Arthritis is inflammation of one or more joints. The most common type of arthritis is osteoarthritis and involves wear-and-tear damage to the joint’s cartilage. Cartilage normally protects a joint, allowing it to move smoothly, and provides shock absorption when pressure is placed on the joint, such as when walking. If enough of the cartilage degenerates, it can result in bone grinding on bone, which can cause pain, inflammation, stiffness and restricted movement. This wear and tear can occur over many years, or it can be triggered by a joint injury or infection. Arthritis often causes pain during movement. In order to avoid the pain, many individuals will avoid movement of the arthritic joint. Unfortunately, lack of movement in the joints can make the condition worse. Joints were meant to move! Movement helps to flush out inflammation, lubricate the joints, and condition the muscles. Successful treatment to help manage arthritis involves maintaining strong muscles, joint mobility, flexibility, endurance, and a healthy weight – all of which can be accomplished through conservative treatment.
A disc herniation is a rupture of the disc material between the bones of the spine (vertebra). A spinal disc is a pad that serves as a cushion between each vertebra. Discs are designed like jelly donuts, with a softer center encased within a tougher exterior. A herniated disc, sometimes called a slipped or ruptured disc, occurs when some of the softer “jelly” pushes out through a crack in the tougher exterior.
A herniated disc can irritate adjacent spinal nerves and result in back pain, leg pain, numbness or weakness in the leg. On the other hand, many people experience no symptoms from a herniated disc. Most people who have a herniated disc don’t need surgery to correct the problem. The vast majority of disc herniations will occur toward the bottom of the spine at L4- L5 or L5- S1 levels. In addition to typical sciatica symptoms, nerve impingement at these levels can lead to:
- L5 nerve impingement (at the L4 – L5 level) from a herniated disc can cause weakness in extending the big toe and potentially in the ankle (foot drop). Numbness and pain can be felt on top of the foot, and the pain may also radiate into the buttock.
- S1 nerve impingement (at the L5 – S1 level) from a herniated disc may cause loss of the ankle reflex and/or weakness in ankle push off (patients cannot do toe rises). Numbness and pain can radiate down to the sole or outside of the foot
A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone to another. Ligaments stabilize and support the body’s joints. A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and in severe cases, ruptures the supporting ligaments. Typically this injury occurs when an individual lands on an outstretched arm, slides into a base, jumps up and lands on the side of the foot, or runs on an uneven surface.
A strain is an injury of the muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction. In most cases the mechanism of injury resulting in a sprain or a strain may be the same, it’s just a matter of which tissues are damaged in the injury.
Lumbar sprains and strains result from injury to the soft tissues of the lower back. Most lumbar sprains and strains are caused by heavy lifting, twisting motions, involvement in sports, poor posture or body mechanics, car accidents, and falls. Sprains result from overstretched ligaments in the low back and strains are caused by overuse of a muscle or overstretching the muscles of the low back.
Spinal stenosis is a narrowing of the spinal canal, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back. Narrowing occurs when the growth of bone or tissue reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself. This may cause pain, numbness, stiffness, or weakness, in the legs, feet, or buttocks. It may also cause problems with bladder or bowel function.
Sciatica is caused by pressure or damage to the sciatic nerve causing pain, weakness, numbness, or tingling that radiates along the path of the nerve. The sciatic nerve branches from your lower back through your hips and buttocks and down each leg, but typically, sciatica affects only one side of your body.
Sciatica most commonly occurs when a herniated disc or a bone spur on the spine compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg. Although the pain associated with sciatica can be severe, most cases can be resolved with conservative treatment in a few weeks.
Spinal instability is defined as an abnormal response to applied loads and is characterized by movement of spinal segments beyond the normal constrains. Lumbar spinal instability can be caused by degenerative disease, post-operation, trauma to the spine, developmental disorders (scoliosis), infections, tumors, or repetitive trauma.
Instability of the lumbar spine occurs often and mostly affects the region of L4-L5 or L5-S1. The clinical symptoms and signs are non-specific and can be described as low back pain with radiculair pain down the legs. These signs are observed especially when the position changes.
The spinal system has three basic functions to perform, namely carrying loads, protection of spinal cord and nerve roots and allowing movement between body parts. To make sure that the spinal system can fulfill these tasks, there needs to be a spinal stabilizing system.
The stabilizing system can be broken down to the the passive subsystem consisting of vertebrae, facet joints, intervertebral discs, spinal ligaments, joint capsules and passive muscle support. Then there is the neural feedback system containing force and motion transducers and the neural control centers. The third system is the active subsystem including the muscles and tendons surrounding the spinal column. Thus the spine needs the integrated function of the three subsystems, mentioned above, to control stability and movement. Instability is found when one of the systems fails to fulfill his task, and disturbs the balance.
