface degeneration was directly dependent on the duration of fixation.  This means that the longer the joint restriction is there, the more it will degenerate.  This is called Immobilization Degeneration.

A problem with spinal joint restrictions is that they are subtle and likely won’t be perceived as pain or discomfort until they have been there for a while.   This means that the joint can be restricted for months or years before a symptom presents and the person seeks help.  That is usually the point at which someone will first visit a chiropractor or other specialist.  In my office, when someone presents in pain, we will usually take a set of x-rays, and 9 times out of 10, I see signs of spinal degeneration.  Since the spinal cord and nerves run through and exit the spine, these degenerative changes can irritate nerves and lead to numbness, tingling, pain, weakness and decrease in overall body function.

Thus, my point is, don’t wait until there’s pain before getting your spinal joints assessed.  Would you wait until your teeth hurt before ever going to a dentist? In our modern world, we move much less often than our ancestors did and are subjected to many more physical, chemical and emotional stressors.  In that context, it is wise to get regular spinal check-ups to ensure that every joint is moving well.  When a chiropractor finds a restricted joint (in the spine or extremities) he or she performs an “adjustment.”  This is a specific force that moves the joint beyond the restriction.  An adjustment from a skilled chiropractor does not hurt and provides significant tension relief.  There are many methods to perform this, whether by hand or instrumentation, but the important thing is that the joint is getting more movement and synovial fluid.

What about the cracking? How can that be good?

I find that many people are concerned about the cracking sound that occurs during this process.  I always ensure patients that no bones are actually cracking and that the sound, called cavitation, occurs due to the synovial fluid in the joint.  Similar to when knuckles are “popped,” when the 2 joint surfaces (facets) are separated from each other, the volume within the joint capsule increases, creating a negative pressure.  Since there is not enough synovial fluid to fill the increased volume, the gases that are dissolved in the fluid (mainly carbon dioxide) are released into the space. As this gas is released from the solution, the collapse of the vapor cavities gives rise to the noise.  Far from harmful, the “cracking” sound is simply an indication that the joint is moving better.

• Eat for joint health – anti-inflammatory and nutrient dense

What we eat (and drink) has a direct impact on the health of our joints.  Research has demonstrated that a poor diet increases inflammation and the activity of enzymes that destroy collagen and other proteins needed for maintaining healthy tissue.  Collagen is a fibrous protein that serves as a building block for connective tissue like skin, tendons, bone and cartilage.  Joints are composed of bone and cartilage, so it’s essential that we consume the raw materials needed to keep those tissues healthy and avoid what breaks them down.  This means we need to eat nutrient-dense, anti-inflammatory foods.

Nutrients to focus on for bone health include calcium, vitamin D & K, magnesium and potassium, while collagen-boosting foods contain manganese, omega-3 fats, Vitamin A & C, and sulfur.  What does this look like in real life?  Without making yourself too crazy analyzing every nutrient your food might contain, you should cover your bases as long as you eat a plant-based diet (ideally local, organic) that includes well-sourced proteins and fats.  Some may call this an “ancestral” or “paleo” diet.  For those who want more detailed direction, you can refer to the following list for food ideas.

• Dark, leafy green vegetables: kale, swiss chard, collard greens, etc
• Brightly colored and cruciferous vegetables: sweet potatoes, peppers, broccoli, cabbage, brussel sprouts, etc
• Whole fruit (not juice): berries, oranges, apples, guava, black currents, etc
• Herbs, spices & teas – turmeric, ginger, oregano, green tea
• Wild-caught fish, grass-fed/pasture-raised meat and cage-free eggs
• Healthy fats – avocado, tree nuts, seeds, coconut oil, extra virgin olive oil
• “Sprouted” Legumes/Beans & Ancient grains
• Bone broth: has recently gained popularity as an abundant source of collagen and many other mineralsWhile focusing on consuming these nutrient-dense foods, try to avoid the following inflammatory foods:
  • Refined carbohydrates and processed grain products – white bread, pasta, cereals, pastries, packaged snacks, etc
  • Fried foods (anything with partially hydrogenated oil/trans fats)
  • Soda, fruit juices, sports drinks and other high-sugar beverages
  • Red meat (non-grass fed) and processed meats (hot dogs, sausages)
  • Pasteurized dairy products – margarine, shortening & lard

  

• Maintain a Healthy Weight

While easier said than done, carrying excess weight will put additional stress and wear on weight-bearing joints, like knees and hips.  It can also contribute to imbalances in the spinal curves, such as an increased lumbar lordosis.  Reaching and maintaining a healthy weight is an ongoing process that should be focused on eating healthy (as discussed above) and enjoyable movement, rather than deprivation and tortuous workouts.  Adequate water intake (1/2 your body weight in ounces) with enough sleep (7-8 hours) are also vital factors to address.

