Advanced Spinal Physiotherapy

 

Concepts

Part of the reason why discs and facet joints become pathological is overstrain of a limited number of spinal segments due to incorrect movement patterns, resulting in instability and "wear and tear" of those segments.

Overstrain and Pain

When excess movement takes place at a limited number of joints, e.g. when most of your forward bending is performed by three vertebrae in your lumber spine, without the hips takimg their "fair share" of the movement, those facet joint capsules become overstretched, lax and painful. With overstretched and lax joint capsules comes instability at those segments.

Shear and Instability

Inability or lack of soft-tissue control at one or two segments can lead to shear. This is where, instead of the vertebra rocking forwards and backwards correctly over its adjacent vertebra, it begins to slide. This damages the disc.

Nerve Irritation

Inflammation in the overstretched joint capsules and damaged disk(s) has two effects on the nerves:

Pressure from the fluid in the inflammation prevents the nerve from conducting its impulses sufficiently.
The nerve tissue itself becomes irritated by the chemicals in the inflammatory fluid.

Pressure from the disk or damaged facet joints can also irritate the nerves. All these can cause buttock and leg pain, pins and needles and heaviness.

Muscles

There are two types of muscle fibres:

Power: Faster acting for movement. They fatigue quickly and cannot hold for long.

Tonic / endurance: Slower acting and serve to hold for long periods to support joints without fatiguing.
Voluntary muscles have a mixture of both fibres. Sprinters have predominantly power fibres and marathon runners have predominantly tonic fibres, for example.
Pain inhibits tonic fibres and so the painful back loses its support mechanism, creating a vicious circle of degeneration.

Role of Physiotherapy

How can Physiotherapy help?

The Physiotherapist works together with the surgeon in order to address the problem "from both angles":

  • Remove the cause of the damage and prevent further occurrences with physiotherapy
  • Repair the structural damage by surgery

Sometimes physiotherapy will resolve the problem without the need for surgery by creating the optimum environment for the body to heal itself.

Physiotherapy therefore aims to identify:

  • Faulty movement patterns.On example being excessive mobility in the lumbar spine and insufficient participation in the hips and thoracic spine. This results in segmental overstrain and pain.
  • Associated imbalance between muscles that have become too overactive and those that have become too weak, as a result of faulty movement patterns.
  • Joint stiffness, soft tissue tightness and tension in the nerve structures, contributing to and resulting in faulty movement patterns.

Physiotherapy then aims to correct these problems by:

  • Developing the tonic function of the deep stabiliser muscles (i.e. deep abdominals, and the gluteal/buttock muscles) to stabilise the spine initially then
  • Re-educating the body to perform new and corrected movement patterns to redistribute the forces of movement more economically, and away from the overused vulnerable segments, and

Elongating shortened structures and mobilising neural tissues and facet joints in order to restore full and correct range of movement.

Pre-operative instruction

All patients will be fully assessed pre-operatively by the physiotherapist so that the exercises can be gauged according to each person's level of pain and disability. Pre-op physiotherapy aims to stabilise your spine and prepare the spine for rehabilitation post-operatively.

Generally most patients are able to perform the following exercises:

  • 4 point kneeling - transversus abdominus (lower abdominals) holds
  • Prone - gluteal holds
  • Lying on your back with knees bent up bracing the abdominals and gluteals together
  • Standing in "neutral" position of the spine using lower abdominals and gluteals together.
  • Provided your pain is not so severe as to be inhibiting your deep stabiliser muscles, you can also begin the process of dissociation.

These examples aim to maintain stability of your spine during other movements involving your upper back, arms and legs.
examples:

  • Bent knee fall out
  • Single heel touches
  • Prone knee bends Post-operative Instruction

The exercises shown preoperatively should be restarted as soon as possible following surgery. If we have attempted to seal your disc wall, then the exercises should be limited to stabilisation drills without stretching the annulus during the first 8 weeks following surgery.

See: Postoperative Information for concise instructions.Professional Support

We provide a more detailed account of the techniques for Neuromuscular rehabilitation, muscle dissociation reprogramming, postural restabilisation & realignment for your physiotherapist. We are in the process of preparing a video to assist.