FACTS & BELIEFS • Katerina Moustaka
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Degenerative Lesions

Having degenerative lesions does not mean you will necessarily suffer because of them.


Don't let your anatomy become your identity.

We live on a planet where a force called gravity continually pulls us downward . And we fall, we get up, we lift, we carry, we ride bicycles, we run, we jump, we fly, we move all our lives. Without going for “tune ups” at regular intervals.

So, it is only natural for myoskeletal pain to appear at some point. Without a specific injury. At least not a recent one. Sometimes it goes away. Sometimes it doesn't. And then we get started with doomsday scenarios. “I am in pain for 5 days/ 3 weeks/ 2 months now and it won't go away, so it must be something serious”.

And we decide, or our doctor does, that we have to do some diagnostic imaging tests, which – as their name suggests – give us an accurate image of our body's anatomy. Nothing more. X-rays, CT scans, MRIs are excellent tools. But we have to realize something very important. Their findings are indicative, not demonstrative.

So we do the tests. And the more we move away from the 2nd decade of our life, chances are increasing that we will get a result that sometimes “paralyzes” us, more immediately and effectively than the symptom itself.

Non-traumatic, musculoskeletal degenerative lesions have a lot of different names: disc herniation, spinal stenosis, degenerative spondyloarthropathy (a pompous term that simply means wear of the spinal column joints). Meniscus tear, supraspinatus tear, disc bulge, calcific tendonitis. Osteophytes (this is not even a diagnosis, it is a frequent phenomenon in osteoarthritis), tendinopathy, chondromalacea, cervical spondylosis, arthrosis...

And their reputation is even worse. Having being diagnosed with something of the above sounds like a prison sentence, and furtherm, one for life.

At this point I need to elucidate the fact that those of us who have graduated Medical School, have been trained to believe that the only, or the main cause of myoskeletal symptoms is structural deterioration, either traumatic or degenerative. So, any time a poor suffering soul arrives in the office, our first thought is to find what exactly has “broken down” anatomically in the area.

So we prescribe diagnostic imaging tests. And the older someone is, the higher is also the probability of them having degenerative lesions, which are considered the main “usual suspects”. And unfortunately, when their existence is confirmed by X-rays, CT scans or MRI’s, they are thought to be the sole cause of the symptoms.

The fact is that degenerative lesions:

• Are essentially a normal part of the ageing proces

• Exist, to some extend and in some joints, in everyone over 40.

• And most important, they are possibly NOT responsible, or at least exclusively responsible, for your symptoms...


Having degenerative lesions does not mean you will necessary suffer because of them.

• Four out of ten people with obvious osteoarthritic lesions as diagnosed by X-rays, do not experience any symptoms.

• Eight out of ten asymptomatic people over 40 have at least one herniated disc (half of them have two).

• Five out of ten asymptomatic women at 45 have osteoarthritic lesions, and at 55 have a meniscus tear.

• Five out of ten of those with osteoarthritis symptoms do not have obvious lesions.


Many are the factors that determine when someone will start feeling pain, and how intense it will be. An anatomical degenerative lesion is only one of them. So, if the lesion is not accompanied by a compatible clinical picture and positive neurologic and orthopedic tests, the diagnosis is at best inaccurate.

It is also highly limiting for the patients, who usually focus on following the indicated treatment for this diagnosis.

They identify with it, and based on it, they limit themselves. They “shrink” themselves.

How many of us have stopped riding our motorbikes or driving our high speed boats because at some point we were diagnosed with a herniated discs? How many have stopped exercising or running because they were diagnosed with a meniscus tear? How many ladies have stopped wearing high heels or dancing because they were diagnosed with chondromalacea patellae?

Let us not forget that, according to the bio-psychosocial model of anatomical degeneration, although there are indeed pathological characteristics that can cause pain, sickness behavior and disability is a product of beliefs, perception, experiences and emotions that are affected by our social environment.

Let us stop creating "patients" just on the basis of an X-ray or an MRI...


The most common bone disease


Osteoporosis is the most frequent disorder of the bones. It affects 25-35% of all women and 15-20% of all men above the age of 50. It is characterized by low bone mass, loss of calcium, low density and disruption of bone microstructure. All of the above reduce bone strength therefore increasing the risk of fracture.