• Assess your lifestyle and body habits and remove “asymmetrical” behaviors

Lastly, it is important that you adjust any ongoing behaviors that may be causing extra stress to your joints.   Such things I commonly encounter with people are: sitting with their wallet in a back pocket, sitting cross-legged, sitting too much in general, carrying a heavy bag on one shoulder, carrying a child one hip, looking down frequently at a phone or computer and sleeping on your stomach.  While it may not be possible to correct every aspect of your life, simple changes like optimizing your workstation and sleep habits can significantly improve your structural balance.

References

Edwards, Jo, ed. (2000). “Normal Joint Structure”. Notes on Rheumatology. University College London. Archived from the original on 19 November 2012. Retrieved 5 April 2013.

McCracken, Thomas, ed. (2000). New Atlas of Human Anatomy. China: MetroBooks. ISBN 9781586630973. OCLC 850877694.

Watson P, Kernoham WG, Mollan RAB. A study of the cracking sounds from the metacarpophalangeal joint. Proceedings of the Institute of Mechanical Engineering [H] 1989;203:109-118.

Degenerative Changes Following Spinal Fixation in a Small Animal Model
J Manipulative Physiol T her 2004 (Mar);   27 (3):   141–154

https://draxe.com/degenerative-joint-disease/

Dr. Mackenzie is the creator of TheWellAdjustedLife.com – a holistic site that empowers people to take command of their health and be inspired by how the body heals and is designed to be healthy.

When practiced correctly, yoga appears to be effective in treating a wide variety of health conditions.  Iyengar yoga is most commonly found in therapy as it strives for precise anatomical alignment and uses various props to assist positioning.  The attention to precise anatomical positioning makes it well-suited to back pain, where dysfunctional alignment may be either contributing to or causing the problem.  In the first randomized trial, evidence that Iyengar yoga can assist in alleviating chronic back pain involved sixty participants who were placed in either a yoga group or an educational group.  Both programs lasted sixteen weeks.  Participants had experienced low back pain for an average of 11.2 years and 48% used pain medication.  At the end of the study and at a three-month follow-up, those in the yoga group had significant reductions in pain intensity, functional disability (including spinal range of motion), and use of pain medication.  These results compare favorably with results obtained with traditional physical therapy.

A growing yoga division is yoga therapy. Yoga therapy can be used as a complement to traditional therapy and medicine. It is a holistic approach working the body, mind, and spirit and is distinct from traditional yoga classes commonly available.  The addition of these elements and increased body awareness distinguish yoga from general stretching and callisthenic activity.  Yoga links back pain to posture, muscle tightness, and muscle weakness, as well as to a lack of body awareness.  Beyond abdominal crunches, and tight hamstrings, many people have tight hip rotators in the pelvis and weak back extensors.  The yogic approach is to determine which muscles need strengthening and which ones need stretching.  Independent of the effect on individual muscles, asana (poses) movements help back pain by improving the circulation that brings nutrients to the intervertebral disks while removing toxins.  The disks that cushion vertebrae and act as gelatinous shock absorbers do not have their own independent blood supply and depend on movement of the surrounding structures to aid in the delivery of nutrients.  Movement causes the disks to be compressed, which squeezes out stale disk fluid, and then to expand, bringing a fresh supply.  (McCall)  

A review of literature on research addressing yoga and low back pain is land-based, but applicable to the water in many ways.  A 1983-84 study at the London-based Yoga Biomedical Trust, run by Robin Monro, PhD surveyed 2700 people between 31 and 60 who used yoga therapeutically.  They were required to have practiced yoga for at least 2 hours a week for a year or longer.  Of the 1142 participants reporting, 98% of back-pain sufferers found yoga helpful.  (McCall)

The Yoga Journal (May/June 2003) introduced a program launched “Back Builders” by Vijay Vad, MD, a specialist in sports medicine at the Hospital for Special Surgery in NY combining yoga, breath work and Pilates.  He theorized that lower back pain is really a mind-body problem, closely related to stress.  All participants took the medications Celebrex and Vicodin.   After 6 months, Vad found that 80% of those in program experienced markedly decreased pain, compared with 44% on medication only.  Only 12% of the yoga practitioners experienced another acute episode of their injury, compared with 56% of those on medications alone.  Another significant result showed reduction in pain medication use of those doing yoga declined by 40%.  The basic idea behind Back Builders is to build core strength and flexibility and lengthen the spine to create space between the vertebrae, thus minimizing pressure on the disks and allowing them to heal.  The program eliminates potentially harmful poses such as sitting postures and forward bends which can compress the vertebrae of the lower spine.  Program emphasizes asanas that build support for the spine by strengthening the abdominal and back muscles.  Hip-opening poses encourage spinal length as do postures that stretch the hamstrings and claves.  This has direct application to practice in the water because of the properties of water assist the specifics he addressed.  

