When we speiik ot bone spurs, or "osteopliytes", the first thing that comes to most people's minds is the painful, bony growth that usually occurs on the heel. They arc noticed more, obviously, when they do occur on the heel, because of the mechanical positioning and weight-bearing of the foot. The presence of a bony spur may lead to the fonnation of tiny tumors at the end of several nerves, and these may be very painful. Bone spurs can occur in other areas, however, and they can develop in the spinal area. My two previous articles have described a situation where conservative treatment, which included proteolytic enzymes fora ruptured disc, enabled me to escape surgery and heal to the point of 100% normal function again. The MR1 (that I had done to determine where the rupture had occurred) identified spinal bone spurs that I also had to address. Fortunately, one of my employers is a chiropractor who has dealt with bone spurs frequently, and has implemented a successful support protocol for spurs that includes chiropractic manipulation, ortho-tic application (in the case of heel spurs), and a nutritional protocol. But first, let's take a look at what causes bone spurs, how they form, and then what to do about them. Bone Spur Formation In the heel, as a part of normal development, bone grows into the Achilles tendon as the calcaneus enlarges. Ossification is preceded by vascular invasion. Ossification is the formation or conversion into bone, however it can mean the pathological condition in which bone arises in tissue not in the osseous system, and in connective tissues usually not manifesting osteogenic properties. In other words, cartilage can turn into bone and create problems of pain. This ossification occurs along rows of enthesis (site of attachment of a muscle or ligament to bone) fibrocarti-lage cells, which are cartilage cells of parallel, thick, compact collagenous bundles, separated by narrow clefts containing typical cartilage cells (chondrocytes). Small bony spurs develop when ossification at one point on the enthesis outstrips that on cither side. Bony spurs can develop in the Achilles tendon without the need for preceding microtears or any inflammatory reaction, and they form by ossification of this fi-brocartilagc. It has been hypothc-sized by some researchers that the increased surface area created at the tendon-bone junction may be an adaptive mechanism to ensure the integrity of the interface in response to increased mechanical loads.1 However, many share the opinion (author included) that one of the main causes of bone spurs is nutritional—that, in fact, an alkalinizing state prevents soluble calcium, and that administering acidifying nutrients will support the removal of the spurs. The nutritional protocol for bone spurs, no matter where they are occurring, is the same. Fortunately, chiropractic manipulation, orthotic application (in the case of heel spurs), and a nutritional protocol can provide help for the situation. Bone Spurs on the Spine A recent anatomic study was conducted (March 15 issue of Spine, 2002) on 22 cadavers, looking at the associations between the fifth lumbar spinal nerve (L5 spinal nerve) and a lumbosacral tun- nel. consisting of the fifth lumbar vertebral body (L5 vertebral body), the lum-bosacral ligament, and sacral ala.2 Additionally, clinical case reports of four patients with lumbar radiculopathy secondary to entrapment of the L5 spinal nerve in the lumbosacral tunnel were recorded. Although several cadaveric studies on a lumbosacral tunnel, as a possible cause of L5 radiculopathy. have been reported previously, few studies had focused on osteophytes (bone spurs) of the L5-S1 vertebral bodies as the major component of this compressive lesion. Clinical reports on patients with this disease have been rare. Entrapment of the L5 spinal nerve in the lumbosacral tunnel was observed in six of the seven cadavers with L5-S1 osteophytes, but in only one of the twenty-two cadavers without such osteophytes. In addition to the cadavers studied, four patients were also observed who had neurologic deficits in the L5 nerve root distribution. MRI and myelography showed no abnonnal findings in the spinal canal, but CAT scans demonstrated prominent osteophytes on the lateral margins of L5-S1 vertebral bodies in all four. It was concluded that extraforaminal entrapment of L5 spinal nerve in the lumbosacral tunnel can cause L5 radiculopathy. and osteophytes of L5-S1 vertebral bodies are a major cause of the entrapment. Possible Causes The suggested causes of bone spurs are systemic alkalinity/parasympathctic tendency, being overweight, and calcium metabolism problems (which include a tendency to form calcium deposits, as in arthritics). It is imperative to have a good balance of calcium and magnesium when addressing bone spurs.' Sometimes extra magnesium is given