Osteochondrosis and its treatment

Osteochondrosis is a slowly developing form of degenerative spinal damage, based on disc degeneration involving the vertebral bodies and ligamentous apparatus.

Main causes of osteochondrosis

• Prolonged immobility (habitual forced posture maintained over years, repetitive movements)
  
• Autoimmune disorders (autoimmune aggression in collagenoses, rheumatoid disease)
  
• Microtrauma (chronic microtrauma)

Mechanism of development

Disc nutrition is provided by blood vessels penetrating it from adjacent vertebrae, but after growth stops (at age 23-25), the feeding arteries calcify and the intervertebral disc becomes avascular; its nutrition is then carried out through diffusion.
The more active the movements in the disc, the more active the diffusion and consequently its nutrition. This principle is the cornerstone of spinal health.

When motor activity decreases, the intervertebral disc undergoes progressive changes.
In the first stage, the elasticity of the nucleus pulposus decreases due to a reduction in acid mucopolysaccharides that make up the nucleus. This leads to impaired shock absorption, decreased intervertebral space height, and displacement of the nucleus pulposus within the disc. The process is asymptomatic, and with proper treatment, full functional recovery is possible.

In the second stage, ligaments around the disc calcify and lose their elasticity. This can lead to ligament tears with disc herniation. Conservative treatment is longer and more complex; for large herniations, surgery may be required.

In the third stage, ligaments completely ossify, the nucleus pulposus partially calcifies, and spur-like growths form on the vertebral bodies. Treatment is symptomatic — pain relief.

Decreased motor activity, as mentioned above, is primarily caused by a habitual forced body position maintained over the years. This is largely the result of a sedentary lifestyle and lack of an ergonomic computer chair, which is extremely important for maintaining mobility even during prolonged work.

Clinical manifestations

Cervical spine osteochondrosis

• Cervical discalgia — sharp pain along the posterolateral surface of the neck, sharply aggravated by any movement.
• Vertebral artery syndrome (vertebrobasilar insufficiency) — mainly occurs with extension subluxation of cervical vertebral bodies due to prolonged sitting in an incorrect position. The caliber of vertebral arteries decreases to 2 mm (normal is 4.5 mm in adults). Manifestations include: headaches, dizziness, tinnitus, visual impairment, and symptomatic hypertension.
• Brachialgia syndrome — also occurs due to extension subluxation of the V, VI, and VII cervical vertebrae. Characterized by sharp shoulder pain (often misdiagnosed as shoulder joint arthrosis), numbness in fingertips, decreased strength and sensitivity.
• Epicondylitis syndrome — elbow pain (in the condyles), cause — see point 3.
• Cardialgia syndrome — pain in the anterior chest wall muscles and heart area (pathology of V-VII cervical vertebrae).
• Less commonly: superficial pain in any part of the skull with clear localization.

Thoracic spine osteochondrosis

The thoracic spine is fixed by the ribs and is relatively immobile. Maximum load falls on the mid-thoracic region. Osteochondrosis primarily begins in the interscapular area due to its limited mobility.

Thoracalgia:

• Burning pain in the interscapular area
  
• Intercostal pain that worsens on inhalation, bending, and turning. Depending on the location, pain may present as retrosternal pain, heart pain, esophageal, stomach, or diaphragm pain.
  Visceral syndrome: manifests as dysfunctions
  
• Biliary dyskinesia
  
• Intestinal atony — tendency to constipation
  
• Reflux esophagitis

C. Lumbosacral spine osteochondrosis

The clinical picture of lumbar osteochondrosis is mainly due to disc damage (herniations, instability, etc.) and to a lesser extent the presence of osteophytes. The traumatic factor is more clearly seen in the development of the disease.

• Acute pain syndrome: occurs due to mechanical factors (lifting heavy objects, bending, etc.)
• Depending on the stage of osteochondrosis, pain may be localized in the lumbosacral spine — lumbalgia. When the nerve root is irritated, pain radiates to the leg — lumboischialgia. Pain may be localized only in the leg — ischialgia.
• Pain often localizes in the pelvic organs — bladder, adnexa, rectum.
• With spinal instability, there is a sensation of discomfort and a frequent need to change body position. Lumbosacral pain varies in character, most often localized in the buttock area and along the posterolateral surface of the leg, worsening with movement and coughing.
• Sensory disturbance syndrome: characterized by decreased pain and tactile sensitivity or, conversely, hyperesthesia (tingling, "crawling" sensations) in strips covering the buttock area, passing along the thigh, lower leg, and foot.
• Pelvic organ dysfunction syndrome: Muscle atrophy syndrome — gluteal muscles, thigh muscles, lower leg, sometimes foot.

Generalized osteochondrosis

Generalized osteochondrosis is the most severe degenerative spinal disease, combining osteochondrosis of two or sometimes all spinal segments. Damage to all spinal segments is called generalized osteochondrosis.
With generalized osteochondrosis, all of the above symptoms may be present.

Self-diagnosis of osteochondrosis

Osteochondrosis is easily diagnosed by symptoms. Each spinal segment has its own symptoms. Using the symptom descriptions above, a preliminary diagnosis can be made independently without being a doctor; however, to confirm the diagnosis and prescribe treatment, it is better to consult a physician.

How to prevent osteochondrosis

The basic principle is: the joint must move.
A pair of vertebrae and the disc between them form a joint, just like any other — elbow, knee, etc. If a healthy joint is immobilized for some time (e.g., in a cast), within 1.5–2 months it will develop stiffness — contracture. This is exactly how, over the years, a person restricts mobility in the intervertebral joints, leading to the development of osteochondrosis.
Special exercises for maintaining mobility in each pair of vertebrae are described in the EXERCISES FOR OSTEOCHONDROSIS section.
Contracture of any joint is eliminated through redression (forced flexion, extension, rotation).

What you can do on your own when acute osteochondrosis symptoms appear before seeing a manual therapist

For acute neck pain:
• Immobilize the head with a semi-rigid collar. You can use a sheet folded in several layers, 10–15 cm wide, wrapped around the neck. This will limit head movements and help avoid provoking pain.
  
• Heating, rubbing with ointments and liniments is contraindicated, as it worsens the swelling and increases pain.
  For acute pain in the shoulder or arm:
  
• Immobilize the arm with a sling bandage over the neck, ensuring a right angle at the elbow joint. Place a small roll or pillow in the armpit area so the arm doesn't press against the torso.
  
• Heating, rubbing with ointments and liniments is contraindicated, as it worsens the swelling and increases pain.

For acute chest pain, an urgent medical consultation is necessary, as diagnosis and treatment require high qualifications.

For acute lumbosacral pain:

• Apply a corset. If you don't have a medical corset, use a 3–4 meter piece of fabric folded in several layers, 20 cm wide. Wrap the lumbosacral area as tightly as possible, additionally securing it with an abdominal belt.
  
• Heating, rubbing with ointments and liniments is contraindicated, as it worsens the swelling and increases pain.
  With good immobilization, the inflammation may subside on its own within 3–10 days.

Exercises for osteochondrosis — self-help guide