As we age, the discs in our spine (gel-filled cushions between the bones of the spine) can wear, narrow, or begin to bulge. These changes can put strain on the cartilage, ligaments, and joints at the involved level of the spine and may result in pain. The narrowing of the disc also results in narrowing of the space between the spinal joints, called the "facet" joints. Weight-bearing forces on the joints increase because of these disc changes. As a result, the cartilage covering the joint surface can begin to fray and wear away over time. This wearing down results in osteoarthritis (OA).

As OA of the spine progresses, your body will try to repair it by growing new bone. This bony growth is called a "bone spur." Spur development can result in a condition known as spinal stenosis. Most often this disorder affects men and women over 50 years of age. If the spurs enlarge, they can create a narrowing of the spaces in the spine. The narrowing can involve small or large areas and can result in pressure on nerves near the involved joints, resulting in symptoms that may include pain, tingling, numbness, or burning.

Symptoms of OA of the spine vary from person to person and can range from mild to disabling. You may not have symptoms even though the condition is present. Its onset and progression can be quite slow.

With early or mild disease, symptoms may be intermittent. You might feel stiffness or aching after sitting a long time, on waking in the morning, or after vigorous activity. You or your family may notice changes in your posture. Some people will bend forward or shift to the side. With more advanced OA of the spine, symptoms will become more constant and tend to interfere more with your daily activities, especially with walking and standing.

Common symptoms of OA of the spine include:

• Pain in the back or neck.
• Pain that is worse after prolonged inactivity, on getting up in the morning, or after physical activity.
• Pain that worsens with standing and walking, and gets better with sitting or lying down.
• Stiffness after prolonged inactivity, on getting up in the morning, or with movement of the involved area of the spine.
• With a more advanced condition, symptoms that do not improve with rest and that interfere with sleep.
• Pain, burning, or tingling sensations that spread to the shoulder or arm, or to the buttocks or leg.
• Difficulty performing normal daily activities, such as dressing and bathing, as well as walking and standing, as the condition progresses.

Your physical therapist will perform a thorough evaluation and ask you questions in order to form a clear picture of your individual situation. These questions may include:

• Your past and current health and use of medication.
• How you are functioning in your daily life. (You may be asked to fill out a questionnaire.)
• How your symptoms came about.
• How long you have had symptoms.
• Where the symptoms are located.
• How and when pain occurs.

Your physical therapist will then conduct a physical examination and may:

• Evaluate your posture and measure the range of motion of your spine.
• Assess the movement of the spine and extremities (arms or legs) in the involved area.
• Check your nerve function with reflex, sensation, and strength testing.
• Observe how you move during commonly performed activities.
• Check your balance to determine your risk of falling.

The information learned in your evaluation will help your physical therapist prescribe a program to ease your discomfort, boost your quality of life, and get you moving your best.

If your physical therapist suspects that your pain might be caused by an underlying condition, they may request imaging testing such as X-rays, CT scans, and MRI from your doctor. Your therapist may also refer you to your doctor for further evaluation. Your physical therapist will work with your doctor to provide the best diagnosis and treatment.

Your physical therapist will help you set goals to reduce your symptoms and slow the progression of the disease. You'll learn how to safely exercise and continue to participate in your normal daily activities.

Your physical therapist can help with a variety of treatment options, including:

Exercise. Exercise is the most important treatment to lessen your pain and improve your mobility. Your physical therapist will prescribe specific low-impact activities that will strengthen your spine, abdomen, and hip muscles—to improve your ability to stand, walk, and balance, and lower your risk of falling.

Caution: Please consult your physical therapist or doctor before starting any exercise program.

Stretching. Your physical therapist will prescribe specific stretching exercises for your spine, arms, or legs based on the results of your initial evaluation. Obese individuals are in special need of stretching and exercises. Combined with strengthening, stretching may help slow the progression of the disease.

Symptom management. Symptom management means learning to feel better and remain active. Sometimes people are fearful that increased activity will worsen their symptoms or increase their pain. Your physical therapist will help you learn how to be more active without worsening your symptoms. The therapist will help you find your appropriate activity levels, and develop a unique program to keep you moving.

Daily activity training. Your physical therapist can teach you how to get in and out of bed, in and out of the bathtub, or out of a chair, and how to bend and walk with more ease.

Use of modalities. Treatment modalities, such as heat or ice, may be used to help manage your symptoms.

Manual therapy. Your physical therapist may use gentle hands-on techniques (manual therapy) to help improve your spinal flexibility and ease stiffness.

Balance and walking training. Exercises and instruction may be used to safely improve your balance and reduce your risk of falls.

Specialized braces or taping. Your physical therapist may use taping or specialized braces to help support your joints. Back bracing may be used in more advanced conditions.

Weight control. If you are obese, you are likely to have more spinal impairment in your upper back. Your physical therapist can help you improve your activity levels, and refer you to nutritional experts.

All cases of OA of the spine are different. Your physical therapist will choose the best treatment options for you based on their evaluation of your specific problem.

Following Surgery

The predominant treatment for OA of the spine is nonsurgical. However, symptoms that interfere with bowel or bladder function and cause problems with the nervous system may require surgery.

Immediately after surgery, a physical therapist will visit you in the hospital to help you get out of bed and walk, and possibly use a cane or walker for safety. When adequate healing has occurred, you may be sent for outpatient physical therapy to continue to improve your walking, and to provide you with an exercise program to safely improve your specific condition.

OA occurs as you age, but is not a direct result of getting older. There are many factors that may put you at risk of developing OA, including your family history. Other factors include exposure to risks at work such as assuming prolonged or awkward positions and smoking. Regular conditioning and strengthening exercises will improve the ability of your muscles to work and may help prevent OA of the spine.

All physical therapists are prepared through education and clinical experience to treat OA of the spine. However, you may want to consider:

• A physical therapist who has treated people with OA of the spine. Some physical therapists have a practice with an orthopedic or geriatric focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or geriatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with OA of the spine.
• Be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.

Other Arthritis Resources

• Community-Based Physical Activity Programs for Arthritis
• Osteoarthritis
• Rheumatoid Arthritis

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our Safe Pain Management page.