Back Clinic Chiropractic Spine Care Team. The spine is designed with three natural curves; the neck curvature or cervical spine, the upper back curvature or thoracic spine, and the lower back curvature or lumbar spine, all of which come together to form a slight shape when viewed from the side. The spine is an essential structure as it helps support the upright posture of humans, it provides the body with the flexibility to move and it plays the crucial role of protecting the spinal cord. Spinal health is important in order to ensure the body is functioning to its fullest capacity. Dr. Alex Jimenez strongly indicates across his collection of articles on spine care, how to properly support a healthy spine. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
The body’s core muscles are used for stability, balance, lifting, pushing, pulling, and movement. Engaging the core muscles means bracing and tightening the abdominal muscles, which include the latissimus dorsi/lats, paraspinal muscles, gluteus maximus/glutes, and trapezius/traps. When engaged, the trunk muscles help maintain spinal stability, support the spine and pelvis in sitting and resting positions and during dynamic movements, and help prevent injury.
Engaging The Core
To know how to engage the core, individuals need to understand what the core is. The most important muscles for engaging the core include: These muscles are involved every time the body inhales and exhales, in posture control, and when using the bathroom, they start and stop the process.
Rectus Abdominis
The rectus abdominis muscle is responsible for the six-pack.
It’s a long, flat muscle that extends from the pubic bone to the sixth and seventh ribs.
The rectus abdominis is primarily responsible for bending the spine.
External Obliques
These are the muscles on either side of the rectus abdominis.
The external obliques allow the torso to twist, bend sideways, flex the spine, and compress the abdomen.
Internal Obliques
The internal obliques lie below the external obliques.
They work with the external obliques in the same functions.
Transverse Abdominis
This is the deepest layer of muscle in the abdomen.
It completely wraps around the torso and extends from the ribs to the pelvis.
The transverse abdominis are not responsible for spine or hip movement but for stabilizing the spine, compressing the organs, and supporting the abdominal wall.
Latissimus Dorsi
Commonly known as the lats, these muscles run along both sides of the spine from just below the shoulder blades to the pelvis.
The lats help stabilize the back, especially when extending the shoulders.
They also contribute to body ability when twisting from side to side.
Erector Spinae
The erector spinae muscles are on each side of the spine and extend down the back.
These muscles are responsible for extending and rotating the back and side-to-side movement.
These are considered postural muscles and are almost always working.
What Not To Do
Individuals learn from mistakes, which might make learning how to engage the core easier by understanding what not to do. Common examples of failing to or not engaging the core correctly.
The back slumps when sitting down – the upper body lacks strength and stability.
When bending, the stomach sticks out more.
Swaying or leaning far to one side when walking – lack of lower body strength causes balance and stability problems.
The lower abdomen and back present with discomfort and pain symptoms.
Training
Engaging the core decreases the chance of sustaining an injury at home, work, or exercising and can help with chronic back pain. It creates a stable musculature around the spine that keeps the vertebrae from over-flexing, over-extending, and bending too far to one side. Engaging the core muscles can mean different things, depending on what is trying to be achieved.
For example, if doing bending work, the muscles needed, and the order in which they contract differs from when trying to maintain balance while standing on one leg.
The muscles engaged will differ in their movement depending on whether an individual is:
Trying to move the spine or stabilize it.
Pushing or pulling weight.
Standing, sitting, or lying down.
For a strong and functional core, the objective is to be able to engage the core in any situation. Engaging the core can be challenging, but with training and practice, the body becomes stronger. Practice engaging the core throughout daily activities that include.
Bracing the core while standing, sitting at a workstation or desk, and walking.
Day-to-day activities, like reaching for something from a high shelf, grocery shopping, and taking the stairs.
Injury Medical Chiropractic and Functional Medicine Clinic can create a personalized program to address musculoskeletal issues, core training, targeted exercise, stretching, nutrition, massage, and adjustments to get the body to optimal health and maintain health.
