Osteoarthritis of the back (spondylarthrosis): causes, symptoms and treatment

Osteoarthritis in the back involves wear and tear on the cartilage and joint surfaces of the vertebrae. Back osteoarthritis can be slowed down with active measures, physical treatment and rehabilitation exercises.

Spinal osteoarthritis can refer to wear and tear changes in the entire back, but the most common is that it occurs in the lower back – in the part we call lower back. Osteoarthritis in the back usually gets worse and worse, with gradually increased breakdown of articular cartilage, and this is exactly why it is so important that you take it seriously. In more severe osteoarthritis, it can lead to other diagnoses, such as spinal stenosis (narrow conditions in the spinal cord). Characteristic symptoms of osteoarthritis include stiffness (especially in the morning), pain and constant feeling of fatigue (in the back and seat). You must not ignore the signs of osteoarthritis, as this is a progressive diagnosis.

- The facet joints are most exposed

On each vertebra we have two 'attachment points' which attaches one vertebra to the next vertebra (see illustration 1 below). These attachments are called facet joints, and due to their biomechanical function and location, it is these in particular that are affected by wear and tear on the joint surface and cartilage. If these are severely worn down, it can cause the facet joints to come closer to each other, thus further restricting mobility. This is called facet joint osteoarthritis. We can divide osteoarthritis into five stages, from 0 to 4, with the latter being the most significant and severe form of osteoarthritis.

"The article has been written and quality checked by publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). You can get to know our core values ​​and quality focus better here . We always recommend having your pain assessed by knowledgeable healthcare personnel. "

Tips: Later in the article shows chiropractor Alexander Andorff you a training video with 5 recommended exercises against calcifications and osteoarthritis. In this guide on osteoarthritis in the back, we also give advice on self-measures and self-help, such as sleeping with pelvic reclining cushion w/ fastening strap, relief with seat cushion and training with minibands. Links to product recommendations open in a new browser window.

In this big guide on spondyloarthritis, you will learn more about:

1. Symptoms of osteoarthritis of the back

2. Causes of osteoarthritis in the back

3. Self-measures against back osteoarthritis

4. Prevention of back osteoarthritis

5. Treatment of osteoarthritis of the back

6. Diagnosis of osteoarthritis in the back

The purpose of this large spondyloarthritis guide, written by a multidisciplinary team with a professional interest in osteoarthritis, is to contribute to improved knowledge among the general public and healthcare personnel. All our clinic departments associated with the Vondtklinikkene Interdisciplinary Health works daily with assessment, treatment and rehabilitation of osteoarthritis patients. Remember that you can always contact us if you have any questions about your complaints.

1. Symptoms of osteoarthritis in the back

[Illustration 1: Overview of facet joints in the back. Source: WikiMedia Commons]

It is easier to understand what osteoarthritis entails if we get a better understanding of which structures are most at risk. In the illustration above, you can see the spine. Next, we take a closer look at two vertebrae where the facet joints are marked in pink. As you can see, this is the way the vertebrae attach to each other, and the only area where "bone meets bone«. In between the vertebrae, we also have a soft intervertebral disc that contributes to shock absorption and relief. But there is therefore wear and tear on these facet joints, most often in the lower back (the lower five vertebrae) which provides the basis for the majority of the symptoms of spinal osteoarthritis.

- The extent of the symptoms will usually be in line with the wear and tear changes

Later and more serious stages of osteoarthritis often give rise to more symptoms and reduced function. But not always (some have symptoms even with mild osteoarthritis). Symptoms of osteoarthritis in the back can include:

• Feeling of fatigue in the lower back

• Local, aching pain in the lower back

• Feeling of "tightness" in the lower back

• Can cause referred pain down the leg to above the knee

• Tenderness to touch over the involved joints

• Possible local swelling (if the facet joints cause local inflammation)

• Stiffness and reduced joint mobility in the back

• Obvious morning stiffness

• Difficulty with «to get the back going» after rest

A stiff and less functional back will lead to poorer shock absorption and weight transfer when we stand and walk. And these burdens are something others have to deal with. Often it goes beyond the hips and knees in particular, which end up "cover up» for the weakened back function. People with a sore and stiff back often experience an increase in hip problems and knee pain. Which, unfortunately, can also increase the risk of osteoarthritis of the knees. For those of you who are unsure of how milder osteoarthritis can be experienced, we recommend our article 6 early signs of osteoarthritis.

- Why is my back extra stiff in the morning or after I sit down?

When we sleep, the circulation of oxygenated blood and synovial fluid in the body is reduced. This also applies when we sit (Maybe you have a sedentary office job?) quiet for several hours. Then, when you get up from a lying or sitting position, it will take some time for this circulation to start - and this can be experienced as both stiff and painful. There are good self-measures that can help counteract this by providing increased relief for the back. Among other things, when using pelvic floor pillow when we sleep, and ergonomic shock-absorbing seat cushion when we sit for long periods of time.

