Arthritis in the Spine

Ask the Chiropractor -  Have you been told you have arthritis in your spine?  Did you know there is no clear way to define that in medical practice.  We do have a way to define it in chiropractic.  #healthy815 #icachiropractor #palmerproud

https://pubmed.ncbi.nlm.nih.gov/37150286/

www.rockforddc.com

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- Hello, I'm Dr. Brant Hulsebus and welcome to another episode of "Ask the Chiropractor"."Ask the Chiropractor's" my podcast that I do for people who have questions about chiropractic or chiropractic care. All too often, people ask the wrong person about chiropractic care. That person is usually someone who's not a chiropractor. Be a physical therapist, occupational therapist, maybe your family physician, even orthopedic surgeon. None of them have ever studied chiropractic or what a chiropractic care does like a chiropractor has. For instance, when I have a tooth problem, I don't ask my podiatrist about what's going on with my tooth. I ask my dentist, because I know the dentist is the expert on that. So, let's talk a little bit today about a question I've received."Dr. Hulsebus, I have arthritis and chiropractors help with arthritis." Well, arthritis is an interesting topic, because this week, a new research paper was just recently put in PubMed. What is PubMed? PubMed is like the gold standard of medical research. This goes through tons of scrutiny and tons of making sure what they're saying can be backed up and can happen over and over again. So, this one's all about the association between clinical findings and the presence of lumbar spine osteoarthritis imaging and systematic review. And what a systematic review is, they go out there and they find all the research that currently exists and they go through it all, the committee, and then they come with conclusions based on all the previous research that's already been indexed. And this one's interesting about the osteoarthritis. See, as a chiropractor, when I went through chiropractic college over at Palmer College in Davenport, we studied a lot about osteoarthritis and about the spine. What's safe to take care of, what the considerations you need to do to work around the arthritis, why the arthritis got there in the first place, and how to work around the arthritis. I had no idea until I read this report that medical doctors do not have any kind of measurement of arthritis. It's kind of whatever they want to say is arthritis can be arthritis. So, a lot of times, I have patients that come here and their doctor says, my lower back pain's just because of arthritis. I've always said, oh boy, look at your x-rays. I don't see any bony changes. I don't know why they call it arthritis. See, there's clear medical parameters that define if you have arthritis in your shoulder or your elbow or your hip. Those are crystal clear. But in the spine, they don't really have a set of guidelines that say you have to have A, B and C and D before you can call it arthritis. You can just call it arthritis if you want to call it arthritis. So, I've always been crucial about why a doctor would call, a medical doctor would call someone's back arthritic, when I look at the x-ray, I don't see any. Now, I understand that they can, anything can be arthritis. But they said that there's some interesting clinical things about the arthritis. Let's talk a little bit about how a spine gets arthritis, how we observe it in chiropractic, and how we take care of it in chiropractic. The bottom line is the spine gets arthritic either from an old injury that healed wrong or if you have a two vertebras that are misaligned and they've been misaligned for a long time. Because what happens when they get misaligned, we call this a subluxation. The two bones get misaligned and there's stress at that area. What the body will do, the intelligence of your body will lock that up, so you can't damage it anymore. Now, genetically speaking, we are all hunters and gatherers. We're designed to be walking the earth, picking fruits and vegetables and killing small animals, and of course avoiding large animals. Well, if you want to avoid large animals like a bear or wolf and you don't want to become food for them, you need to be able to heal on the go. So, what happens is when you walk, your muscles contract, they squeeze and they do different activities, which actually push nutrients into your disc space and pulls the toxins out. So, when the two vertebras get injured and they get locked up, they get subluxated, they get locked up and they stop moving, what happens there is when you're walking, those two don't move, the ones that above and below move extra. And over time, that disc will dehydrate and start to flatten. As it happens, it becomes unstable. And the intelligence of the body starts putting more calcium down around that area to solidify it. This is the arthritis process. So, as chiropractors, we go in and we find those vertebraes that aren't moving and we do a chiropractic adjustment and we restore the motion. So, if you come see me in your early 20s, we probably were not going to find arthritis in your spine. But we could do some adjustments today, so hopefully when you're 60, 70, you don't have arthritis in your spine, because we corrected the problem now. That's how chiropractors look at arthritis as somebody young. When somebody comes that's older and they have arthritic spurs and sometimes degeneration that we know that we have to be, have to take special consideration, how we adjust that, how long it's going to take to make it better. Bottom line is the less arthritic changes you have in your spine, according to the chiropractic charts and the chiropractic way of looking at it, the less you have, the faster you get better. The more you have, the longer it takes to get better. So, as chiropractors, we always look at the disc height and we look at the amount of spurring that are formed. The spurring is the fancy word for the spurring is called osteophyte. So, we always look at the osteophyte formation and we look at the disc height. Now, in medical world, any kind of thinning of a disc, any type of osteophyte, they call it arthritis. Another determining factor is they call it arthritis is whether or not you're stiff in the morning. That's supposed to be one of the earliest signs that you're getting arthritis. So, if you wake up in the morning, you're really stiff, it's easy for me to say, oh, you just have arthritis. I don't have to take an x-ray, because according to the medical literature, if you wake up in the morning and your back is stiff, it's arthritis. So, as chiropractors, those are some of the things that we look at. Some of the