The Non-Surgical Solution
References
Eickmeyer, Sarah M. “Anatomy and Physiology of the Pelvic Floor.” Physical Medicine and rehabilitation clinics of North America vol. 28,3 (2017): 455-460. doi:10.1016/j.pmr.2017.03.003
Lawson, Samantha, and Ashley Sacks. “Pelvic Floor Physical Therapy and Women’s Health Promotion.” Journal of Midwifery & Women’s Health vol. 63,4 (2018): 410-417. doi:10.1111/jmwh.12736
Seaman, Austin P et al. “Building a Center for Abdominal Core Health: The Importance of a Holistic Multidisciplinary Approach.” Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract vol. 26,3 (2022): 693-701. doi:10.1007/s11605-021-05241-5
Vining, Robert, et al. “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial.” Journal of Alternative and complementary medicine (New York, N.Y.) vol. 26,7 (2020): 592-601. doi:10.1089/acm.2020.0107
Weis, Carol Ann, et al. “Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review.” Journal of Manipulative and physiological therapeutics vol. 43,7 (2020): 714-731. doi:10.1016/j.jmpt.2020.05.005
Zachovajeviene, B et al. “Effect of the diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial.” Scientific Reports vol. 9,1 19192. 16 Dec. 2019, doi:10.1038/s41598-019-55724-4
As humans, there are a variety of stressors experienced daily. Stress collects in various body areas, most commonly the upper back, jaw, and neck muscles. Stress leads to tension in the muscles. The built-up tension can cause the spinal bones to shift out of alignment, irritating the nerves between the spinal bones. A cycle begins as increased nerve tension causes the muscles to continue to contract/tighten. The extra muscle tension continues to pull the spinal bones out of alignment, making the spine stiff and less flexible affecting posture, balance, coordination, and mobility, causing the spine to become further unstable. Chiropractic treatment at regular intervals is recommended to help realign and maintain proper position.
Why The Spine Goes Out of Alignment
The nerves in the body are intricately linked to the spinal cord, and small distortions in the alignment can cause nerves to misfire and malfunction. When the spine goes out of alignment, the nervous system/brain and nerves get stuck in a stressed or tense state. Even a minor misalignment can cause a series of discomfort symptoms to travel throughout the body.
Causes
Causes of misalignment that creates tension in the nerves and muscles include:
A chiropractor will feel/palpate the spine to see if the bones are in alignment, move well, or are out of alignment and not moving correctly or moving at all.
Posture Exam
If the head, shoulders, and hips are uneven or the shoulders and head are pulling forward, the spinal bones are out of alignment/subluxations.
Balance and Coordination
Unhealthy balance and coordination can indicate the brain, nerves, and muscles are malfunctioning by spinal misalignment.
Range of Motion
A loss of spinal movement flexibility can show tension in the nerves, muscles, and misalignments.
Muscle Test
Loss of strength in a muscle can indicate the nerve signals are weak.
Orthopedic Tests
Tests that put the body in stressful positions focus on what tissue/s may be injured and the causes.
X-rays
X-rays look for abnormalities, dislocations, bone density, fractures, hidden/invisible injuries, and infections.
Injury Medical Chiropractic and Functional Medicine Clinic provide personalized treatment plans. These specific therapies are made to generate long-term spine benefits. Spinal manipulation, deep tissue massage, MET, and other manual therapy techniques, combined with exercise, help get the bones moving properly, the muscles functioning correctly, and the spine back into proper form. Treatment relieves muscle spasms, tension, and joint dysfunction, increases circulation, and retrains the muscles to remain relaxed.
