CMT II: DDD Flashcards
Degenerative disc disease is a degeneration of the ______
annular fibers of the intervertebral discs.
Basis of DDD Treatment
Herniated Disc or Other Space Occupying Lesion (SOL) Except for a Tumor
Treatment of DDD
Multiple manual tractions interspersed within the general protocol
The hard part of a disc; composed of fibrocartilage arranged in rings; contains a hollow chamber in the center of the disc that houses the nucleus pulposus
Annulus Fibrosis
The viscous fluid in the center chamber within the annulus fibrosis; 88% water at birth, 65% by age 65
Nucleus Pulposus
Joints that allow for movement between individual spinal segments
Facet Joints
A bulging of a disc w/o structural damage to the annulus fibrosis - not classified as a herniation
Protrusion
A bulging of a disc w/ structural damage to the annulus fibrosis
Herniation
The 3 Sub-Categories of Herniation
- Prolapse
- Extrusion
- Sequestration
When nucleus pulposus seeps into layers of annulus fibrosis, but does NOT escape from the disc.
Prolapse
When nucleus pulposus seeps out of the disc at a weak point, but disc material is not fragmented.
Extrusion
When disc material is compromised and both disc material and nucleus pulposus escape into the surrounding area
Sequestration
Common layperson’s term used a describe a herniated sic
Slipped Disc
Arthritic changes to the spine, especially the facet joints
Spondylosis
Fixation of a joint by bony material
Ankylosis
Non-specific medical term used to classify low back pain
Lumbago
Compression or inflammation of the sciatic nerve at the spine
True Sciatica
Impingement of the sciatic nerve by the piriformis muscle
False Sciatica
Compression of sacral nerve root can result in bladder and/or bowel dysfunction and numbness across low back, gluteals, inner thighs, and around hips
Do Not Treat; Refer Out
Saddle Anesthesia
True Neurological Symptoms
- Motor weakness specific to level of lesion and dermatomal sensory change such as numbness
- More common with extrusions and sequestrations (when nucleus leaks out of annular fibers and impinges on the nerves)
- Nerve pain will be present
- Irritation of dura or nerve root will not be relieved by movements
Cause of DDD
Continuous compressive and shearing forces placed upon the discs
Contributing Factors of DDD
- Trauma
- Muscle Imbalances
- Hyper/Hypomobile Spine
- Postural Deviations
- Bending/Twisting/Lifting as Part of Job
3 Stages of Degeneration
- Dysfunction
- Instability
- Stabilization
(T/F)
Pain is always present during the stages of degeneration
False
Onset of Cervical DDD
Gradual
Areas of spine where most disc issues occur
Cervical and Lumbar
Early Cervical Disc Degeneration Signs
- Stiffness
- Pain-Free Crepitus
- Pain Often Radiating into the Shoulder of the Affected Side
Later Stage Cervical Disc Degeneration Signs
- Nerve Pain into the Involved Side Upper Extremity
- Loss of Neck and Arm Strength
- Loss of Reflexes
- Occipital Regional Headaches
Areas where 98% of all low back disk injures occur
- L4 to L5
- L5 to S1
Sex that is more prone to lumbar herniations (3:2 ratio)
Men
Most common ages when acute herniations occur
30 to 45 y/o
Cause of Nerve Pain
Pressure on nerve roots or spinal cord
Cervical DDD Special Tests
- Spurling’s
- Cervical Compression Test
- Cervical Distraction Test
Lumbar DDD Special Tests
- Straight Leg Raise w/ Various Variations
- Valsalva
- Kemp’s
- Kernig’s
Contraindications of DDD Treatment
- Saddle Anesthesia
- No Position that Alleviates Symptoms
- Positioning that Increases Symptoms
- Mobilization of Hypermobile Joints
- Pressure and Direction that Increase Symptoms
- Deep and Longitudinal Friction Strokes
Hydrotherapy for DDD
Ice if pain and spasms are present
When not to remove spasms as the spams are part of the body’s protective mechanism
Acute Stage
DDD Treatment Direction
- Peripheral
- Central
- Peripheral
