DDD

What is the age range in which a traumatic rupture can occur

30-45

If scoliosis develops from the herniation which way will the shift in the vertebrae happen in most cases

A lateral shift away from the pain

Describe the Instability stage

Arthritic changes occurs, lax joint capsules, hypermobile vertebral segments...at this stage tissue change is permanent

What is spondylosis

Arthritic changes to the spine, especially the facet joints

What is protrusion

Bulging of a disc w/out structural instability of the annulus fibrosis

What is the cause of DDD

Chronic overloading of the disc leading to annular fibre micro tearing and migration of the nucleus

What is the annulus fibrosus of an intervertebral disc

Concentric layers of collagen forming a laminated band which holds two vertebra together

Describe the Dysfunction stage

Disc is weaker, bulges, shows signs of tearing. At this stage it is reversible

What is happening at the Sequestration Stage

Disc material is comprised and both disc material and nucleus pulposus escape into the surrounding area

What are some contraindications when working on a client with DDD

Do not treat client with saddle anesthsia and bladder weakness, do not treat if you cannot find a comfortable position (one without pain) for the client, Do not mobilize hypermobile joints, do not remove all protective muscle spasming in the acute stage, no deep work

What are the 3 stages of DDD

Dysfunction, Instability and Stabilization

What works with the discs to help bear the weight of the body

Facet joints

What is the common cause of a disc herniation

Flexion or rotation of the lumbar spine

What muscles are addressed for a client with DDD that has Posterior Pelvic Tilt

Hamstrings, Hip Flexors and lumbar extensors

What muscles are addressed for a client with DDD that has Hyperlordosis

Hip flexors, rectus femoris, it band, iliopsoas, tfl, erector spinae group, ql and glutes

What is the location of most herniated discs

L4 - L5, L5-S1

What are some neurological signs of the client may experience with a disc herniation/DDD

Motor weakness, numbness, nerve pain, irritation of dura or nerve root will not be relieved by movement, nucleus leaks out and impinges on the nerves

What is happening in the Prolapse Stage

Nucleus Pulposus seep out of the disc into the layers of annular rings, but does not escape from the disc

What is happening at the Extrusion Stage

Nucleus Pulposus seeps out of the disc at a week point, but disc material is still intact

Describe the Stabilization stage

Osteophytes form, disc height is decreased, decreased ROM...at this stage degeneration will spread to other vertebrae

What muscles are addressed for a client with DDD that has Forward head carriage in the supine position

Pecs, Intercoastals, Scalenes and SCM

What muscles are addressed for a client with DDD that has Hyperkyphosis in the supine position

Pecs, subclavious deltoids, anterior intercoastals, Lats

What are the 3 stages of herniation

Prolapse, Extrusion and Sequestration

What are some special tests the therapist can perform to check for a disc herniation in the cervical region

Spurling's, Cervial compression, cervical distraction

What are some special tests the therapist can perform to check for a disc herniation in the lumbar region

Straight leg raise w/ various variations, Valsalva, Kemp's and Kernig's

What might you feel while palpating on a client with a disc herniation

Tenderness, heat, muscle spasms and active trigger points

What might you feel upon palpation of the client with DDD

Tenderness, trigger points, fascial restrictions as well as fibrosed and hypertonic muscles

What is Degenerative Disc Disease

The Degeneration of the annular fibres of the intervertebral disc on the outside part of the disc

What other structures surrounding the disc are innervated by nerves

The anterior and posterior longitudinal ligament, nerve roots and vertebral body

As a therapist what might you observe with the clients alignment or posture

The neck might be sidebent and rotated, forward head carriage, leg length discrepency, accute scoliosis, decrease in normal lordosis

What part of the intervertebral disc is innervated by nerves

The posterioperipheral aspect of the annulus fibres

What is the function of an intervertebral disc

They act as shock absorbers between the vertebrae when the bones are load bearing

What is the nucleus pulposus of an intervertebral disc

Transparent jelly in the central part of the disc surrounded by the annular fibres

What are some contributing factors of DDD

Trauma, muscle imbalance, postural dysfunction such as forward head carriage, poor blood supply to the disc, lack of flexibility, improper back support and poor posture

What are some notable changes that happen in the disc as it degenerates over time

Vascular supply decreases, becomes wedge-shaped, the posterior side narrows, the posterior portions of the annulus appear to be thinner and shorter than the anterior ones