The Natural Way to Heal
References
Ando, Kei et al. “Poor spinal alignment in females with obesity: The Yakumo study.” Journal of Orthopaedics vol. 21 512-516. 16 Sep. 2020, doi:10.1016/j.jor.2020.09.006
Le Huec, J C et al. “Sagittal balance of the spine.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 28,9 (2019): 1889-1905. doi:10.1007/s00586-019-06083-1
Meeker, William C, and Scott Haldeman. “Chiropractic: a profession at the crossroads of mainstream and alternative medicine.” Annals of internal medicine vol. 136,3 (2002): 216-27. doi:10.7326/0003-4819-136-3-200202050-00010
Oakley, Paul A et al. “X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks.” Dose-response: a publication of International Hormesis Society vol. 16,2 1559325818781437. 19 Jun. 2018, doi:10.1177/1559325818781437
Shah, Anoli A, et al. “Spinal Balance/Alignment – Clinical Relevance and Biomechanics.” Journal of biomechanical engineering, 10.1115/1.4043650. 2 May. 2019, doi:10.1115/1.4043650
Body misalignment can cause various symptoms to be experienced, ranging from headaches, neck and back pain, sore feet, discomfort in the joints, muscles, or nerves, and digestive problems. Improperly aligned vertebrae can press against nerves, pinching or compressing them, causing the nerve signals of the digestive system, including those in the stomach and intestines, to misfire or fail to transmit at the appropriate moment. This can cause the organs to malfunction, resulting in heartburn, gas, constipation, cramping, diarrhea, and other symptoms. Chiropractic realignment adjustments are an effective treatment option for frequent stomachaches, reflux, constipation, and other gastrointestinal conditions.
Body Misalignment Digestive Problems
There are over a million nerve cells within the digestive system. A collection of nerves branch out from the lower part of the spinal cord and travels to the stomach and intestines. Nerve transmission plays an essential role in the following:
Digestion.
Movement of food through the gastrointestinal system.
Absorption of nutrients and minerals.
Removal of waste products.
Misalignments of the vertebrae are known as subluxations. Pressure on nerve roots caused by misalignment can interfere with the function of the bowel and other organs, which can lead to gastrointestinal issues. Muscle tension in the abdomen can also contribute to digestive problems, whether because of stress or sitting for long hours daily.
Misalignment Symptoms
When the body is out of alignment, symptoms of discomfort begin to appear. The most common include:
Fatigue.
Stiff neck.
Sore shoulders.
Chronic headaches.
Sore muscles.
Pain throughout the back.
Joint pain throughout the body.
Chronic aches.
Tight hips.
Difficulty walking.
Tingling, pins and needles, and numbness nerve sensations – sciatica.
Constantly getting sick.
Healthy Gut
A balanced healthy gut will have less difficulty processing food and eliminating waste, leading to reduced and eventually alleviated symptoms. The following show healthy gut function:
Regular, consistent energy levels.
Increased mental clarity.
Regular and healthy bowel movements.
No pain or discomfort symptoms.
A normal amount of gas and bloating.
Healthy stress levels.
Chiropractic
Chiropractic care will realign the body to its proper form, improving gastrointestinal issues. The chiropractic team will use various tools and techniques to guide and correct any subluxations, relax the muscles, and increase nerve and blood circulation.
Healthy Diet and Chiropractic
References
Ernst, Edzard. “Chiropractic treatment for gastrointestinal problems: a systematic review of clinical trials.” Canadian Journal of Gastroenterology = Journal canadien de Gastroenterologie vol. 25,1 (2011): 39-40. doi:10.1155/2011/910469
Hills, Ronald D Jr, et al. “Gut Microbiome: Profound Implications for Diet and Disease.” Nutrients vol. 11,7 1613. 16 Jul. 2019, doi:10.3390/nu11071613
Hornbuckle, William E., et al. “Gastrointestinal Function.” Clinical Biochemistry of Domestic Animals (2008): 413–457. doi:10.1016/B978-0-12-370491-7.00014-3
Leeming, Emily R et al. “Effect of Diet on the Gut Microbiota: Rethinking Intervention Duration.” Nutrients vol. 11,12 2862. 22 Nov. 2019, doi:10.3390/nu11122862
Li, Yuanyuan, et al. “The Role of Microbiome in Insomnia, Circadian Disturbance, and Depression.” Frontiers in psychiatry vol. 9 669. 5 Dec. 2018, doi:10.3389/fpsyt.2018.00669
Redwood, Daniel. “Chiropractic and visceral disorders.” Journal of Alternative and complementary medicine (New York, N.Y.) vol. 13,5 (2007): 479-80. doi:10.1089/acm.2007.7146
Valdes, Ana M et al. “Role of the gut microbiota in nutrition and health.” BMJ (Clinical research ed.) vol. 361 k2179. 13 Jun. 2018, doi:10.1136/bmj.k2179
Spinal Stenosis Walking Issues:Stenosis means a narrowing. Spinal stenosis can happen in any spine region, but the neck and lower back are the most common locations. The spinal canal becomes narrower and can cause the nerves to become compressed, pinched, and irritated and can extend from the lumbar spine through the hips, buttocks, legs, and feet. Individuals with lumbar spinal stenosis may have difficulty walking caused by sensations of discomfort like numbness, electrical shocks, and pain, requiring the need to lean forward to relieve pressure and symptoms. Additionally, symptoms are likely to worsen the longer the walk. Chiropractic treatment can treat spinal stenosis because it corrects and re-aligns the spine, thus reducing pressure on the spinal cord, joints, and nerve roots.
