Spinal Osteoarthritis: Understanding Pain, Movement, and Treatment
Being told that you have osteoarthritis in your spine can sound as though your back is simply wearing out. Fortunately, the relationship between structural change, pain, and function is far more complex and more hopeful than that description suggests.
Osteoarthritis affects hundreds of millions of people worldwide. However, these global estimates primarily reflect osteoarthritis of the knee, hip, hand, and other peripheral joints rather than the spine specifically.
In the spine, osteoarthritis usually refers to degeneration of the facet joints, the small joints connecting adjacent vertebrae. It may occur alongside disc degeneration, osteophyte formation, or spinal stenosis, but these are related rather than identical conditions. Degenerative findings also become increasingly common with age and may be present in people with little or no pain.
If you have been diagnosed with spinal osteoarthritis, you may be wondering:
How much do the findings on my scan explain my symptoms?
What can I do to manage pain and stiffness?
Is it safe to remain active?
Which treatments and exercises are appropriate for me?
The Good News
Spinal osteoarthritis cannot be reversed, but its presence does not determine how much pain you will experience or what you will be able to do. Many people can improve their mobility, strength, confidence, and daily function through appropriate education, progressive exercise, activity modification, and, when suitable, manual therapy.
This article explains what spinal osteoarthritis means, how it is assessed, when imaging is useful, and how an individualized conservative-care program can support a more active life.
Article Index
Anatomy and Biomechanics of Spinal Osteoarthritis
The spine is not a stack of isolated bones. Each spinal segment includes two vertebrae, an intervertebral disc, paired facet joints, ligaments, muscles, and nearby nerves. These structures share load and coordinate movement.
Understanding this relationship helps explain why several degenerative changes may appear on the same scan and why imaging alone cannot determine which structure, if any, is causing pain.
Facet Joints: Facet joints are small, paired synovial joints located at the back of the spine. Like the knee and hip, they contain articular cartilage, a joint capsule, and synovial tissue. They guide spinal movement while helping control rotation, bending, and shear forces.
Facet-joint osteoarthritis may involve:
Thinning or irregularity of the articular cartilage
Changes in the underlying bone
Joint-space narrowing
Enlargement of the joint
Formation of osteophytes
Changes within the joint capsule and synovium
These tissues contain pain-sensitive structures and may contribute to symptoms in some people. However, facet-joint osteoarthritis becomes increasingly common with age and is frequently found in people without back pain. Its importance depends on whether the imaging findings correspond with the person’s symptoms, examination, and functional limitations.
Intervertebral Discs: Intervertebral discs are fibrocartilaginous structures located between the vertebral bodies. Each disc contains a tough outer annulus fibrosus surrounding a more hydrated central nucleus pulposus.
Disc degeneration is not technically the same process as facet-joint osteoarthritis, but the two frequently coexist. As a disc loses hydration or height, the way load is distributed across the spinal segment may change. This can increase the mechanical demands placed on the facet joints, ligaments, muscles, and adjacent vertebral endplates.
A degenerative disc does not automatically cause pain or nerve compression. These changes are also common in people without symptoms.
Vertebrae and Osteophytes
The vertebrae may adapt to changing loads by forming osteophytes, commonly called bone spurs. Osteophytes are signs of structural remodelling and are not inherently painful.
In some cases, osteophytes, enlarged facet joints, disc changes, and thickened ligaments can collectively reduce the space available within the spinal canal or neural foramina. When this narrowing affects a nerve root, symptoms may include radiating pain, numbness, tingling, or weakness. Spinal narrowing without corresponding neurological symptoms may simply be an incidental imaging finding.
Ligaments and Muscles
Ligaments help guide and limit spinal movement, while the surrounding muscles provide active support and control. When movement becomes painful or restricted, people may develop muscle guarding, reduced endurance, or altered movement strategies.
These adaptations can contribute to stiffness and reduced function, but they are not always permanent. Appropriate movement and progressive exercise can improve muscular capacity even when the underlying joint changes remain visible on imaging.
