Physiotherapy and rehabilitation
Here we present the most common spine injuries. Every spine pathology or injury has a description of general features, the cause of the injury, the characteristics of the symptoms, diagnostics, and the course of treatment.
Low back pain is becoming a modern epidemic among Europeans. Sudden low back pain, which 80% of individuals experience, usually resolves within two to three weeks; however, approximately 21% of all low back pain develops into chronic spinal problems, accompanied by other pathologies, such as: herniated disc, spinal stenosis, spinal arthrosis, sciatica, and joint arthritis.
Low back pain can develop without prior muscle injury and spinal pathology – in that case, it is non-specific low back pain caused by stress, prolonged sitting, or muscle spasms.
It is important to be aware that non-specific low back pain often represents the beginning of chronic spinal problems.
The occurrence of pain in the low back can be isolated to the lumbar spine, where it often extends all the way to the pelvis. However, additional complications may also occur in the form of burning pain of neurological origin down the leg to the knee or foot, and general pain that can spread to the buttocks.
Other symptoms that may accompany pain and are a good reason for a diagnostic examination:
– tingling in the leg,
– buttock pain,
– feeling of numbness (lower extremities).
In the first phase, it is primarily necessary to strengthen, stabilise and increase the load-bearing capacity of the spine. Treatment must be comprehensive – regular physiotherapy, which is based exclusively on manual therapy, devices and only targets symptoms, is not sufficient, especially not in the long term.
Comprehensive treatment and treatment of low back pain at MEDICOFIT clinic takes place in three phases:
– Acute physiotherapy – pain reduction, joint mobilisation, strengthening spinal muscles in non-painful positions.
– Post-acute kinesiology – strengthening the spine in full range of motion, core strength endurance exercises, strengthening spinal flexion and extension with additional loads.
– Kinesiotherapy – increasing the load-bearing capacity of the spine.
A disc herniation or herniated intervertebral disc is a frequently painful pathological condition of the spine that represents one of the specific causes of low back pain. Intervertebral discs are gelatinous structures between the vertebrae of the spine, which are made up of a soft (pulpous) nucleus and a hard (fibrous) annulus. The function of the intervertebral discs is to cushion forces in the spine.
In a herniated disc, the nucleus pulposus pushes into the cracks in the annulus, which occur as a result of degenerative changes. Herniated disc most often occurs at the L5-S1 and L4-L5 levels, less common at the L3-L4 level, while herniated discs in higher segments of the spine are rarer. The intervertebral disc bulges most often in the posterolateral direction, where the annulus fibrosus is weakest. The nerve root affected depends on the direction of the disc herniation.
Symptoms of a herniated disc in the lumbar region include low back pain of varying intensity, which can radiate down the leg, and decreased muscle strength. Major problems predominantly occur when standing and sitting. Symptoms usually improve when lying down.
The cause of disc herniation are prolonged incorrect postures and body positions, e.g. sitting in an office, sitting on a bicycle, sitting while driving, etc. The development of a herniated disc is rarely associated with a one-time situation; it is often a long-term process resulting from a combination of an inappropriate lifestyle and poor muscle function. Risky movements for developing a herniated disc include: bending the body forward, sitting, and lifting weights with incorrect technique.
Pain occurs during activities that involve bending forward or backward, lateral bending to the left or right, lifting weights, sneezing, and coughing.
The intensity of the pain depends on the position of the body and the location of the herniated disc, but in principle it is one of the more severe pains of orthopaedic origin.
The patient experiences the pain in the lumbar region, but it often also spreads to the buttocks, groin, thigh, shin, or even the foot.
Pain and neurological symptoms are present in one or both legs, and there may be markedly reduced muscle strength in the lower extremities, altered skin sensitivity, and tingling. In more severe disc injuries, there is also a dysfunction in urine and stool retention.
Intervertebral disc protrusion is the initial form of disc herniation, where there is an eccentric protrusion of the intervertebral disc. Intervertebral disc protrusion is the most common of all intervertebral disc herniations. In a disc protrusion, the nucleus pulposus does not break through the annulus fibrosus, but there are microdamages to the latter.
The cause of disc herniation are prolonged incorrect postures and body positions, e.g. sitting in an office, sitting on a bicycle, sitting while driving, etc.
