Spine Health & Spinal Hygiene

Spondyloarthritis is a group of inflammatory, immune-mediated diseases that cause chronic low back pain, inflammation, irritating aches, and pains. The conditions mostly affect the spine but can affect joints in the arms, legs, hips, skin, eyes, and intestines. Spondylitis types can significantly affect daily function, physical activity and compromise bone health.

Spondylitis Types

The main types include:

• Ankylosing spondylitis
• Psoriatic arthritis
• Enteropathic arthritis
• Reactive arthritis
• Juvenile spondylitis
• Undifferentiated spondylitis

Axial Spondylitis vs. Peripheral Spondylitis Types

Spondylitis conditions are classified as axial - axSpA or peripheral - pSpA.

• Axial means relating to the body's central region, as in the trunk and head.
• Axial spondyloarthritis is arthritis and inflammation in the hips and spine.
• The condition starts before age 45.
• The pain typically starts in the low back but can begin in the neck or other regions.
• Characterized by back pain, usually in the lower back and/or buttocks.
• Morning back stiffness lasting 30 minutes or longer.
• Sacroiliac joint inflammation can also present.
• The back pain gradually progresses.
• Lasts longer than three months.
• Improves with physical movement, not with rest.
• Peripheral spondyloarthritis is arthritis and inflammatory pain in the peripheral joints and tendons and does not include the spine.
• Individuals can have peripheral and axial spondylitis symptoms simultaneously.
• Diagnosis depends on whether symptoms are primarily peripheral or axial.

Spondylitis and Spondylosis

Spondylosis and spondylitis are similar in they cause pain and inflammation in the back and hips. The difference is in each condition's triggers.

• Spondylitis is a disease in which the body's immune system degrades joints, causes inflammation, overproduces bone formation, and causes bone fusion.
• Spondylosis is a category of arthritis that presents as the spine ages from normal wear and tear.
• It happens during the degeneration of the spine's discs and joints.
• It also presents when bone spurs develop on the spine's vertebrae.

Ankylosing Spondylitis

Ankylosing spondylitis is the most common form of arthritis affecting the spine, other joints, and body regions. The condition causes spinal joint inflammation causing extreme discomfort and chronic pain. In some cases, the inflammation progresses to ankylosis, where spine sections fuse and become immobile. Other body areas that can trigger inflammation include:

• The ribs
• Heels
• Shoulders
• Hips
• Small joints of the feet and hands.

Ankylosing spondylitis symptoms vary from person to person. Common early symptoms include:

• There is general discomfort, appetite loss, and mild fever early in the condition.
• Persistent stiffness and pain in the buttocks and low back, gradually progressing over a couple of weeks or months.
• The pain and stiffness can travel into the neck and spine within months or years.
• The pain is usually spread out and dull.
• The stiffness and pain are worse in the morning and night and improve with light exercise or a warm shower.
• The pain typically becomes chronic, lasts for a minimum of 3 months, and can be felt on both sides.
• Tenderness and pain in the hips, thighs, shoulder blades, heels, and ribs may also occur.

Treatment approaches include applications of ice and heat to reduce swelling, increase circulation, and decrease joint pain, posture exercises, stretches, physical therapy, and medication.

Psoriatic Arthritis

Psoriatic arthritis causes swelling, pain, and inflammation in the small joints of the hands and feet; however, the joints of the knees, ankles, and wrists can also be affected. Psoriasis is a rash that causes scaly skin patches.

• Individuals can develop dactylitis when a finger or toe swells between the surrounding joints.
• Spinal stiffness and pain can present.
• Typically the ends of the finger joints are most affected and experience pain and inflammation.
• The condition also includes fingernail and toenail symptoms.
• Medications frequently utilized to treat ankylosing spondylitis can be used.
• Exercise helps preserve the range of motion and maintain strength.
• Isometric exercise work muscles without joint motion reducing the risk of further injury to inflamed joints.
• Occupational and physical therapy can significantly assist in optimizing arthritic joint function.