In the Annals of Internal Medicine (Dec. 2005) Loren Fishman, MD, specialist in back pain with a rehabilitation clinic in NYC and author of Relief Is in the Stretch: End Back Pain Through Yoga published a randomized, controlled clinical trial with low back pain that showed that yoga not only did yoga work, but it worked so well that it surpassed even traditional physical therapy exercises.  

Researcher Karen Sherman at the Group Health Cooperative in Seattle studied 101 adults suffering from chronic low back pain and randomly assigned them into 3 groups.  One group attended weekly yoga classes for 12 weeks, following a therapeutic yoga routine developed specifically for lower back pain. Participants were expected to also practice at home every day.  A second group attended a once a week program of stretching and strengthening exercises developed by a physical therapist with expected daily home practice.  The third group received a self-care book that included some stretches and relaxation exercises.  The yoga participants had less pain and were better able to go about their daily activities than people in either of the comparison groups.  Follow-up at three months showed the yoga practitioners continued to have less pain and better function and needed fewer pain medications.  

Reported in the International Journal of Yoga Therapy (2003), Kimberly Williams at the WVU School of Medicine compared effects of an adapted regimen of Iyengar yoga on patients with chronic low back pain to a group that received a weekly informational newsletter.  Forty-two of 66 subjects completed the study.  The yoga group attended 16 weekly classes.  Compared to control subjects, the yoga group experienced a 64% reduction in pain, a 77 % reduction in “functional disability” and a 25% improvement in perceived control over pain.  They also gained significantly in hip flexibility.  Those taking pain medication at the beginning of the study found 88% of the yoga group either reduced their dose or eliminated medication entirely as compared to 35% in the control group.

Elise Browning Miller has done extensive work with yoga and scoliosis.  Scoliosis is classified as either structural or function.  Structural is more serious than functional and develops as a result of unequal growth of the 2 sides of the vertebral bodies and usually appears during adolescence.   Functional scoliosis is more common and affects the muscular back.  It does not alter the body structurally and can result from poor posture or repeated unbalanced activity such as carrying heavy objects always on one side.  In yoga for scoliosis, the goal is to stretch muscles that have tightened and strengthen muscles that have become weak from asymmetrical imbalance.

Examining yoga poses that are most often included in therapeutic land yoga that transfer to the pool, we find some direct correlations.  Supporting the proposal of aquatic yoga, we recognize that poses have a calming effect on the nervous system and help to alleviate stress.  They can facilitate harmony between the muscular and nervous systems of the body possibly resulting in move fluid movement and relief from muscle tension.  The buoyancy of the water enables many to continue an exercise program in a supportive, positive environment resulting in improved coordination and balance, increases flexibility and strength, and an overall feeling of well-being.

General benefits of aquatic yoga include increased flexibility and balance, increased range of motion in the joints, improved muscle tone, and isometrically work most of the body’s muscle groups. The range of motion in these poses is adjusted to the ability of the patient on the particular day.  Holding the pose not only challenges balance, but requires moderate strength through correct body alignment and awareness, and cognitive attention to the posture’s position to enhance key areas relating to Activities of Daily Living.

Poses moved to the water can begin at the wall for support and moved to chest depth water when lumbar stability is proven.  Some can be incorporated into Pilates exercises.

Cross-over Stretch – On your back on land, or against the pool wall, pull the right knee toward the chest.  Keep both shoulders grounded while using the left hand to assist the right bent leg across the body.  Right arm is extended to the side.

Eye of Needle – Sitting in chair position against pool side, left foot stays on the pool bottom.  Right ankle crosses to top of left knee.  Assist stress by applying pressure on right thigh.  Repeat on the opposite side.  (Hip replacement caution)

Examples of progressive postures include chair and tree – two-legged balance to one-legged balance and multiple movement planes.

Tree – Vrkasana – Begin with knee to the front and open to side.  Arm position progresses as balance improves.  Problems include lack of gluteus contraction, hip juts to side/hip hike and forward or downward looking head position.

Chair – Utkatasana – From the front standing position – feet hip-width apart and pretending to sit in a chair – squat position.  Begin with extending arms forward and progress to extending arms in line with ears.  Maintain a flat back.

Spinal Rotation – Marichyasana – Stand facing the side of the pool.  Cross one leg over the other and rotate from the waist to look behind you toward the side with the leg in front.  Shoulders stay level.  Axial elongation and cervical rotation assists with releasing pressure on spine.  Chin up remains up.

Mary O. Wykle, PhD, is on the Advisory board of Aqualogix Fitness.