The Spine Functions as a Connected System
Changes in one structure can influence how other parts of the spinal segment share load, but this relationship is not a simple chain of damage. The body continually adapts to changing demands.
For patients and practitioners, the important question is not merely, “What does the scan show?” It is, “Do these findings help explain the symptoms, examination findings, and loss of function?”
Diagnosis of Spinal Osteoarthritis
Spinal osteoarthritis is not diagnosed from one test or imaging finding. Degenerative changes are common, particularly with increasing age, and may be present in people who have little or no pain. The central question is whether the findings correspond with the person’s symptoms, physical examination, neurological status, and functional limitations.
A comprehensive assessment may include:
A detailed history of symptom onset, location, behaviour, and effect on daily activities
Observation of posture, gait, balance, and movement
Assessment of spinal and hip mobility
Orthopedic and functional testing
Neurological testing when nerve involvement is suspected
Vascular screening when symptoms could have a circulatory cause
Diagnostic imaging when the results are likely to influence management
The examination also screens for conditions that can resemble spinal OA, including disc-related pain, spinal stenosis, radiculopathy, hip disorders, inflammatory disease, fracture, infection, vascular disease, and other causes of back or leg symptoms.
Orthopedic Testing
Orthopedic tests assess how symptoms respond to particular movements, positions, and mechanical loads. The examination may include spinal and hip range of motion, repeated movements, joint-loading procedures, palpation, gait analysis, and functional activities such as bending, walking, or transitioning between positions.
No individual orthopedic test can confirm that facet-joint osteoarthritis is the source of pain. Instead, clinicians interpret patterns across the history and examination while considering other possible explanations. The video demonstrates several commonly used procedures in a low-back examination.
Lower Limb Neurological Examination
A neurological examination is particularly important when back pain is accompanied by radiating leg pain, numbness, tingling, weakness, altered balance, or changes in walking.
The assessment may include:
Muscle strength testing
Sensory testing
Deep-tendon reflexes
Neural tension or neurodynamic testing
Gait, balance, and coordination
These findings help determine whether a spinal nerve root or another part of the nervous system may be affected. Progressive weakness, saddle numbness, or changes in bladder or bowel control require urgent medical assessment.
Peripheral Vascular Examination: Key Considerations
Not all leg pain originates from the spine. Reduced arterial circulation can produce cramping, aching, fatigue, or weakness during walking and may resemble symptoms associated with lumbar spinal stenosis.
When the history suggests a possible vascular contribution, the examination may include inspection of the skin, assessment of temperature and colour, palpation of peripheral pulses, capillary refill, and comparison of symptoms during activity and rest. Abnormal findings may require further medical or vascular investigation.
Imaging for Spinal Osteoarthritis
Imaging can reveal changes associated with spinal osteoarthritis, including facet-joint narrowing, osteophytes, subchondral sclerosis, disc-height loss, and narrowing of the spinal canal or neural foramina. However, these findings are common with increasing age and may be present in people without pain.
For this reason, imaging does not replace a clinical assessment. Its value depends on whether the findings correspond with the person’s symptoms, examination results, neurological status, and functional limitations.
Imaging is generally considered when:
Serious pathology, such as fracture, infection, or malignancy, is suspected
Neurological deficits are present or progressing
Symptoms persist despite appropriate conservative care
Trauma or significant structural instability is suspected
An intervention or surgical consultation is being considered
The results are likely to change clinical management
Key Imaging Modalities
X-Rays
X-rays provide a useful overview of spinal alignment and bony anatomy. They may reveal:
Facet-joint narrowing and sclerosis
Osteophytes
Reduced intervertebral disc height
Vertebral slippage
Deformity or fracture
X-rays cannot adequately show discs, nerves, the spinal cord, or most soft tissues. They may demonstrate changes associated with spinal OA, but they cannot establish whether those changes are causing pain.
