Disk Pathology Sprain & Strains Postural Dysfunction

Presentation - HNP – 30-50 y/o  still hydrophilic - Result of trauma/overuse - Slouched/rounded shoulder
- Later on: NP dries out to resemble AP - Stiff & tentative w/ acute pain - Forward head
- Result of: - Decrease trunk rot w/ amb. - Kyphosis thoracic
Spondylolisthesis Spondylolysis Spondylosis
- trauma - Lordosis lumbar
- poor posture (flexed) - Protruding buttocks
Presentation - rep. microtrauma
- Congenital or develop later in life - Defect/splitting in pars - Chest flattens of
Degeneration & intervertebral
abdominal sagdisk
- Most common cause of(truck
- certain professions driver
low back etc)
pain interarticularis. - Shoulder,hip,knee
Common: over ageheight40. not equal
- smokers, athletes
in adolescent sedentary lifestyle, obese - Men more common. Result levels
- Many in abnormal
of spinealignment!
involved
- Genetic factor
Males more common– 2x more likely - Risk increases w/ age & more - Lead
Pain w/ prolonged sitting in muscle &
to adaptive changes
Certain
- Kids w/ postures/activities increase or
growth spurts are common common in adults . a biased recruitment of muscle while
-decrease
Result ofintradiscal
repetitivepressures
hypertext.(p.activities
519) - Athletes more common. performing mvmt.
- Pain w/ ext. & rot.
Signs & Symptoms - 85% affects L5, S1 -- Result of repeated
Dull aching pain microtrauma – - Localized pain w/ prolong bad posture
- L4 second most results
- Worseinday fx of pars
after articularis.
injury - Unable to maintain posture due to
-May start w/ pain lumbar region and - Trauma
- C/O stiffness/achiness w/ flex and stretch weakness.
progress to LE active ext.
Signs & Symptoms -- Localized
C/O shooting lowpain
backinpain
butt down to foot -- L5 vertebra
Good w/ rest,most common
NSAID, muscle - Morning stiffness
-- Radiating pain if stenotic
C/O numbness/ altered sensation.– worse w/ - Most
relaxants children asymptomatic - Sharp pain to an ache
prolonged
- Possible +standing/walking
SLR, Slump Test -- Back painROM w/ A/PROM flex
Decrease - Bilateral SI pain may refer to post.
-- Limited
Possible ROM lumbar
alteration ext. (L4-L5-S1)
of Derm, Myo, DTR -- Presents
weak/soreduring growthmotion
w/ resisted spurt thigh.
-- Worse
Mild weakness of LE in 15-20% - Hx of trauma w/ sports
w/ seated (flex), Better w/ lying - Localized pain, may refer (spasm) - Male predominance.
- +SLR - if not
Postpresent
or Post(only w/ disk hern)
Lat bulge. -- Tender
X-ray needed to confirm fx
upon palpation
- X-ray needed to confirm -- Child
Diff. b/w musclew/
continues andgood
lig!range of
- Palpate a step-off in region of slippage motion of spine then its not due to
- Hypermobility at segment specific injury but of years of stress
Treatment -- Depends on direction
Most children of bulge
asymptomatic -onStretch
back. - Reviewed in class/lab
- Most: Post/Post-Lat bulge - Strengthen
- Need extension (McKenzie) w/ post. - Pt. education
- Postural corrections - Modalities
Treatment -- Traction
Stretching (irreversible derangement) -- Exercise/activity
Core Stabilizationrestricted until Sx - Acute phase – modalities
-- Strengthening
Manipulation are gone. - Immobilized/ braced.
- Activity
- Grade modification
5 (not w/ shooting) - Back braces for gross instability - Soft cervical collars
- avoid hyperextension - Exercises to strengthen back and - Lumbosacral orthotics
- avoid heavy lifting abdominal muscles – stabilize spine. - Teach strengthening to abs and
- avoid excessive bending - Meds (anti-infl) paravertebral muscles.
- Meds to dec. inflammation & spasm - Surgery (if nothing works) - Lifestyle modification
- Braces - Decompressive laminectomy - Surgery – Seldom!
- Slipping vert can be surgically fused to - Spinal fusion
decrease pressure on spinal nerves.
Facet Jt. Dysfunction Nerve Root Involvement Scoliosis
 Presentation -Result of: - Pts. 30-50 y/o w/ disk problems - Functional Structural
- Prolonged activities in static - Osteoarthritis or DJD - 80-90% idiopathic
postures. - narrowing of IV foramen - Occurs in childhood B4 puberty
- One-sided repetitive mvmts - Trauma - More Common: Adolescent females
- Results in: - Radiating Pain - 10-20% caused by neuromuscular,
- postural overstrain musculoskeletal, or congenital
- muscle imbalance abnormalities.
- hypomobility- stiffness/loss of mvmt
- hypermobility- loss of stability
- Localized pain