Osteoporosis occurs most often in women (the frequency increasing after menopause) and affects both sexes in the ages above 70 y.o.a . It may also appear as a secondary effect after long-term immobilization or as a drug related side-effect ( high doses or prolonged use of corticosteroids drugs)

The most important fact we need to acknowledge is that osteoporosis does not cause pain by itself. It could remain “silent” for years, allowing the bone thinning to progressively worsen, but if not timely diagnosed it makes its presence known suddenly. The main clinical expression of osteoporosis is low energy fractures, caused by a light injury, such as falling from a standing position.

Early diagnosis (bone density scans), frequent exercise, dietary supplementation or/ proper medication – when necessary – support calcium absorption by the bones and can effectively delay or halt its advancement.


The anatomical cause of pain is not yet clear


Arthritis means inflammation of the joint. Out of 100 different types of arthritis, osteoarthritis is the most common. Anatomically, O.A. is characterized by the destruction of cartilage, -the material that covers the bone surfaces that come into contact within the joint- and is often accompanied by osteophytes (small bony projections made of calcium salts at the margins of the joint).



Osteoarthritis' main expression is pain and joint stiffness that worsen with inactivity. Sometimes the symptoms above are also accompanied by swelling of the joint after bodily strain.



It is a chronic, progressively advancing condition and directly related to:

• mechanical overload of the joints,

• The advancement of age, and

• High bodily weight.

Weight bearing joints are commonly affected: Knees, hips, lumbar and cervical spine facet joints, and sometimes the small joints of the hands.


Causes of symptoms

The appearance of osteoarthritic lesions in a joint does not always surmise the development of symptoms. And if we rely only on X-rays or other Diagnostic Imaging Modalities, we cannot explain why some people with minimal lesions experience intense symptoms, while others with extensive lesions experience minimal symptoms. On top of that, the osteoarthitic joint itself with the same degree of anatomical degradation can have flare-ups and remissions over time.

The anatomical cause of pain is not yet clear. Joint cartilage tear and marginal osteophytes are not the primary "usual suspects" anymore. The most recent view is that osteoarthritic pain is caused by inflammation of the joint capsule, a possible wear of the underlying tissue or legions of the bone marrow, as well as inflammation of fasciae, ligaments and tendons in or around the joint.



However, there is a functional component that is always present, both alongside the first appearance of symptoms, and in all subsequent ones: overload of the joint biomechnics. Either in the form of one-time or recurrent overload of a mechanically healthy joint that results in subluxation, disruption of its normal load distribution ability and causes its progressive degeneration, or as a normal load in an already subluxated joint that has lost its biomechanical protective mechanisms.

Even though we have no means of correcting or putting a stop to the degenerative process itself, we can usually treat the symptoms associated with it in a more than successful way. And even prevent their recurrence or further deterioration of the joints' anatomical integrity.

The later, however, requires a combined approach, involving both the practitioner and the patient.

Chiropractic can restore the function and biomechanics of the joint. Load distribution improvement and increased mobility not only reduces the pain and stiffness but also enhances both muscle and ligamentous strength, therefore providing support for the joint. Nevertheless, this will be pointless if the body itself is not supported by its owner.

Active treatment

• Regulation and maintenance of a steady body weight.

Being overweight increases both pain levels and the rate of joints' wear and tear. Reducing excess body weight just by 5 kg, decreases the probability of symptoms recurrence by 50%.

• Movement-activities

I realize that when we are in pain the last thing we want to do is work out. However, the most effective way of dealing with osteoarthritis is movement. Even simple activities such as walking, or mild tasks in the house or garden can improve joint mobility, reduce pain, and help stabilize our body weight at a more normal level.

• Exercise

Strengthening exercises promote muscle building around the arthritic joints, thus stabilizing the joint and facilitating load support.

Slow, gentle practices including stretching (Yoga, Tai-chi) improve flexibility and pliability.

Aerobic work outs like walking, swimming, bicycling and dancing, increase our stamina and energy levels.

All forms of exercise reduce pain and support our bodies against a possible recurrence or worsening of the symptoms. The form of exercise indicated in each case depends on the body type, our age, the severity of symptoms, and our own personality. The important thing for us to realize is that if we want to counteract osteoarthritis, a month-long exercise program won't do it.

We need to incorporate movement and exercise in our lives. Daily. For life.