SCOLIOSIS and LUMBAR CONDITIONS

• 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

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

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

• 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 .

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

• 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 .

>40 degrees Signs & Symptoms .• Classifications • Mild – < 20 degrees • Moderate – 20-40 degrees • Severe .

Signs & Symptoms .

• • • • Pain LOM Postural Deviation Weakness of LE Signs & Symptoms of Lumbar conditions .

Signs & Symptoms of Lumbar conditions .

Lab Tests .

Lab Tests .

• SCOLIOSIS • • • • Cobb’s angle X-ray Leg length measurement Forward Bending test • LUMBAR CONDITIONS • X-ray • MRI • CT Scan Diagnosis .

PT Intervention .

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 • • • • • C.

• 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 .

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