The spine is made up of the vertebrae and the intervertebral disks; they form the skeleton of the body’s trunk and protect the nerve structures (spinal cord and roots), that transmit electrical impulses from the brain to the periphery.
The spine plays a fundamental role in providing mobility and functionality, however it is extremely vulnerable to trauma and subject to degenerative disorders related to age.
The spine is normally divided into four parts: cervical, thoracic, lumbar and sacral. The dorsal (or thoracic) column is generally less subject to pathologies, as it is protected by the ribcage. The cervical and lumbar-sacral column contribute the most to movement and are more affected by degenerative disorders.
The spinal column presents three curvatures on the sagittal plane (cervical lordosis, dorsal cystitis, lumbar lordosis) which allow for a uniform distribution of body weight. Transient or permanent changes to these curves can cause pain and postural disturbances.
On the frontal plane, on the other hand, the spinal column is straight. In a developing body, the growth in the spinal column can be anomalous and create curves on this plane as well, leading to what is called scoliosis.
Approximately 2% of the population is affected and there is a strong hereditary disposition.
The majority of scoliosis cases are idiopathic, or rather, their cause is unknown.
In the treatment planning for each patient, the doctor will carefully evaluate a series of factors, including family history of scoliosis, age of the child, age in which the deformities appeared, the location and the severity of the curve.
The majority of the spinal column curves in children with scoliosis remain slight and only a periodic orthopedic evaluation will be necessary. To limit progression in more severe cases, orthopedic braces can be used, which will allow the little patients to conduct a normal social and physical lifestyle.
The most common cause of “backaches” are degenerative disk disorders; the intervertebral disk is made up of a hard cartilage wrap (fibrous annulus), which contains a very hydrated gelatinous portion inside (fleshy nucleus). This structure is the perfect mechanism for mechanical shock absorption. Due to aging or disorders such as arthrosis or arthritis, the disks being to lose their watery portion, get dehydrated and collapse under the weight of the above vertebrae. The vertebral disk is somewhat like a balloon: when crushed, it decreases in height and widens in the middle, thus occupying the back of the vertebral canal where it comes into contact with nerve roots, causing pain and, in the most severe cases, neurological deficits.
If the nerve irritation happens at the cervical level, the patient will have what is called brachialgia, if it occurs at the lumbar-sacral level the patient will have cruralgia or sciatica.
A disk hernia, on the other hand, refers to the rupture of the outer wrap of the disk and the posterior exit of the fleshy nucleus which, by crushing the roots of the spinal nerves, causes pain, lack of sensibility and limited movement.
A disk hernia which appears suddenly causes very painful symptoms and the loss of major neurological functions (sensitivity and motility). Many disk hernias are treated conservatively with good results; the attack phase involves the use of drugs (anti-inflammatories, cortisone, neurotrophic, pain relievers, etc) while physical therapy represents the second and most important treatment step to control the symptoms and restore proper function to the column.
A disk hernia in time will dehydrate, decreasing its volume and thus reducing the mechanical insult to the nerve structures.
In cases where conservative therapy is not effective, a hernia surgery (the surgical removal of the hernia) is recommended.
The minimally invasive therapies available today allow for fast recovery times.
A rehabilitative program and physical therapy specific to the spinal column are fundamental for total functional recovery.
Arthrosis of the spinal column or spondyloarthrosis, is a frequent cause of back pain in patients over 60 years old.
The degenerative-arthrosis process affects the disks, the ligaments and the bones of the spinal column, causing deformation, pain and rigidity.
The segments of the column most frequently affected are those with the most movement: the cervical column (cervicalgia) and the lumbar region (lombalgia).
Previous traumas, arduous work and little physical activity can contribute to the acceleration of the degenerative process.
Symptoms include pain in the compromised area: cervicalgia and lombalgia are accompanied by the sensation of contracted muscles and rigidity or loss of movement in the neck and back. In the case of cervicalgia, headaches, dizziness and nausea are also common.
Anti-inflammatories (NSAIDs and cortisones) and muscle relaxants are used in the acute phase, while in chronic phases instrumental-physical therapies and physical-rehabilitative programs are the best treatment for this pathology and are fundamental to maintain an optimal condition.
In the most severe cases, resistant to conservative treatment, surgery can be a valid alternative.
Spondylolysis and Spondylolisthesis
The vertebrae are made up of a body (front portion) and a back arch. In the embryonic life, these two portions are made up of two separate ossification nuclei that subsequently merge.
When, for various motives, this does not happen, the vertebrae are interrupted and divided into two parts: the front part, the body, and the back part, the arch. This pathological condition is known as spondylolysis. Spondylolysis from traumas (stress fractures, tumors, etc), also exists.
Spondylolysis normally affects the 5th lumbar vertebrae, very rarely, the 4th.
When the fracture cannot sustain the tangent forces of the vertebrae, the vertebral body will tend to slip forward; this condition is known as spondylolisthesis.
The symptoms of this pathology include pain, especially under stress and muscular contractions leading to a certain rigidity in the lumbosacral hinge.
Initial treatment for spondylolysis and spondylolisthesis is always conservative. The patient must suspend physical activity until symptoms disappear, as often happens. A pharmacological therapy with anti-inflammatories and muscle relaxants can contribute to reducing back pain. In some cases the use of an orthopedic bust could be recommended.
After the acute phase, a physical-rehabilitative therapy is always recommended, to allow for a total recovery with regards to symptoms and mobility. In the majority of cases, activities can be started gradually even if relapses are frequent; stretching and strengthening exercises for the back and abdominal muscles can help to prevent them.
Periodical x-ray checkups are fundamental to evaluate any further sliding of the vertebrae.
If the vertebral sliding is excessive and provokes painful symptoms and the crushing of the nerve roots, a surgical intervention to reduce and stabilize the vertebrae will be necessary.
The prevention to avoid backaches includes specific exercises as well as an adequate behavior and lifestyle:
- Physical activity that combines aerobic exercise, such as walking or swimming, with specific exercises to maintain the back and abdominal muscles strong and flexible
- Correct lifting of weights: be sure to lift heavy objects with your legs, not your back. Do not bend over to pick something up. Keep your back straight and bend your knees.
- Body weight control: keep body weight under control. Excess weight negatively influences the lumbar column.
- Avoid smoking: both smoke and nicotine cause faster aging of the spinal column.
- Correct posture: good posture is important to avoid future problems. A physical therapist can indicate the right positions to correct any defects. Sedentary patients that spend hours sitting at a computer are at risk of developing a backache caused by muscular imbalance and immobility.