The spine makes up the core of the skeleton and is essential to our existence. Through evolution, the human spine has become unique. Due to the fact that we ambulate on two feet and do not have a stabilizing tail, our spines are vertical in nature. Due to this, our spines are susceptible to a myriad of pathologies. This increased susceptibility combined with our ‘western lifestyle’ causes about 50% of the adult population to have regular back complaints to some extent. Back complaints are the biggest culprit of sick/work-leave and have a high financial impact on society. (Translated from source: leerboek orthopedie)
Different pathological presentation of the back:
- Low back complains
- Acute backache
- SI dysfunction
- Bechterew disease
- Scheuermann disease
- Collapsed vertebrae
Lumbar stenosis (narrowing in the lower back):
A lumbar stenosis or narrowing of the lumbar spinal canal is a pathology that mostly occurs in the elderly population. A person suffering from a stenosis will complain of pain in the legs whilst walking and standing. It is not always a painful feeling, but may also present as a feeling of fatigue. As the complaints worsen, so does the ability to walk long distances. Having a seat or leaning forward will help temporarily alleviate the complaint. Generally the pain is present in both legs, but in some cases symptoms may only be present in 1 leg. Lying on ones side with the knees pulled up to the chest also alleviates the pain. Standing still after walking does not alleviate symptoms as pain may arise during prolonged standing. Rather than walking upright like they used to, the patient will choose to slouch as this position alleviates the pain. People suffering from a stenosis find it increasingly difficult to complete activities of daily living such as going grocery shopping or other social activities, putting them at a higher risk of social isolation. Moreover, it is remarkable that patients suffering from this have no problem cycling without any leg- and back discomfort. This can be explained as the bent over posture adopted while cycling creates more space within the spinal canal.
The cause of the complaints is due to the narrowing of the canal in which the nerve resides (stenosis). As a result of continuous loading over time, the spinal column shows degenerative changes; though the severity differs from person to person, this degeneration is a normal part of the aging process. This degeneration within the joints is also referred to as arthrosis, and occurs in other parts of the body including the hip and knee joints. As a response to arthrosis, the spinal bones become thickened and create a narrowing of the neural space. Moreover, the ligaments in these areas also thicken, creating even less space for the spinal cord and nerve roots. The amount of space left in the canal is dictated by the severity of the degeneration and by the initial width of the canal which differs from one individual to another.
Scoliosis is a three-dimensional sideways curvature of the spine. A curvature as well as a torsion occurs in the spine. The spine can curve to one side, creating a c-shaped or single curve, but generally there are two curves creating an s-shape. The torsion of the spine causes the ribs on the back to be elevated. This elevation is referred to as a gibbus.
In The Netherlands approximately 60.000 people have a scoliosis and each year this number increases by 1000, generally females between the ages of ten and eighteen years of age. Each year approximately 6.500 patients are treated in the hospital of which 600 undergo surgery.
A scoliosis can sometimes already be present at birth, but in most cases it occurs during growth. In 15% of cases scoliosis is congenital in nature. Generally the curvatures can only be seen when the child is around 10 years of age. Sometimes the scoliosis is caused by abnormalities of the bones, nerves, muscles or of connective tissue. In 80% of cases the true cause of scoliosis remains unknown. A scoliosis can also occur at a later age. Generally this is the result of the aging process.
- Sometimes few or no complaints
- Back ache
- Pain in the legs
- Mobility impairments
- Aesthetic drawback
Picture: Straight vertebrae, Scoliosis, Normal shape, Scoliosis
Translated from source: https://www.scoliose.nl/wat-is-scoliose/
The sacroiliac joints (SI-joints) are present bilaterally in the lower spine. The SI-joint acts as a bridge between the two pelvic halves. Complaints of the SI-joint can be due to a joint blockage, an increased mobility and/or injury to the ligaments surrounding the joint.
- A highly prevalent cause of SI-joint pain is a fall on the buttock(s).
- Motor vehicle accident
- When taking a false step
- Pain in the lower back and buttock area
- Referred pain to the leg
Picture: Pain in the SI-joint
Axial spondyloarthritis causes inflammation of the joints in the back and in the pelvis. Especially the joints in between the lower spine and the pelvis (SI-joints). Other joints can also become inflamed such as the knees, ankles and shoulders (this is called peripheral spondyloarthritis). Chronic inflammation of the joints in the back can cause damage through new bone growth. This can cause the joints to become stiff and over time lead to complete immobility. This phenomenon is referred to as Bechterew Disease.