Our recommendation: Use a shock-absorbing, ergonomic seat cushion on the office chair

Many, many of us have jobs where we sit a lot. This results in a low-grade compression load on the lower back and hips. No problem if it was just now and then, but when sitting for x-number of hours every single day, this can lead to back pain and hip pain over a longer period of time. To reduce the pressure load on the lower vertebrae, we therefore recommend the use of shock-absorbing seat cushion with memory foam. This is of course also suitable for relieving stress in places other than the office. But it is a popular and cheap investment for many office landscapes that can have an effect on reduced sickness absence due to back problems. You can read more about our recommendation here .

A more ergonomic sleeping position can provide better recovery in the back and hips

Sleeping on your side is one of the most relaxing things you can do for your back and hips. This is also the position recommended for pregnant women, but also with one pelvic cushion with fastening strap between the knees. Such a pillow can lead to a better angle in the knees and hips when we lie on our side. The reason why it is recommended for pregnant women is precisely the relief of the back, pelvis, hips and knees. But it is actually a sleeping position that can suit the vast majority of us, and especially if you have osteoarthritis in your back, hips and/or knees.

Our recommendation: Try sleeping with a pelvic pillow with a fastening strap

The benefit of sleeping with one pelvic floor pillow lies in the fact that you can achieve an improved and more ergonomic sleeping position. But it is also important to mention that this resting position can also provide relief during painful periods as well (while awake). Many people use it simply to give their backs and hips a well-deserved break in everyday life. It also has a fastening strap that makes it easier to keep it in place when you sleep. You can read more about our recommendation here .

Spinal osteoarthritis can lead to cartilage damage and calcifications

It may not come as a surprise that osteoarthritis and wear and tear can cause physical changes to the vertebrae and their anatomical appearance. In the later stages of osteoarthritis, the body fights a desperate battle to try, as best it can, to repair the worn-out cartilage in the joints. Unfortunately, this is difficult for the body in the later stages of osteoarthritis because there is so much wear and tear. It therefore becomes an ongoing battle, which eventually, due to incomplete repair, causes the body to form extra bone and calcifications in the areas it is trying to repair. These calcifications, also known as calcifications, can cause the joint surface to take on a more "rugged" appearance, which also creates more friction during movement.

- Can change the way we walk

Both the back and the hip help to give us a normal movement pattern as we stand and walk. If you have a very stiff back, you will, for purely biomechanical reasons, get less shock absorption and worse weight transfer when you step on your feet. This could lead to guarded walking, meaning that you are almost afraid to put your legs down when you walk, and thus tense up. Such guarding can lead to a reduced stride length and also increase the risk of pain in the hip.

2. Causes of osteoarthritis in the back

Wear and tear changes in the spinal joints occur gradually, and occur more frequently as we get older. There are a number of factors that influence how we are affected by osteoarthritis. These include:

• Genetics

• Back curvature and scoliosis

• Previous back surgery

• Previous back injuries

• epigenetics

• Diet

• smoking

• Gender (women more at risk)

• Weight

• Age

The biggest risk factor for osteoarthritis is old age. A factor that is very difficult to do anything about. Previous injuries and back surgery can also lead to the early development of back osteoarthritis. But fortunately there are also factors that we can influence, and this includes especially maintaining stability muscles, a good diet and avoiding smoking. It is important to take active measures to improve your own back health. Osteoarthritis in the back and back pain are some of the most common causes of reduced quality of life and impaired function.¹

- As we get older, the chondrocytes' repair ability weakens

Chondrocytes are the body's cartilage repair team. They maintain and build cartilage. Their ability to repair the cartilage is unfortunately weakened over the years, which in turn results in wear-and-tear changes occurring on the joint surface and in the cartilage. Among other things in the form of what we call osteophytes – which are bony deposits on the articular cartilage surface. These lead to the joint surfaces not being as smooth, and can thus create friction and reduced mobility. In addition to pain from inside the facet joints themselves.

3. Self-measures against osteoarthritis

We have previously mentioned how you can relieve your back by using ergonomic seat cushion and use of pelvic pillow when you sleep. For further symptom relief, the use of back stretches can also be considered. But in addition to this, it is important to mention that focusing on diet, training back muscles and quitting smoking can be three beneficial self-measures to slow the development of osteoarthritis. Studies have shown that anti-inflammatory diet (read also: fibromyalgia diet) can reduce symptoms of certain types of osteoarthritis (knee osteoarthritis).² They showed in particular that turmeric and ginger had a documented effect and reduced inflammatory markers in the body. We have previously written two guides about exactly this, so if you wish, we recommend that you read the articles named 8 incredible health benefits of eating ginger og 7 amazing health benefits of turmeric.

Tips: Try a back stretch

The purpose of a back stretch is to open the facet joints and stretch the vertebrae apart. This treatment technique is also known as traction. By opening the facet joints during traction treatment, increased mobility and circulation of synovial fluid can be stimulated. Which of course can be beneficial for osteoarthritis. You can read more about the back stretcher here .

