By Christina Nowak BSc, MScPT, PhD(c)
Low back pain and hip pain are two large contributors to pain and disability as we age. Many doctors prescribe XRays as a first means to investigate what might be going on. Previously, I have done articles related to back pain and knee arthritis that has shown that the degree of arthritis does not seem to predict pain and dysfunction. In fact, taking images of persons without knee pain or back pain has shown signs of degeneration in a majority of cases.
Is this going to be true of all joints?
Maybe? A study published this month in the Journal of Bone and Joint Surgery (1) by Eno and colleagues did a similar investigation into the sacroiliac joint (SI joint). The SI joint is located at the base of the spine and is the link between the spine and the pelvis. In this study, they looked at 500 individuals who were going into an abdominal CT scan for unrelated circumstances (for example abdominal cancer) and therefore had no complaints of hip or low back pain. What they found was that the older you are, the more likely you are to have degeneration in that joint. This makes sense as living life creates more wear and tear of the joints in your body.
In persons as young as 50-59, 68% of persons had some evidence of degeneration in the SI joint, with 29% of those cases deemed significant. When you go up to the 80-89 age category, those numbers jump to 91% and 43%. This is showing that even persons who are asymptomatic, i.e. have no back pain, can show breakdown at this joint.
So is arthritis a cop out?
In my opinion, the answer is we don’t really know. Do I think that we can use this as a reason to not perform activities to strengthen and maintain the integrity of our joints? No. Persons do get relief after joint replacements but this opens the question as to whether this is the real cause of the pain or something else related to the arthritic process. Conservative management of arthritis at a variety of joints has been shown to be effective in relieving pain related to arthritis which usually consists of stretching and strengthening of joints in the lower body. Maybe we should be pushing for an intake process that requires an exercise-based intervention be trialed before entering into a surgical intervention.
Studies such as these provide further proof that even though a picture says 1000 words, sometimes it doesn’t tell the whole story.
1. Eno JT, Boone CR, Bellino MJ, Bishop JA. The prevalence of sacroiliac joint degeneration in asymptomatic adults. J Bone Joint Surg Am. 2015. 97: 932-6.