Vertebrogenic Disorders

Fig. 27.1

Degenerative spinal canal stenosis

Arthritic changes often result in a different movement pattern than other spinal disorders. Movement is limited primarily in back and side bending, when articular facets get closer to each other. There may also occur claudication similar as in congenital spinal canal stenosis. Combination with vascular processes should be distinguished [6–8]. It is believed that degenerative changes sometimes lead to development of synovial cysts that may compress nerve roots [9].

27.1.3 Sacroiliac Joint

Disorders of this joint cause low back pain and occur often in association with lesions in other parts of the spine. Pain radiates to the S1 segment and to the groins (Fig. 27.2). The most common disorder is “mobility blocking” that does not always correlate with a radiographic finding and is detected by special tests. In men, it can be associated with the prostate disease [10, 11].

Fig. 27.2

Pain radiation in S1 lesion

27.1.4 Stabilization System of the Spine

Ligaments

Ligaments alone cannot ensure the stabilization function in individual segments. Their attachments are a source of pain caused particularly by chronic overloading. The condition develops or exacerbates mainly as a result of the loss of muscle support. Discomfort increases in the evening or when the patient is tired; at rest the symptoms usually improve [12, 13].

Muscles

Progressive age-related changes often combined with hypomobility and overweight result in dysfunction of the muscular system and impairment of stabilization function of autochthonous muscles of the back and the diaphragm, pelvic floor and abdominal muscles.

Pain syndrome is as a rule associated with hypertonia of certain muscle groups and hypotonia in others. Hyperactive muscles are the source of pain which may generate painful irritation in the musculoskeletal system. There are two types of muscle activity during spinal movements.

Long superficial muscles of the back serve to move individual parts of the spine, but they do not ensure stabilization of two neighbouring vertebrae (Figs. 27.3, 27.4 and 27.5) [14, 15]. The deep stabilizing system is exposed to atrophy from inactivity, and in advanced age, this is accentuated by involutional changes. The stabilization system of the spine includes also the diaphragm and pelvic floor muscles, as well as lateral abdominal muscles that function as antagonists and synergists of the posterior muscles of the back [16–18].

Fig. 27.3

Trunk muscles – dorsal muscles. 1 Trapezius, 2 deltoid, 3 infraspinatus, 4 latissimus dorsi, 5 aponeurosis lumbodorsal, 6 obliquus externus abdominis, 7 trigonum lumbale, 8 gluteus maximus, 9 teres major, 10 teres minor, 11 speculum rhomboideum, 12 sternocleidomastoideus (Courtesy of Grim et al. [32])

Fig. 27.4

Dorsal muscles (left) and sacrospinous (right) systems. 1 Serratus posterior superior, 2 m. serratus posterior inferior, 3 iliocostalis, 4 longissimus thoracis, 5 longissimus cervicis, 6 longissimus capitis (Courtesy of Grim et al. [32])

Fig. 27.5

(a) Dorsal muscles, spinospinal system and deep short muscles. 1 Rectus capitis lateralis muscle, 2 cervical intertransversarii muscles, 3 external intercostal muscles, 4 spinalis muscle, 5 lateral lumbar intertransversarii muscles, 6 medial lumbar intertransversarii muscles, 7 levatores costarum muscles, 8 thoracic intertransversarii muscles, and 9 obliquus capitis superior muscle (Courtesy of Grim et al. [32]). (b) Dorsal muscles and transversospinal system. 1 Multifidi muscles, 2 rotator muscles, 3 semispinalis capitis muscle (Courtesy of Grim et al. [32])

Hypoventilation

Pain syndrome is characterized by non-physiological breathing and decreased tone of abdominal and pelvic floor muscles (often associated with obesity), especially in the elderly. Activity in the area of axial organs as well as movements of the limbs require fixation of spinal segments. A significant role in spinal stabilization is played by the diaphragm.

Electromyographic studies have proved that regardless of the breathing phase, contraction of the diaphragm precedes limb muscle activity [19, 20].

Muscle dysfunction is treated by targeted rehabilitation, an integral part of which is training of proper breathing.

Lower Limb Joints

Monitoring of the muscle activity in the standing position has revealed that the most marked activity takes place in the region of muscles controlling the sole and toes (Fig. 27.6) [21, 22]. Mobilization of lower limb joints should be an integral part of a comprehensive treatment of both chronic and acute complaints, especially in advanced age. Lower limb joints get blocked due to hypomobility as well as due to weight-bearing stereotypes, such as walking on the same type of ground (asphalt, pavement). Removal of the block restores function also in more remote regions.