4. Prevention of osteoarthritis

All our clinicians at Vondtklinikkene Tverrfaglig Helse know that it is incredibly important that the patient himself is motivated to do something about his ailments. It is important to have a healthy body weight to reduce the strain on the vertebrae and other weight-bearing joints. Training of stability muscles and mobility training can help the body to relieve joints in osteoarthritis of the spine. Larger research studies have concluded that exercise is an important part of the holistic treatment of osteoarthritis.³ Regular movement and exercise will keep the blood circulation and synovial fluid going to prevent stiffening of the back.

VIDEO: 5 exercises against back osteoarthritis

In the video below shows chiropractor Alexander Andorff came up with a recommended exercise program against osteoarthritis consisting of five exercises. You will be able to reap good benefits from doing them every other day. In addition, you may also be interested in the training program we present in the article 8 exercises for back pain.

Join our family by subscribing for free our YouTube channel (click here) for more training programs and good self-help. We also point out that elastic training with mini bands can be beneficial for patients with back pain and hip pain.

5. Treatment of osteoarthritis in the back

Spinal osteoarthritis brings with it symptoms and problems in the form of both stiffness and pain. Our physiotherapists and chiropractors at Vondtklinikkene Tverrfaglig Helse work regularly with functional assessment, active treatment and rehabilitation training for patients with osteoarthritis. We know how important it is to see each individual as unique, and that is precisely why it is so important for us to have an individually adapted approach.

Physical treatment against osteoarthritis

Manual treatment techniques, i.e. physical treatment of joints and muscles, have a well-documented effect against osteoarthritis.⁴ Such treatment techniques may include:

• Physiotherapy

• Intramuscular acupuncture

• Joint Mobilization

• Modern chiropractic

• Therapeutic laser therapy

• Traction treatment (to free up space between the joints)

• Shockwave Therapy

Low-dose laser therapy in particular is a treatment method that more patients with osteoarthritis should be familiar with. This form of treatment has a well-documented effect, both in terms of functional improvement and pain relief, on osteoarthritis.⁵ You can, for example, read this the guide to low-dose laser therapy like ours clinic department at Lambertseter in Oslo has written. The link to the guide opens in a new browser window.

Training and rehabilitation exercises for osteoarthritis in the back

Don't quite know where to start when it comes to training against back osteoarthritis? Our physiotherapists are happy to help you get started with guidance and setting up individualized rehabilitation exercises. Just contact us if you are near one of them our clinics. If not, you can contact one of your local physiotherapists. But make sure they have a professional interest in osteoarthritis.

6. Diagnosis of osteoarthritis in the back

All investigations will start with a history taking (anamnesis). This means that at the initial consultation (your first visit to the clinician) you will tell about the symptoms and complaints you are experiencing. The therapist will ask relevant questions along the way to get as much information as possible about your ailments. You then move on to a functional examination. Here, the therapist will, among other things, look at:

• Your mobility

• Joint rash (specific joint testing)

• Your walking team

• Your muscle strength

• Painful areas (palpatory examination)

In addition to this, the therapist may also examine reflexes and perform certain orthopedic tests. If osteoarthritis is suspected, chiropractors have the right to refer for diagnostic imaging, including MRI and X-rays. To map osteoarthritis and wear and tear changes, it is best to use an X-ray.

Imaging examination of spinal osteoarthritis

An example of an X-ray of the back can be seen in the image below. After you have taken the picture, it will take approximately one week before we receive the radiology report.

Above we see an X-ray of the lower back - with clear wear and tear changes in the lowest lumbar vertebra (L5).

Do you see how there is less space at the bottom of the back there? And that the vertebra lies quite closely together with the one below? This is a common finding in more obvious osteoarthritis of the back.

Summarizeering: Osteoarthritis of the back (spondylarthrosis)

There are a number of good measures you can take if you have osteoarthritis. But one of the most important things is that you decide to take active steps and make changes. Feel free to start with easy, small steps and gradually work your way forward. If you need guidance or have questions, just contact us via message or via our pages on social media. We are passionate about achieving a better everyday life for you.

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Article: Osteoarthritis of the back (spinal osteoarthritis)

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene Tverrfaglig Helse

Fact check: Our articles are always based on serious sources, research studies and research journals, such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

Research and sources

1. Lindsey et al, 2024. Spinal Osteoarthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. 2023 July 9.

2. Mathieu et al, 2022. A Meta-Analysis of the Impact of Nutritional Supplementation on Osteoarthritis Symptoms. Nutrients. 2022 Apr 12;14(8):1607.

3. Daste et al, 2021. Physical activity for osteoarthritis: Efficiency and review of recommendations. Joint Bone Spine. 2021 Dec;88(6):105207.

4. Brakke et al, 2012. Physical therapy in persons with osteoarthritis. PM R. 2012 May;4(5 Suppl):S53-8.

5. Hamblin et al, 2013. Can osteoarthritis be treated with light?. Arthritis Res Ther 15, 120 (2013).

Photos and credit

• Illustration 1 (overview of facet joints): Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0 , via Wikimedia Commons.

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Frequently asked questions about osteoarthritis of the back (FAQ)

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