Back (Lumbar Spine)

*If you are experiencing persistent pain, diminished function, loss of strength, range of motion, and/or sensation, BCPT recommends that you contact your physician, as a serious underlying physical condition may be present.

Stenosis

Stenosis is a term synonymous with narrowing. Stenosis of the lumbar spine can occur at various locations of the spinal column, including the central region (area of spinal cord), the lateral recesses, or the intervertebral foramen (area of nerve roots). This syndrome is most common in the elderly population who demonstrate age related spinal degeneration and arthritis. The narrowing can be caused by bony changes, and/or space-occupying lesions, and typically results in neurological compression. Symptoms can include pain and sensory changes in one or both legs, which may be temporarily relieved with forward bending at the waist, and is often exacerbated with extension of the lumbar spine (i.e. leaning back, looking up at the sky). Exercises which are based on forward bending and abdominal strengthening, with postural and positional education, may help to manage symptoms related to stenosis.

Disc Lesions

Disc lesions and herniations can be extremely debilitating when they occur, and require proper evaluation, in order to successfully manage and treat the associated symptoms. An intervertebral disc is a piece of fibrocartilage that links two vertebral bodies together. The disc is made up of two parts consisting of an outer annulus fibrosis (12 - 15 concentric rings - think of tree rings) which contain a liquid inner center, the nucleus pulposus. The disc is an avascular structure (without blood supply) which gives it a limited capacity for repair. Because of this, the intervertebral disc is susceptible to several age related changes such as thinning and tearing of the annulus and dehydration of the nucleus. The disc is also subject to traumatic injuries which include tears and delamination of the annular rings. These injuries are often caused by subjecting the disc to excessive or repeated loading. As the annular rings weaken, they are unable to contain the contents of the nucleus. With repeated loading, the nucleus may then begin to bulge against the annular rings or leak through the tears. This bulge, protrusion, or herniation, can result in localized or radiating pain, numbness, and/or weakness, depending on the structure compressed. While surgical relief has been successful for selected patients with nerve compression that fail to resolve naturally, a nonoperative, aggressive, physical rehabilitation program for disc herniations with radiculopathy (radiating pain) can also be a successful method of treatment.

Fractures

Fractures of the lumbar spine are of many different types. Compression fractures usually results in the collapse of the anterior aspect of the vertebral body. Fracture-dislocation is due to combinations of compression, rotation, and shear stress. Fractures are commonly associated with some sort of trauma, and the pain is often localized. Once a fracture is determined to be stable, and the risk of neurological compromise has been addressed, physical therapy can help to strengthen the supporting musculature.

References: Norkin, CC and Levangie, PK: Joint Structure and Function, A Comprehensive Analysis Magee, DJ: Orthopedic Physical Assessment Richardson, JK and Iglarsh ZA: Clinical Orthopaedic Physical Therapy