Spinal Stenosis Walking Issues
The spine is made up of interlocking vertebrae. The regions are cervical, thoracic, lumbar, and sacral bones with a foramen opening. These openings form the protective tunnel/spinal canal surrounding the spinal cord. The spinal cord is a group of nerves that run through the tunnel. The narrowing suffocates the nerves supplying the lower extremities that can influence walking activity.
Symptoms
There may be no symptoms with early lumbar spinal stenosis. Most individuals develop symptoms gradually and may begin to notice them while walking or standing. These can include:
Lower back pressure sensations when standing upright or walking.
Leg numbness, tingling, weakness, burning, and/or cramping.
Muscle weakness.
Persistent pain in the back, hips, buttocks, or legs while walking.
Difficulty lifting the top part of the foot – known as drop foot.
Loss of sensation in the feet.
A weak foot that drops/slaps down when walking.
Loss of sexual ability.
In more serious cases, severe numbness, bladder problems, and inability to stand.
Individuals begin to lean forward when symptoms start, bringing relief by reducing the pressure on the nerves. However, constantly leaning forward leads to other posture and health problems.
Diagnosis
A doctor or chiropractor will ask questions about symptoms and medical history and perform a complete physical examination to diagnose lumbar spinal stenosis. During the physical examination, a healthcare provider will look for signs, such as loss of sensation, weakness, and abnormal reflexes.
Tests:
X-rays of the lumbar spine may show bone growths called spurs that push on spinal nerves and/or narrowing of the spinal canal.
Imaging tests – A CT or MRI scan can provide a detailed look at the spinal canal and nerve structures.
Other studies include – bone scans, myelogram, which is a CT scan that uses a color dye, and EMG, which is an electrical test of muscle activity.
Chiropractic Treatment
Chiropractic care combined with physical therapy is a tried-and-true treatment for spinal stenosis. A chiropractic treatment plan can include targeted and passive exercise programs. Targeted exercises involve strengthening the core and back muscles. Passive treatments include hot and cold therapy, massage, decompression, and electrical stimulation. The objective of chiropractic therapy is to:
Strengthen muscles in the core and legs
Correct posture and body mechanics.
Improve mobility.
Maintain ability to perform day-to-day activities.
Recommend stretches.
Educate on how to keep the spine and back muscles safe.
Train on using devices like a back brace, cane, or walker properly.
Advise about shoe inserts and splints.
Suggest work and home environment modifications, such as ergonomics and cushions.
