In a spinal pain syndrome, a number of things may cause pain: facet joints may have become inflamed; muscles may have become tight and painful; a disc may be injured, and so forth. If the source of pain is inflamed facets, a symptom-based practitioner may prescribe rest, anti-inflammatory drugs or some form of therapy. The inflammation would go away, and the treatment would be seen as successful. Similar treatment philosophy would be used for other sources of pain. Those familiar with spinal pain syndromes will realize that patients treated in such a manner will likely continue to experience episodes of pain, and eventually end up with a degenerated spine. Why? Facets inflame for a reason. Muscles tighten for a reason. They do so as a result of factors that usually include an underlying change to the spine's function and structure.

The Underlying Changes To a Spine

Over a person's lifetime, the spine is usually subject to trauma, abnormal stress and other forms of abuse. When the spine is injured, the natural response is for the body to make adaptations to take the load off the effected joint while it heals. Such adaptations may include tightening intrinsic muscles to immobilize the area, adopting an unnatural static position and the recruitment other joints to compensate. It is known that changes gradually occur to immobilized or unusually stressed joints. For example, muscles and ligaments associated with the immobilized joint will shorten and\/or waste. Some scar tissue may form. If healing is prolonged, or damage is repeated (such as occurs with habitual bending and twisting or poor posture), these changes will become significant and will result in the abnormal spinal biomechanics remaining. Abnormal spinal biomechanics may cause the following to occur.

Functional Changes

	The relationship between facet joint surfaces may later, creating abnormal stress.
	There may be various forms of interference to nerve roots.
	Muscles may become chronically tight, under abnormal load, or be underused.
	Joints may become hypermobile in compensation for hypomobile joints.
	The body may use further compensatory measures to protect from the ongoing injury caused by the four factors listed above.
	Neurological feedback from joints is used to control balance, movement and coordination. Abnormal joints will send abnormal information, interfering with these processes.

Structural Changes

	The muscles and ligaments associated with hypomobility, making the problem progressively wore.
	Without the pumping effect of movement, joint linings and discs associated with hypomobile joints will be deprived of nutrients and will suffer a build-up of waste products, causing a gradual deterioration.
	There will be a re-adaptation of muscles and ligaments to suit the abnormal movement.
	The growth of young bone responds to stress, while older bone remodels with osteophytes. Long-term functional changes will cause changes in bony structure.

Why This Condition May Not Cause Pain for Years?

Despite all the changes and abnormal stress, this condition may persist causing ongoing deterioration for years without causing pain. Some reasons follow:

	Abnormally loaded muscles may become tender and develop myofascial trigger points. Pain will not occur until something such as a strain or a chill finally aggravates them.
	When a disc develops tears, it is not until the rear reaches the innervated outer layers that pain signals are generated.
	Just as mild sunburn is not painful unless slapped, mildly irritated and damaged facet joints may not be painful until aggravated.
	Spinal degeneration has to be substantial before there is bony occlusion of the nerve root pathways.
	A spine may stiffen significantly before there is not enough pain-free movement to do essential tasks.
	Compensating parts may cope with the extra demands for a long time before deteriorating or being unable to cope.

Why Symptom-Based Care Usually Does Not Correct the Underlying Problem?

Significant wasting occurs to an arm or leg placed in a cast for six weeks. Frozen shoulders may result from a relatively short period of immobilization. These examples demonstrate how significant and rapid structural changes may occur due to abnormal function and help explain the possible extent of changes to the spine as a result of years of dysfunction.

Blennerhassett, G.
How to Get Rid of Your Back Pain…So it Stays Away.
1999 Self-published in Australia

For further consideration:

Why continue care after the pain is gone?

Why should you see your chiropractor a minimum of once a month?

According to the Journal of Manual and Physical Therapy October 2000:

	Patients 65 and older who see a chiropractor a minimum of one time per month make half the annual visits to a MD (4.76) compared to the national average (9).
	Expenditures for 65 and over is estimated to be $10,041 annually. Total annual health care cost associate with 65 + receiving chiropractic maintenance care was $3,106. Maintenance care patients in this study spent only 31% of the national average for health service for their age group.
	The average spending on hospital care was $1723 for the chiropractic patients versus $3510 for the non-chiropractic patient.