Case Study – Lumbar Degenerative Disc Disease

December 1, 2017 | By | Reply READ MORE...

A 46-year-old man, Mr. X, came to PhysioRehab with the following complaints:

  • Constant pain in the low back area which builds up as the day progresses. Pain more on the right side
  • Low back stiffness while getting up from the bed in the morning, which stays for an hour and decreases as the day progresses.
  • Unable to sleep due to the thought of pain bothering his sleep.

Examination:

On examining the patient’s posture, there was flattening of the lumbar curve, which has normally an inverted curvature (Lumbar Lordosis).

Lumbar Degenerative Disc Disease

Patient’s MRI findings:

  • L5-S1 disc desiccation (dry disc).
  • This means that there is “blackening” of disc between lower lumbar and sacral vertebrae which causes the space between the two vertebrae to reduce.
  • Although there is a genetic component to some individuals who suffer from degenerative disc disease, the true cause is probably multifactorial.
  • It could be from part of the ageing process, wear and tear, trauma, poor diet & nutritional habits, poor lifestyle habits (smoking, overweight, bad posture, sedentary activity).
Lumbar Degenerative Disc Disease

NORMAL DISC SPACE

 

Lumbar Degenerative Disc Disease

DESICCATED/DEHYDRATED DISC       

Short Term Goals:

  • Patient education: A disc is a sponge between two bones in the spine which distributes the pressure equally through the spine (shock absorber). When a disc no longer is capable of taking the pressure there is excessive pressure on the surrounding structures especially the muscles and joints. A specific program designed to strengthen the muscles to take up that load. If ignored a degenerated disc gives rise to pain and can lead to arthritis at the spinal segment. Identify the cause of degenerated disc and modify or treat it. Give guidelines for lifestyle changes.
  • Pain relief: Through various therapeutic modalities like US (Ultrasound), IFT (Interferential therapy), hot pack
  • Cardio activity: walking, swimming
  • Nutrition program: focussed on healthy diet and weight loss if required.

Long Term Goals:

  • Spine stability training
  • Deep core muscle activation
  • Axial lengtheners to relieve the pressure on the back

Implementation Of Goals:

We at PhysioRehab make a tailor-made program to target specific problem areas for a specific person.

After achieving the initial goals of pain relief the next step will be to strengthen the muscles without placing excessive load on the spine.

  • To avoid placing excessive load on the spine, posture correction is done and maintained in lying down, sitting and standing.

Lumbar Degenerative Disc Disease
Correct Lying Down Posture
Lumbar Degenerative Disc Disease
Correct Sitting Posture
Lumbar Degenerative Disc Disease
Correct Standing Posture

  • Deep core activation – Core muscles include our abdominal and back muscles that form an ‘internal corset’. If these muscles are strong, the load on the back is drastically reduced and hence, no back pain. Also, in conditions like this where a degenerated disc is causing pain, it’s important to not twist the spine and rather do variations for exercises using arm and leg modifications.

CORE EXERCISES

Lumbar Degenerative Disc Disease
Lumbar Degenerative Disc Disease
Lumbar Degenerative Disc Disease

  • The buttock muscles also play an important role in back pain rehabilitation and if the buttocks and abdominal muscles work optimally then the spine is stabilised on the pelvis and thus, recurrence of pain can be avoided.

Lumbar Degenerative Disc Disease
Lumbar Degenerative Disc Disease
Lumbar Degenerative Disc Disease
Lumbar Degenerative Disc Disease

  • Stretching is also important to improve flexibility

BACK STRETCHES
Lumbar Degenerative Disc Disease
Lumbar Degenerative Disc Disease

Outcome:

  • Within 8 weeks of physiotherapy Mr. X’s back stiffness had become negligible and pain had gone down drastically.
  • He felt more confident in doing his daily activities and his fear of back pain had gone away.

Hence, a detailed evaluation and treatment program is very important for the outcome.

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Category: Case Studies

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