Chiropractic Relief
References
Conway, Justin, et al. “Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures.” The spine journal: official North American Spine Society journal vol. 11,9 (2011): 816-23. doi:10.1016/j.spinee.2010.10.019
Lurie, Jon, and Christy Tomkins-Lane. “Management of lumbar spinal stenosis.” BMJ (Clinical research ed.) vol. 352 h6234. 4 Jan. 2016, doi:10.1136/bmj.h6234
Macedo, Luciana Gazzi, et al. “Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review.” Physical therapy vol. 93,12 (2013): 1646-60. doi:10.2522/ptj.20120379
Tomkins-Lane, Christy C et al. “Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls.” Archives of physical medicine and rehabilitation vol. 93,4 (2012): 647-53. doi:10.1016/j.apmr.2011.09.023
Prolonged standing can cause the pelvis to push backward, increasing the curve of the lower back/lumbar region. This increased pressure on the soft tissues surrounding the spine causes the lower back muscles to tighten and/or spasm, resulting in discomfort in the joints and nerves. Weakened core muscles and unhealthy posture/postural syndrome are the most common causes, but injury, aging, congenital malformations, or a disease/condition can also contribute to the symptoms. Injury Medical Chiropractic and Functional Medicine Clinic has a top team of professional therapists to evaluate the problem, diagnose the cause/s accurately, and develop a customized treatment and rehabilitation plan.
Prolonged Standing Back Discomfort
Back Structure
The lower back is one of the most used areas of the spine, moving around and bending during a normal day. When the body stands, the spine naturally curves both in and outwards.
The inward curve, called lordosis, curves towards the front of the body at the lower back and neck regions.
The outward curve, called kyphosis, curves towards the back of the body at the chest.
When bending over while standing, the five lumbar vertebrae of the lower back change position and shift from lordosis to kyphosis when bent completely.
When standing up from bending, the lumbar vertebrae change position again and return to the lordosis position.
Causes
The facet joints allow movement between each spine level. The standing spinal curvature can increase contact between the facet joints. As the body ages, the facet joints and discs begin to wear out, which can cause the discs and facet joints to become inflamed. Prolonged standing during normal daily activity combined with inflammation in these joints can aggravate the inflammation and cause symptoms. Regular routines and habits may contribute to low back discomfort during prolonged standing. These include:
Sleeping on a sinking or unsupportive mattress.
Practicing unhealthy postures that cause imbalances with proper weight distribution.
Not wearing proper footwear and/or supportive orthotics forces the lower spine into increased curvature and can compress the facet joints.
Not getting enough physical activity that strengthens the core.
Chiropractors are experts on the musculoskeletal system. They will:
Listen to the patient about symptoms, medical history, and occupation.
A physical examination of muscle tone, strength, and range of motion.
Therapeutic massage, electric muscle stimulation, and ultrasound therapy can help reduce muscle inflammation and increase circulation to injured soft tissues.
Chiropractic adjustments will reset joints, removing pressure from the surrounding muscles and nerves.
Targeted therapeutic strength training is recommended for core and leg muscles to improve hip flexibility.
Non-surgical decompression or traction, either with a machine or suspension, can reverse the pressure in spinal discs.
Standing Lower Back Relief Exercises
References
Hasegawa, Tetsuya, et al. “Association of low back load with low back pain during static standing.” PloS one vol. 13,12 e0208877. 18 Dec. 2018, doi:10.1371/journal.pone.0208877
Jo, Hoon, et al. “Negative Impacts of Prolonged Standing at Work on Musculoskeletal Symptoms and Physical Fatigue: The Fifth Korean Working Conditions Survey.” Yonsei medical journal vol. 62,6 (2021): 510-519. doi:10.3349/ymj.2021.62.6.510
Ognibene GT, Torres W, von Eyben R, Horst KC. Impact of a sit-stand workstation on chronic low back pain: randomized trial results. J Occup Environ Med. 2016;58(3):287-293. Abstract. www.ncbi.nlm.nih.gov/pubmed/26735316. Accessed March 2, 2017.
