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SPINAL JOINT DYSFUNCTION
BY JAMES G HALVORSON, DC, DACAN
SPINAL JOINT DYSFUNCTION
is the initial phase of spinal degenerative arthritis. The degeneration is caused
by the accumulation of micro traumatic, repetitive stresses and strains of life—gravity, bending, lifting, twisting, and
psychological/emotional stresses. Major traumas such as car accidents or fall injuries are causative agents as well. The
stresses and strains can alter the mechanics of spinal joints and cause them to malfunction (hence the name spinal joint dysfunction). This 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, scar tissue formation (the 3 S’s) as
it attempts to heal.
TISSUE
STRAIN
TISSUE
REPAIR
1. SPASM of muscle—
2. SWELLING and PAIN: When the breaking point
a response to the accumulating stresses of life.
is reached—“the straw that broke the camel’s back.”
A strain/sprain event occurs due to tissue overload
resulting in micro-tearing of muscles and ligaments.
JOINT
FIXATION
3. SCAR TISSUE in muscle is like
gristle in a tough piece of meat. In the
joint, it may cause fixation or locking—
like rust in a hinge.
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 and osteopaths 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 or osteopaths. 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.
MAINTENANCE CARE:
Taking care of the spine should be similar to taking care of the teeth. We are instructed to
brush and floss our teeth 2-3 times a day even when we don’t have symptoms. Periodically, we are supposed to get a checkup with a dentist who has been trained to detect abnormalities even when we don’t have symptoms. There is no cure for the
process of tooth decay so the goal is preventative. The same can be said about the spine—there is no cure for the process of
arthritis so the goal should be preventative as well. Brushing and flossing the spine would entail doing daily things like
stretching, strengthening, core stabilization exercises, and pressure point therapy. Also, a periodic check-up with your chiropractor can ensure early detection and treatment of spinal joint fixation even when there are no symptoms. Following these
preventative measures can help decrease exacerbations of pain and also, may slow down the progression of arthritis.