THE CLINIC: For Spine Disorders, Swim First, Surgery Last

Thu, 13 Sept. 2012 - 9:07 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I have been diagnosed with a skeletal problem called Diffuse Idiopathic Skeletal Hyperostosis (DISH). I am in fact fighting four things: stenosis (narrowing of the cervical canal), DISH the build-up of excess bone in the spinal canal, spondylosis (the wearing down of the discs in the spine and decrease in space between the vertebrae), and cervical disc disease (which leads to herniated discs). I really want to know how to avoid surgery. Doesn’t it largely depend on how much pain I can withstand and whether my spine is getting weaker? I have neck pain but I feel I have experienced little if any increase in actual bone weakness. I Am thinking of taking up swimming again, and doing a lot of stretching. Can you please advise me on what my outcomes might look like with these interventions as well as with surgery?

 

Jonathan Frum

Washington, DC

 

ANSWER:

My field's specialty is involved with providing non-surgical care to a variety

of orthopedic conditions. A significant number of my patients are spine

sufferers. 

 

In your case, you have neck pain which seems only tolerably better with regular swimming, meds, activity modification, and therapy. If you have DISH, I would be surprised, since it is defined by an abnormally accelerated process of spur formation all along the spine at multiple levels, and commonly semi-fuses the spine gradually all along its length. These patients are very stiff from neck to bottom. I would suspect that the spur formation in your neck is more probably just at the levels of disc injury/degeneration, and in time these spurs can and often do fuse together. 

 

If you can't stand the pain, then surgeons can speed this process along by stimulating your body to fuse the painful neck joint levels quicker, and can implant a plate and screw system to reduce the joint motion significantly. I would ask your doctors about Prednisone pill trials (one or two), and keep up the swimming. Take an occasional aspirin, Motrin, or Tylenol. 

 

It may be helpful to discuss certain aspects of how, more generally, the musculoskeletal system works. When we are born, all of our bones are strong and the ligaments (straps)

that hold these bones together are both strong and elastic. In the spine, we have discs, which lie between the vertebrae of our spine, to cushion the blows of everyday life. At birth, these discs have strong walls, and are filled with a gelatinous type fluid, which provides shock absorption to the adjacent bones in upright postures. Traveling within the

vertebrae, through continuous tunnel systems, are nerves, which connect the brain with the body Our bone-to-bone connections (joints) have a continuous production of internal joint fluid, to lubricate the joints. Periodic movements relieve the internal pressures on our joints, releasing some of this fluid.

 

As we age, gravity and lifting demands on our spine squeeze out the fluid in

the discs, and cause the bones to progressively lie closer to one another. There is less space between the bones for movement, "stenosis," and the rubbing of bones together produces spinal pain. The hyper-mobile walls of the discs or in the ligaments are another cause of local pain (spinal pain). In the end, as a result of the natural aging process,

gravity's influence, or of the physical demands of our lives, our ligaments are loose, the discs are deflated, the bones are experiencing high frictional rubbing against one another, and in severe cases the crowding of structures around the nerve channels becomes

stenotic and strictured. The bone/disc/ligament abnormalities are associated with neck pain and stiffness. Nerve irritation yields arm pains/numbness/weakness. Nerve injuries are often irreversible.

 

Surgery is at the end of the treatment chain, and attempts to change the anatomical

relationships of the above structures in patients with chronic unremitting pain levels, or in individuals who are experiencing nerve function loss. And generally, surgery can only be

performed if the injury/arthritis is confined to a small area. In a sense, all surgeries mimic real-life biologic activities. If no surgery were performed on individuals with disc degeneration, where bones are rubbing painfully against one another, the constant biologic drive within our body is to grow bone spurs from one bone to another, bridging the gap. In time, years typically, the adjacent bones will fuse together, thereby eliminating altogether the painful joint. 

 

Before reaching surgery as an option, keep generally active or swim, to "pump" out the joint fluid in our spine in a natural way. Repetitive low-impact exercise pushes out the joint fluid, and makes other activities that follow more tolerable. I can't emphasize

this point enough, since swimming is at the core of all arthritis interventions. Thee process of simply moving your joints relieves joint fluid build-ups and related pain levels. So swim away or pursue simple walking on soft surfaces. Any low-impact repetitive activity is fine. And on the other end of the scale, avoid high impact, torsional loading to your spine. Activities which knock bone ends together, or which have high inherent shear

forces will cause an increase and more rapid production of joint fluid, and redness. 

 

Try and maintain a straight or reasonable neck posture while at work, or while performing static tasks. If we maintain a flexed neck posture, we are essentially placing all of the weight of the head and neck on just the front portion of our discs. This in turn will cause increased neck pain.

 

John Schnell, MD

Cleveland, OH

 

 

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

(RUNNING & FITNEWS® March / April 2009 • Volume 27, Number 2)




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