Low Back Pain

Low back pain is a condition that will affect 80% of the population at some point in their life.  Fortunately, for the majority of these cases, the problem will resolve itself without any medical intervention.  And, of the low back pain cases that do require medical intervention, the majority of those episodes can be managed without surgery.

Good news, right?  Well it is if the problem were well understood.  Unfortunately, however, low back pain is not that well understood and has been an enigma to the medical community for centuries. 

Written by Malton A. Schexneider, PT, MMSc

Degenerative Disc Disease

Degenerative disc disease is a term often used to explain the process of low back pain.  Although the intervertebral disc can be is a potential source of low back pain, it’s important to remember that low back pain has many causes and we aren’t always 100% certain of exactly why people experience back pain.  The purpose of this article is to describe the process of degenerative disc disease , the symptoms associated with the condition, and the treatment options available.

The spine is made up of 24 moving vertebrae stacked one on top of each other.  Between 22 of these vertebrae are the intervertebral discs (there are no discs between the base of the skull and the first cervical vertebra or between the first and second cervical vertebrae).  Health care practitioners will often use terms like degeneration or degenerative disc disease to describe the natural changes that take place to the disc due to aging, but in no way do these terms mean your spine is degenerating or that you’re headed for pain in the future. 

Written by Malton A. Schexneider, PT, MMSc

Neck Pain

Neck pain is not as prevalent as back pain when reviewing the medical literature primarily because it is often included under the heading of “back pain”.  Neck pain is also difficult to differentiate from shoulder pain as the two conditions often overlap one another.  Nevertheless, neck pain does represent a common reason people visit their doctor and will be reviewed here.

There are many causes of neck pain many of which overlap one another. Below is a brief overview of some of the most common causes of neck pain.

Written by Malton A. Schexneider, PT, MMSc

Spondylolisthesis

Spondylolisthesis is a condition of the spine where one vertebrae slips forward over the one below it. As the bone slips forward, the nearby tissues and nerves may become irritated and painful causing localized low back pain and sciatica.

Spondylolisthesis can be present at birth, occur in childhood as a result of injury or be present in older adults as a result of degeneration of the disc and spinal joints.

Written by Malton A. Schexneider, PT, MMSc

Spinal Stenosis

Spinal stenosis is a term used to describe narrowing of the bony canal surrounding either the spinal cord or the opening through which the spinal nerve exits the spine.  Narrowing within the spinal canal is referred to as central stenosis while narrowing of the opening through which the spinal nerve exits is called lateral stenosis.  In either case, spinal stenosis is a consequence of the degenerative changes that take place within the spine as a natural course of aging.

Following medication management, physical therapy may also be incorporated into the treatment regimen.  The goals of physical therapy to treat spinal stenosis include the reduction of symptoms, restoration of functional movement, and patient education on how to best manage the condition on your own.  Spinal decompression therapy or traction is often recommended and may be beneficial in alleviating symptoms by taking pressure off the spinal nerves.  Specific strengthening and endurance exercises are often prescribed at this stage to maintain spinal health and build tolerance to daily activities.  Here’s a simple exercise that will often take stress off the spine ===> Treatment for Spinal Stenosis

Written by Malton A. Schexneider, PT, MMSc

Spinal Arthritis

Spinal arthritis associated with the degeneration of the spinal facet joints has been implicated in the development of neck and back pain.  These joints link each vertebra together and a pair of these joints are located on the backside of the spinal column.  The facet joints are responsible for providing some load bearing activity as well as providing stability to the spine.  In addition, they restrict excessive rotation of the spine.

Like most skeletal joints, the facet joints fit together and glide smoothly without excess friction being developed.  If sustained pressure begins to build within the joints, the cartilage on the joint surfaces begins to wear away creating joint inflammation.  This entire degenerative process is referred to as spondylosis or spinal arthritis.

Written by Malton A. Schexneider, PT, MMSc

Sciatica

Sciatica nerve pain describes irritation of the sciatic nerve and the associated symptoms that ensue.  People complaining of sciatica symptoms will usually report discomfort, numbness, or tingling sensations in the buttocks and extending into the back of the thigh, the back and outside part of the lower leg, and around the outside part of the ankle and top of the foot.

When a medical diagnosis of sciatica is made, it will often be referred to as “radiculitis” or “radiculopathy”, which simply means irritation of the nerve root in the lower back.  An important note here is that sciatica is often times the result of irritation of the sciatic nerve outside the spine.

Written by Malton A. Schexneider, PT, MMSc

Piriformis Syndrome

Piriformis syndrome is a common condition whose clinical presentation is often mistaken with disc herniation and/or spinal stenosis.  The symptoms of piriformis syndrome include pain in the buttocks and, often times, sciatic nerve pain.

The piriformis is a small muscle situated deep in the buttocks that runs from the sacrum (tailbone) to the hip.  The piriformis, along with 5 other small muscles deep in the buttocks functions to externally rotate the hip (toes pointing outward).  Because of its position in the buttocks, the piriformis lies in close proximity to the sciatic nerve and its branches.  In about 10% of the population, the sciatic nerve will actually run directly through the muscle itself.

Written by Malton A. Schexneider, PT, MMSc

Osteoporosis

Osteoporosis is a skeletal disorder in which a reduction in bone mass can result in a disfiguring posture, collapsing vertebrae and an increased susceptibility to bone fractures such as broken hips or spinal compression fractures later in life. The condition can affect both men and women, although much more common in women.

According to the National Osteoporosis Foundation, one in two women over age 65 will develop fractures due to osteoporosis.  Usually diagnosed in people around the age of 60, the disease actually begins to develop around age 30 or 35.  Steps can be taken to prevent the disease, but it is best to start early in life. At each stage of your life, your level of exercise and calcium intake influences the condition of your bones.

Written by Malton A. Schexneider, PT, MMSc

Herniated Disc

Contained protrusions are localized disc bulges where the annular fibers (outer rings of the disc) remain intact and firmly connected to the bony vertebrae above and below and protrudes beyond the outer rim of the vertebra.  Noncontained herniations are actual disruptions of the annular fibers and permit extrusion of the nuclear material (central jelly like portion of the disc).

These conditions mainly affect people between 30 and 50 years of age.  Although the disc undergoes a natural aging effect, abnormal stress to the disc in the form of excessive bending, twisting, and lifting can result in disc injury.  Disc injury can also result from excessive compression loads on the spine such as those encountered from a fall.

Written by Malton A. Schexneider, PT, MMSc