Last month, we addressed low back pain (LBP) in the younger patient (age 30-60), so it only seems appropriate to continue the discussion for those over the age of 60. As previously mentioned, back pain does NOT discriminate when it comes to age. In fact, chiropractors see many children and teenagers with low back pain as well as 90+ year-olds! Let’s take a look at the “usual” differences…
In the younger adult, facet syndrome and disk derangement are common conditions, and though this can still occur in the older adult, it becomes less common after age 60. The primary reason is because our disks become dehydrated or “dry up” as we age, making them less likely to herniate compared to a young, well-hydrated disk. During this “dehydration” process, the disks gradually narrow and bulge outwards. Therefore, in the 60+ year-old adult, disk-related pain is typically NOT from the soft liquid center herniating through the tough outer “annular” layer as it does in the younger patient. Rather, it’s from a combination of conditions. These conditions combine together and result in narrowing of the openings through which the nerve root exits the spine (called the neuroforamen).
The multiple conditions that contribute to this process include (but are not limited to): narrowing and bulging of the disk, osteoarthritis, or spurring extending off the vertebral endplates where the disk attaches, facet joint arthritis resulting in “hypertrophy” or enlargement, calcification of ligaments, and more. WHEN the neuroforamen narrows to the point of pinching the nerve root, symptoms occur. This condition is called “spinal stenosis” (SS), which literally means, “narrowed spinal canals” with entrapment of the spinal cord and/or nerves. Classic symptoms associated with SS include low back pain and stiffness. Most importantly, SS causes a gradual reduction in the amount of time that people with this condition can tolerate walking. Restricted mobility is initially subtle, but after months and years, walking may become more and more limited. That is, every time a certain time frame is reached (like 5 or 10 minutes of walking), the symptoms become significant to the point they force the SS patient to stop and sit or bend over often for one to two minutes, after which time they are able to resume walking for a similar amount of time.
Another common feature is that bending forwards HELPS (because it opens up the neuroforamen), and many SS patients walk bent over as their “norm.” When walking in a grocery store, they may lean forwards on the grocery cart because it allows for a longer, less painful walk. Other symptoms common with osteoarthritis (which always precedes SS), include morning stiffness, stiffness and pain when rising from sitting, decreased range of spinal motion or flexibility, localized painful joints, and others. As mentioned previously, degenerative joint disease or osteoarthritis is a slow, smoldering process that can often be traced back over the past 5, 10, and even 20 years.
As chiropractors, we can improve spinal joint flexibility and slow this process down. Give chiropractic a try as back pain in our elderly years DOES NOT have to be disabling!
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