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Thursday, June 21, 2012

Spinal Degeneration:

What is Spinal Degeneration?

The spine comprises of many bones known as vertebrae each of which has a large hole in its center. (Because these bones are situated on top of each other, their holes line up, forming the spinal canal. This canal provides protection and space for the spinal cord and nerves to travel from the brain to the rest of the body. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. There are also small holes on each side of the spine known as intervertebral foramen. These are located between adjacent vertebrae and allow nerves to exit the spinal canal.



 Over time, wear and tear to the discs, joints and bones can occur resulting in degenerative changes to the spine. These degenerative changes may include decreased disc height, loss of joint cartilage, bony spurring (osteophytes) and thickening of bone. This condition is known as spinal degeneration. As this condition progress the spinal canal and intervertebral foramen can begin to narrow and may eventually place pressure on the spinal cord and nerves resulting in a variety of symptoms.

Signs and Symptoms of Spinal Degeneration

As the condition progresses one may experience low back pain and stiffness. In more severe cases involving spinal cord or nerve compression, pain, pins and needles, weakness or numbness may be experienced in the lower back, legs or feet.
 
People with this condition generally experience an increase in symptoms during activities that repetitively or continuously straighten or extend the spine. Symptoms may also increase during activities that place weight on the spine (eg. lifting, prolonged standing, walking etc). Symptoms tend to ease during activities that bend the spine (e.g. sitting) or take weight off it (e.g. lying).



Diagnosis of Spinal Degeneration

An X-ray of the spine will typically demonstrate changes associated with degeneration. Other investigations such as CT scan, bone scan or MRI may also be indicated to assess the severity and to determine the exact structures that are affected.

Treatment for Spinal Degeneration

People with this condition can attempt management with an appropriate physiotherapy program. While little can be done to reverse the changes to the spine, the primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. This can be achieved by having regular breaks from levels of activity that increase symptoms (e.g. excessive walking, standing, lifting) with positions of comfort (e.g. sitting or lying). Activities should be balanced ideally to prevent any increase in symptoms. A gradual increase in activity and exercise can occur as guided by the treating physiotherapist provided symptoms do not increase.

Alternative exercises placing minimal force through the spine should be performed to maintain fitness, provided they do not increase symptoms. Better activities include cycling on a stationary bike and hydrotherapy exercises designed by a physiotherapist. People should also perform flexibility, strengthening and core stability exercises to ensure an optimal outcome. The treating physiotherapist can advise which exercises are most appropriate for the person and when they should be commenced.

Physiotherapy for Spinal Degeneration

Physiotherapy treatment for people with spinal degeneration is important to assist with pain relief, improve flexibility and strength, and to ensure an optimal outcome. This may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • mobilization
  • traction
  • dry needling
  • ice or heat treatment
  • education
  • activity modification advice
  • prescription of walking aids
  • hydrotherapy
  • exercises to improve flexibility, strength and core stability

Other Intervention for Spinal Degeneration

Despite appropriate physiotherapy management, some people with spinal degeneration continue to deteriorate. When this occurs, other intervention may be required. This may include pharmaceutical intervention, corticosteroid injection, the use of supplements such as glucosamine and chondroitin, investigations such as an X-ray, CT scan, bone scan or MRI, or assessment from a specialist. The treating physiotherapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically. In more severe cases of spinal degeneration involving spinal canal stenosis or nerve compression, surgery may be required to relieve the pressure on the spinal cord or nerves.

Exercises for Spinal Degeneration

The following exercises are commonly prescribed to people with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Rotation in Lying:

Lie on your back, knees bent, feet flat and together as demonstrated. Gently take both knees from side to side as far as possible without increasing your symptoms. Repeat 10 times provided it is pain free.



Figure 4 – Rotation in Lying 

Knees to Chest:

Lie on your back with your knees bent as demonstrated. Take both knees towards your chest as far as possible without increasing your pain. Use your hands to take them a little further provided your symptoms do not increase. Hold for 5 seconds and repeat 10 times.



Figure 5 – Knees to Chest

Physiotherapy Products for Spinal Degeneration

Some of the most commonly recommended products by physiotherapists to help patients with spinal degeneration include:

  1.  Back Braces
  2.     Lumbar Supports (for sitting)
  3.     Ice Packs or Heat Packs
  4.     McKenzie Treat Your Own Back Books
  5.     TENS Machines (for pain relief)
  6.     Spikey Massage Balls (for self massage)
  7.     Nutritional Supplements (such as glucosamine and chondroitin)
  8.  
     *****Click on image to enlarge

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