Today we know about;
Lumbar Spondylosis ?
- Clinical Presentation
- Diagnostic Procedures
- Physiotherapy Management
** Lumbar Spondylosis **
Lumbar Spondylosis can be described as all degenerative conditions affecting the discs, vertebral bodies, and associated joints of the lumbar vertebrae. Spondylosis is not a clinical diagnosis but instead a descriptive term utilized to designate spinal problems. Within the literature, lumbar Spondylosis encompasses numerous associated pathologies including spinal stenosis, degenerative spondylolisthesis, osteoarthritis and many others. It also captures effects of aging, trauma and just the daily use of the intervertebral discs, the vertebrae, and the associated joints. Concerning older patients, the disease is said to be progressive and irreversible. Often is the lumbar region the most affected, because of the exposure to mechanical stress. When a patient suffers from lumbar Spondylosis, it is possible that osteophytes are formed. These osteophytes are bony overgrowths that occur due to the stripping of the periosteum from the vertebral body. Pain can be produced when a neural foraminal stenosis is formed, which comes from the formation of osteophytes. The patient can also experience joint stiffness, which can limit motion. Patients with lumbar Spondylosis also have neurologic claudication, which includes: lower back pain, leg pain, numbness when standing and walking.
Spondylosis is a form of lower back pain and is an important clinical, social, economic and public health problem affecting the worldwide population. It is a disorder with many possible etiologies and many definitions. The incidence of lumbar Spondylosis is 27-37% of the asymptomatic lower back pain population. Approximately 84% of men and 74% of women have vertebral osteophytes, most frequently at T9-10 and L3 levels. Approximately 30% of men and 28% of women aged 55-64 years have lumbar osteophytes. Approximately 20% of men and 22% of women aged 45-64 years have lumbar osteophytes. Sex ratio reports have been variable but are essentially equal. Lumbar Spondylosis can begin in persons as young as 20 years. It increases with, and perhaps is an inevitable concomitant of, old age. That is why it appears to be a nonspecific aging phenomenon, also known as spinal arthritis. Most international studies suggest no relation to lifestyle, height, weight, body mass, physical activity, cigarette and alcohol consumption, or reproductive history. Adiposity is seen as a risk factor in British populations, but not in Japanese populations. The effects of heavy physical activity are controversial, as is a purported relation to disk degeneration. Spondylosis can therefore be seen as a cascade- anatomical changes of the spine occurs, which leads to more degeneration and changes in other spine structures. These changes combine to cause Spondylosis and its symptoms.
** Characteristics/Clinical Presentation
Patients with lumbar Spondylosis have pain in the axial spine. The location of these degenerate changes is not surprising as nociceptive pain generators that were identified within facet joints, intervertebral disks, sacroiliac joints, nerve root dura and myofascial structures. These changes may peak in different clinical presentations such asSpinal sstenosis, Disk herniation, bulging of the ligamentum flavum and Spondylolisthesis Patients suffering lumbar Spondylosis also have neurologic claudication, which includes lower back pain, leg pain, numbness when standing and walking. These symptoms improve in sitting and supine positioning.
** Differential Diagnosis
When a patient is suffering from low back pain, there are a lot of possible pathologies that could be the cause of this pain. Along with lumbar Spondylosis (and its sub-divisions), there are other causes as well.
• Rheumatoid arthritis
• Minor back trauma
• Excessive exercise
• Back strain
• Bekhterev’s disease (Ankylosing Spondylitis)
• Coccyx Pain
• Disk Herniation
• Lumbar Compression Fracture
• Lumbar Degenerative Disk Disease
• Lumbar Facet Arthropathy
• Mechanical Low Back Pain
• Overuse Injury
** Diagnostic Procedures
For the clinical diagnosis of lumbar Spondylosis, a thorough investigation is necessary to ensure that other pathologies are excluded. In clinical practice we use: X-rays: show bone spurs on vertebral bodies in the spine, thickening of facet joints (the joints that connect the vertebrae to each other), and narrowing of the intervertebral disc spaces. MRI: expensive, but shows the greatest details in the spine and is used to visualize the intervertebral discs, including the degree of disc herniation, if present. An MRI is also used to visualize the vertebrae, the facet joints, the nerves, and the ligaments in the spine and can reliably diagnose a pinched nerve CT scan: able to visualize the spine in greater detail and can diagnose narrowing of the spinal canal (spinal stenosis) when present SPECT: Single-photon emission computed tomography bone scintigraphy is used to further evaluate patients with suspected spondylolysis. Controversy surrounds the designation of one of these tests as most useful in the evaluation of spondylolysis.