Magnetic Resonance Imaging
MRI provides detailed images of the intervertebral discs, spinal cord, nerve roots, ligaments, bone marrow, and other soft tissues. It is particularly useful when spinal stenosis, nerve-root involvement, myelopathy, infection, malignancy, or another soft-tissue condition is suspected.
MRI may demonstrate:
Disc desiccation and loss of disc height
Disc bulging or herniation
Annular fissures
Facet-joint enlargement or effusion
Spinal canal or neural foraminal narrowing
Nerve-root or spinal-cord compression
MRI findings must be interpreted carefully. A disc bulge, osteophyte, or narrowed foramen may be clinically important, incidental, or one contributor among several.
Computed Tomography
CT provides excellent detail of bony anatomy and can demonstrate:
Facet-joint degeneration and hypertrophy
Small osteophytes
Fractures
Bony narrowing of the spinal canal or neural foramina
Complex structural abnormalities
CT may be useful when MRI is unavailable or contraindicated, or when detailed assessment of bone is required. Because CT uses ionizing radiation, it is not routinely needed for uncomplicated spinal pain.
Bone Scans and SPECT/CT
Bone scintigraphy and SPECT/CT detect areas of increased bone turnover. They are not routine tests for diagnosing spinal OA and should not be described as methods for detecting “early OA.”
In selected cases, they may help investigate unexplained focal pain, occult fracture, infection, malignancy, or metabolically active areas when other imaging has not provided a clear answer. Increased tracer uptake is not specific to osteoarthritis and does not prove that an identified area is the source of pain.
Ultrasound
Ultrasound has a limited role in evaluating the deep structures of the spine. It cannot provide the same view of the spinal canal, neural foramina, discs, or facet joints as MRI or CT.
Its main applications are assessing selected superficial soft tissues and assisting with certain image-guided procedures. Ultrasound is therefore not a primary diagnostic test for spinal osteoarthritis.
Imaging Must Be Interpreted in Context
There is no single imaging feature that establishes spinal OA as the cause of a person’s symptoms. The most clinically meaningful interpretation comes from asking whether the anatomical findings match:
The location and behaviour of the symptoms
Aggravating and relieving movements
Orthopedic and neurological findings
Walking and activity tolerance
Functional limitations
Changes observed over time
The scan shows structure. The clinical assessment determines whether that structure helps explain the person’s pain and loss of function.
Understanding Spinal OA Grades
“My scan says I have severe osteoarthritis. What does that actually mean?”
Terms such as mild, moderate, and severe usually describe the appearance of structural changes on imaging. They do not necessarily describe how much pain a person will experience, how limited they will become, or which treatment they require.
There is no single grading system used for every region of the spine or every type of degeneration. Radiologists may separately evaluate facet-joint osteoarthritis, intervertebral disc degeneration, osteophytes, spinal stenosis, and neural foraminal narrowing.
For lumbar facet-joint osteoarthritis, one commonly used radiological system is the Weishaupt classification, which grades changes from 0 to 3:
Grade 0: No evidence of facet-joint osteoarthritis
Grade 1: Mild joint-space narrowing, small osteophytes, or mild enlargement of the articular processes
Grade 2: More apparent joint-space narrowing, moderate osteophytes or joint enlargement, and possible early bone erosion
Grade 3: Marked joint-space narrowing, large osteophytes, pronounced joint enlargement, bone erosion, or subchondral cysts
Other grading systems may use different criteria. The terminology in a radiology report should therefore be interpreted according to the structures and classification being described.
Mild Spinal OA
Typical imaging findings:
Mild facet-joint narrowing
Small osteophytes
Early joint enlargement or sclerosis
Relatively preserved surrounding anatomy
Some people experience intermittent stiffness or discomfort, while others have no symptoms. Mild imaging changes do not mean that the condition will inevitably progress or become painful.
Management is based on symptoms and function. Staying active, developing strength and physical capacity, and addressing relevant lifestyle factors may help maintain mobility and confidence.
