SCOLIOSIS and LUMBAR CONDITIONS

Is a lateral curvature of the spine. It is a deformity rather than a disease May have its onset between infancy and adulthood depending on the etiology

Scoliosis

 Slipped discs
is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic There is damage in the annulus fibrosus

Spondylisthesis
is the anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below

Spondylosis
aka degenerative osteoarthritis of the vertebra

Spondylitis
is an inflammation of the vertebra Example: Potts disease and Ankylosing spondylitis

Spondylolysis
is a defect of a vertebra. More specifically it is defined as a defect in the pars interarticularis of the vertebral arch

Lumbar Conditions

Anatomy Kinesiology Physiology

 Provides basic support for the head and internal organs Stable base for the attachment of ligaments, bones, ribcage, muscles of the extremities and the pelvis A link between the lower and the upper extremities Protects the spinal cord

Vertebral Column

 The vertebral column has a complex function Able to provide stability as well as mobility

Stability and Mobility

 33 short bones
7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccygeal

Structure

 23 intervertebral discs
6 cervical 12 thoracic 5 lumbar

Structure

 Primary Curves
Thoracic Sacral

Secondary Curves
Cervical Lumbar

Curves

 Kyphotic Curves Lordotic Curves

Curves

 2 main types of articulations

Cartilaginous
Between vertebral bodies and interpost discs

Diarthrodial
Joints between the superior articular process of one vertebra and of the inferior articular process of an adjacent vertebra

Articulations

 All facet joints except for the first two cervical vertebra are plain synovial Sacroiliac joints are found where the vertebra articulate with the pelvis Coupling consistent association of one motion about an axis with another motion with another axis

Articulations

 Divided into two parts:

Intrasegmental Intersegmental

Ligaments

Muscles

Muscles

Muscles

Muscles

Muscles

 2 Major Parts
Vertebral Body Vertebral Arch

Typical Vertebra

Typical vertebra

 Makes up about 20-33% of the length of the vertebral cord Increases in size from the cervical of the lumbar region

Intervertebral discs

 The disc is composed of two parts:

Nucleus Pulposus Annular Fibrosus

Intervertebral discs

Cervical Vertebrae

Thoracic Vertabrae

Lumbar Vertabrae

Etiology

 Two main classifications of Scoliosis

Structural Non Structural

Etiology

 Structural
Idiopathic Congenital Neuromuscular Neurofibromotosis Scoliosis due to disease of vertebra

Etiology

 Non structural
Postural Due to LLD Due to nerve root irritation Due to Contractures of the hip

Etiology

Epidemiology

 Idiopathic scoliosis
Female > Male

Scoliosis is typically equal in occurrences in both male and female in specific cases

Epidemiology

Signs & Symptoms

 Uneven shoulder levels Uneven musculature on one side of the spine A rib prominence and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis Uneven hips/leg lengths

Signs & Symptoms

 Non structural
Not accompanied by rotational or asymmetrical changes in the individual structure of the spine

Structural
Morphologic abnormalities are present Concave side structures are compressed and shortened Convex side structures are stretched and lengthened The intervertebral disc may bulge on the opposite side as a result of the pressure

Signs & Symptoms

 Classifications
Mild < 20 degrees Moderate 20-40 degrees Severe - >40 degrees

Signs & Symptoms

Signs & Symptoms

Pain LOM Postural Deviation Weakness of LE

Signs & Symptoms of Lumbar conditions

Signs & Symptoms of Lumbar conditions

Lab Tests

Lab Tests

 SCOLIOSIS
Cobbs angle X-ray Leg length measurement Forward Bending test

LUMBAR CONDITIONS
X-ray MRI CT Scan

Diagnosis

PT Intervention

 Scoliosis
C- Curve (Cross Walk) S- Curve (Ambling Walk) CAT and CAMEL exercises Dry Swimming Exercise Klapps exercise
L4 reversed L2 kneeling T11-12 on fingertips T8 on hands T6 prone on elbows T4 ALLAH position

PT Intervention

 Scoliosis
Bracing

PT Intervention

 Lumbar Conditions

PT Intervention

Prognosis

 Factors of prognosis:
Sex Curve Pattern and Severity Growth potential

Prognosis

 Girls whose scoliosis were discovered before menarche has greater progression as compared to girls whose scoliosis were discovered after menarche

Prognosis