|
(Continued from page 18)
small improvement in 2-4 weeks.
PHYSICAL THERAPY FOR DISK DISEASE
Exercise training for disk disease consists of several phases. The first is soft tissue flexibility concentrating on the hamstring, quadriceps, illopsoas and gastroc-soleus musculotendinous unit as well as the external and internal hip rotaters. Next there is joint mobility of the lumbar spine and thoracic segment and hip range of motion. After the flexibility and mobility training comes the stabilization program. Stabilization is done by finding neutral position, sitting stabilization, prone gluteal squeezes, supine pelvic bracing, bridging progression of basic position, one leg raised, stepping and then balancing on gym ball. Stabilization continues with quadriped stabilization with alternating arm and leg movements, kneeling stabilization with double knee, single knee and lunges then waft slide, quadriceps strengthening and position transition with postural control. An important aspect of the stabilization is the abdominal program. This consist of curl-ups, dead bugs, diagonal curl-ups, diagonal curl-ups on incline board and straight leg lowering. Associated gym program consist of latissimus pull downs, angled leg press, lunges, hyperextension bench, general upper body, strengthening exercises and pulley exercises to stress postural control. Finally there is an aerobic program of progressive walking, swimming, stationary bicycling, cross country ski machine and running, initially supervised on a treadmill.
STENOSIS TREATMENT
Sometimes all parts of the spine combine to cause problems. There is usually facet and ligament hypertrophy, protruding, often calcified disk and occasionally instability. This can manifest in stenosis, centrally and lateral, with or without instability. Stenosis is associated with decrease oxygen and nutrients to the nerve, especially when there is increased demand such as walking or exercise. This is called claudication. The facets hypertrophy, and there may be over growth of the facet joints to the lamina. The neural foramina become elongated and narrowed, and if there is disc disease there may be a figure eight or right angle that the nerve root needs to travel in order to exit. There will then be thickening of the nerve roots with chronic conditions leading to peri-neural adhesions and ischemic changes. Over time venous obstruction causes hypoxia with the previous mentioned peri-neural fibrosis and persistent symptoms. In the later stages, patients may develop radicular pain with walking, which may progress to pain while being in the upright position. Patients may also have pain with only standing and this neurogenic claudication is different from vascular claudication, which is increased when the blood flow cannot meet the metabolic demands. Patients with neurogenic claudication are able to ride a bicycle without difficulty because of the flexed position, they are able to walk up an incline or stairs, but not able to walk down the incline or down stairs which extends the spine. These signs and symptoms of neurogenic claudication have been attributable to ischemia of the nerve root. Stenosis is most common at L4-5 and then L3-4. Generally, patients have congenitally narrower canal. A variety of medical conditions cause stenosis, such as calcium pyrophostate crystal deposition, amyloid deposition, and intradural spinal tumors. The treatment for advanced disease is difficult and usually succumbs to surgery. However, if caught early, symptoms may respond to anti-inflammatories, spine stabilization exercises, aquatics and epi-dural steroids. Weight loss once again plays a major role, as does smoking cessation. The (Continued on page 20)
|
|