Moderate Spinal OA
Typical imaging findings:
More noticeable facet-joint narrowing
Moderate osteophyte formation
Joint hypertrophy
Possible disc-height loss or narrowing of nearby spaces
These findings may contribute to pain or movement limitations, but they can also be incidental. Treatment decisions should consider whether the imaging corresponds with the person’s symptoms, examination findings, and activity limitations.
A management plan may include education, progressive exercise, activity modification, medication when appropriate, and manual therapy as an adjunct to active rehabilitation.
Severe Spinal OA
Typical imaging findings:
Marked facet-joint narrowing
Larger osteophytes
Pronounced joint hypertrophy
Subchondral sclerosis, erosion, or cyst formation
Possible narrowing of the spinal canal or neural foramina
Severe structural changes do not automatically mean severe pain, disability, or the need for surgery. Some people remain active despite extensive degeneration, while others experience substantial symptoms with less dramatic imaging findings.
The clinical importance increases when structural changes correspond with progressive neurological deficits, spinal instability, significant stenosis, or persistent functional limitations. Surgical consultation may be appropriate in selected cases, but the decision is based on the complete clinical picture rather than the OA grade alone.
The Grade Describes the Image, Not the Person
An imaging grade is one piece of information. A meaningful assessment also considers:
The location and behaviour of symptoms
Neurological findings
Mobility, strength, and activity tolerance
The effect on work and daily life
General health and personal goals
Response to previous treatment
The purpose of grading is to describe structural changes consistently. It is not a forecast of inevitable decline. Treatment should be tailored to the person, not simply to the language used in the imaging report.
The Role of Manual Therapy in Managing Spinal OA
Manual therapy may help people with spinal osteoarthritis experience improvements in pain, stiffness, mobility, and day-to-day function. It does not reverse cartilage loss, remove osteophytes, restore disc height, or change the underlying appearance of osteoarthritis on imaging. Its value lies in helping the person function more comfortably despite those structural changes.
Over more than 30 years in clinical practice, I have seen many patients use spinal mobilization, soft-tissue treatment, myofascial techniques, and procedures informed by traditional Chinese medicine to remain active and manage their symptoms. For some, this has meant continuing to exercise, work, travel, or participate more fully in daily life. These clinical observations do not mean that everyone will respond in the same way, but they reflect an important goal of conservative care: improving quality of life even when the underlying condition cannot be reversed.
Spinal symptoms rarely depend on one structure alone. Facet-joint changes may coexist with disc degeneration, muscular guarding, reduced hip mobility, altered movement patterns, decreased physical capacity, and increased nervous-system sensitivity. Treatment should therefore focus on the person’s symptoms and functional limitations rather than attempting to correct an imaging finding.
Manual therapy may include:
Spinal manipulation or mobilization
Soft-tissue and myofascial techniques
Acupressure or procedures informed by traditional Chinese medicine
Assisted movement
Neurodynamic procedures when clinically appropriate
Treatment of related restrictions in the hips, pelvis, and surrounding regions
The type, intensity, and frequency of treatment should be adapted to the individual’s comfort, health history, bone quality, neurological findings, goals, and response to care. Continued treatment should produce a meaningful benefit, such as easier movement, greater activity tolerance, improved sleep, or better participation in exercise and daily life.
Manual therapy is generally most valuable when it creates an opportunity for movement. Reduced discomfort may make it easier to exercise, rebuild strength and endurance, and gradually return to meaningful activities. Some patients may benefit from periodic treatment to help manage recurring stiffness or pain, while others may need only a short course of care. The need for ongoing treatment should be reassessed rather than assumed.
Chiropractic Adjustments
This video demonstrates one form of spinal manipulation that may be considered for a person with spinal OA. Other options include lower-force mobilization, table-assisted procedures, or movement-based techniques.
These procedures are intended to influence pain, mobility, and neuromuscular responses. They should not be described as repositioning vertebrae, restoring perfect alignment, or reversing osteoarthritis.
