Frequently Asked Questions
Degenerative Lumbar Spine Therapy
Q: What happens when a spine degenerates?
A: The lumbar spine is made up of bones, cartilage, and nerves. The small bones making up the spine are called vertebrae. Between each vertebra sits a disc made of cartilage and water. When the vertebrae and discs are stacked on top of one another, small canals are formed on each side of the spine. It is through these canals that the leg nerves exit the spine. As we age, the disc’s ability to hold water decreases and subsequently the discs shrink down in size. (This is why people over age 65 gradually get shorter in height.) As the discs shrink, each vertebra moves closer together. This can be a problem for a couple of reasons. First, there can be increased pressure on small joints in the back of the spine called facet joints. Too much pressure on these joints can cause pain. Second, the canals where the nerves exit the spine become narrower. They can become so narrow that the nerves become pinched and pain in a leg may result. Nerves can also be pinched by abnormal bone growth, called bone spurs, which occur around the canals. Bone spurs are a result of years of wear and tear on the spine.
Q: Why does standing cause more pain than sitting?
A: Standing causes the spine to bend backwards (extend), whereas sitting causes the spine to bend forwards (ex). Any activity that causes the spine to bend backwards will increase joint pressure and close the canals where the nerves exit, resulting in back and/or leg pain. Any activity that causes the spine to bend forward will decrease joint pressure and open the canals where the nerves exit, resulting in back and/ or leg pain relief. This is why some people with lumbar spine degeneration will bend forward when they walk. Bending forward allows them to stand and walk without joint pressure and nerve pinching. Walking around bent over is not the answer, however. There is a better way!
Q: Is walking the best exercise for someone with a degenerative lumbar spine condition?
A: Not necessarily. Unless you can hold an effective pelvic tilt, walking often times irritates inflamed nerves and joints and results in increased back and or leg pain. While it is necessary to walk in order to get from one place to another, there are other aerobic exercises that will not aggravate a degenerative lumbar spine condition. Other options include bicycling, walking backwards in the pool, and rowing. These exercises place the lumbar spine in a flexed and pain free position.
Q: Can the type of shoes I wear affect the pain I experience in my back and/or leg?
A: Definitely! A shoe with heels, such as cowboy boots and women’s dress shoes, cause the lumbar spine to bend backwards resulting in painful joint pressure and nerve pinching. It is much easier to hold a pelvic tilt standing when wearing shoes without heels.
Q: What is the purpose of my home exercise program?
A: Your home exercise program consists of carefully selected exercises tailored to your speci c back condition. Doing these prescribed exercises at home will allow you to progress much more quickly with pain relief and increased mobility. It is common for patients to experience an increase in pain for 7 to 10 days when rst beginning an exercise program. This is normal and expected because the body is not used to performing these new activities. If you suspect the increase in pain you are experiencing is not normal, inform your physical therapist so that modi cations to the exercises can be made.
Q: What is the posterior pelvic tilt?
A: When a person walks around in a bent-over position, they are bending the spine from the top down. This effectively decreases joint pressure and opens the canals where the nerves exit. However, the person is now bent over, looking at the ground. It is not only difficult to see where you are going but also difficult to maintain this “bent-over position” causing extremely high strain on the back muscles. Another option, which is a much better option, is to bend the spine from the bottom up! We do this by tilting the pelvis backward or in a posterior direction. This position is called posterior pelvic tilt. It will effectively decompress painful joints and open nerve canals without having to bend over. With some training and practice, a person can hold this posture during all standing and walking activities without anyone even noticing. Maintaining the posterior pelvic tilt can dramatically increase the time a person with a degenerative spine condition can be on his or her feet.
Q: How does the posterior pelvic tilt relate to me?
A: Anyone with a degenerative spine condition should maintain a posterior pelvic tilt 100% of the time. This may come natural when performing some activities, but for other activities it may take some practice. For example, our spine naturally assumes the posterior pelvic tilt when sitting but we must put forth some effort to hold this posture when standing and walking.
Q: Is there a “right” and “wrong” way to sleep?
A: It is also very important to hold the posterior pelvic tilt when sleeping.
Sleeping in a “fetal” position on either side with the knees drawn up or on the back with the knees elevated is a good way to sleep because the pelvis naturally tilts posteriorly. Sleeping on the stomach with several pillows under the hips is also an acceptable position. Conversely, sleeping on the back or on the stomach are not good sleeping positions because the pelvis is naturally forced in the opposite direction causing painful joint pressure and nerve pinching.