Lumbar Spondylosis
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Definition/Description [1]
Lumbar spondylosis can be described as a degeneration of the lumbar vertebrae. This means that the disease is progressive and irreversible. It mostly occurs in older patients. The lumbar region is mostly affected because this region is most exposed to mechanical stress due to the loading of the spinal segments while standing and the spinal motion.
When a patient suffers from lumbar spondylosis, osteophytes can be formed. These are bony overgrowths that occur due to the stripping of the periost from the vertebral body. The formation of these osteophytes can cause neural foramental stenosis, which will produce pain. The patient can also experience joint stiffness, which will limit the motion.
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Physical Therapy Management
Although the idea that bed rest is indicated when the vertebrae are degenerating is widespread, the opposite is true. It is important that someone with lumbar spondylosis overcomes his fear of moving and remains active, in order to avoid muscle atrophy and joint stiffness. Lumbar spondylosis can not be cured, but physiotherapy and movement play an important role in improvement of the living conditions and in slowing down or even avoiding further degeneration.
The treatment of lumbar spondylosis includes different possibilities, such as conservative therapy, alternative therapy and, if necessary, a medical surgery can also be performed.
The conservative therapy can be divided into various stages.
• NSAID, heath and massage[2]
At the beginning of the treatment, non-steroidal drugs can be given to decrease the inflammation and the pain. Also heath and massage can be used to reduce the pain and relax the muscles. Heath can be given under the form of fango, hot packs, compresses, electrotherapy, etc.[3]
Massage will abduct the waste products and, similar as heath, stimulate the venous return of the blood.
Massage and heath have a relaxing effect, which influences the mood of the patient and can be beneficial for further rehabilitation.
• Mobilization and traction
In the second stage the therapist will implement mobilizations and tractions. These will conserve or even improve the motion of the lumbar spine. However, the effect of traction on the lumbar spine is not really proved.
• Muscle strengthening and stretching[2][4]
In the third phase the patient will have to perform active exercises. In this phase it is important to improve the lumbar stabilization, by increasing the strength of the abdominal and back muscles.
Movements which should be avoided in lumbar spondylosis are hyperextension, flexion – e.g. bending forward to touch your toes –, lateral flexion and rotation.
Because there is a large variation between the painful areas and movements in different persons, it is important to create a patient specific training program
Exercises can be carried out while standing or sitting. When exercises are performed with the patient lying face down on the stomach, a pillow must be put under the stomach to avoid the hyperextension in the lumbar spine.The muscles also need to be stretched to conserve the flexibility of the muscles and so conserve the range of motion of the spine.
•Other exercises[4]
In the last stage the patient can perform low impact sports, such as swimming, cycling or aqua fitness. This will help the patient to conserve his endurance and to keep on using the muscles without too much load on the spine.
High impact sports as volleyball and running need to be avoided.
Alternative therapy is also an option. This kind of therapy includes acupuncture, osteopathic manipulative medicine (OMM), trigger-point therapy, etc. The effect of this therapy is not really proved.
Physiotherapy is one aspect in rehabilitation, but lifestyle changes, posture corrections and psychological help can also play a role. Lifestyle changes, as using the stairs instead of the elevator or watch your nutrition can be important to lower the ballast on the spine. Posture corrections will also make sure that there is less load on the spine and they can also strengthen the back muscles.
The psychological aspect also needs to be handled to make clear to the patient that fear is not necessary, and movement is a must to avoid further degeneration. Also the fact that a cure is impossible can be an indication for the need of psychological support.[5]
In some cases, for example when there is an entrampent of a nerve, surgery can be inevitable.[3]
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- ↑ Cheung, Kenneth M.C. Low-back pain, sciatica, cervical and lumbar spondylosis. Spine,vol 10, nov 2010. P 958-960
- ↑ 2.0 2.1 Meeussen R. Praktijkgids rug- en nekletsels deel 1&2. Dienst uitgaven VUB, 2001
- ↑ 3.0 3.1 Treatments for spondylosis: http://www.wrongdiagnosis.com/s/spondylosis/treatments.htm (November 2010)
- ↑ 4.0 4.1 P. A. Houglum. Therapeutic exercises for muskuloskeletal injuries. Human Kinetics, 2005.
- ↑ Abstract: Abbott AD, Tyni-Lenné R, Hedlund R. Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Department of Physical Therapy, Karolinska University Hospital, Stockholm, 2010.
