The Back

Approximately 85% of the population is affected by spinal problems or back pain. The spine is composed of 33-34 bones: 7 vertebrae in the cervical region, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae (fused), and 4-5 coccygeal vertebrae. The spine has four curves, two lordoses (anterior convexities) and two kyphoses (posterior convexities).

The vertebrae are short bones composed of the body, arch, and vertebral foramen. Between the vertebral bodies are the intervertebral discs. These are composed of the fibrous ring and the pulposus nucleus and their main role is to provide cushioning and assist the movements of the spine.

The main functions of the spine are related to support, protection, and movement. The lumbosacral segment is the place where both upper and lower forces converge. For this reason, the lumbar region is subjected to continuous overloads that can damage the vertebral joints, ligaments, discs, and muscles that provide support and stability to this region.

The cause of spinal pain is determined after a thorough evaluation and careful medical examination, which may involve additional imaging investigations.

Contents

Common Conditions

• Acute / post-traumatic back pain
• Fractures of the lumbar vertebrae
• Disc protrusion

Chronic Conditions

• Chronic lumbar pain
• Spondylolysis and spondylolisthesis
• Lumbar canal stenosis

Surgical Interventions

• Surgical intervention for disc herniation

Common Conditions

Acute / Post-traumatic Back Pain

Back pain in the lumbar area can be caused by a wide range of injuries or conditions. However, we specialize in treating them all. A common cause of acute back pain can be a kind of stabbing pain caused by a sudden straightening of the spine. It is very important to check for pinched/compressed nerves in these cases, which usually involve severe stabbing pains around the location of the nerve. In most of these cases, patients will also feel muscle pain in the back that leads to sleep problems, which in turn can aggravate their condition. X-rays are often used to diagnose these injuries, although MRI or CT scans may also be used if the doctor suspects that intervertebral discs are involved. We have extensive experience in treating these types of conditions with physiotherapy, therapeutic massage, global postural reeducation (RPG), osteopathy, and effective exercises for muscle toning. Selective strengthening and core consolidation exercises are very effective here, strengthening the muscles needed to support the back and reduce instability. One thing that should not be overlooked when dealing with this type of injury is that back pain is often aggravated by the patient's habits. Poor posture and excess weight are factors that contribute to back pain.

Fractures of the Lumbar Vertebrae

Fractures of the lumbar vertebrae can cause intense pain. These injuries are divided into two clinical categories: fractures without neurological implications (stable fractures) and those with neurological implications (unstable fractures). These are more complex types because the spinal nerves can be damaged if involved in subsequent injuries. In both cases, patients will experience localized back pain, limited movement, or postural changes. These injuries can lead to kyphosis or scoliosis in some cases. X-rays are usually sufficient for diagnosis, although CT or MRI scans may be necessary for further checks. Stable fractures can be treated through physiotherapy in our rehabilitation rooms where the goal is to reduce pain and regain full mobility. In the case of unstable fractures, surgery is necessary primarily to stabilize the spine. In any case, we specialize in post-operative rehabilitation.

Disc Protrusion

Intervertebral discs act as shock absorbers for the spine, so when a disc shifts its position, it can cause significant pain and many postural deficits. Several factors must be considered in these cases - the direction in which the disc has moved, whether a hernia is present or not, and if the nerve roots are compressed/strangled. In almost all cases, conservative treatment is specific and effective. Through a combination of manual therapy and physiotherapy designed to improve the strength of the lumbar and abdominal muscles and the endurance of the lower limbs, we can reduce pain and restore normal posture. Orthopedic manual therapy, osteopathy, and global postural re-education are also very effective in achieving balance in the affected area.

Chronic Conditions

• chronic lower back pain

Low back pain is a general term that can refer to a wide variety of conditions, from intervertebral disc degeneration to sciatica and cruralgia, as well as other conditions affecting the intervertebral discs and their inner core. Due to the complexity of these conditions, they are often difficult to diagnose and even harder to treat. We are a team of physical therapists, well-prepared to treat chronic back pain. Patients should be aware that healing persistent pain of this type can be a long-term process. Work in the physiotherapy room and hydrotherapy are crucial in the long-term treatment of back pain. Also, complex approaches including mechanical spinal traction, TECAR WINBACK physiotherapy, wireless electrotherapy, and a range of osteopathic techniques and global postural re-education make our center unique in Brașov.

• spondylolysis and spondylolisthesis

Spondylolisthesis refers to a defect in the morphology of the lumbar spine. This occurs when the vertebral isthmus (a thin strip of bone connecting the superior and inferior facets of the spine) deforms and allows the vertebrae to slip over one another. This can be anterior - anterolisthesis or posterior - retrolisthesis. If the problem is bilateral, posterior stability is lost, and an anterior slip of the L5 vertebra (in most cases) relative to the sacrum occurs. The cause is not fully known, but some researchers believe that some people may simply have a congenital weakness of the isthmus. Repetitive microtraumas or a single severe trauma can trigger this condition. This condition is the main cause of low back pain in adolescents and young athletes. This problem is essentially benign, but tends to progress over the years and can cause instability in the lumbar spine. For this reason, it should be monitored. The first step is a clinical diagnosis, although more tests may be needed to confirm this diagnosis, but an X-ray of the lumbosacral region is usually sufficient to support a clinical diagnosis. In more advanced cases, listhesis can cause stenosis, leading to nerve compression and the appearance of all related problems. Conservative therapy is preferred and consists of strengthening exercises, exercises that reduce vertebral body slippage, increasing pelvic retroversion, and reducing lumbar lordosis. As a result, physical therapy and manual therapies are used, depending on the clinical manifestation of the disease.

• lumbar canal stenosis

Lumbar canal stenosis represents a narrowing of the anteroposterior and transverse diameter of the spinal canal. Symptoms include paresthesia, pain, discomfort, weakness, and a feeling of heaviness in the legs. Intermittent sensory-motor difficulties during walking are similar to those resulting from chronic vascular insufficiency. These problems can affect one or both legs and may occur either after a long period of standing or even after a short walk. During a specialist consultation, doctors will be aware of the limited range of motion in the lumbar area and will likely request an X-ray if stenosis is suspected to be the cause of this limitation. CT and MRI can allow for a more accurate diagnosis of the severity of the stenosis. Recovery will take at least 2 months, with 2-3 sessions per week in the pool, the physiotherapy room, accompanied by osteopathic treatments. It is very important to perform massages to relax the dorsal and lumbar regions, as well as stretching the muscles of the posterior chain and basic stability exercises. Surgical treatment should be considered as a backup plan and should be performed when motor impairment occurs in the affected limb.

Surgical Interventions

• surgical intervention for disc herniations

Surgical treatment here is reserved for cases where selected conservative treatments have proven ineffective. Surgical interventions can also be used in cases where neurological lesions progress, and the exacerbation of symptoms becomes a risk. Depending on the location and size of the hernia, the neurosurgeon will choose an appropriate intervention method. Treatment is usually done with a non-invasive technique (2-3 cm scar). In cases of major complications, it may be necessary to adopt a more traditional approach using laminectomy. Some surgeons may also perform percutaneous disc decompression using lasers. However, this treatment does not guarantee that symptoms will not recur. After surgery, a rehabilitation program is essential to ensure optimal recovery.