when calcium has been supplemented out of proportion; a 1:1 ratio is OK. but a ratio higher than 2:1 calcium to magnesium is not recom-« mended, and it may be warranted, as it was in my case, to take a ratio of almost 2:1 magnesium to calcium. Proper amounts of magnesium will help prevent calcium deposits. It is not the calcium that's a problem, it just needs to be ioniz-able and absorbable. Calcium needs an acidic environment to be absorbed; this is why you will normally observe that reputable nutrition companies will include the nutrients in their calcium formulas that combat alkalinity, i.e., HC1 (hydrochloric acid), and vitamin C. Ever notice that one of the medical side effects from the popular acid antagonists (i.e., Tagamet, Pepcid AC, Axid, etc.) is osteoporosis? That's because suppression of the body's normal acid production reduces absorption of calcium. Nutrients such as magnesium and vitamin D will also facilitate absorption of calcium. Nutritional Applications for Bone Spurs Individuals may vary in their exact protocol and should attempt a protocol only under the supervision of a licensed professional. In my bone spur protocol, I followed a regimen that included an acidifying calcium: Calcium chelated to phosphate, ascorbate, and aspartatc, plus HCl (hydrochloric acid), ammonium chloride, and glutamic acid (elemental calcium amount was 40 mg., dosage was 2 TID). In addition, I took magnesium aspartate (70 mg., dosage 2 TID), and liquid phosphoric acid (75%, 13 mg., combined with inositol and choline) 10 drops TID in wa- ter. The phosphoric acid is a great calcium mobilizes but it is extremely important to remember that it is an acid and must be diluted with water before it is taken. If the patient yawns, it is usually a sign to drop back the dosage. Comprehensive essential fatty acid support is helpful to support a balance of inflammatory substances; fish oil. flax oil, and black currant seed oil are some of the oils that produce prostaglandins, lcukotrienes, and other hormone-like substances of a series that do not promote pain and inflammation. And, of course, protelytic enzymes taken away from meals will also help with pain and inflammation. \ uamin C and bioflavonoids support the integrity of collagen and connective tissue repair, and can be good adjunctive nutrition to include in the protocol. Chiropractic Tips Chiropractic adjustment will, of course, be helpful. For spinal bone spurs, adjustment will increase the integrity of the spine and help prevent mechanical overloads; for heel spurs, adjustment (not a specific ad-justment, but gentle manipulation of the foot), helps facilitate a return to homeo-stasis. Fitting the patient with orthot-ics that address heel bone spurs can be extremely beneficial. Making a lipstick mark on the orthotic impression where the exquisite tenderness occurs, in order to include a calcaneous spur cradle, will help to pinpoint the trouble area. Dietary and Lifestyle Tips A detoxification program is beneficial, and will help eliminate some of the problems of systemic alkalinity. Eat a healthy diet, free of refined foods. Keep citrus fruits (alkalinc-ash foods) intake to a minimum while on the protocol, and avoid sugar, alcohol, and coffee—they inhibit the healing process and can alter the mineral balance in the body. Long term support is needed; for heel spurs, wearing the proper shoes is * Continued on Page 23 ....from page 20 important; rubber heels may help, and orthotics with a calcaneous spur cradle may be necessary. Alternating hot and cold foot baths, with ice massages can provide some relief, and adding chamomile tea and arnica to the water will increase the effect. A linseed hotpack can help relieve pain. Avoid weightbearing exercises when bone spurs are! present—try swimming or biking, instead. Dr. Lynn Toohey received her Ph.D. in nutrition from Colorado State University in Ft. Collins, CO. She has lectured to chiropractors and other health professionals across the country and also in Canada and Europe on nutrition-related topics and complementary medicine. Various lecture engagements have included speaking for the International College of Applied Kinesiologv (ICAK), the United Chiropractors of New Mexico (UCNM), and the Florida Chiropractic Association (FCA). You may contact Dr. Toohey by e-mail at drtooheyfcv.nutri-west.com. References I . Henjamin M. Rufai A. Ralphs JR. "The mechanism of formation of bony spurs (enthesophytes) in the achilles tendon." Arthritis Rheum 2000 Mar:43(3):576-83. 2. Matsumoto M. Chiba K. Nojiri K. Ishikawa M. Toyama Y. Nishikawa Y. "Extralb-raminal entrapment of the fifth lumbar spinal nerve by ostcophytes of the lumbosacral spine: anatomic study and a report of four cases." Spine 2002 Mar 15:27(6):E 169-73. 3. Balch. J. & Balch. P. "Prescription for Nutritional Healing." Awry Puhl.. Ciarden Citv. NY. 1993.
