What is Spondylosis?
Spondylosis is also known as degenerative joint disease (DJD) or osteoarthritis of the spine. As we age there is normal wear and tear on the bony joint surfaces between the individual vertebrae which make up the spinal column.1 However, if the normal aging process is coupled with other factors such as faulty posture, poor nutrition, inactivity, excessive use, high impact activities in the face of pain, injury, and micro or macro trauma, the process of degeneration is often more accelerated and exaggerated in nature.2 Abnormal growths, bone spurs or osteophytes can form between joint surfaces. The bony spur formations can place pressure on the spinal nerves as they exit the spinal cord (radiculopathy) or on the cord itself (stenosis) if the condition is severe enough.
As We Age
So what happens to our spine and bones as we age? There are four facet joints between each adjoining vertebral level. These joints function as hinges to provide all spinal movements: flexion, extension, rotation and side-bending (lateral flexion).3 These joints are covered with cartilage or a special kind of connective tissue that provide lubrication and gliding of the joint surfaces with minimal friction.
With bony degeneration and loss of the cushioning cartilage, the joint surfaces become uneven especially in response to weight bearing. The irritation of bone against bone without cushion and lubrication can then cause hypertrophy of the bony end plates and bone spurs form. Degeneration of bony end plates can also change as the bone beneath these outer plates thickens and hardens or scleroses resulting in further dysfunction and stiffness. Circulation to the vertebrae can also be impacted as blood supply is compromised due to bony spur formation.3 Ligaments or the fibrous bands of tissue which connect vertebra-to-vertebra may lose integrity or strength. The primary posterior spinal ligament (ligamentum flavum) can even thicken and begin to buckle or bulge posteriorly.
Degenerative disc disease (discussed separately in our paper Spinal Disc Disease) or degradation of the cushion between the vertebral bodies is often present in combination with spondylosis. These cellular and gross changes can lend to further cyclical dysfunction and impairment as they occur singularly or in combination. Most commonly spondylosis occurs in the cervical region. In fact, it is the most common cause of spinal dysfunction in older adults, according to Mayo Clinic.4 Spondylosis can onset as early as age 40 and continues to progress with age. By 60 years of age most people will have telltale signs of osteoarthritis on x-ray.5 Both men and women are vulnerable to cervical spondylosis, although the onset is usually earlier in men than in women.
Symptoms of cervical spondylosis can include the following, depending upon the level of involvement (spinal nerves or cord):2
- Neck Pain
- Loss of Balance
- Shoulder and/or Arm Pain (spinal nerves)
- Numbness or Weakness in Arms, Hand, & Fingers (spinal nerves)
- Difficulty Swallowing or Dysphagia (osteophytes at front of cervical-spine)
- Lower Extremity Numbness or Weakness (spinal cord)
- Loss of Bowel or Bladder Control (spinal cord)
Although less common, thoracic spondylosis or DJD will often result in pain associated with movement or positioning, especially end range forward flexion (outcurve) and hyperextension (incurve).3 In the lumbar spine, the vertebrae are once again vulnerable since they bear the most body weight. Lumbar spondylosis will often involve multiple vertebral levels. Poor posture, prolonged sitting and manual work with lifting and bending may aggravate symptoms which include:3
- Back Pain
- Leg or Hip Pain
- Numbness or Weakness in Legs
- Morning Stiffness
- Pain increases with Movement and Activity
Traditional medical treatment for mild spondylosis includes physical therapy to stretch and strengthen involved musculature, water aerobics or low impact aerobics, use of a neck brace or collar and non-steroidal anti-inflammatory medications.6 With moderate to severe cases other medical options might be bed rest with traction, muscle relaxants or narcotic medicines, corticosteroid injections into the joints, or surgery.
Surgery may involve an anterior fusion where bone spurs are removed and a bony graft or a metal implants such as rods, plates and screws are used to fuse and stabilize the spine. Other approaches include a posterior fusion of two or more vertebral levels; a laminectomy (bone over spinal canal is removed); or a laminoplasty (bone is rearranged to make more room for the spinal canal).
Precautions & Contraindications
Movement will impact a student/client with a significant spondylosis. Movements that become problematic depend upon where the bony spur formations or osteophytes are located. If the bony spurs are mostly in the posterior spinal structures, extension movements of the spine will aggravate while flexion movements may relieve symptoms. If the spurs are in the anterior spine, flexion movements will likely aggravate symptoms and extension movements may relieve symptoms. Likewise a left or right rotation or side bending motion may cause an increase or decrease in pain or other symptoms and thus be an indicator of the location of bony spurs in the spine.
