Subluxations and Immobilization Degeneration

Interesting information found in patients without pain. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations .AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov27.

RESULTS:

Thirty-three articles reporting imaging findings for 3110 asymptomatic (no pain) individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96%of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age.The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.

 

•  So, don't wait for pain before seeking treatment. You brush your teeth to prevent damage that can lead to pain. You don't start brushing your teeth after you have pain. So, why do you wait until you have back pain to take care of your spine? You can replace teeth but there is no such thing as a spine replacement. So what causes this degeneration to take place?

Subluxations cause immobilization of the Vertebrae 

This is a 1987 study by Dr. Videman which foundthat after just 7-14 days of immobilization, we can see arthritis forming in a joint.  This arthritis can also form after repeated short periods of loss of motion in a joint lasting several days.  Once the wearing of the bone has taken place, these changes are not considered to be reversible.  Also, one joint that loses motion effects the joints around it.

This is what happens to your spine when you have a subluxation

 Articular surface degeneration begins within 1 wk of initial experimentalhypomobility & osteophytes begin to form after 1 wk of fixation.
Hypomobility results in degenerative changes.
Increased mobility may put the brakes on this degeneration.
Re-establishing mobility tends to improve the joints.
But the window of opportunity for such improvement is limited. There seems to be a time threshold.

 If the bony changes have just begun, it’s possible for improvement. But if they're well established, we’re not going to have much effect on the bony changes.This indicates that it's important for people w joint hypomobilityto increase mobility as early as possible - before that threshold time is reached when it's not possible to reverse degenerative changes. Findings support the notion that degenerative changes were reversibleup to a certain time threshold, after which degenerative changes remainedrelatively constant. Articular surface degeneration changes that showed no sign of reversal occurred between 1 & 4 wks of fixation (hypomobility). Osteophytic (boney changes) changes that showed no signs of reversal occurred between 4 & 8 wks of fixation. Findings support that inducing motion into hypomobile segments as early as possible & before this threshold is reached may be clinically important.

Joint changes with hypomobility Loss of motion

Articular changes.

Day one measurable changes of chondrocyte activity.

Day two-four there is marked decrease in proteoglycan which causes decrease in cation and water content in the cartilaginous matrix.

Day 15 flattening of the the opposed cartilage surfaces and mark loss of chondrocytes

Day 45 marked cyst formation and adhesions between articular cartridges.

By day 90 have penetrated the subchondral bone.

In human cadavers the degenerative spinal joints had adhesions bearing an extension from single strands to dense mats which preclude all movement

 Cramer GD, DC, PhD, Henderson C, DC, PhD .Zygapopyseal Joint Adhesions After Induced Hypomobility. JMPT 2010;33:508-18

Ligamentous Changes: Joint immobilization, decrease in proteoglycan content accompanied by a decrease in Hyaluronate and water. This  allows the collagen fibers to approach eachother more closely which causes ligamentous shortening or atrophy.

Capsular Changes: Studies on joint stiffness following immobilization clearlydemonstrated that capsule contracture increases pressure on the Cartilage of the joint and thus contribute to cartilage damage.

Synovium and Synovial Fluid Changes: The synovial space becomes infiltrated with fibrofatty tissue which obliterates the joint cavity, creating fibrotic adhesions in the joint space adding to loss of joint motion.

Bone Changes Documented immobilization has been shown to weaken insertions of ligaments into the bone.

Disc Changes: Immobilization vertebral motor unit impairs the supply of nutrients to the avascular disc. intervertebral disc obtain the nutrients required to maintain health and function through motion.

 So how do thecells of the intervertebral disc obtain the nutrients required to maintain healthand function?through motion

Immobilization vertebral motor unit impairs the supply of nutrients to the avascular disc. Intervertebral disc obtain the nutrients required to maintain health and function through motion

As VertMooney, MD, noted in his Presidential Address to the International Society forthe Study of the Lumbar Spine (4):

“Mechanicalactivity has a great deal to do with the exchange of water and oxygenconcentration” in the disc.  An important aspect of disc nutrition andhealth is related to pumping action maintains the nutrition and biomechanicalfunction of the intervertebral disc. Thus,“research substantiates the view that unchanging posture, as a result ofconstant pressure such as standing, sitting or lying, leads to an interruptionof pressure-dependent transfer of liquid. Actually the human intervertebraldisc lives because of movement.” So the Loss of movement (immobilization) will cause the disc to degenerate.

 

How long will it take to correct the Subluxation. 

The exact amount of time your vertebralsubluxation complex will take to correct will depend on several factors.

1. How long your vertebral subluxation complex has been present.

2. How severely vertebralsubluxation complex has degenerated and decayed spinal tissues and posture.

3. Other areas of toxicity and deficiency that are hampering your healing – your current health status and healing potential

 Vavrek DA,Sharma R, Haas M. Cost Analysis related to dose response of Spinal ManipulativeTherapy for chronic low back pain. JMPT2014 PubMed.

Concluded that a Dose of 12 Spinal Manipulation Therapies yielded the most benefit InPAIN FREE and DISABILITY FREE days. Did not increase the costs of treatment or lost productivity.

Senna Mk,Machaly SA. Rheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University. Spine (phila PA 1976). 2011 Jan 17. 

 They Concluded: Spinal Manipulative Treatments of 12 Treatments over a one-month period along with maintenance spinal manipulation every 2 weeks after the initial intensive manipulative therapy to obtain long-term benefits.

AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov27.