Disc Herniation
The term “herniation” is defined as a contained displacement of disc material beyond the boundaries of the intervertebral disc space.The most common levels for a herniated disc are L4-5 and L5-S1. History of symptoms associated with an acute herniated disc often can progressive from multiple episodes of flexion biased movement without proper ergonomics. Spontaneous movements into flexion increase the pressure of the posterior intervertebral disc which weakens the annulus fibers. Increased intradiscal pressure and forces generated are at the highest levels in a seated position while lifting an object. As stated before, faulty postures in a slouched position can also contribute to the symptoms of a herniated disc. The patient will not note any pervious symptoms down the anteriolateral portion of the lower extremity prior to a disc herniation. In some case patients could state diffused lumbar pain prior to the onset of radicular symptoms. Risk factors that increase a patient’s susceptibility for disc protrusion has been studied with family history being the strongest predictor followed by loads placed on lumbar spine, and finally the type of work being performed.
Signs and Symptoms
Spinal Stenosis
Spinal stenosis is often degenerative in nature and develops with acquired age related changes to the lumbar disks and facet joints. This ultimately causes decrease disk height and with associated bulging of the disk and infolding of the ligamentum flavum. History of symptoms associated with lumbar stenosis is often insidious at first but then progressively worse over time. Patient will note chronic lumbar pain for many years with his directional preference being flexion, and state that extension exacerbates the pain which causes his radicular symptoms to present. Throughout the degernative process of the spinal stenosis, the impairments noted earlier increase with intensity as the spinal canal decreases in size. The symptoms that occur due to pathological changes tend to go from a unilateral to a bilateral distribution. When questioned about any relieving factors the PT might ask the patient “when shopping if you lean on you cart does your pain relieve for that period of time?” The patient will state that indeed pain does decrease and radiating symtoms is no longer present; it known as the “shopping cart sign” in which leaning onto lumbar flexion increases the space of both the spinal canal and intervertebral foramen.
Signs and Symptoms
The term “herniation” is defined as a contained displacement of disc material beyond the boundaries of the intervertebral disc space.The most common levels for a herniated disc are L4-5 and L5-S1. History of symptoms associated with an acute herniated disc often can progressive from multiple episodes of flexion biased movement without proper ergonomics. Spontaneous movements into flexion increase the pressure of the posterior intervertebral disc which weakens the annulus fibers. Increased intradiscal pressure and forces generated are at the highest levels in a seated position while lifting an object. As stated before, faulty postures in a slouched position can also contribute to the symptoms of a herniated disc. The patient will not note any pervious symptoms down the anteriolateral portion of the lower extremity prior to a disc herniation. In some case patients could state diffused lumbar pain prior to the onset of radicular symptoms. Risk factors that increase a patient’s susceptibility for disc protrusion has been studied with family history being the strongest predictor followed by loads placed on lumbar spine, and finally the type of work being performed.
Signs and Symptoms
- Sharp, burning, stabbing pain radiating down the posterior or lateral aspect of the leg to below the knee
- Pain is superficial and localized and associated with numbness or tingling
- Advanced cases will display motor deficits, diminished reflexes, and weakness
- Increase in symptoms with sitting/bending, relative flexion
- Deep buttock, posterior or posterolateral thigh pain that may or may not extend below the knee, into the lower leg and lateral foot
- Pain is often aggravated by coughing, sneezing, or straining
Spinal Stenosis
Spinal stenosis is often degenerative in nature and develops with acquired age related changes to the lumbar disks and facet joints. This ultimately causes decrease disk height and with associated bulging of the disk and infolding of the ligamentum flavum. History of symptoms associated with lumbar stenosis is often insidious at first but then progressively worse over time. Patient will note chronic lumbar pain for many years with his directional preference being flexion, and state that extension exacerbates the pain which causes his radicular symptoms to present. Throughout the degernative process of the spinal stenosis, the impairments noted earlier increase with intensity as the spinal canal decreases in size. The symptoms that occur due to pathological changes tend to go from a unilateral to a bilateral distribution. When questioned about any relieving factors the PT might ask the patient “when shopping if you lean on you cart does your pain relieve for that period of time?” The patient will state that indeed pain does decrease and radiating symtoms is no longer present; it known as the “shopping cart sign” in which leaning onto lumbar flexion increases the space of both the spinal canal and intervertebral foramen.
Signs and Symptoms
- Long history of back pain
- Neurogenic claudication; leg pain or parathesis
- Provocation of symptoms with extension and relief with flexion
- Burning, aching in the buttock region, lower extremity, and lumbar region upon standing
- Standing, walking, climbing stairs will provocate symptoms
Cauda Equina
A large space occupying mass at the level of the cauda equine located in the spinal canal, which supply neurologic function to the bowel and bladder. The cauda equine is the nerve roots of the lumbar and sacral extending from the lower part of the spinal cord. Physician referral is recommended if cauda equina is present
Risk Factors
- impaired sensory disturbances in the L3-4 and L5-S1 innervated areas
- herniated discs
- spinal stenosis
- hematoma
Signs and Symptoms
- Motor weakness in legs
- Sensory deficit in legs
- Bilateral sciatica
- Lower limb reflexes
- Sexual dysfunction
- Low back pain
- Bowel/Bladder Dysfunction
- Saddle anesthesia