If the bulge occurs directly in the back (central protrusion), symptomatic pain occurs in the lumbar region. If the bulge occurs in a backward and sideways direction (posterolateral protrusion), the pain occurs in the lower back and buttocks, and may radiate down the leg to the level of the foot.
If the disc protrusion slides extremely laterally in the direction of the sciatic nerve (lateral protrusion), there is characteristic symptomatic pain radiating only to the lower extremities. Major problems predominantly occur when standing and sitting. Symptoms usually improve when lying down.
Disc protrusion is treated conservatively in most patients, as special conservative rehabilitation with exercises has a good prognosis for treatment. Absolute indications for surgical treatment of disc protrusion are rare, e.g. inability to retain stool and urine or complete loss of touch sensation in the lower extremities.
Despite clear indications for surgical treatment, the decision to perform surgery remains difficult. Surgery means immediate alleviation of pain, which is often unbearable – that is why many patients opt for surgical treatment.
Our conservative treatment system for disc protrusion consists of four phases:
Osteoporosis is a bone disease characterised by the gradual loss of bone mineral density and the organic network of collagen structure, manifesting as bone fragility.
Osteoporosis can, in rare cases, occur early in life, but the first symptoms most often appear after the age of 50. Bone mass increases in the first half of life (most rapidly between the ages of 11 and 20), with peak bone density reached on average by the age of 25. After the age of 35, there is a slow decline in bone mass in both sexes, which is accelerated in women in the first few years after menopause due to reduced secretion of female sex hormones.
Individuals with osteoporosis are at higher risk for:
The key when diagnosing osteoporotic bones is that the patient begins special guided training that will slow down the reduction of bone mineral density and maintain appropriate activity of the muscular system.
As part of osteoporosis management training, we perform exercises to improve active joint stability, exercises to learn awareness of pelvic position, maintain aerobic fitness, and a progressive strength training programme that includes both isolation and more complex strength exercises. A tailored strategy for consuming nutritional supplements and avoiding factors that accelerate bone loss is also recommended.
Arthritis is a general term for a number of inflammatory diseases of the joints.
Arthritis is a rheumatic disease and is a common disease of the joints that most often affects the population over the age of 65.
The two most common types of joint arthritis are:
Symptoms of arthritis include high-intensity joint pain with frequent swelling and redness at the site of inflammation. Common symptoms also include joint stiffness and immobility, crooked small joints, general fatigue, increased temperature, and a tingling sensation in the fingers.
Join arthritis is characterised by joint stiffness that is most intense in the morning, with pain occuring later while performing various everyday activities.
Treatment of joint arthritis is carried out with a combination of instrumental therapy and therapeutic training, the most effective being low-pulse electromagnetic therapy and laser therapy. If the patient is overweight, aerobic training is performed in combination with an individually tailored nutritional strategy to reduce body weight.
This is a common type of joint arthritis that results from the cartilage in the joint wearing down.
Joint wear or arthrosis leads to uneven cartilage surfaces and bone outgrowths on the edge of the joint surfaces, which cause inflammation.
Cartilage wear is a natural ageing process and affects 60% of people over the age of 65, who consequently suffer from symptoms of osteoarthritis (OA).
Osteoarthritis most often affects weight-bearing joints, i.e. the knee and hip joints, with previous joint injuries also representing a risk for the development of osteoarthritis. Is also often affects the lumbar and cervical spine.
Osteoarthritis is characterised by less intense signs of inflammation than rheumatoid arthritis, and morning stiffness of the joints is also shorter.
Symptoms of osteoarthritis typically worsen when the affected joint is under load.
Osteoarthritis is characterised by pain in the initial phase of the pathology not being constant, but is only provoked by the stress caused by a specific movement.
As cartilage wear progresses, muscle laxity also occurs, which places additional stress on the joints. Symptoms include a sensitive and slightly enlarged joint with limited mobility. If osteoarthritis develops in the knees, it is characterised by poor joint control or knee instability.
Osteoarthritis is managed with a conservative approach of therapeutic training and instrumental physiotherapy. In the final stages of joint wear, joint replacement or reconstruction is possible; however, in the earlier stages of joint arthrosis and osteoarthritis, treatment with training and therapies is recommended. Conservative treatment of osteoarthritis is aimed at slowing down joint degeneration and reducing acute inflammation or symptoms. It is important to educate the patient about the disease and to maintain joint mobility and flexibility. If the patient is overweight, aerobic training is performed in combination with an individually tailored nutritional strategy to reduce body weight.