Parry, Sharon P et al. “Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers.” The Cochrane database of systematic reviews vol. 2019,11 CD012487. November 17, 2019, doi:10.1002/14651858.CD012487.pub2
Rodríguez-Romero, Beatriz, et al. “Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Pain Intensity During 1-h Laboratory-Based Standing in Office Workers.” International journal of environmental research and public health vol. 19,4 2221. February 16, 2022, doi:10.3390/ijerph19042221
Smith, Michelle D et al. “The Influence of Using a Footstool during a Prolonged Standing Task on Low Back Pain in Office Workers.” International journal of environmental research and public health vol. 16,8 1405. April 18. 2019, doi:10.3390/ijerph16081405
Neck aches, soreness, and pain symptoms are not always neck-related. Tight thoracic or mid-back muscles can pull on the neck muscles causing various symptoms. Upper back tightness occurs anywhere from the neck’s base to the bottom of the rib cage. The bones in the upper area don’t move or flex as much as the neck and low back. This can lead individuals to believe there is nothing wrong with the mid-back, as there are no pain symptoms or signs of discomfort. However, individuals don’t realize how tight the muscles are, which can go on for years, causing neck issues. Injury Medical Chiropractic and Functional Medicine Clinic can relieve symptoms, release, and relax tight muscles, increase circulation, and restore optimal function.
Mid-Back Muscle Tightness
The upper and middle back is the thoracic spine. The thoracic spine has twelve small bones called vertebrae. Each vertebra on the thoracic spine is connected to a pair of ribs. The ribs wrap around the body and attach to a long, flat sternum bone. This forms the rib cage. The bones in the upper back work with the ribs to stabilize the back and protect vital organs, including the heart and lungs. The tightening and pulling eventually cause neck aches that can come out of nowhere; even when not moving and looking straight ahead, there can be persistent dull achiness or stinging sensations.
Causes
Unhealthy posture, disc problems, injuries, fractures, or other issues or conditions can cause mid-back muscle tightness.
Posture
Constant sitting or standing combined with unhealthy posture and being hunched over can cause the muscles to tighten, limiting mobility.
Holding Onto Stress
Chronic stress can cause muscle tightening, whether it is in the low back, mid-back, neck, or elsewhere.
Hereditary
Individual genetic makeup may make the body more susceptible to muscle tightness.
For example, individuals with a lot of muscle tone vs. individuals with less muscle tone may experience muscle tightness more often.
Adequate Hydration
Being properly hydrated is important for muscle and joint lubrication.
Water provides nutrients to contracting muscles.
This keeps the body loose and ready for movement.
Muscle Imbalance and Underlying Weakness
Individuals that tend to work one side of the body more than the other or have repeatedly been moving in a certain way for years can cause muscle imbalances and trigger points to develop.
If muscle tightness continues, even after stretching, it could be an underlying weakness.
The muscles can sometimes seize up and guard, so they feel tight when they have become chronically weak and not strong enough to meet the physical demands.
Chiropractic Care
Chiropractic care involves various therapies to address the root cause fully and relieve neck aches. These include:
Massage therapies to break up compacted muscle tissue.
Remove trigger points.
Relax the muscles to a pliable state.
Perform chiropractic adjustments to realign the spine.
Stretching and strengthening.
Posture training that includes stretches/exercises.
Nutritional plans to help strengthen muscles.
Thoracic Tension Release
References
Gatt, Adrianna, et al. “Anatomy, Fascia Layers.” StatPearls, StatPearls Publishing, Jul 25, 2022.
Liebsch, Christian, and Hans-Joachim Wilke. “How Does the Rib Cage Affect the Biomechanical Properties of the Thoracic Spine? A Systematic Literature Review.” Frontiers in bioengineering and biotechnology vol. 10 904539. Jun 15, 2022, doi:10.3389/fbioe.2022.904539
Maciejewska-Skrendo, Agnieszka et al. “Genetics of Muscle Stiffness, Muscle Elasticity and Explosive Strength.” Journal of human kinetics vol. 74 143-159. 31 Aug. 2020, doi:10.2478/hukin-2020-0027
Modes RJ, Lafci Fahrioglu S. Anatomy, Back. [Updated 2022 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK539746/
Page, Phil. “Current concepts in muscle stretching for exercise and rehabilitation.” International journal of sports physical therapy vol. 7,1 (2012): 109-19.