Enteropathic Spondylitis

Enteropathic Arthritis is chronic inflammatory arthritis linked to inflammatory bowel disease. The most recognized are Crohn's and ulcerative colitis.

• The peripheral limb joints and sometimes the whole spine are the most prevalent body areas afflicted with enteropathic spondylitis.
• The main symptom is intestine inflammation, including bowel and joint pain and/or inflammatory back pain.
• Other symptoms can include weight loss, blood in the stool, abdominal pain, and/or chronic diarrhea.
• Managing enteropathic arthritis typically means managing the underlying bowel disease.

Juvenile Spondyloarthritis

Juvenile spondyloarthritis is a group of childhood rheumatic diseases that cause arthritis before age 16 and can continue through adulthood. Juvenile spondyloarthritis encompasses:

• Enteropathic arthritis
• Enthesitis-related arthritis
• Undifferentiated spondyloarthritis
• Psoriatic arthritis
• Reactive arthritis
• Juvenile ankylosing spondylitis

Juvenile spondyloarthritis causes inflammation and pain in joints in the lower body, like the ankles, hips, knees, and pelvis. Other body areas that could be affected include:

• The bowels
• Eyes
• Skin
• Spine

Lethargy and fatigue can also present. The symptoms can be unpredictable and episodic, appearing and disappearing without a specific cause. The condition cycles between flare-ups and remission. Common treatment approaches include:

• Medication
• Exercise
• Posture training
• Physical therapy, medication
• Ice and heat to decrease joint pain and relax muscles.
• In severe cases, surgery could be recommended.

Reactive Arthritis or Reiter's Syndrome

Reactive arthritis is arthritis that causes pain and inflammation in the mucous membranes, bladder, skin, joints, eyes, and genitals.

• Reactive arthritis is believed to be a reaction to an infection, usually in the gastrointestinal or urinary tract.
• Reactive arthritis does not affect the sacroiliac joints and spine in most cases.
• Reactive arthritis is typically treated with nonsteroidal anti-inflammatory medications, steroids, and rheumatoid arthritis medications.
• A physician could prescribe antibiotics if a bacterial infection brought on reactive arthritis.

Undifferentiated Spondyloarthritis

Undifferentiated spondyloarthritis is where the signs and symptoms of spondylitis don't meet the criteria for a specific rheumatoid disorder. Individuals diagnosed with undifferentiated spondyloarthritis will have one or more of the symptoms that include:

• Fatigue
• Back inflammation
• Back pain
• Buttock pain that alternates or presents on both sides.
• Swollen toes or fingers
• Heel pain
• Arthritis in the small joints.
• Arthritis in the large limb joints.
• Enthesitis or inflammation where the ligament or tendon connects to the bone.
• Eye inflammation
• Individuals can also present symptoms of other spondylitis types, like psoriatic or ankylosing.

Treatment approaches include:

• Exercise
• Physical therapy
• Posture training
• Ice and heat to decrease joint pain and loosen up muscles.

Spondylitis Types Diagnosis of Spondyloarthritis

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Carron, Philippe, et al. "Peripheral spondyloarthritis: a neglected entity-state of the art." RMD open vol. 6,1 (2020): e001136. doi:10.1136/rmdopen-2019-001136

Dougados, Maxime, and Dominique Baeten. "Spondyloarthritis." Lancet (London, England) vol. 377,9783 (2011): 2127-37. doi:10.1016/S0140-6736(11)60071-8

Gill, Tejpal, et al. "The intestinal microbiome in spondyloarthritis." Current opinion in rheumatology vol. 27,4 (2015): 319-25. doi:10.1097/BOR.0000000000000187

Rosenbaum, James T. “The eye in spondyloarthritis✰.” Seminars in arthritis and rheumatism vol. 49,3S (2019): S29-S31. doi:10.1016/j.semarthrit.2019.09.014