Treatment selection depends on:
Symptom irritability
Spinal mobility
Bone density and fracture risk
Neurological status
Coexisting conditions
Patient preference
Response to previous care
Some patients prefer manipulation, while others are more comfortable with slower mobilization. Neither approach is universally appropriate, and treatment should be modified or discontinued if symptoms worsen or meaningful functional benefits are not observed.
Fascial Expansion: MSR Low Back Pain Protocol
In this video, Dr. Abelson demonstrates fascial expansion procedures used within a Motion Specific Release low-back protocol. These techniques apply controlled pressure and movement to selected soft tissues while considering their relationships with nearby joints, nerves, and functional movement patterns.
Motion Specific Release has evolved beyond treating an isolated muscle or presumed fascial restriction. The current approach integrates clinical assessment, joint and soft-tissue procedures, neural mobility, functional movement, and progressive exercise. The objective is to identify modifiable factors that may be limiting movement or contributing to symptoms.
Fascial expansion techniques may help some patients move with less discomfort and participate more fully in rehabilitation. They do not break apart osteophytes, rebuild cartilage, or prove that fascia is the source of pain. Their value should be assessed through meaningful changes in symptoms, mobility, activity tolerance, and quality of life.
Manual therapy is not the entire treatment, but for the right patient, it can be a valuable part of living well and remaining active with spinal OA.
Exercise: Building Capacity With Spinal OA
Exercise is one of the most important components of managing spinal osteoarthritis. It cannot rebuild lost cartilage, remove osteophytes, or restore disc height, but it can improve mobility, strength, endurance, balance, confidence, and the ability to perform daily activities.
Regular physical activity also supports cardiovascular health, sleep, metabolic health, and emotional well-being. These benefits become particularly important when spinal pain has caused someone to reduce activity or become concerned about movement.
There is no single exercise program for spinal OA. The most appropriate starting point depends on:
Whether symptoms involve the neck, lower back, or both
The person’s current strength and mobility
Symptom sensitivity and movement tolerance
The presence of spinal stenosis or neurological symptoms
Balance and fall risk
General health, previous activity, and personal goals
A well-rounded program may include comfortable spinal mobility, trunk and hip strengthening, aerobic conditioning, balance training, and gradual practice of meaningful activities such as walking, lifting, carrying, or gardening.
Exercise Examples
The following exercises represent only a small selection of what may be included in a spinal OA program. They are demonstrations rather than personalized prescriptions. Exercise selection, range, resistance, and progression should be based on the individual’s clinical presentation and response.
Cat-Camel Movement
The Cat-Camel is a gentle movement that takes the spine through a comfortable range of flexion and extension. It may help reduce morning stiffness, maintain spinal mobility, and increase confidence with movement.
The goal is not to force the spine to its end range. The movement should remain smooth, controlled, and comfortable. Some people find it helpful after getting out of bed and moving around briefly, while others may prefer to perform it later in the day.
Bird Dog Exercise
The Bird-Dog is performed from a four-point kneeling position and challenges trunk control while the opposite arm and leg move away from the body. This exercise can help develop:
Trunk and hip endurance
Coordination between the upper and lower body
Control of unwanted spinal rotation
Balance and proprioception
Confidence with loaded movement
The exercise can be modified by moving one limb at a time, reducing the range, or sliding the hand or foot along the floor. Progression should be based on control and tolerance rather than how high the arm or leg can be lifted.
Swiss Ball Squat
A Swiss-ball wall squat may provide a supported way to practise squatting when an unsupported squat is difficult. It can strengthen the quadriceps, gluteal muscles, hamstrings, and other muscles involved in standing, walking, and climbing stairs.
The ball does not automatically make the exercise safe or ensure ideal alignment. Foot position, squat depth, balance, surface stability, and symptom response must still be considered. Some individuals may be better served by a sit-to-stand exercise or a supported squat using a stable rail or countertop.
Balance Exercises
Balance training may be valuable for people whose spinal pain, reduced activity, weakness, medication use, or age-related changes have affected stability and confidence.