Petrofsky, Jerrold et al. “The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness.” Clinical journal of sports medicine: official journal of the Canadian Academy of Sports Medicine vol. 27,4 (2017): 329-337. doi:10.1097/JSM.0000000000000375
Non-radiographic axial spondyloarthritis or nr-axSpA and non-radiographic ankylosing spondylitis/AS are related. However, non-radiographic axial spondyloarthritis can present AS symptoms with active inflammation of the spine and sacroiliac/SI joints, causing back and hip pain but does not reveal joint damage on X-rays or MRIs. Injury Medical Chiropractic and Functional Medicine Clinic can explain what it means to have non-radiographic axial spondyloarthritis, how it can be managed, and what to do to prevent it from turning into ankylosing spondylitis.
Non-Radiographic Axial Spondyloarthritis
Non-radiographic axial spondyloarthritis means there are early AS symptoms but have not developed enough joint inflammation or damage to show up on an X-ray or other form of imaging. Early evidence of joint inflammation includes blurring of the joint edges and localized regions of joint erosion. It can be difficult for physicians to see these subtle changes on an x-ray.
Ankylosing Spondylitis
Ankylosing spondylitis, or AS, is a form of inflammatory arthritis that affects joints in the spine and elsewhere.
It is a chronic, inflammatory, autoimmune disease.
Medical research is still ongoing to determine the exact cause, but a genetic component is believed to be contributing factor.
Around 85% of individuals with ankylosing spondylitis have inherited the HLA-B27 gene, which is associated with multiple autoimmune conditions.
In the early stages, individuals will present lower back pain around the sacroiliac joints or the joints that connect the spine to the pelvis.
Later stages have more obvious X-ray findings, like the fusing of the sacroiliac joints and the lower spine that takes place over time.
Joint inflammation can progress, causing permanent joint damage and spine rigidity.
Most individuals with the condition can manage their symptoms with NSAIDs, chiropractic care, physical and massage therapy, and range of motion exercises.
Stage 1
There is no evidence of spinal inflammation on x-rays.
MRI provides more detailed images of bones and may reveal bone marrow edema or accumulation of fluid in the structures of the spinal bones and joints.
Individuals with non-radiographic axial spondyloarthritis, you are here.
Stage 2
There is visible inflammation of the spinal joints on the x-ray.
The sacroiliac joints between the spine and the pelvis are the most affected.
Stage 3
Chronic inflammation of the joints has caused bone loss and permanent joint damage, resulting in spine rigidity.
Symptoms of Non-Radiographic Axial Spondyloarthritis
There are differences between back pain associated with muscle strain and arthritis. Back pain symptoms include:
Starts to present before age 40.
It has a gradual onset and can go unnoticed for years.
Improves with movement or activity.
Eases up throughout the day.
Starts up in the evening when resting.
Other symptoms include:
Joint stiffness
Swollen fingers
Heel pain
Bilateral buttock discomfort and pain
Slowing Progression
Progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis occurs in 10% – 20% of individuals over a two-year period. Progression factors include genetics, gender, degree of joint damage, and level of inflammatory markers at the time of diagnosis.
Early diagnosis and treatment can slow the progression before significant joint damage with anti-inflammatory therapy, rheumatological therapy, and targeted exercise.
Work with a specialist like an orthopedic spine specialist and rheumatologist that understands the disorder and is up to date on the most recent treatment modalities.
D. J. Pradeep, A. Keat, K. Gaffney, Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, July 2008, Pages 942–945, doi.org/10.1093/rheumatology/ken195
Kucybała, Iwona, et al. “Radiologic approach to axial spondyloarthritis: where are we now and where are we heading?.” Rheumatology international vol. 38,10 (2018): 1753-1762. doi:10.1007/s00296-018-4130-1
Michelena, Xabier, López-Medina, Clementina, and Helena Marzo-Ortega. “Non-radiographic versus radiographic axSpA: what’s in a name?”.” National Center for Biotechnology Information. October 14, 2020. doi.org/10.1093/rheumatology/keaa422
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Why The Spine Goes Out of Alignment
