Do Spinal Adjustments Prevent Osteoarthritis?

I went to a chiropractor last week to get help for low back pain that I've had on and off for about six months. He took x-rays, had me move in different directions and had me watch a video on why spinal adjustments are needed to prevent arthritis.

On my second visit, he showed me my x-rays which he marked up with different lines showing that I already have some arthritis in my back and that I need to sign up for a year of treatments to correct things.

I'm not convinced that spinal adjustments are going to help me or if I even need them. Can you please shed some light on why he thinks I need so much treatment? He is recommending adjustments 3 times a week for the first three months plus 2 times a week for the rest of the year. He told me that each treatment session would take just a few minutes because he can correct everything with adjustments.

Thank you in advance for your help.

Sophia R.
Fremont, CA

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While I can't give specific recommendations to people who are under another practitioner's care, I can share some general thoughts on this topic.

My experience in the field has been that many chiropractors rely on radiographic findings to illustrate the need for spinal adjustments. Marketing companies that supply chiropractors with their educational tools emphasize the need for spinal adjustments to ward off osteoarthritis in the spine.

Common radiographic findings that are associated with osteoarthritis include:

1. Uneven joint space loss - as cartilage that lines joint surfaces is eroded, the space between the joint surfaces decreases in non-uniform fashion.

2. Osteophyte formation - also called bone spurs, osteophytes are typically the result of the body laying down more bone in response to persistent physical stress in the area, much like scar tissue is laid down to stabilize injured tissues.

3. Cyst formation - as cartilage is destroyed and joint surfaces begin to erode, cysts begin to form just under affected joint surfaces.

4. Subchondral sclerosis - as erosion continues, the body attempts to repair and remodel joint surfaces, leading to areas of increased bone density - called subchondral sclerosis - just below the joint surfaces.

Here's the thing: if you take X-rays of the average 40-year old's spine, chances are good that you will see some of these signs of osteoarthritis.

The average 60-year old will definitely show most if not all of these signs on X-rays, and into one's 70s and beyond, it would be exceedingly rare to have healthy joint spaces throughout the spine with no osteophytes, subchondral cysts, or subchondral sclerosis.

As we get older, we can also expect to see subluxations, which are areas where vertebrae don't appear to be perfectly aligned with adjacent vertebrae.

Put another way, in my experience, it is normal to have radiographic signs of osteoarthritis as we age. This is really no different from other expected signs of aging like losing natural hair pigment, producing less of certain hormones, and having decreased capacity to build and maintain skeletal muscle mass.

So that's the first thing - having signs of arthritis in your spine on plain film radiographs is not something that you should be horrified or depressed over.

Can spinal adjustments prevent further progression of arthritis?

To some degree, yes, but only when adjustments are applied in a non-traumatic way and if they lead to improved range of motion in the joints being adjusted. Joints that are capable of healthy range of motion experience less overall stress during activities of daily living, so are less likely to undergo loss of cartilage and ensuing changes like loss of joint space and bone spur formation.

But the same can be said for regular stretching, foam rolling, mobility exercises, and all other activities that promote healthy range of motion of our joints.

I have consistently told patients that they can do so much more for their joints, ligaments and muscles through 20 to 30 minutes of stretching and mobility work every evening than any practitioner can do for them through spinal adjustments a few times a week. This is just common sense, right?

Sometimes, joints can be rigid enough where spinal adjustments can be helpful in inducing needed range of motion that makes doing regular mobility exercises more effective or even possible.

But there is no denying that when a person is capable of proactively working on their mobility, there is not a more cost-efficient and effective way of maintaining joint health and warding off the natural degenerative changes that our joints will inevitably go through over decades.

I appreciate the benefits of spinal adjustments. But I don't get my spine adjusted regularly. I find that the best way to take care of my spine, surrounding tissues, and joints throughout my extremities is to proactively work on my mobility every day. When I feel that an area is somewhat locked up, I will have that area adjusted to facilitate restoration of optimal range of motion.

To answer Sophia's question directly, yes, properly applied spinal adjustments can help prevent arthritis in the spine, but in my opinion, spinal adjustments should only be a part of her plan to address chronic back pain. And long term, I believe it's best to rely primarily on mobility exercises to stay physically healthy.

Hope these thoughts are helpful.