Spinal stenosis is a pathological narrowing of the spinal canal caused by degenerative changes in the intervertebral discs, facet joints, and vertebrae.
Degenerative changes in the spine are a natural ageing process, but can be accelerated by inappropriate lifestyle factors. Degenerative changes in the spine are present in 95% of individuals after the age of 50.
Symptoms of spinal stenosis occur mainly in older people, usually after the age of 60. The size of the spinal canal is genetically determined, and individuals with a narrow spinal canal are more prone to developing spinal stenosis and degenerative changes in the spine.
Narrowing of the spinal canal gradually causes mechanical compression of the nerve fibres and spinal cord, which results in severe pain and functional disorders of the lower extremities.
Sciatica is the name for a set of symptoms in the lower extremities that result from compression of the sciatic nerve (nervus ischiadicus), which is the largest or thickest nerve in the human body.
The sciatic nerve is composed of individual nerve roots that merge into a main nerve fibre that runs down the lower extremities.
The fourth and fifth lumbar nerves, along with the three sacral nerves, merge to form the sciatic nerve.
Symptoms of sciatica include:
– tingling,
– burning pain,
– muscle weakness in the lower extremities.
Symptoms can occur from the buttocks to the foot, depending on the degree of compression of the sciatic nerve.
Progressive forms of sciatica symptoms may lead to foot drop or loss of neurological function of the foot.
Sciatica pain originates in the lumbar spine and spreads through the buttocks down the leg, but can also be present in isolation in the lower extremity.
Sciatica rarely occurs before the age of 20, and most often occurs between the ages of 40 and 50.
Treatment for sciatica symptoms depends on the type and progression of the degeneration causing the symptoms.
It is important to realise that sciatica is not a disease, but just a name for the symptoms that accompany degenerative changes in the spine, which in the initial stages are treated with instrumental physiotherapy and therapeutic training.
Surgical treatment is performed when conservative therapies do not significantly improve the patient’s symptoms and quality of life within a period of three to six months.
There are also some indications (cauda equina syndrome) for immediate surgery. Most patients alleviate their sciatica symptoms with an appropriate movement programme that focuses on learning proper training techniques, strengthening the core, and controlling pelvic movement.
Spondylosis is a degenerative disease that describes the development of bone deformities or outgrowths (osteophytes) on the edges of spinal vertebrae, where they border the intervertebral discs.
We often refer to spondylosis as osteoarthritis of the spine.
The symptoms of spinal spondylosis depend on the segment of the spine where it is present.
Cervical spondylosis often causes pain in the back of the head, which can radiate to the jaw, shoulders, and earlobes. As a result, cervical spine mobility, muscle strength, and muscle mass of the neck segment can be reduced. Severe migraines are possible.
The key to treating spondylosis is setting an appropriate diagnosis with an MRI and/or X-ray.
In the initial stages of spondylosis, conservative treatment is recommended, which is tailored depending on the level of spondylosis and the symptoms caused.
The training part of conservative treatment of spondylosis is aimed at:
– strengthening stabiliser muscles,
– maintaining mobility,
– preventing muscle atrophy.
In the early stages of spondylosis, conservative therapeutic techniques are highly effective in slowing the spread of spondylosis and reducing acute symptoms.
Surgical treatment of spondylosis is performed when spondylosis causes dysfunction of internal organs and vital functions, severe compression of the spinal canal, or major neurological disorders in the extremities.
Facet joints are small joints of the spine between the vertebrae, located posterolaterally on the vertebral arches, with the facets of the upper and lower vertebrae in each pair contacting each other.
Each vertebra of the spine has a total of four facets, two on each side, below and above.
The fibres of the multifidus muscle group, which play an important role in stabilising the spine, attach to the small facet joints. The synovial membrane of the facet joints is also attributed with an important proprioceptive function due to the high number of mechanoreceptors present.
Before starting treatment for pain originating from injury or wear and tear of the facet joints, an accurate diagnosis is necessary, as several different degenerative spinal conditions cause similar symptoms.