** HK PHYSIO Examination
HKP clinic team, does the thurro examination of the lumbar spine to rule out any other condition related to spine and proper diagnosis. We have specific programme set for different conditions.
1) General examination of the spine Inspection of the entire spine Look for any obvious swellings or surgical scars. Assess for deformity: scoliosis, kyphosis, loss of lumbar lordosis or hyperlordosis of the lumbar spine. Look for shoulder asymmetry and pelvic tilt.
Palpate for tenderness over bone and soft tissues. Perform an abdominal examination to identify any masses and consider a rectal examination to exclude other pathologies in this region
Flexion, extension, lateral flexion and rotation. Examination of the
spine must also include examination of the shoulders and examination
of the hips to exclude these joints as a cause of the symptoms.
4) Neurovascular examination
Sensation, tone, power and reflexes should be assessed. All
peripheral pulses should also be checked, as vascular claudication in
the upper and lower limbs can mimic symptoms of radiculopathy or canal
** Physiotherapy Management
The conservative therapy can be divided into various exercise-based
and behavioral interventions:
A. Exercise therapy
It is the main conservative treatment approach for lumbar Spondylosis.
The therapy must include aerobic exercise, muscle strengthening, and
stretching exercises. The exercises and programs have to be of various
intensity, duration, and frequency. Core muscle strengthening
exercises together with the strengthening of the gluteus maximus end
flexibility training of the lumbar spine is an effective
rehabilitation approach for all patients with chronic low back pain.
Lumbar traction helps to relieve chronic low back pain. The traction
forces open the intervertebral space and decrease spine lordosis. This
temporary spine realignment relieves (theoretical) mechanical stress,
nerve compression, adhesions of the facet and annulus and disrupts
nociceptive pain signals. Nonetheless, little is known about the risks
associated with lumbar traction.
C. Manual therapy:
Its conservative treatment commonly involves manual therapy, more
specifically spine manipulation. Even though the precise mechanism for
improvement in low back pain remains unclear, spine manipulation
proves to be useful. On the other hand, there might be a risk using
spine manipulation, there is a risk of calcifications in the spine
should be taken into consideration. Depending on the patient condition
the risk may be high or low.
Is a frequently used therapeutic modality. It appears to give an
immediate reduction in pain symptoms following the therapy.
Nevertheless, there remains little evidence of the long-term relief.
E. Patient education
Educating the patient must include reviews of lumbar anatomy,
explanations of the concept of posture, ergonomics and giving
appropriate back exercises.
F. Lumbar back support
Can be beneficial for patients suffering from chronic LBP. It occurs
to limit spine motion, stabilize, correct deformity and reduce
mechanical forces. There is no consensus if it may function as a
placebo or really improve pain and functional ability. (Level of
evidence 1A) Sitting decreases lumbar lordosis and increase disc
pressure, squeeze on the ischium and muscle activity in the lower
back. These are all associated with low back pain.
G. McKenzie exercises
McKenzie method focuses on extension, and has promising results
concerning the prevention of further degeneration of the lumbar spine.
McKenzie therapy results in a decrease in short-term (<3 months) pain and disability for low back pain patients compared with other standard treatments, such as no steroidal anti-inflammatory drugs, educational booklet, back massage with back care advice, strength training with therapist supervision, and spinal mobilization. It is well-known that chronic spinal pain is often associated with bio-psychosocial problems. Therefore, multidisciplinary back therapy is needed. A bio-psychosocial approach involved reinforcement, modified expectations, imagery/relaxation techniques, and learned control of physiological responses aim to reduce a patient’s perception of disability and pain symptoms. (Level of evidence 1A) It has also been showed in several studies that Yoga could be helpful in reducing pain in patients with chronic low back pain. The stretching of muscles is an important part of this technique. The stretching and relaxing of muscles help the patients to cope with the pain and relieving them. It should also be noted that Yoga alone is not a therapy for chronic low back pain, it can be an additional technique in the therapy.