Pain tolerance of a given movement can be used to determine the problem area and act as a guide to any necessary movement modifications. By coaching the client in small movements in the various planes of motion and monitoring comfort, both the practitioner and the client can identify risky movements and modify future exercises/movement explorations appropriately.
To understand the potential impact of Bones for Life® or the Feldenkrais Method® in individuals with Spondylosis, see the addendum to this article.
Addendum: Somatic Education Benefits with Osteoarthritis of the Spine
Bones for Life®
Bones For Life® (BFL) can make an enormous contribution for a person at the onset of degenerative changes in their spines. Let’s take a look at how it can help. Posture and dynamic alignment are key factors in limiting further deterioration of the joint surfaces. If we are able to “even out” the weight bearing surfaces of a joint in the spine (or elsewhere) through improved alignment, it can help to limit the irritation which leads to the formation of bony spurs in the first place. If the entire joint surface between vertebral bodies bears weight consistently, the consequences of weight bearing and micro trauma are minimized.
Alon has devised a remarkable program to neutralize postural faults by engaging each vertebral level in unique and multi-faceted ways, as demonstrated in the weight bearing processes: Knot on the Wall and Bagel or Two Knots on the Wall. Furthermore the constant attention to alignment in all 90 processes ensures protection of the vulnerable joints in the lumbar and cervical regions as well as a reciprocal interplay and integration between these curves in processes such as Wave, Axis, and Foot Steps over Thigh/ Finger along the Nose.
The Feldenkrais Method®
The Feldenkrais Method of somatic education can be beneficial to those who are suffering from the pain and physical limitations of osteoarthritis of the spine and other joints. Awareness through Movement® lessons (group classes) can be done by those with osteoarthritis even when they are unable to perform traditional exercise programs. Much of the movement exploration takes place on the floor in the relative ease of not having to work against gravity as we do in our usual habituated patterns of action. The strong emphasis on relaxation, movement within a pain-free range of motion, and reduction of effort contribute to the unique offerings of this method.
One-on-one Functional Integration® sessions can provide further pain relief and reorganization of movement in these students/clients. A Feldenkrais® practitioner’s role includes the ability to observe the distinct needs of the client and to construct each session in a way that is optimal for that client on that day. This process-oriented approach (versus a set protocol) has many advantages for the individual challenged with spondylosis. The practitioner holds a deep understanding that each person is not only structurally differently but has a nervous system and personality that is unique. As long-held patterns and unhelpful habits are uncovered, new choices around movement possibilities and activities of daily life emerge. The expansion of possibility is not limited to the physical but spills over into other realms such as mental and emotional capacity. A fuller life and the empowerment of self-care is a welcome prospect for those who have known the physical limitations of osteoarthritis.
Denise Deig is the author of Positional Release: from a dynamics systems perspective. A Physical Therapist, Guild Certified Feldenkrais Practitionercm and Bones for Life® Teacher/Trainer, she has a private practice in Fishers, Indiana. You can find out more about her and her practice at www.denisedeig.com. Deig can be reached by email at firstname.lastname@example.org. She offers certification and continuing education programs through www.integrativelearningcenter.org.
- MayoClinic.com. Cervical spondylosis. Online access 10/12/2007 11:08 a.m. http://www.mayoclinic.com/health/cervical‐spondylosis/DS00697/DSECTION=1
- MayoClinic.com. Cervical spondylosis. Online access 10/12/2007 11:13 a.m. http://www.mayoclinic.com/health/cervical‐spondylosis/DS00697/DSECTION=9
- SpineUniverse.com. Spondylosis. Online access 10/12/2007 9:56 a.m. http://spineuniverse.com/displayarticle.php/article1440.html
- MayoClinic.com. Cervical spondylosis. Online access 10/12/2007 11:11 a.m. http://www.mayoclinic.com/health/cervical‐spondylosis/DS00697/DSECTION=7
- MayoClinic.com. Cervical spondylosis. Online access 10/12/2007 11:10 a.m. http://www.mayoclinic.com/health/cervical‐spondylosis/DS00697/DSECTION=3
- MayoClinic.com. Cervical spondylosis. Online access 10/12/2007 11:12 a.m. http://www.mayoclinic.com/health/cervical‐spondylosis/DS00697/DSECTION=8