Pain originating from facet joint degeneration becomes more intense with specific movements such as turning the torso or head, while in the case of a herniated disc, symptoms are aggravated primarily by sitting, which is often worst in the morning.
In the case of a herniated disc, the pain occurs on the opposite side of the protrusion, while in the case of a facet joint injury, the pain symptoms occur on the same side. When a facet joint of the cervical or thoracic spine is injured, neurological symptoms do not radiate to the arms, as is often the case with a herniated disc at the same level.
Pain resulting from facet joint degeneration or injury is usually present in the immediate vicinity of the damaged tissue right next to the spine; in the case of cervical facets, the pain may radiate to the back of the head, and in the case of thoracic facet injuries, the pain is often between the shoulder blades.
The pain is usually burning or stabbing with quick and jerky movements of the cervical or thoracic spine, and often becomes dull and more difficult to define with prolonged postures.
Treatment of symptoms resulting from wear and tear of the facet joints is carried out after initial MRI and/or X-ray diagnostics and after clinical tests have been performed.
Conservative treatment is aimed at slowing down the degeneration of bone and cartilage surfaces and stopping the thinning of the intervertebral discs.
It is important to perform appropriate instrumental physiotherapy to alleviate acute symptoms and training to strengthen the deep stabilising muscles of the spine and maintain mobility in key affected segments.
The conservative programme should be implemented intensively for three to six months, then it should move into the maintenance phase or degeneration management, which should take place in the long term as a less intensive programme, e.g. twice per week.
In the initial stages of spondylosis, conservative treatment is recommended, which is tailored depending on the level of spondylosis and the symptoms caused.
The training part of conservative treatment of spondylosis is aimed at:
strengthening stabiliser muscles,
maintaining mobility,
preventing muscle atrophy.
In the early stages of spondylosis, conservative therapeutic techniques are highly effective in slowing the spread of spondylosis and reducing acute symptoms.
Surgical treatment of spondylosis is performed when spondylosis causes dysfunction of internal organs and vital functions, severe compression of the spinal canal, or major neurological disorders in the extremities.
The sacroiliac joint is the joint between the sacrum and the ilium, is responsible for the optimal transfer of forces from the lumbar spine to the lower extremities, and is primarily designed to provide stability in the lumbosacral region of the spine.
The stability of the sacroiliac joint is provided by the gluteal muscles and the muscles of the erector spinae group.
The cause of most pain symptoms in the lumbar spine is intervertebral disc degeneration, and in 20% of symptomatic cases of the lumbar spine, the cause is related to defects in the sacroiliac joint.
Pain originating from the sacroiliac joint can be the result of traumatic injury, repetitive stress, lumbar spine stiffness, childbirth, or it can occur as a result of degenerative changes.
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Symptoms can be either unilateral or bilateral. Sacroiliac joint pain often affects young women after childbirth due to the separation of the pelvic bones.
Symptoms originating in the sacroiliac joint include discomfort when placing full weight on the lower extremities in a standing position, pain can radiate to the level of the knee and can occur after walking a short distance. A typical symptom is the inability to lie on the side of the affected joint. SI joint dysfunction can cause symptoms similar to sciatica, meaning that pain radiates through the buttocks into the lower extremities.
Before starting treatment for SI joint dysfunction, a precise differential diagnosis is necessary to rule out certain degenerative spinal injuries that cause related symptoms. SI joint problems are treated in most cases with conservative therapy and lifestyle changes. In the case of a more severe traumatic injury to the SI joint, surgical stabilisation of the joint is possible using titanium implants designed to stabilise an unstable sacroiliac joint.
Depending on the mobility of the SI joint, i.e. hypomobility or hypermobility, appropriate rehabilitation training is prescribed. If the mobility of the SI joint is too low, stretching and manipulation of shortened soft structures is recommended, whereas if the mobility is too high, strengthening of the muscle groups that are the primary stabilisers of the SI joint is recommended.
A progressive kinesiology training regimen is crucial throughout the entire rehabilitation for SI joint pain or injury; most symptoms of pathological changes in the SI joint resolve within three months of implementing an appropriately individually tailored rehabilitation programme, which includes combined outpatient physiotherapy and kinesiology training.
Pronounced or flattened thoracic kyphosis refers to an unnatural pathological position of the thoracic spine, which usually affects the adult population as a result of long-term incorrect postures.
