♪ Bob and Brad. ♪
♪ The two most famous physical therapists on the internet. ♪
- Hey!
(deep breathing)
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together, we are the most famous
physical therapists on the internet.
- Well Bob, in our opinion of course, of course.
- I'm gonna let you pronounce these words, Brad.
- Well, Bob, we're gonna do this on back pain,
associated with these four diagnosis.
They are probably the most difficult for me to pronounce,
so, and different people pronounce 'em differently.
So if you get diagnosed with either,
spondyloly-, spondylolysis,
spondylolisthesis,
spondylitis or spondylosis. - Spondylosis
Very nice, Brad.
- Yes!
And you say, "Oh."
Don't worry for the majority of these diagnosis,
it's not necessarily serious.
It can be, but we're gonna go through 'em one at a time.
- I would say for the majority, it's not serious.
- Isn't that what I said?
- I don't know.
(chuckles)
- What did I say, Tim?
- I was backing you up.
- (laughs) Thank you.
- You know the thing is that they all sound similar.
- Right.
- Because they all involve 'spondy', which is?
- The spine. - The spine.
- Yep.
I dunno if it's Latin or Greek
but it's one of those.
So anyways, once you understand them, these,
and it's, it's not so bad, with any luck.
So, spondylolysis.
- Gotcha.
- Spondylolysis is typically in the low back.
It doesn't have to be though,
but we're gonna look at it in the low back
cause many of these are.
And what we're gonna do, is let's say we take out,
1, 2, 3, 4 on the fifth vertebra
is where you have this diagnosis with spondylolysis.
(laughing)
There is a.
- The fifth bone down.
- Well, we actually gonna look up here.
- Oh yeah.
- Just because it's easier to show on here.
It's typically, it's a stress fracture in the vertebra.
So often times it's from multiple movements,
something of that nature.
You don't really know what happened.
- Right.
- It just starts to hurt.
And it's typically found with a C-scan, not an X-ray.
Although you can see it with an X-ray,
but it's, that's beyond our capabilities.
So if we look at the fourth vertebra on this model,
we just took this part off and here we've got the pelvis.
Okay.
The sacrum.
And we're right about this level.
Now you're gonna have to zoom in Tanner.
Okay.
So vertebra are basically all the same
from the lumbar to the neck.
They're just shaped a little differently.
- [Bob] Yeah, they are.
- [Brad] They have the same parts.
- [Bob] Right.
- [Brad] So if you look at this line right here,
that is the pars interarticularis.
So that is where you have the stress fracture, right there.
The spinal cord is right here.
We've got the peripheral nerves here.
So it's close to a lot of important structures.
- [Bob] But, fortunately it's only on one side.
- [Brad] Right.
So there's no real physical movement there.
- Right.
- On, on the vast majority.
- The spine, the, the vertebra stays stable.
- Right.
So typically you have back pain with this.
And the back pain is typically worse
when you extend backwards.
So you avoid that.
20%, not 20%, 1 out of 20 people have this diagnosis.
Oftentimes it's asymptomatic.
You're not even.
- 20%?
- No, 1 out of 20.
- Oh, 1 out of 20!
- Yeah. One out of 20.
So it's 5%.
- Right.
- Yeah.
So anyway, typically it goes and people, you know,
live their life with some back pain.
- Right.
They avoid extension.
It's not a real big deal.
- And it might not even give 'em any pain.
- Right. Exactly.
Let's go to the next one.
Now this is a mouthful.
- Sure.
- I'm really particular to this one
because I have this diagnosis and have a good model of it.
Spondylolisthesis.
Bob, can you pronounce it the way you like to pronounce it?
- Spaa-thesis.
- There you go.
That sounds good too.
One way or another, this is where,
it's the same fracture right here,
except for the fracture is not just on one side.
It's on both sides. - It occurs on both sides.
- [Brad] And the thesis is the movement.
So you actually have movement of one vertebra
on top of the other.
So these are vertebra coffee cups.
They start out lined up like they're supposed to,
and one shifts forward like this one.
L4, L5 are the most commonly ones that are moved.
This is what I have.
I have, there's four grades 1, 2, 3, 4.
- [Bob] So one would be very slight.
- [Brad] Yep.
- [Bob] And you know, just eyeballing it,
you know by the time you get to four, it might need surgery.
- [Bob] Right.
And they'll put in, typically hardware,
something to stabilize it- - [Brad] stabilize it.
- [Bob] With surgery,
it doesn't get to that point very often.
5, 5 to 7% of the population have this
to a certain degree, they estimate.
You often, it, it can be asymptomatic or non-painful.
Often times it does result in back pain.
Mine at this point,
and I do have, oftentimes it's common.
The disc actually disintegrates or-
- Right. Is fused.
- It's fused.
So this bone.
- That bone is fused to that bone.
- [Brad] Yeah. And that doesn't happen overnight.
