The Spine

Discogenic DysfunctionSpinal StenosisPostural Dysfunction
ScoliosisSpondylolisthesisSacroiliac Dysfunction

Discogenic Dysfunction

Many patients with neck or back pain, arm or leg pain, or weakness of the upper or lower extremity muscles are diagnosed with a herniated disc. When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushed outside its normal position and into the spinal nerves that are very close to the edge of these spinal discs. When the herniated disc ruptures or pushes out, the nerves may become pinched.

A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine predominately due to poor posture or repetitive forward bending. When a herniated disc occurs, the space for the nerves is and irritation of the nerve results. Symptoms include pain that can radiate down the limb, electrical shocks, numbness and tingling, muscle weakness and even bowel and bladder dysfunction.

Treatment for discogenic dysfunction may include stretching, strengthening, stabilization and disc reducing exercises, as well as modalities such as ultrasound, traction, heat or cold, and IFC or TENS for further reduction of the disc and pain control. Education of the spine, ergonomics, and ADL (activities of daily living) training are crucial to treatment and prevention of discogenic dysfunctions.

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Spinal Stenosis

Spinal stenosis is the narrowing of the space surrounding the spinal cord or the spinal nerves. The spinal cord extends from the brain to the bottom of the spine. Along the spinal cord, spinal nerves exit the spine and extend to the rest of the body. Spinal stenosis affects men and women equally, and most often is seen in people over the age of 50 and often in people who have careers that are labor intensive. The most common cause of spinal stenosis is arthritis of the spine. It is uncommon to find this condition in individuals younger than 30 years old. When spinal stenosis does occur in younger patients, it is often related to traumatic injury to the spinal column.

Spinal stenosis can cause a wide variety of symptoms throughout the body with the most common symptoms being pain, numbness, tingling, and weakness. If the area of narrowing of the spine is in the cervical (neck) region, the symptoms are felt in the arms, and if the area of narrowing is in the lumbar (low back) the symptoms are felt in the legs.

Therapy is often beneficial for spinal stenosis for reduction of symptoms and correction of the mechanical dysfunction. Exercises are provided specific to the cause of the stenosis and modalites are used to improve mobility through pain and spasm reduction. Education is also extremely important in reducing symptoms and eliminating further episodes of back pain.

Postural Dysfunction

Postural dysfunctions occur over years of improper body mechanics and ergonomics. Postural dysfunctions can be the underlying cause of many diagnoses. With proper exercise and training, most postural dysfunctions can be corrected and further injury avoided.

Scoliosis

Scoliosis is the most common deformity of the spine. The most common form of scoliosis (over 80% of cases) is called "idiopathic scoliosis." meaning that the cause is not known. Idiopathic adolescent scoliosis is the most common type of scoliosis.

Congenital scoliosis is the result of an abnormality of the development of the vertebrae when the bones of the spine fail to develop normally. Also, some specific congenital syndromes can include a scoliosis deformity.

Another category of scoliosis is non-structural, or functional, scoliosis. This occurs when there is a problem with another part of the body that is causing a curve in the spine. For example, a discrepancy in leg length can cause the spine to curve to one side, pelvic rotations, or muscle spasms and inflammation. When a scoliosis is classified as non-structural, treatment is aimed at the underlying problem, not the spine itself.

Therapy can offer exercises specific to the nature of the scoliosis including curvature, muscle imbalance, tightness and addressing any underlying complications such as inflammation, spasm, leg length discrepancies or pelvic rotations.

Spondylolisthesis

Spondylolisthesis is the displacement of one vertebra on top of another. Spondylolysis means there is a specific defect in the bone of the vertebra. This bone defect may lead to spondylolisthesis (displacement), or it may not. The symptoms of spondylolisthesis can be wide ranging from an incidental finding on x-ray (no symptoms) to severe back and leg pain with nerve damage.

When the nerves exiting the spinal cord, or sometimes the spinal cord itself, become pinched by the spondylolisthesis, then nerve symptoms can result. Common nerve symptoms seen are similar to symptoms seen with a herniated disc including symptoms include leg pain, electric shock-like symptoms traveling down the leg, numbness or tingling in the legs and feet, and muscle weakness of the legs.

Any symptoms of problems with bowel or bladder function, or any numbness around the genitals, you should be alerted to your doctor immediately, as these symptoms may be a sign of cauda equina syndrome, and may be a medical emergency.

Therapy treatments include ROM, stretching, and stabilization exercises. Treatments may also include modalities such as ultrasound, heat or cold, and IFC or TENS, for muscle spasm and pain control.

Sacroiliac Dysfunction

There are many different terms for sacroiliac joint problems including: SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refers to a condition that causes pain in the SI joints from a variety of causes. Osteoarthritis is the most common cause of SI joint dysfunction.

Another common cause of SI joint dysfunction is pregnancy due to hormones being released in the woman's body that allows ligaments to relax preparing for child birth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern associated with pregnancy also places additional stress on the SI joints. The most common symptom of SI joint dysfunction is pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. The pain is typically worse with standing and walking and improved when lying down. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis.

Therapy has many treatment options for SI dysfunctions. These treatments range from exercises including stabilization and mobilization techniques to anti-inflammatory treatments to reduce pain and inflammation.