Most cases of pronounced thoracic kyphosis develop during adolescence or later in adulthood, but we also know Scheuermann’s disease and thus congenital pronounced thoracic kyphosis, which is also characterised by anatomical changes in the vertebrae.
The most important cause of pronounced thoracic kyphosis is the asymmetrical stiffness of the soft structures that enable upright posture and extension of the thoracic spine.
When the trunk flexors are excessively rigid on the front side, pronounced thoracic kyphosis occurs, whereas when muscle tone is pathologically increased on the back side of the trunk, flattened thoracic kyphosis or military posture often occurs.
The cause of the pathological curvature of the thoracic spine can also be an incorrect curvature of the lumbar spine, which, according to the principle of a chain reaction of kinetic chains, establishes a compensatory pattern in the thoracic spine, which assumes an incorrect position.
Symptoms of thoracic spine misalignment may include, in milder forms:
– pain in the cervical spine and shoulders,
– difficulty breathing,
– lumbar pain,
– chronic tension in the upper torso.
Progressive symptoms in long-term pronounced or flattened thoracic kyphosis may include anatomical changes in the spine that can no longer be corrected with training, neurological disorders in the upper extremities, and the development of secondary degenerative conditions of the thoracic spine, such as herniated discs, wear and tear of the facet joints, spinal stenosis, etc.
Pronounced or flattened thoracic kyphosis is treated with targeted kinesiology training, which must be based on an individualised training programme considering the specific causes of the patient’s thoracic spine misalignment.
In the case of pronounced kyphosis, strengthening the spinal extensor complex in the thoracic region and manual release of rigid structures on the anterior side, usually the pectoral muscles, trunk flexors, and indirectly the hip flexors, are recommended.
In the case of flattened thoracic kyphosis, strengthening the deep spinal stabilisers, trunk flexors, and relaxing the spinal extensors are recommended. Training should be focused on establishing muscle balance and building strength endurance.
Scoliosis is a three-dimensional deformity of the spine and body.
A healthy spine has a balanced vertical position in the coronal plane with bilateral symmetry. In a spine with scoliosis, there is a lateral deviation from the normal vertical axis, axial rotation of the vertebrae, and physiological curvatures of the thoracic or lumbar spine.
It can occur due to congenital defects in the development of the vertebrae and spinal cord, due to hereditary diseases of the neuromuscular tissue, due to severe trauma (traffic accident), or due to congenital and later defects in the connective tissue.
In most cases, scoliosis does not have a negative impact on quality of life. It is crucial that its development is identified early in childhood, as an appropriate approach can stop the progression of the pathology, which, without treatment, could cause symptomatic problems in adulthood.
Scoliosis most often occurs in children up to the age of 16 and progresses rapidly during the period of body growth. The average prevalence of scoliosis is 2% to 3% in the paediatric population.
Scoliosis often does not cause problems and negative consequences on an individual’s lifestyle.
When scoliosis is untreated in childhood or exceeds 45 degrees of curvature from the natural vertical position of the spine, it can cause serious consequences such as lung and heart defects.
By regularly monitoring scoliosis early in childhood, scoliosis can be stopped in time by implementing tailored therapies.
In scoliosis between 20 and 45 degrees of deviation, there is a greater risk of spinal pain and accelerated development of degenerative conditions, therefore regular tailored training is recommended to maintain adequate muscle stabiliser strength and muscle balance.
For individuals with scoliosis resulting from trauma or an unhealthy lifestyle, performing tailored kinesiology training is an important treatment strategy for the condition.
Before treating scoliosis, it is recommended to have an X-ray of the spine to obtain the exact dimensions and structure of the scoliosis. After an X-ray, an orthopaedic specialist determines the pattern or type of curvature, the degree of scoliosis, and the state of physiological curvatures. Scoliosis is defined as a diagnosis when the spinal deformity deviates from the vertical axis by more than 10 degrees.
Scoliosis with a spinal curvature of 10 to 20 degrees is monitored; if scoliosis reaches a curvature of 20 to 45 degrees, it is treated with a conservative approach of outpatient physiotherapy and therapeutic training, which is individually tailored to the type of scoliosis, the patient’s age, and the individual characteristics of the spinal curvatures. Surgical treatment is performed for scoliosis exceeding 45 degrees.
