When a disc herniation becomes severe, patients may begin to experience burning, numbness, tingling and weakness in their upper or lower extremities due to nerve root compression. If these symptoms are the result of a large herniation, your surgeon may decide to perform a discectomy.
This surgery removes the protruding disc material, freeing up the nerve roots. Following surgery, your physical therapist will help you to improve your flexibility and range of motion, instruct you on stabilization exercises, educate you on activities to avoid or modify, and provide you with strengthening exercises to work on the muscles weakened by the herniation.
Foot drop occurs when you do not have enough strength in your ankle to flex your foot up against gravity, known as dorsiflexion. This can occur from general weakness and range of motion dysfunction, or can occur as a result of compression of the deep peroneal nerve in the leg, the sciatic nerve in the thigh, or nerve roots in the spine. Lack of dorsiflexion can lead to problems and safety concerns when you are walking as you are more likely to drag your foot and trip.
Physical therapy can help by reducing compression on the nerve and this is achieved through a variety of manual therapy techniques, nerve mobilization exercises, stabilization exercises, postural re-education, strengthening of the ankle dorsiflexors, and gait training.
Low Back Pain
Low back pain (lumbar backache) is the leading cause of disability worldwide, and affects 80% of people at some point in their lifetime. There are many conditions and causes that can lead to low back pain, including disc herniation, disc degeneration, stenosis, facet joint irritation, fractures, spondylosis (arthritis), spondylolisthesis (vertebrae slipping forward) or muscle strain.
While pain and discomfort may occur at the site of the issue, you may also experience pain into your pelvis, hips and legs if there is nerve involvement. Your physical therapist will conduct a comprehensive evaluation to find the cause of your back pain and then develop a plan specifically tailored to your needs. This may include lumbar stabilization exercises, soft tissue mobilizations, joint mobilizations, stretching, functional activity training, and postural re-education.
Neck pain (cervical ache) is a common issue that many individuals deal with on a daily basis. There are many different causes of neck pain including disc herniation, disc degeneration, stenosis, spondylosis (arthritis), nerve entrapment, or muscle strain. Besides pain occurring at the site of the problem, pain may also be referred into your arms, upper back, head, or face.
Your therapist will conduct an evaluation to find the cause of your pain and work with you to design and implement an appropriate treatment plan consisting of soft tissue and joint mobilization, stretching, strengthening, postural re-education and ergonomic education.
Radiculopathy is a very common spinal condition that occurs when a nerve root or roots become compressed as they exit the spine. This can cause a variety of symptoms including radiating pain, burning, numbness, and tingling. While radiculopathy can occur anywhere along the spine, it is most common in the lumbar and cervical regions.
Some common causes of radiculopathy include disc herniations, arthritis, disc degeneration, stenosis, and fractures. Physical therapy can help by reducing the compression on the nerve, thus decreasing your symptoms. This occurs through soft tissue and joint mobilizations, stretching, stabilization exercises, postural re-education, and improving movement strategies.
Stenosis is a common condition of the spine that occurs when nerves become compressed by the narrowing of the canal that they exit through when leaving the spinal cord. This primarily occurs in the cervical and lumbar spine and is caused by degenerative bone changes in the spine, osteophyte (bone spur) formation or disc degeneration/herniation.
Symptoms of stenosis include chronic and worsening back pain, weakness or pain in one or both arms/legs depending on where the stenosis is occurring, decreased range of motion and loss of sensation with severe symptoms. In lumbar stenosis, cramping can occur in one or both legs. This is referred to as neurogenic claudication, and can be aggravated by prolonged standing and walking, and is relieved by sitting, lying down or leaning forward.
The goal of physical therapy is to reduce the symptoms associated with stenosis, and this occurs through manual therapy, stretching, core stabilization training, postural re-education and education on strategies to avoid symptom provoking positions and activities.
Thoracic Spine Pain
The thoracic spine is the area of your back located between the neck and low back. This part of the spine serves as an attachment for your ribs. Dysfunction in this area can occur when the joints of the thoracic spine become too loose or too stiff.
Pain may also occur due to muscle tightness or spasm on this area. Physical therapy can help by restoring proper motion or stability to this area by soft tissue mobilization, joint mobilization, stretching, strengthening and postural re-education.
There are three kinds of fractures that can occur in the spine: compression fractures, burst fractures and fracture dislocations. Compression fractures are the most common of the three, and can occur with rapid forward flexion (bending) of the spine. Risk factors may include a history of any of the following: osteoporosis/osteopenia, diabetes, kidney failure, gastrointestinal issues and hyperthyroidism. Onset is sudden and can be associated with trauma.
Symptoms are aggravated by weight bearing and forward bending activities. Patients relieve pain by offloading their legs. Physical therapy can help by first ensuring the injury is protected, allowing the bone time to heal and reducing the risk of re-injury. Once it is safe to do so, physical therapy will include mobilization of the soft tissue and joints to increase flexibility, stabilization exercises and postural re-education to prevent re-injury.
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