Degenerative joint/disc disease is a chronic and common progressive degeneration of the joints and or intervertebral disc of the spine. Although this disorder is a natural process of aging of the spine and is often asymptomatic, it sometimes develops as a result of injury of excessive wear and tear on the spine. The term spondylosis is also used to describe the various degenerative disorders of the spine.
Common signs and symptoms include back pain, stiffness, and loss of range of motion. Sometimes, the loss of height of the intervertebral disc causes the bony vertebrae to move closer together. This can result in pinching or encroachment of the space where the nerve roots exit the spinal cord and run into the legs. If this happens, the patient may experience radiating pain down the back of the leg (sciatica). In extreme cases, the nerve can be pinched so that muscle weakness, loss of sensation or loss of reflexes occurs in the leg. Usually, patient’s symptoms are worsened by standing, walking, or backward bending and improved somewhat by sitting or lying with the knees bent.
With regards to treatment, physicians can prescribe various medicines to help with the symptoms including anti-inflammatory medications, pain medications, muscle relaxants, etc. These are all intended for relatively short term use and are most useful for acute flare-ups. Ultimately, the condition cannot really be “cured”, as it is a degenerative process. The symptoms can be controlled and, in many cases, alleviated with treatment programs.
From the physical therapists perspective, treatment consists of exercises to maintain/improve mobility in the spine and decrease pain, and various physical therapy treatments such as moist heat, electrical stimulation, ultrasound, massage, and traction to decrease muscle guarding, decrease pain and improve extensibility of the muscles and connective tissue.
Designing an individualized exercise program for the patient to maintain mobility, fitness and function is very important. Although short periods of decreased activity may be necessary for acute flare-ups, patients are generally encouraged to be as active as their pain allows. Losing weight, improving physical fitness, and maintaining muscle flexibility can certainly contribute to the patients overall level of well-being.
Occasionally, surgical decompression of the pinched nerves is necessary; however, the vast majority of cases are managed without surgery. The prognosis is generally good but depends considerably on how extensive the degenerative changes are in the spine. Often, the patient will need to make back exercises a regular part of their overall fitness program.
If you have any additional questions with regards to degenerative joint/disc disease, please feel free to call a physical therapist at East Suburban Sports Medicine Center.
David R. Reynolds, MHS, PT, ATC, SCS, edited by Zak Boss DPT
Spondylolysis is a “defect” in a part of the vertebrae forming the natural “bony arch” around the spinal cord. This arch of bone serves to protect the spinal cord and create a space through which the spinal cord runs. The part of the arch of bone that is affected with spondylolysis is called the pars interarticularis. This is the part of the arch that joins onto the vertebrae above or below.
A frequent disorder affecting the pars area is a stress fracture. This is a relatively common cause of back pain in young active individuals, particularly athletes who are involved in backward bending type sports (i.e.: gymnastics, swimming) or involved in high impact type sports (i.e.: football lineman). The most common site for this sort of disorder is in the low lumbar spine (low back area).
The physician usually diagnoses stress fractures of the pars area with a bone scan or MRI. Sometimes it can show on a plain X-ray. The treatment is focused on decreasing stress to the involved area and usually involves a rigid brace for a period of 6-8 weeks followed by gradual reconditioning and strengthening of the trunk muscles. Correcting any imbalances in terms of flexibility, strength or endurance in the back and hip/lower extremity muscles is important as well.
A physical therapist is usually consulted once the brace is removed to supervise the process of reconditioning and rehabilitation.
If you have any additional questions with regards to spondylolysis, please feel free to call a physical therapist at East Suburban Sports Medicine Center.
David R. Reynolds, MHS, PT, ATC, SCS
In the lumbar spine, the discs are cushions of cartilage that separate the bony vertebrae. Their function is to act as a shock absorber for compression and weight bearing as well as facilitate movement between the vertebrae. They consist of a series of rings made of fibro-cartilage, which are tough but flexible. In the center of the disc is a fluid like material called the nucleus pulposus.
In the case of a herniated disc, the fluid like center called the nucleus pulposus migrates or pushes through cracks in the rings of cartilage to bulge outwards from the posterior wall of the disc. Located just behind the disc is pain sensitive tissues such as ligaments, the spinal canal and nerve roots that eventually form the nerves that run down your leg (the sciatic nerve).
Disc problems can range from minor bulges and degeneration to larger herniations that are capable of producing significant compression of the nerve root and pain as well as numbness and tingling, weakness and altered sensation in the legs. Herniated discs can occur from a variety of mechanisms. Commonly, the person strains to lift an object and feels a ripping or tearing sensation in the low back. Often the onset of pain is rapid and the patient may feel back or leg pain come on very quickly. Sometimes herniated discs can occur as a gradual accumulation of small strains over the course of many years. The discs experience degenerative changes as we go through life and these changes can produce cracks and weak areas in the disc that are predisposed to injury. Sometimes small strains such as prolonged sitting, small twists, even coughing or sneezing can be enough to cause a already degenerated disc to become symptomatic.
The treatment for a herniated disc usually involves both a physician and physical therapist. The physician is crucial for establishing the specific diagnosis including ordering imaging studies such as MRIs, X-rays, myelogram, etc. These are often used to help confirm the diagnosis and determine which disc is injured as well as the degree of injury. Initial management typically consists of medication, controlled activity and physical therapy. The medications that are used to range from short course steroids, pain relieving medications, non-steroidal anti-inflammatory, muscle relaxants, etc. Avoiding activity that worsens the pain is often necessary in the initial stages of management. Studies have shown that resting in bed for more than 2-3 days; however, does not contribute to a more rapid recovery compared to getting up and moving around. Certainly, avoiding prolonged slumped sitting, bending and twisting, lifting, etc. are important components of preventing additional injury to the disc.
With regards to physical therapy, an initial evaluation is performed in order to determine the extent of mobility loss, any involvement of the nerves in the legs, muscles that may by tight or weak, etc. The physical therapist then develops a treatment program in conjunction with the referring physician that may typically include spinal traction, massage or muscle relaxation techniques, mobilization techniques, physical therapy modalities (i.e.: moist heat, electrical stimulation, ultrasound, ice packs, etc.). Once the pain levels are diminished somewhat, the next step is typically on to a comprehensive rehabilitation program focusing on strengthening “core” muscles around the lumbar spine that help to support and protect the injured segment, correction of any muscle “imbalances” (i.e.: tight muscles or weak muscles) and a general fitness and reconditioning program. Also important is instructing the individual in the correct body mechanics involved in their daily activities or work responsibilities.
The majority of patients suffering from herniating discs do not get surgery. Sometimes; however, surgery is necessary if the injury is extensive or there is significant nerve root compromise. Surgical technique varies from surgeon to surgeon but basically consists of decompression of the involved nerve root. There is a period of rest and immobilization after surgery and then the patient typically returns for post op rehabilitation.