BONE CONDITIONS

Amongst muscular, joint, disc, ligament & nerve injuries of the spine, specific bone conditions and injuries such as osteoarthritis, compression fractures and canal stenosis can also be a prevalent source of lower back pain.

 

OSTEOARTHRITIS (DEGENERATIVE ARTHRITIS)

This refers to joint related changes, where the cartilage between the facet joints surfaces wear down and in some cases results in bone spurs forming. Individuals are more likely to develop this if they have undergone repetitive wear and tear at the level of a particular joint.

 

Intervertebral discs do also deteriorate, meaning the space between the vertebrae becomes narrow thus increases the pressure on the facet joints. If there is severe degeneration of these above structures, there can be compression of the spinal nerve roots which may result in peripheral symptoms (numbness, pins/needles into the lower limbs).   

 

SIGNS & SYMPTOMS OF OSTEOARTHRITIS

  • Pain in the local region of the osteoarthritic joints, which can be exacerbated by movement. 

  • Joint stiffness (likely to be most noticeable upon awakening or after static positions). 

  • Muscular tightness & tenderness around the area of the osteoarthritic joint. 

  • Loss of spinal flexibility.

  • Bone spurs.

  • Joint swelling & inflammation, which can place additional pressure on spinal nerves (and so, pins and needles or numbness may develop down the leg).

TREATMENT FOR OSTEOARTHRITIS

Whilst conservative treatment cannot reverse osteoarthritis, the main aim for this condition is to manage & prevent accelerated progression of the bone condition. Addressing the joint stiffness and muscular tenderness/tightness will help to decrease pain and restore mobility throughout the spine. This can be done with hands on treatment by a highly trained physiotherapist and complemented through a specific exercise program for this condition. 

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COMPRESSION FRACTURES

compression_fracture

This condition develops in the ageing individual, predominantly due to decreased bone density of the vertebrae (osteoporosis). The 2 common types of compression fractures include: 

 

Crush fracture: when the entire bone breaks (rather than just the front anterior part of the vertebra), we call this a crush fracture. 

Wedge fracture: involves the vertebral compression fracture occurring anteriorly (front) or laterally (side). Fortunately, this type of fracture is found more commonly in the thoracic spine). As the front of the vertebral body collapses but the back does not, the bone forms a wedge shape. With multiple wedge fractures, curvature of the mid and upper spine can occur forming a ‘hunchback’.

 

CAUSES OF COMPRESSION FRACTURES

Osteoporosis is the most prevalent condition which can result in a compression fracture, especially in women over the age of 50. As osteoporosis causes bone thinning, resulting in weakness and being brittle, the thinning bone can collapse during normal activity, leading to a compression fracture. More severe cases of osteoporosis can result in a compression fracture happening from more simple and non~trauma exposing forces to the spine, such as sneezing, coughing or turning over in bed. 

Trauma to the spinal vertebrae can also result in minor or severe spinal compression fractures. Falling (with a hard landing), a forceful jump, motor vehicle accident or any event which causes a mechanical strain to the bone can lead it to the point of a fracture.

SIGNS & SYMPTOMS OF COMPRESSION FRACTURES

TREATMENT FOR COMPRESSION FRACTURES

compression fracture brace

Typically, the standard protocol for treating a compression fracture is as follows:

  1. Bed rest/activity limitation ranging from days to weeks (depending on severity). Pain medication may be prescribed by your treating doctor if needed. 

  2. Bracing: an 8~12 week period in a Jewett or Cruciform Anterior Spinal Hyperextension brace (CASH).

  3. Casting: 8 to 12 weeks.

  4. Physiotherapy: the introduction to spinal range of motion and strengthening rehabilitation to rebuild the integrity of your spinal column, with the aim of returning you to your previous level of function. 

  • Back pain at the site of the compression fracture.

  • Pain that worsens with standing or walking, but eases with sitting/laying.

  • Inability to bend and twist your body (usually limited by pain and stiffness: limited spinal mobility).

  • Loss of physical height

  • A curvature/stooped shape to the spinal column (lumbar lordosis). 

 

LUMBAR STENOSIS

This type of spinal bone condition is the irregular narrowing of the spinal canal in the lower back, where a spinal bone or ligament grows/thickens, therefore compressing the spinal nerve. Typically, it is a part of the degenerative process in older adults, or those who are middle aged with a predisposition to spinal changes (born with a narrow spinal canal). The spinal canal extends through the centre of the spine, containing the spinal cord and nerve bundles that supply the lower half of the body.

 

SIGNS & SYMPTOMS OF SPINAL CANAL STENOSIS

  • Neural symptoms into the lower limbs (numbness, tingling, fuzzy sensations)

  • Pain at the local site of where the stenosis presents

  • Weakness through the hips or lower limbs

  • Muscular tightness and joint stiffness of the lower back

  • In severe cases, loss of bowel & bladder control

Whilst canal stenosis is closely linked to the degenerative processing in aging adults, the condition may also be triggered by:

  • Herniated or slipped discs

  • Ligament thickening (causing nerve compression in side the spinal canal)

  • Bone spurs (overgrowth of bone in the spinal canal)

  • Osteoarthritis (inflammation of joints, therefore compressing on spinal nerve

  • Tumours which may grow inside the spinal canal

 

lumbar-stenosis.jpg

TREATMENT FOR LUMBAR CANAL STENOSIS

Canal stenosis (if not on the severe end of the condition) is largely effectively treated by improving spinal flexibility, stability and overall mechanical health through physiotherapy and appropriate rehabilitation. Other factors such as maintaining a healthy weight will also relieve pressure from the spine, as well as practicing good posture can help to keep your spinal curve in a healthy position throughout the day (this can further alleviate pressure on your lower back).

If however there is no success with conservative treatment, and your symptoms are more on the severe end (e.g: loss of bowel and bladder control, severe neural symptoms or weaknesses), your Physiotherapist or Doctor is likely to refer you to have an MRI, CT or Xray scan completed and to then seek the advice of a specialist surgeon.

If this sounds like you, come in an see one of our friendly Sydney physiotherapists who will be able to help you manage your condition. Alternatively, if you are not local check out one of our online services which may suit you. We'd love to help!