Exercises may progress from standing with a wider base of support to narrower positions, stepping tasks, reaching movements, or controlled single-leg activities. A stable support should remain within reach when needed.
Balance exercises do not treat spinal OA directly, but they can improve functional mobility and may help reduce fall risk when incorporated into a broader, appropriately progressed program.
From Exercise to Everyday Function
The ultimate purpose of exercise is not simply to perform isolated movements correctly. It is to develop the capacity needed for daily life.
Progress should therefore extend toward the activities that matter to the individual, whether that means walking farther, lifting groceries, returning to recreation, working comfortably, playing with grandchildren, or maintaining independence.
The goal is not to protect the spine from every load. It is to build a spine and body that can tolerate more.
A Practical Approach to Managing Spinal OA
Spinal osteoarthritis cannot be reduced to an imaging grade or treated with one universal protocol. Effective care begins by understanding the individual: where symptoms are felt, which activities are limited, how the nervous system is functioning, and what the person wants to regain.
A comprehensive approach may include several interconnected elements:
Assess the person, not just the scan: Imaging findings should be compared with the history, physical examination, neurological status, movement tolerance, and functional limitations. Degenerative changes may be relevant, incidental, or one contributor among several.
Explain the findings clearly: Terms such as degeneration, bone spurs, and severe arthritis can sound alarming. Patients should understand that structural changes do not automatically predict pain, disability, or inevitable decline.
Use manual therapy when appropriate: Mobilization, manipulation, soft-tissue treatment, myofascial techniques, and related procedures may help reduce pain or stiffness and make movement more comfortable. These treatments do not reverse OA, but they may help some people remain active and participate more fully in rehabilitation and daily life.
Build physical capacity through exercise: Individualized exercise can improve mobility, strength, endurance, balance, and confidence. The program should progress toward the activities that matter to the patient rather than remain limited to isolated rehabilitation exercises.
Address the broader context: Sleep, general health, stress, physical activity, body weight, work demands, and beliefs about pain can all influence symptoms and recovery. These factors should be considered without implying that pain is simply psychological or the patient’s fault.
Measure meaningful progress: Improvement should be evaluated through changes that matter, such as walking farther, sleeping better, returning to exercise, working more comfortably, or performing daily tasks with greater confidence. Imaging changes are not required for meaningful recovery.
Adapt the plan over time: Treatment frequency, exercise difficulty, and activity goals should change as the person improves. If meaningful progress is not occurring, the diagnosis and management plan should be reconsidered.
Recognize when referral is needed: Progressive neurological deficits, significant trauma, systemic illness, suspected fracture or infection, or substantial functional decline may require medical investigation or specialist consultation.
The most useful approach is neither entirely passive nor based on exercise alone. Manual therapy may help create a more comfortable opportunity for movement, while exercise develops the capacity required for lasting function.
The goal is not to create a structurally perfect spine. It is to help the person move with greater confidence, remain active, and maintain the best possible quality of life despite the changes associated with spinal OA.
REFERENCES
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811–816.
GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023;5(9):e508–e522.
Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nature Reviews Rheumatology. 2013;9(4):216–224.
George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11):CPG1–CPG60.
Hutchins TA, Peckham M, Shah LM, et al. ACR Appropriateness Criteria Low Back Pain: 2021 update. Journal of the American College of Radiology. 2021;18(11S):S361–S379.
Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Seminars in Arthritis and Rheumatism. 2007;37(2):69–80.
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National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE Guideline NG59. NICE; 2016, updated 2020.
Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis and Cartilage. 2013;21(9):1145–1153.
Perolat R, Kastler A, Nicot B, et al. Facet joint syndrome: from diagnosis to interventional management. Insights into Imaging. 2018;9(5):773–789.
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World Health Organization. WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings. World Health Organization; 2023.
Disclaimer:
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
Viewing or using this content does not establish a practitioner-patient relationship. If you have questions about a medical condition or symptoms that are new, severe, or worsening, consult an appropriately qualified healthcare provider.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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