Seo, Mi Ryoung et al. "Delayed diagnosis is linked to worse outcomes and unfavorable treatment responses in patients with axial spondyloarthritis." Clinical rheumatology vol. 34,8 (2015): 1397-405. doi:10.1007/s10067-014-2768-y

Sharip, Aigul, and Jeannette Kunz. "Understanding the Pathogenesis of Spondyloarthritis." Biomolecules vol. 10,10 1461. 20 Oct. 2020, doi:10.3390/biom10101461

Inflammatory spinal arthritis can cause significant joint pain and severely damage sleep quality. Any of the following conditions can cause individuals to experience sleep problems:

• Spondylosis (osteoarthritis)
• Rheumatoid arthritis
• Ankylosing spondylosis
• Juvenile idiopathic arthritis

Dr. Jimenez from Injury Medical Chiropractic and Functional Medicine Clinic gives insight into how inflammatory spinal arthritis can disrupt healthy sleep, along with some tips to help individuals with joint pain restore healthy sleep.

Inflammatory Spinal Arthritis and Sleep

First, it is not just the joint pain of arthritis that is causing sleep problems. Research is discovering that more factors could be at play. A study in the journal SLEEP examined how individuals with chronic pain, including osteoarthritis slept. What was revealed was a strong connection between chronic pain and insomnia.

Insomnia can lead to added joint pain because poor sleep can trigger inflammatory pathways that worsen arthritis pain. Plus a poor night of sleep can heighten an individual's perception of pain the next day. Arthritis pain does not just impact the sleep of adults, but young individuals with juvenile idiopathic arthritis can also struggle with getting healthy sleep. Sleep, pain levels, and mood are strongly related.

Sleep Tips

Achieving quality sleep and a well-rested body can be done. Things to consider to help secure a healthy sleep.

Medication interference/side effects

Corticosteroids could be part of the sleep problem, as corticosteroid treatment has been linked to insomnia. If struggling to fall asleep, talk with a doctor about altering any prescribed medication regimen before sleep like taking aspirin or a nonsteroidal anti-inflammatory NSAID medication in its place.

Adjust sleep position to joint pain

If the neck is sore/aching rest the head on a flat pillow so the cervical spine is in a neutral position. For low back joint pain, individuals might find relief by sleeping on their back or side with the knees and hips flexed at a 90-degree angle. For hip joint stiffness, sleeping on the side with a pillow between the legs is recommended.

A firm mattress and support pillow

A firm mattress will support the body and help reduce pain. The right pillow/s are also important for healthy sleep. A lumbar and cervical pillow can help cushion tender areas.

Readjust chores

Joint pain first thing in the morning needs time to adjust. For morning physical chores try to reschedule for later on in the day or if possible the night before. This could be fixing lunches, picking out clothes, preparing breakfast, or packing the work case, tools, etc. The extra time will reduce morning stress and allow the body to gently adjust.

Wake up and stretch

With joint pain in the morning, some gentle stretching can help. Doing some stretches before even getting out of bed will help minimize pain and allow the body to gradually prepare for movement. Follow the stretch session up with a hot shower to loosen stiff joints.

Increase Sleep Quality

Sleep problems can affect anyone even those that don't have inflammatory spinal arthritis/joint pain. There could be other issues causing sleep problems unrelated to joint pain. If still not getting quality sleep, talk to a rheumatologist about available options.

Body Composition

Osteoarthritis and Exercise

Obesity is a significant risk factor in the development of osteoarthritis. This is not only from the effects of extra weight on the body's joints but also as a result of the pro-inflammatory effects of adipose tissue. The hips and knees are the weight-bearing joints. Excessive adipose tissue on the midsection and legs have been shown to negatively impact these weight-bearing joints.

