First question: which kind?
Osteoarthritis is mechanical — local wear and tear. The disc loses height, the facet joints enlarge, bone spurs form. It’s the body’s attempt to stabilize a joint that’s losing integrity. It responds to movement, weight management, and maintaining muscle strength around the spine. Sometimes it needs targeted intervention — nerve blocks, ablation, or in advanced cases, surgery to decompress the nerves it’s crowding.
Inflammatory arthritis is a completely different animal.
- Rheumatoid arthritis, ankylosing spondylitis, reactive arthritis — these are systemic. Your immune system is attacking your own joints. Ankylosing spondylitis in particular is one I watch for in young men in their 20s and 30s with morning stiffness that gets better with movement, not worse. That pattern — stiffness that improves when you move — is the opposite of mechanical pain and it’s a red flag for something autoimmune.
The treatment paths diverge completely. Osteoarthritis is managed with movement, loading, and upstream prevention. Inflammatory arthritis needs a rheumatologist and often immunomodulating medication.
One thing I never tell patients: stop moving. People who exercise have less pain long-term than people with pristine spines who sit on the couch. The answer is almost never “stop running” or “stop lifting.” The answer is modify the movement to match the problem.
If someone told you that you have arthritis and didn’t specify which kind, go back and ask. It changes everything