An overwhelming number of Americans are awakening each day to upper back pain and neck stiffness, chronic ailments that can be a result of our neoteric lifestyle. Day-to-day life in the 21st century presents new, modernized “first world problems” that our predecessors didn’t suffer from. Two of the new-age culprits that cause chronic upper back and neck pain are the daily strain of carrying heavy backpacks and shoulder bags, as well as the worldwide smartphone epidemic, which can lead to “text neck” or iPosture issues. “Text neck” is the term used to describe the neck pain and damage sustained from looking down at your cell phone, tablet, or other wireless devices too frequently and for too long. Let’s take a biomechanical look at each issue, why it causes damage to your spine, and explore methods we can employ to keep our spines healthy and happy in our modern society.

Backpacks

When carrying a backpack, the weight of the load is carried on the shoulders. However, because the weight settles to the bottom of the bag, it strains the upper back and supportive muscles of the spinal column, causing neck and upper back pain. If this amount of strain and spinal compression continues each day, over time it can lead to long-term nerve damage. The skeletal structure of the spine is very delicate, with nerves passing through vertebrae. Any damage caused to nerves from being compressed by a heavy weight can last temporarily or can lead to more permanent chronic ailments. A backpack can easily weigh upwards of 20 pounds, which places constant load and compression along the spine. This can potentially lead to the cervical vertebrae impinging on the nerves that run from the neck, across the shoulders, and down the front of the arms. This is a risk for both adults, who routinely carry backpacks, as well as college, high school, and elementary school students who carry heavy backpacks each day. If this is repeated for days, weeks, months, and so on, it is easy to see how this could cause long-term back problems and considerable medical bills to treat the numbness and loss of motor control caused by nerve damage.

Text-Neck

Similarly, imagine the neck strain caused by looking at our handheld wireless devices for hours each day. The human head weighs about a dozen pounds. However, as the neck bends forward and down, as it does while texting, emailing, or surfing the web, the weight on the cervical spine begins to increase. At a 15-degree angle, the head’s weight is about 27 pounds, at 30 degrees it is 40 pounds, at 45 degrees it is 49 pounds, and at 60 degrees it weighs a whopping 60 pounds! Imagine carrying an 8-year-old around your neck several hours per day. Smartphone users spend an average of two to four hours per day hunched over, reading e-mails, sending texts, or checking social media sites. That is 700 to 1,400 hours per year that people are putting stress on their spines, according to current research published by Kenneth Hansraj in the National Library of Medicine. According to Hansraj, “As you stretch the neck tissue for a long period of time, it gets sore, it gets inflamed. It can also cause muscle strain, pinched nerves, herniated disks and, over time, it can even remove the neck’s natural curve.” Poor posture can cause other problems as well, such as reduced lung capacity, headaches, neurological issues, even heart disease and depression.

The Solution

So how can we combat the habits of our daily lifestyle that can be potentially damaging our spine and overall health? Prevention, mindfulness, and developing core strength and flexibility are essential. A good backpack should fit correctly and have several pockets and zippered areas so that the weight of the contents can be distributed more evenly. The best ones also have a strap that latches across the chest, pulling the pack forward and reducing some of the weight in the shoulder area. The shoulder straps should be wide and well-padded to cushion the shoulder area and reduce pain from pressure. Load the backpack with the lightest items on the sides and top and restrict the number of heavy items carried in the bottom. Reduce the weight by carrying only what is needed for the day. Make sure the backpack is the right size for the user. It’s tempting to use a larger bag because it holds more items, but it also adds more weight.

We know modern technology is here to stay, so how can we continue to use our smartphones and wireless devices without causing long-term harm to our spines? Individuals should make an effort to look at their phones with a neutral spine and to avoid spending hours each day hunched over. Look down at your device with your eyes, there’s no need to bend your neck and compress your cervical spine. “I love technology. I’m not bashing technology in any way,” says Hansraj. “My message is: Just be cognizant of where your head is in space. Continue to enjoy your smartphones and continue to enjoy this technology — just make sure your head is up.”

Routine and consistent exercise and stretching plays a large role in preventative spinal health. Many people don’t know this, but you need to have strong core muscles—the abdominal and spinal column muscles—to support your upper body, including your neck. Your core muscles usually do not get enough exercise during normal daily activities, so you need to do specific exercises to target these muscles. You also need strong and flexible muscles in the neck and back to minimize strain on your cervical spine and help support the weight of your head. Again, your neck will not get sufficient stretching and strengthening during normal daily activities, so it is best to learn specific neck exercises with the help of a health professional. By keeping a strong, healthy core and being mindful in your biomechanics and daily habits, you can continue enjoying your busy life in the 21st century, all while maintaining a healthy, happy spine and body.

This article by  Melissa Treat, RN, BSN, CPT at Tysons Sport and Health was originally published in the Spring 2016 issue of the SRF Journal, Your Spine Through the Years.