Promoting Lean Body Mass and encouraging weight loss can potentially lower the risk of osteoarthritis and improve the quality of life. Gentle exercise is regarded as safe for individuals with osteoarthritis and is a key component to improve body composition, reduce body fat mass, improve lean body mass and maintain a healthy weight. Improving body composition and utilizing exercise in weight management can have a direct and positive effect on joint health.

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References

Myers W. 9 Ways to Rise and Shine With Osteoarthritis. Everyday Health. http://www.everydayhealth.com/osteoarthritis/ways-to-rise-and-shine-with-osteoarthritis.aspx. Last updated September 25, 2014. Accessed April 18, 2017.

Watson S. Why Osteoarthritis Could Disrupt Your Sleep—and Your Partner’s. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/comorbidities/sleep-insomnia/osteoarthritis-and-sleep.php. Accessed April 18, 2017.

Combat insomnia with chiropractic care. Struggling to get a full night's sleep, wide awake at three in the morning trying to fall back to sleep before the alarm goes off. Everyone suffers from occasional sleepless nights, but when insomnia occurs regularly it can lead to other issues like:

• Daytime fatigue and/or sleepiness
• Irritability
• Depression
• Anxiety
• Gastrointestinal symptoms
• Low motivation and energy
• Poor concentration
• Inability to stay focused
• Lack of coordination can lead to errors and accidents

Research shows that around 50 percent of the population are experiencing some type of sleep problem. Adults require a little more than eight hours of sleep every night. However, very few individuals are able to manage that with busy/hectic lives. Job, children, and other obligations require many to be up and on the move and getting to bed much later than if following the body's natural biological rhythm. A disruption to the body's circadian rhythm, which governs hormone production, body temperature, and sleep, can lead to insomnia.

Combat Insomnia

The body needs adequate, restful healthy sleep to perform its best. Insomnia can cause mental fuzziness and interfere with how the body performs its regular activities. It also increases the risk of:

• Depression
• Headaches
• Accidents

Stress, anxiety, regular caffeine, and alcohol use are some of the greatest contributors to insomnia. Learning how to combat stress effectively is highly recommended to increase the chances of getting a healthy night’s sleep, along with making small lifestyle adjustments could be the difference in getting back to normal sleep.

Sleep Suggestions

• Some light regular exercise before dinner time can help put the body in a restful state by bedtime. But do not exercise close to bedtime, as this can amp up the body creating restlessness.
• Get out into the sun as often as possible to stimulate melatonin release, which will help reset the circadian rhythm.
• Reduce stress through yoga, meditation, and Tai Chi, whichever works and are great ways to help teach the mind and body to relax.
• Caffeine and smoking keep the body stimulated. Try to avoid them from mid-afternoon onward.
• Keep alcohol consumption to a minimum.
• Have a small snack of protein with a complex carbohydrate just before bed, like some peanut butter on a whole-grain cracker. This will keep the blood sugar from dropping too low, causing the body to wake up.
• Maintain a regular sleeping and waking schedule.
• Turn off the television or any type of electronic device screen an hour before bed, as it stimulates the brain, causing sleep difficulties.
• Keep the bedroom dark, quiet, and cool.
• If lying awake for more than about 20 minutes, get up and sit in another dark/dimly lit room until sleepiness begins to come on.

Creating healthy sleep habits, along with discussing treatment options with a chiropractor, can help combat insomnia and bring sound sleep.

InBody Composition

Lack of Sleep Stops Muscle Growth

Lack of sleep has a significant effect on catabolic hormones, and specifically, a hormone called cortisol. Cortisol is a hormone that is released as a stress response. It helps break down tissue including muscle tissue, which gives the body energy that it needs to deal with whatever stressful situation the body is dealing with.

Research has shown that during restricted sleep and complete sleep deprivation, cortisol levels become elevated the following evening by up to 45%, potentially accelerating the development of metabolic and cognitive impairment. Cortisol has a muscle-reducing effect, and increased levels from a lack of sleep can threaten muscle development. The overall effect of not sleeping enough can seriously hamper efforts to gain muscle and increase Lean Body Mass.