Signs & Symptoms - Spine stiffness/pain - Radicular pain - Poor posture

- w/ hyperext & rot. - Segmental neurological deficit.
- Localized pain may refer - Ventral root- muscle weakness
- Muscle spasm - Dorsal root- sensory impairment
- 2o to instability or muscle guarding - dermatome
from pain. - Shooting/sharp pain
- DTR absent or depressed
- Hysteria
- Nerve root irritation
- Leg length discrepancy
- Hip contracture
- Rib hump – convex side
- Lateral Thoracic curve: most common
- Difficulty breathing
- Pain in neck, upper limb, lumbar, LE

Treatment - Good posture - Structures involved must be assessed - See Sheet p. 7-8
-Neutral pelvis, supportive neck pillow - DJD- spinal fusion needed to open
- Heat/Cold IV foramen
- Avoid prolonged postures - Traction to relieve pressure off root
- Rest frequently- promoting neutral pos - Repeated motion to reduce disc
- Anti-Infl Meds derangement
- Manipulations - Pain management (analgesics)
- Cervical traction - Modalities- help spasm muscles

Osteoporosis Spinal Stenosis Rheumatoid & Osteo Arthritis

(DJD)
 Presentation - Either gender @ any age
- Common: post-menopausal women
- no hormone replacement
- thin and fair skinned
- family hx of osteoporosis
- inactive
- More common: Men later in life
- Increase chance:
- alcoholism, smoking, malnutrition
- dec. Ca, corticosteroids
Signs & Symptoms - Loss of height
- Postural change
- Fx usually compression
- Vertebral wedging ant. causing kyphosis
- Muscular pain/spasms
- Inability to correct posture
- Weak
- Increase fall occurrence
Treatment - Exercise – most important.
- Walking program or light wt training
- Ca and Vitamin D intake
- Estrogen Replacement Therapy – women
S-I Dysfunction
- Older population
- Develops from degenerative changes
- Presents in: 5th & 6th decades
- Slouched position when sit or stand
- Complex stenosis may present w/ other
spinal deformities (spondylolisthesis,
scoliosis, lumbar kyphosis)
- Idiopathic, Degenerative, Surgery
induced
- Numbness in butt, thigh, calves
- worse w/ standing, walking, or ex
- Pain radiates to legs
- Weakness of LE
- Hot, cold, heavy, tired feelings in LE
- Imbalance when walking
- Stiffness in LE
- Intermittent Claudication
- On/Off w/ activity & rest
- NSAIDS
- Corticosteroid injections
- Restrict activity
- Strengthening of trunk flex/ext
- avoid inc. ext  strengthen in neut.
- Lumbar brace
- Surgery – Laminectomy
- result in inc strength & ROM
Kyphosis
Osteoarthritis
- Stiffness, Pain
- Cervical more common
- Age: over 50
- Overused jts from work/sports
- Injury/trauma to bones (Fx)
- Obesity
- Family Hx
- Gender: Women 2x likely
- Chronic illness (diabetes, cancer)
- Weakened immune system
- Infections (lyme disease)
Rheumatoid Arthritis
- Progressive – swell & thicken
- Affected joint disintegrates
- Early middle ages & women
Osteoarthritis
- Back pain comes and goes
- Stiffness in morning
- Pain, tenderness, numb in neck
- Lower back pain radiating LE
- Pain in shoulder, hip, knee, heel
- crunching sound (bone-bone)
- weakness/numbness UE/LE
- Limited ROM, spinal deformity
RA
- Fatigue, weakness, loss of
apetite, fever.
- Upon rising, jts are stiff, swollen
DJD
- Strengthen thru dynamic stability
- Flexibility – ROM exercises
- Modalities
RA
- Gentle strengthening & ROM
- Grade I & II spinal mob.
- NO Grade III & IV !!
 Presentation - May be due to: - Excessive post. spinal curvature
- Systemic arthritis - Results from:
- traumatic/microtraumatic arthritis - vertebral compression fx
- ligament sprains - Scheuermann’s disease
- Fall on buttocks - Juvenile scoliosis
- MVA – jamming femur into pelvis - ankylosing spondylitis
- Progressive stress – Leg Length Discr. - osteoporosis
- Hypermobility – more problems - tumors
- congenital abnormalities
- Forward head posture accompanies
- see w/ Parkinson’s syndrome

Signs & Symptoms - C/O inc. pain w/ walking – heel strike - Stretch weakness in spinal extensor
– prior to heel off - Wedging of vertebra (structural)
- 1 leg hop – painful! - Anterior structures adaptively shortened and tight
- Rolling in bed – painful! - C/O achiness in thoracic region.
- Extension – most painful! - Decrease ROM of shoulders into flexion
- consider possible pathologies
- tumors, bursitis, etc
- Occur over post. aspect of SI jt. And
into butt, w/ occasional radicular
symptoms down post thigh and knee.

Treatment - If hypomobile: mobilize restriction - Active/Passive thoracic extension

- If hypermobile: SI belt - if no vertebral structural damage
- Postural training
- Strengthening of spinal extensors
- Determine cause of Kyphosis
- Extension brace.