questions we asked you, how do you feel when you wake up in the morning? Are you stiff and sore? Here in my office, we always take images of your spine. We were taught at Palmer, you can learn a lot about somebody by looking at their images. So, we always image your spine to get a better idea of the osteophyte formation. Can we know if you have arthritis in your spine or a thin disc without x-rays? Not that I know. That's the only way to definitively take the diagnosis is to take the x-ray. So, we take the x-rays to see what's going on with the health of your spine. Now, if you go to see a chiropractor and you have arthritis in your spine, those are some determining factors of how much care you'll need or not need based on what they see though. Compare your disc height to disc height to disc height. And here in my office, we just show it to the patients. Look at this disc, it's perfect. Look at this one's great. Look at this one. This one's a little thinner. Can you see that? And the answer is usually yes. Now, the exception to disc is usually the bottom disc. A lot of times, that disc doesn't form right, because when you're small, this tailbone is six bones and they fuse together and make one sacrum. A lot of times, that L5 can get, what they call a sacralization, where it starts to join that area. So, the L5 disc isn't always the best one to measure, although that's the number one disc that we get described when people come in, hey, I have arthritis in my spine. My doctor told me I have a bad L5 disc. A lot of times, we look at that L5 disc and we'll determine, I don't know, you get some sacralization, this disc might not have ever been very good. We'll go over those factors with you, determine whether it's really a thin disc or whether it just, this didn't form right. This happens at about 25 to 30% the population. That's why I bring it up. So, when you go to the chiropractor, that's what they should be able to do. They should be able to tell you whether there's any osteophyte formation. You'll see the osteophytes on the x-ray, because they're really dense with calcium. So, on the x-ray, they'll come up really, really white. Really, really, you'll see like a bony, kind of see through a little bit and you'll see that along the edges, the rigid and it'll have really, really white, really, really, really dense with calciums. So, it'll really show up on the x-ray. And again, the disc, you're just measuring the heights. It's not a big deal there. So, as chiropractors, do we see people with arthritis all the time? Do we know how to take care of people with arthritis all the time? If I start adjusting you, should that disc return? Absolutely. Should this osteophytes be reabsorbed? I don't know. Probably not. They say it takes 50 years to reabsorb and we've been practicing for almost 75 years here. We haven't had a patient live long enough to take that, post study is 50 years later. I have no idea how they came up with that 50-year number, but I've heard that number problem at multiple times. If you'd like to read more about the research paper, it's at PubMed. It was published, it was Epubbed in 2023, May 6th from the "Journal of Osteoarthritis and Cartilage", September 31st, 2023, Epubbed, May 6th. So, "Association between clinical findings and the presence of lumbar spine osteoarthritis images: A systematic review". I will try to put a link to this wherever I post this podcast, so you can check it out yourself. I love using the science behind what we do and try to show you again why you should ask a chiropractor.'Cause we do read research papers, we do do our homework. We know what we're talking about. So, again, if you've been to a medical doctor, they say you have arthritis in your spine, that's a very generic diagnosis by the very generic definition of spinal arthritis in the medical profession. I'm not saying anything negative or positive, I'm just saying how it is. As chiropractors, we actually grade it, grade one, grade two, grade three, grade four. And we have different levels of care and different ways we treat you based on the amount of arthritis that's present. We have other symptoms. Like I said, if you wake up in the morning, and you're really stiff and we see it. The biggest thing we also see with with arthritis here in the office, a lot of times, people will come in and we x-ray part of their spine and they don't even know they have arthritis. That's the whole tricky part about this arthritis thing. Sometimes it shows up, sometimes it doesn't show up as far as like it hurts or it doesn't hurt. Now, it always shows up on the x-ray. So, sometimes we'll take an x-ray, we'll say, look at this degeneration you have down here, arthritis you have going on. And the patient says,"I've never had any problems here in my life." And that's good, that's good. That means we found it first. But those are things that we can definitively see, objectively see on the x-ray and describe those to you and show those to you before. Hopefully we can take care of it before you do feel it. You don't have to feel the arthritis. We can definitely help out with that before. And I also want you to keep in mind the side of the vertebrae. There's a hole like a kidney bean hole where the nerve comes out. That hole is made up of the bone, above and the bone below. And the height of that hole is made up by the disc. If you lose your disc, you lose the height of that hole. So, as that hole gets smaller and smaller, it's more and more easy to stress or inflamed. So, if we can help you get your disc back, we make that hole bigger, the nerve's happier. And if osteophytes or the spurring grows, allowing in the backside of the facet joint, in the front side of the area, then what's going to happen is that's going to take a more stress in that hole and make that nerve more irritated. So, it's really important to keep upon your maintenance of your spine too. So, there you have it, osteoarthritis and arthritis in the spine. Can the chiropractor help? Absolutely. We help all the time. We might not be able to get rid of the spurs, but if you get the disc to come back, the motion to go, the theory there is we can also prevent more arthritis from happening. I hope I answered your question. If you want to learn more, check out our website or rockforddc.com. That's R-O-C-K-F-O-R-D-D-C.com. You can find all kinds of information there. And if you have a question about chiropractic or chiropractic care and you'd like to get a hold of me, just go to my website and leave me a message there. DM me wherever you're listening or watching this video. We'll get it there too. And come back next week. We have another edition of "Ask the Chiropractor". Thanks, everybody.