Spinal Dysfunctions

Escaping the pain of spine and neck disorders is almost impossible.

The spine runs from the base of the neck all the way down to the torso, twisting, curving and supporting the body along the way. The stacked cervical, thoracic and lumbar vertebrae withstand a high amount of stress every day.

A breakdown somewhere along the chain, at some point in peoples’ lives, seems inevitable. For more than 80 percent of Americans, that’s exactly what happens when back and neck pain set in. In most cases, a common spinal dysfunction is the culprit.

Do you know how to identify the problem and can you differentiate between these disorders? This is the initial step to providing relief to patients. Of course, the usual relief advice includes proper body mechanics, exercise and tips to maintain a healthy back, but it’s important to stay familiar with common spine dysfunctions.

• Degenerative discs. Cervical discs are made up of about 80 percent water, which creates a sponge-like shock absorber that provides a cushion between spinal vertebrae. These discs are comparable to a jelly donut with a sturdy outer layer and a pliable inner core.

Neck pain caused by degenerative discs is a common health problem. This condition is caused by disc wear-and-tear that eventually causes pain. Pain varies from patient to patient, and it doesn’t seem to be connected with the level of disc degeneration. For instance, a patient with little degeneration may experience debilitating pain, while a patient with a severely damaged disc may have little or no pain at all.

Water content decreases as the body ages. This lack of hydration affects many parts of the body, including the discs in the back. A lack of water content diminishes the disc’s ability to act as a shock absorber. And, because lack of hydration causes reduced blood supply to discs, they lose the ability to repair themselves.

Patients may complain of increased pain during lifting, bending and twisting, and discomfort while sitting or standing for long periods. Pain may spread from the neck to the upper back and shoulder regions.

When diagnosing these patients, it’s important to consider the neck, scapulae and upper extremities. Look for muscle imbalances, and check flexibility of levator scapulae, rhomboids and aspects of the trapezius muscles.

In addition, test strength of bilateral upper extremities and review home and work ergonomic situations. Look at different postures that a patient may use during the day. In most cases, degenerative discs can be treated without surgery.

• Herniated cervical discs. As discs lose water, they also lose strength and cushioning capability is compromised. In extreme cases, as a disc continues to deteriorate the once-sturdy outer covering of the “jelly donut” can tear, displacing the disc’s center and causing contact with the nerves and spinal cord. (This is also called a ruptured disc.) A tear causes extreme pain, numbness, weakness and tingling sensations in the arms and, in rare cases, legs.

In addition to evaluating ergonomics and muscle instability, you should also consider mechanical cervical traction. Be sure to address patient positions that cause radical apathy, and attempt to correct body mechanics.

• Sciatica. True sciatica is characterized by sharp pain that shoots from the buttocks to the knees. This pain stems from the sciatic nerve. Often, patients who experience pain from lumbar and sacroiliac programs may initially think they’re suffering from sciatica—called “false sciatica.”

Sciatica is caused by pressure, usually from a herniated lumbar disc that’s pressing on the radicular nerve or nerve root, which extends from the sciatic nerve. Sciatica usually affects only one side of the body and causes pain that radiates down the leg. Pain may also be accompanied by burning, tingling or weakness.

Clinicians have experienced success applying manual manipulations, treatments and exercises to relieve pressure on the nerve. Doctors may also prescribe over-the-counter or prescription medications to relieve inflammation that accompanies sciatica. In extreme cases, a patient may need surgery to provide relief.

Initially, you should address radiculopathy, and start with natural glides, mobilizations and stretches for the hamstrings, gluteals, piriformis and hip extensions.

• Spinal stenosis. Spinal stenosis is a narrowing of the spinal column. With this condition, the spinal column narrows and pinches the spinal cord and nerves that are housed within the canal. The result is low back pain, accompanied by possible leg pain. When stenosis severely affects nerves, a patient will have compromised leg muscle function, control and leg sensations.

Spinal stenosis can be caused by age, heredity, and changes in blood flow and body composition.

As the body ages and loses hydration, bone spurs can develop and the spine’s facet joints may begin to break down, which leads to pain. Some people may also inherit this problem. For instance, if a spinal canal is too small at birth, pain and stenosis symptoms may be present in young children.

Stenosis can also manifest itself in other ways, which makes this condition difficult to diagnose. Once diagnosed, you should recommend posture changes and exercises to relieve pressure on affected nerves. It’s also important to highlight flexibility and core stabilization, and a patient may also need to lose weight to relieve spinal load.

• Scoliosis. Scoliosis causes moderate or extreme curvature of the spine. In some cases, surgery is required to correct the damage.

Tailor treatments to correct scoliosis to a patient’s specific situation, since cases vary. If a patient needs surgery, it can be performed from the front, back or in a combination of both directions. At our facility, the front portion of surgery is done using very small incisions and a video imaging system. The back part of the procedure is done by making an incision down the center of the back. Once the curve is corrected, it’s held in place using a system of rods, screws and wires. A bone graft helps fuse portions of the spine.

Once again, rehab should focus on core stabilization and scapular stabilization, along with flexibility exercises for tight muscles. Tight muscles are common in scoliosis patients.

• Postsurgical issues. After back surgery, patients face several issues, such as pain sensitivity, reduced flexibility, structural or functional changes, lower endurance, altered body mechanics, and psychological and postural changes.

Successful lumbar rehab after surgery depends on cooperation between the clinician, patient and surgeon. It’s critical for any post-surgical therapy program to include neuromuscular re-education and core muscle strength training. As you rebuild core strength, you can shift the focus to increase flexibility, muscular strength, endurance and coordination.

Regardless of the condition, a therapist’s role is key to the treatment plan for back and neck pain. Regardless of the spinal dysfunction disorder a patient presents with, you must carefully evaluate each patient, examine complaints of pain, strength, range of motion, coordination and balance. For relief, it’s important to recommend several primary areas, such as: exercise; core body stabilization and strengthening; soft tissue therapies, including muscle-targeted movements; movement and flexibility; and pain control, including ice, heat, massage and electrical stimulation.

Education also plays a part in the treatment plan. Teaching patients good posture enables them to move correctly, deal with limitations and perform daily activities efficiently, such as lifting and bending.

The spine isn’t indestructible, and it’s going to take a pounding from daily activities. But the pain doesn’t have to last a lifetime.

Ben Crawford, MS, PT, is a staff physical therapist and documentation-based care coordinator (DBC) at the Texas Back Institute in Plano, Texas. DBC is a documentation-based treatment program that’s available in a limited number of clinics across the country.