Do you have an aching back with point tenderness? Have you ever wondered where that pain and tenderness might be coming from? Odds are, it could be due to a varying degree of spinal instability. If you have ever had back spasms, pain with lifting, bending and/or extending your spine backward, then you could be dealing with some varying degree of spinal instability. Other symptoms might include numbness and tingling in the leg, pain in the buttock and pain radiating down the leg. We actually reserve this term spinal instability for more severe cases, and we use another term, hyper-mobility, for less severe instabilities and all the gray areas in between. A person’s mild to moderate low back and or buttock pain may not be due a clinically definable insatiability as observed on MRI or X-ray, but an experienced Physical Therapist in manual therapy should be able to determine if you have a varying degree of spinal hyper-mobility with just a few simple tests. Being able to properly quantify the degree of hyper-mobility will lead to better treatment and understanding for long-term management of your condition.
First and foremost, to understand instability it is important to understand the anatomy of the spine at each vertebral motion segment. As you may know each vertebra has a corresponding spinal disc, but what many people don’t realize is that there are two other articulation points, called facet joints. These three joints are connected to the adjacent vertebrae above and below by ligaments and small muscles and tendons. These three joint complexes create the stability of the spine that supports its movements in all directions.
When the wear and tear of life causes sufficient deterioration and thinning of the opposing joint structures on either the facets and/or the disc joints then the whole structure loses its anatomic integrity. In other words, when erosion of the disc occurs the ligaments that were designed for let’s say a 10mm span across the disc joint now would only need to be let’s say 6mm long depending on the amount of disc degeneration. This extra slack in the joint gives rise to extra movement in the forward and backward direction. In the physical therapy world, we give this a term, called translation (see diagram above). There should be a certain amount of translation in each joint to allow for a normal amount of movement, but this excessive translation we would consider hyper-mobility and in worse cases, instability.
Manual Physical Therapists have ways of diagnosing and quantifying the amount of excess translation in a spinal joint. For example, in the picture below the side-lying test shows the therapist feeling for the slight degree of movement between the two adjacent spinous processes. During the test, the therapist can quantify the movement into varying degrees of movements on a scale of 0-6 with 0=no perceivable motion and 6=unstable.
Many times, spinal hyper-mobility symptoms include pain and tenderness to direct pressure on the spine as well as a diffuse ache in the low back. There are also subclinical signs that an experienced manual physical therapist can look for such as adjacent areas of limited flexibility. Often hyper-mobile spinal joints occur as a compensation for more restricted joints elsewhere, or joints with a decreased amount of translation – joints that are considered tight or shortened. When examining the causes of spinal hyper-mobility, it is also wise to examine the surrounding tissue for joints that have shortened, become restricted or have limited ROM.
Often times in traditional medical and traditional physical therapy settings spinal hyper-mobilities may go undiagnosed because the examiner has not been trained or lacks the clinical skill to detect them. A Manual Physical Therapist trained in identifying and treating spinal hypermobility may be hard to find. Many physical therapists try to treat back pain with non-ergonomic stretching, traditional nonspecific exercises and/or poorly stabilized spinal manipulation without regard for protection of the hyper-mobile segments. The primary purpose of physical therapy in the case of a spinal hyper-mobility is to teach a stabilization program that involves teaching that person how to stabile their spine not just with exercise but also during all aspects of our daily routines. Movement re-education techniques and other more advanced muscle training may become necessary for many higher-level patients. Through physical therapy, we can educate patients who present with spinal hypermobility to change any habitualy bad motor behaviors and ultimately create a long-term movement re-education program for them that emphasizes functional postures and return to a pain-free lifestyle including sports.
If you have any questions and would like to speak to a Physical Therapist who’s experienced in manual therapy as well as one who is skilled in identifying and appropriately treating spinal hyper-mobility please feel free to set up an appointment with us by emailing or calling our office at 678-667-3435.