Spinal Pathologies: A Guide to Diagnosis and Treatment

In physiotherapy it is important to understand the various conditions that can affect the spine. From disc herniations to spondylosis, spinal stenosis, and spondylolisthesis, each condition presents unique challenges for both patients and healthcare providers. In this article, we will explore the diagnosis, signs, symptoms, and treatment options for these common spinal pathologies.

Disc herniations occur when the soft inner core of a spinal disc protrudes through the tough outer layer, causing pain and discomfort. Diagnosis typically involves a physical exam, imaging studies such as MRI or CT scans, and if indicated nerve conduction tests.

Signs and symptoms may include:

• Sharp or shooting pain
• Numbness or tingling in the extremities
• Muscle weakness.

Physical therapy plays a crucial role in treating disc herniations by focusing on strengthening the muscles supporting the spine, improving flexibility, and relieving pain through manual therapy techniques.

Spondylosis, also known as osteoarthritis of the spine, is a degenerative condition that affects the joints and discs of the spine. Diagnosis may involve imaging studies such as MRI, Xray, CT scan and a physical exam to assess range of motion and pain levels.

Signs and symptoms of spondylosis include:

• Reduced range of motion
• Pain
• Muscle weakness
• Difficulty performing daily activities
• Numbness and tingling throughout the extremities

Physiotherapy can aid in the management of spondylosis by incorporating exercises to improve strength and flexibility, manual therapy to reduce pain and stiffness and education on proper biomechanics.

Spinal stenosis occurs when there is narrowing of the spinal canal putting pressure on the spinal cord and nerves. Some people are born with a narrow spinal canal, and this is referred to as congenital stenosis. However, narrowing of the spinal canal is most often due to age-related changes and commonly affect persons over the age of 50.

Diagnosis typically involves:

• Imaging studies and a physical exam to assess symptoms such as pain exacerbated by prolonged walking, standing and pain which is relieved by holding over.

• With neurological involvement, symptoms include pain or discomfort that radiates to the buttock, thigh and lower leg after walking for a certain distance.

Physical therapy for spinal stenosis focuses on improving posture, strengthening the core and back muscles, and reducing pain through modalities such as heat.

A common pathology seen by physiotherapists and commonly known as “slipped discs” or disc herniations occur when the soft inner core of a spinal disc protrudes through the tough outer layer, often causing compression of nerves and resulting in pain and dysfunction. Common causes of disc herniations include:

• Gradual, aging-related wear and tear. As people age, the disks become less flexible and more prone to tearing or rupturing with even a minor strain or twist.
• Using the back muscles instead of the leg and thigh muscles to lift heavy objects
• Twisting and turning while lifting
• Rarely, a traumatic event such as a fall or a blow to the back is the cause.

There are 4 stages of disc herniations:

• Bulging: occurs when disc material on the inside of the spinal disc moves around in a way that causes the disc to extend abnormally to one side.

• Disc Protrusion: During this stage, the disc material reaches the annulus fibrosus, which is the name for the outer shell of the disc. The disc material is still inside the outer shell, although the spinal disc bulge is more noticeable, which often means an increase in discomfort. At this point neurological symptoms become present.

• Disc Extrusion: At this stage, the inner disc material goes through the outer shell. Once the inner material breaks through, you may experience severe discomfort, such as lower back pain that extends downward if the affected disc is in the lumbar area, which is common with disc herniation.

• Disc Sequestration: occurs when the inner disc material comes out of the shell altogether and fully detaches from the spinal disc. This is serious and often requires a surgical procedure called a discectomy. It can also contribute to some equally critical issues, especially if it gets lodged within the spinal canal.

Treatments for the first three stages of herniation include postural correction exercises from your physiotherapist, steroid injections and NSAIDS, heating modalities and activity modification.

Conclusion

Understanding the diagnosis and treatment options for common spinal pathologies is essential for physiotherapists. By providing personalized care plans that address the unique needs of each patient, physiotherapists can help individuals with disc herniations, spondylosis, spinal stenosis, and spondylolisthesis improve their function and quality of life.