SCOLIOSIS and LUMBAR CONDITIONS

Scoliosis

• Is a lateral curvature of the spine.• It is a deformity rather than a disease• May have it’s onset between infancy and adulthood

depending on the etiology

Lumbar Conditions

• 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

AnatomyKinesiologyPhysiology

Vertebral Column

• 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

Stability and Mobility

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

Structure

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

Structure

• 23 intervertebral discs• 6 cervical• 12 thoracic• 5 lumbar

Curves

• Primary Curves• Thoracic• Sacral

• Secondary Curves• Cervical• Lumbar

Curves

• Kyphotic Curves• Lordotic Curves

Articulations

• 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

Ligaments

• Divided into two parts:

• Intrasegmental

• Intersegmental

Muscles

Muscles

Muscles

Muscles

Muscles

Typical Vertebra

• 2 Major Parts• Vertebral Body• Vertebral Arch

Typical vertebra

Intervertebral discs

• 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

Cervical Vertebrae

Thoracic Vertabrae

Lumbar Vertabrae

Etiology

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

Epidemiology

Epidemiology

• Idiopathic scoliosis• Female > Male

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

Signs & Symptoms

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 of Lumbar conditions

• Pain • LOM• Postural Deviation• Weakness of LE

Signs & Symptoms of Lumbar conditions

Lab Tests

Lab Tests

Diagnosis

• SCOLIOSIS• Cobb’s angle• X-ray• Leg length measurement• Forward Bending test

• LUMBAR CONDITIONS• X-ray• MRI • CT Scan

PT Intervention

PT Intervention

• Scoliosis• C- Curve (Cross Walk)• S- Curve (Ambling Walk)• CAT and CAMEL exercises• Dry Swimming Exercise• Klapp’s 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

Prognosis

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