- [Bob] And you had symptoms at one point
where you couldn't run.
- Right.
- You had pain all the way down legs.
- Yep.
'Cause what'll happen is that the,
this gap right here changes
and you get some pinching on the nerve,
you get sciatica symptoms with it.
- You could also get pinching on the main spinal cord.
- Yep, yep.
And that's where sciatica,
I don't know if that's quite as common,
but the sciatica is more common.
- Sure.
- This, if you have this, you should see someone.
- Right.
- We've got great videos on it.
There's some specific exercises you can do
to help curb this.
Mine has stabilized over a few years.
I'm back to running.
I, I ski, I do a number of things, but I'm careful.
- Right.
- You know, relatively.
- Yeah.
- So that's, spondylolisthesis
there is such a thing as retro-spondy,
which the vertebra actually moves the opposite direction.
It's not near as common.
And there's people that do ask for that.
We do have a video on it.
- [Bob] But it actually, it, the symptoms are the same.
Right?
Going back, it's gonna hurt?
- No, I think you flex forward on that one.
- Really?
- Yeah. I'd have to look at my video.
I, I did do research on that, and the videos out.
- I didn't- - Right.
- Refresh my memory.
- Sure.
- So, that's a good one.
Let's see.
Did we forget anything else with that?
- Nope.
- And typically, I do wanna mention if you're younger
and you have this, like gymnasts often have it
when they land and or you jump off a, a, a higher level,
like off a back of a pickup truck
and you land with your back arched that can spur this on.
Mine I think started either in wrestling
with a really silly move that they,
I hope they outlawed by now or made it illegal.
Or when I was
- You getting pinned?
- No, no.
If I, if I show you, you would not believe they allow that,
this move where your arch back.
Anyways, knee boarding is where I really arched hard,
where you jump to wake
and your knees are strapped down anyways.
- It sounds like waterboarding.
- Yeah.
It's a little different than that.
But it definitely hurt.
Anyways, if you're younger,
usually four to six weeks of serious therapy and exercises,
and you should be getting ready to get,
go back to the event.
- Really, that's kind of showing you what you can do,
what you can't do.
- Yeah.
- And how to manage things when things go bad.
- Exactly. Exactly.
So the next one's spondylitis.
- Right.
- So spondy spine, itis, ITIS.
- Right.
- Inflammation.
So it simply inflammation of the spine.
This one oftentimes occurs around the facet joints,
where arthritis can set in and cause the inflammation.
There's other reason for inflammation,
there's up to eight forms of spondylitis.
So if you have this you need to talk to your doctor
and get details.
- The most common is ankylosing spondylitis.
- Right.
- And in that case it's the entire spine that gets affected.
- Yeah.
- And it gets a bamboo appearance.
- Sure.
- If you look at the spine,
especially from the front view,
it looks like a bamboo.
- And I think part of that is,
is there's degeneration of the disc.
- Sure.
- And then the, the bones start to fuse together-
- Right
- And get very rigid and stiff.
So activity, gentle stretching,
pretty much on all these, is important.
You just need to know which direction to stretch
and which direction not to stretch.
- What I do remember about ankylosing spondylitis Brad,
it would affect the shoulders and the hips too.
- Sure.
Yeah. It's one of those things.
Maybe a little systemic.
- Yeah. It was.
- So, again, refer to your doctor on that
and make sure you understand it.
Spondylo, Spondylosis.
- Right.
- Now, this is probably the most vague term,
because spondy, spine,
osis just means a lesion or a pathology on the spine.
Typically it's degenerative spine disorder,
it gets worse with age, it's like getting gray hair.
You might get this diagnosis
and it's because you have a spine that's degenerating,
but it's not unusual, but-
- It's like arthritis almost really.
- Right.
- I mean, it just degenerating and,
and not being what it was.
- Right.
For example, in the United States,
3 million people are diagnosed with this every year
and they're living a life relatively normally.
They probably have some pain
and are taking some maybe over the counter meds oftentimes.
- Right.
- It can get worse.
It can get to the point on a serious end
where there's actually, where the.
Let's take this one, where the spinal cord goes into,
it is actually getting compressed.
And that can cause some problems.
And you'll know about that.
You definitely, your doctor will talk to you about that
and approach that accordingly.
- Yeah.
A friend who had in the cervical spine,
and they called it cervical stenosis
and he was getting symptoms out into his legs.
- Yep. Yep.
- So.
- And that's, like you said, it's not a common one.
- Right.
- But it can be, so be aware,
keep in close touch with your doctor if you have that.
So you clear that out and they'll let you know.
- Yep.
- Alight. So there we go.
We have the Spondy's.
Four Spondy's.
- Oh, that's right.
- Spondylo, Spondy
- No, don't even try it.
- They're a mouthful one way
or another good luck with your back.
And we hope that everything goes well, keep your powder dry.