Diffuse idiopathic skeletal hyperostosis, also known as D.I.S.H is a misunderstood and often misdiagnosed source of back pain. Dr. Jimenez gives some insight into this condition and prevention. There are many health conditions that have back pain as a symptom. This is why it can be difficult to pinpoint the exact cause. Usually, this is not a problem because most cases of back pain resolve on their own in a matter of days or weeks. Spinal conditions like muscle strains and herniated discs are the usual suspects when back pain presents. But when the common conditions are not the cause healthcare providers need to delve deeper. One spinal condition that is rarely discussed or known by medical professionals is diffuse idiopathic skeletal hyperostosis. Along with D.I.S.H, it is also known as Forestier disease.

Diffuse idiopathic skeletal hyperostosis involves the tendons that connect muscles to bones and ligaments that connect the bones to each other, around the spine, begin to harden. This is a process called calcification. Bone spurs or osteophytes typically accompany the calcification process. However, the Arthritis Foundation states that bone spurs can develop along the spine but also around the:

• Hips
• Knees
• Shoulders
• Hands
• Throughout the body

Diffuse Idiopathic Skeletal Hyperostosis Symptoms

An important reason that diffuse idiopathic skeletal hyperostosis is not recognized and underdiagnosed is that many individuals do not experience symptoms. It is usually asymptomatic/without symptoms or mildly symptomatic. A healthy spine is flexible enough to distribute the force from a fall or hit and prevent injury. The condition fuses the spine. So someone with the condition suffers a fall and lands on their back has an increased risk of a fracture. Even low energy trauma could lead to a serious fracture. Common symptoms are:

• Stiffness that is worse in the morning
• Mild but constant low or upper back pain
• There could be symptoms of spinal stenosis where the pain radiates down the extremities or into the arms
• The most severe form can present as a fracture even after a low-energy trauma like a fall from a sitting position.
• Limited range of spinal motion
• Individuals can also experience sleep apnea
• Severe calcification in the cervical spine/neck can also compress the esophagus and trachea. This can lead to dysphonia/hoarseness and trouble swallowing or dysphagia.
• Extensive pressure along the spinal cord can lead to partial paralysis

D.I.S.H Risk Factors

Doctors and scientists still don’t know how or why the condition happens. There are some statistics that indicate which individuals are more likely to develop the condition:

Age

Around twelve percent of the general population is affected. However, the percentage increases with age. Individuals that are fifty and older have an increased risk of developing the condition. The average age of individuals with the condition is 65, with around twenty-eight percent of adults ages eighty and up being affected by the condition.

Sex

About twenty-five percent of men are affected and around fifteen percent of women.

Metabolic disorders

Individuals with certain metabolic disorders are at risk. These include:

• Type 2 diabetes
• Prediabetes
• Hyperinsulinemia
• Obesity

Injury/s

Injuries from lifting, moving heavy objects and falls increase the risk, as well as spinal injuries.

Diagnosis

Doctors and clinicians that are experienced in correcting diffuse idiopathic skeletal hyperostosis are more likely to recognize and properly diagnose it. X-rays and advanced imaging for the cervical, lumbar or thoracic spine have certain characteristic appearances that are easy to pick up. This is when an expert realizes an individual’s diagnosis and treatment plan requires reassessment. For further confirmation, a healthcare provider will order a computed tomography CT scan or magnetic resonance imaging MRI scan.

Treatment

Because the cause is not clearly understood and there are no medications yet, the treatment plan is usually to manage symptoms along with any complications. When the condition causes mild neck and back discomfort/pain, Conventional sprain, strain, and arthritis treatments can help ease the pain. These include:

• Heating pads
• Over-the-counter anti-inflammatories like aspirin and ibuprofen
• Exercises that a doctor and/or chiropractor/physical therapist recommend
• Physical therapy
• Orthotic shoe inserts can help relieve bone spur pain

Prevention

The condition can develop from common aging with few to no symptoms. Weight loss is important in the prevention of the condition. This is believed because issues like diabetes and high blood pressure seem to be associated with the condition.

• An anti-inflammatory diet is recommended along with bone health supplements
• Individuals need to learn to use proper posture when lifting and pulling heavy objects
• Follow a doctor, chiropractor-approved exercise routine slowly
• Wear the right supportive footwear

Spotlight

Body composition phase angle analysis

There is a condition known as Lymphedema and is characterized by chronic swelling in one or more areas of the body caused by an impaired lymphatic flow. Secondary lymphedema usually presents after cancer treatment or surgery. Because of this, it is crucial to monitor patients undergoing cancer treatment as this condition is commonly underdiagnosed until the edema progresses. There is no cure, so early detection is key to managing symptoms and progression, as well as, improving individual outcomes and quality of life. The InBody is a medical-grade bioimpedance device that measures body water and composition, providing thorough objective measures of fluid and muscle-fat. Lymphedema specialists use the InBody to:

• Monitor body water and composition for early detection and treatment
• Identify fluid imbalances through tracking segmental body water values and edema index variables
• Evaluate additional health risks

Based on objective data, clinicians can more effectively identify, treat and manage lymphedema, improving the success of the treatment programs.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Arthritis Foundation (n.d.), “Diffuse idiopathic skeletal hyperostosis,” www.arthritis.org/diseases/diffuse-idiopathic-skeletal-hyperostosis

Mayo Clinic (n.d.), “Diffuse idiopathic skeletal hyperostosis (DISH),” www.mayoclinic.org/diseases-conditions/diffuse-idiopathic-skeletal-hyperostosis/symptoms-causes/syc-20371661

StatPearls, August 10, 2020, “Diffuse Idiopathic Skeletal Hyperostosis,” via NCBI: www.ncbi.nlm.nih.gov/books/NBK538204/#article-23350.s2