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References

Bolash R, Drerup M. How to Beat Insomnia When You Have Chronic Pain. Cleveland Clinic Web site. https://health.clevelandclinic.org/2015/12/managing-insomnia-for-those-with-chronic-pain/. Published December 18, 2015. Accessed April 18, 2017.

Improving Sleep: Special Health Report. Boston, MA: Harvard Medical School; 2015.

What is Sleep? American Sleep Association Web site. https://www.sleepassociation.org/patients-general-public/what-is-sleep/. Accessed April 18, 2017.

Chiropractic care for spinal disc problems is steadily increasing in popularity. As more and more research proves the effectiveness for chiropractic for these types of problems, doctors and therapists are incorporating it into treatment plans for their patients.

Spinal disc problems can be debilitating, causing significant pain and severely limiting mobility. Degenerative disc disease is one of the most common spinal problems, causing back pain that, like other spinal conditions, can extend into the hip and leg or even the arm and hand.

It is caused by degeneration or thinning of the spinal joints or discs which can disrupt the mechanics of the spine and contribute to bulging discs that press on spinal nerves. Traditional treatment of this condition usually consists of strong pain medication and sometimes surgery.

Patients who are dealing with pain from discs that are bulging or ruptured as well as herniated, or slipped discs, do respond well to chiropractic care. Where surgery has long been a primary medical answer to pain relief for these spinal conditions, chiropractic treatments offer a nonsurgical alternative that has been shown to be very effective.

Most spinal or disc problems are marked by a specific set of symptoms including neck and back pain, stiffness, arm pain, leg pain, and tenderness in the spinal muscles or the spine itself. Other more serious symptoms can present at the onset of the condition or over a period of time. These symptoms indicate a dangerous problem that could even be life threatening; they include:

• Back pain accompanied by fever
• Loss of control of bladder or bowel
• Severe weakness that inhibits the ability to use arms, legs, walk, etc.
• Loss of sensation in both arms and/or both buttocks
• Inability to defecate or urinate

More serious or life threatening symptoms may require medical intervention, but most spinal conditions can be helped or even corrected with chiropractic care.

Through the careful, precise manipulation of the spine, a chiropractor can make adjustments to the body that help relieve the pain and pressure. This treatment can halt the debilitating progression of certain spinal problems while relieving pain and increasing mobility.

Spinal problems are usually diagnosed by a combination of complete physical examination and a thorough patient history. During the examination the patient’s musculoskeletal and nervous systems are carefully assessed. A doctor of chiropractic will examine the patient by moving the patient into different positions using their legs, arms, and back while applying pressure to the joints. Other diagnostic tools include x-rays and magnetic resonance imaging (MRI).

The preferable course of treatment for spinal problems is more conservative in nature. The earlier the problem can be diagnosed and treatment can begin, the better. There are several different treatments that a doctor of chiropractic may do to control and treat the pain. Modalities such as heat and ice applied to the affected area have been proven effective in controlling injury related pain in the lower back.

Movement is also crucial to healing and the sooner the patient gets back on their feet, the better. For most injuries or back problems, those problems are exacerbated when the patient stays in bed or coddles their back instead of walking and moving. It can result in long term back problems.

Spinal manipulation by a doctor of chiropractic has been proven to be an effective, safe treatment for disc problems and associated pain. In some cases therapeutic exercise may be added to the treatment and this too has been shown to be very effective.

In most cases, chiropractic care is sufficient and surgery of the spine or injections are unnecessary to manage the problems. In fact, these more invasive therapies often create more problems than they cure. Chiropractic care should be the first course of action for spine related pain, injury, or problems. So if you or a loved one are suffering from spinal disc problems, make sure you give us a call. We’re here to help!

Spinal Disc Problems: Chiropractic Treatment Can Help