Picture: Healthy back and Ankylosing Spondylitis
Axial spondyloarthritis usually occurs gradually before the age of 40. With axial spondyloarthritis the immune system starts to attack its own cells as if they were intruders. Your immune system works to expel these cells. During this process, certain chemicals are released which cause inflammation of the joints, tendons, muscles or organs. The immune system is basically attacking itself. For this reason, axial spondyloarthritis is classified as an auto-immune disease. The reason of this remains unknown. There is speculation that genetics play a role in this process. In certain families, axial spondyloarthritis has a higher prevalence. If one of the two parents suffers from this, there is a 1 out of 10 chance (10%) that the child will also have it.
- Pain and stiffness of the (lower) back and/or neck
- Inflammation of other joints such as the knees, shoulders and hips
- Inflammation of tendons, especially the Achilles tendon
- Inflammation of a finger or toe
- Inflammation of the eye (uveitis), psoriasis and intestinal inflammation (colitis ulcerosa and Crohn’s disease)
Translated from source: www.thuisarts.nl and www.reumanederland.nl
Scheuermann disease is a growth related disorder. This pathology often occurs between the ages of 13-17. This disorder causes a deformation of the upper vertebrae in the back. The cartilage on the anterior side of the vertebrae slowly turn into bone. The vertebrae becomes flatter on the front than the back creating (wedge-shape). In turn, the upper back become increasingly rounded. This is referred to as a kyphosis. A slight rounding of the upper back is normal. Scheuermann disease causes and excessive rounding or kyphosis.
The cause of Scheuermann disease is still unknown. The disorder lasts for a few year until growth stops. The increased kyphosis remains, but it does not worsen after that.
- Generally no complaints
- Sometimes bending forward, lifting or sports can cause sharp pain in the upper back
- Muscle aches and fatigue of the back, especially towards the end of the day
Translated from source: www.thuisarts.nl
Osteoporosis occurs when the rate at which bone density is lost is greater than that of it being produced. Because of this the bones become brittle. The vertebrae become more hollow and therefore weakened. Possible causes are:
- Lack of exercise;
- Lack of nutritional calcium;
- Lack of exposure to sunlight;
- Hormonal changes in woman during menopause (bone breakdown is increased);
- Certain diseases (of the thyroid for example);
- Medication (prolonged daily use of prednisone)
No symptoms are associated with osteoporosis, but the chance of bone/vertebrae fractures increases drastically. If a vertebral fracture occurs due to osteoporosis, it is referred to as an osteoporotic vertebral fracture or a collapsed vertebrae or a compression fracture. This happens when the corpus (or body) of the vertebrae becomes squished. It can either be causes by a fall or happen spontaneously in people with osteoporosis.
Complaints associated with an osteoporotic vertebral fracture/collapsed vertebrae:
- Acute onset of back pain
- Referred pain to the skin or limbs
- Falling out symptoms such as decreased sensation or loss of strength in the arms/legs
- A collapsed vertebrae can also occurs gradually causing the back to become increasingly rounded and you to become shorter. With the collapse of a single vertebrae, height can be reduced by 2-4cm. With the collapse of multiple vertebrae, the difference in height can be upwards of 10cm.
Translated from source: website Medisch Spectrum Twente en www.thuisarts.nl
- Dry needling
In layman’s terms this is also referred to as wear and tear (degeneration). In this case, the joints aren’t entirely degenerated, as cartilage has the ability to heal and new cartilaginous tissue is consistently being produced. Arthrosis is a disorder of the cartilage in the joints. The joints become stiffer and this is especially noticeable when getting out of bed first thing in the morning. Through movement the pain and stiffness decreases. Arthrosis is most prominent in the hips, knees, thumbs, and fingers, but can also occur in other joint within the body.
The Orthopaedic Manual Therapist can improve the mobility of the painful joints using special techniques, which alleviates the pain. Furthermore, the therapist will assess your overall movement patterns and treat additional limitations (which can be present in other parts of the kinetic chain). Using this strategy, the therapist will guide you to move better in order to avoid pain and stiffness.
(Translated from source: NAOMT.nl)