Physical Therapy Guide to Spondylolysis and Spondylolisthesis (Fracture of the Lumbar Spine and Slipped Vertebra)→

Spondylolysis (spon-dee-low-lye-sis), or lumbar stress fracture, is a stress fracture of a section of the lumbar spine. The area of the fifth lumbar vertebra is most often affected. The injury can occur on the left or right of the vertebra. Lumbar stress fractures occur in up to 11.5% of the general population in the United States. It is a common cause of low back pain in older children and youth, most often young males. It is a common cause of low back pain in older children and youth. It most often occurs in young males, but also can occur in girls. Highly active teens who engage in activities like lifting heavy loads, repeated backward bending, or twisting of the trunk, are most at risk. Activities like football, hockey, gymnastics, or dance put athletes at higher risk. Only a small percentage of cases require surgery. The majority (85% to 90%) of young patients recover in three to six months with proper treatment. Recovery time can be longer and is different for each person.

Spondylolisthesis (spon-dee-low-lis-thee-sis), or slipped vertebra, is a condition that involves the forward slippage of one vertebra over the one under it. If a crack or stress fracture occurs on both sides of the vertebra it is called spondylolisthesis.

Lumbar stress fracture and slipped vertebra are often described together because they are similar in:

• The mode of injury.

• Age of the patient.

• Symptoms.

• Treatment.
  
  

What Are Stress Fracture and Slipped Vertebra of the Lumbar Spine?

Lumbar stress fracture is a fracture of the part of the bony ring that connects the front part of the spinal column to the back part. The fracture occurs between the part of the bone that sticks out of the back of the spine and the part that sticks out of the side of the spine. Doctors sometimes refer to this condition as a "pars defect." Strain on the lumbar spine due to repeated activities in a growing child can cause this type of injury. It results in low back pain.

Slipped vertebra is the forward slip of a defective, unstable vertebra. There are five grades of slips, with grade I being the smallest amount of slippage and grade V being a slippage of 100%. With milder slippage, and a defect on just one side of the vertebra, physical therapy treatment is effective. Young athletes whose teenage growth spurt has not yet occurred are at greater risk for continued slippage. These athletes and are monitored until they are fully grown.

Key points to understand about lumbar stress fracture and slipped vertebra:

• Early detection and proper diagnosis of these conditions are important. With early diagnosis and treatment, people with these conditions can safely return to sport or an active lifestyle. If symptoms last a long time and you wait to get help, healing may take much longer.

• The majority of symptoms can resolve with rest and the help of a physical therapist.

• Surgery may be needed when treatment of more than six months fails, and symptoms persist.

• Both of these conditions need to be ruled out in a young athlete who is has low back pain that lasts for more than a few weeks. Active young athletes in sports such as football, hockey, gymnastics, and dance are at the greatest risk. This is especially true while the athlete is still growing.

• If an X-ray does not show a fracture, but a clinical exam suggests a high likelihood of lumbar stress fracture, your doctor may order an MRI to rule it out.

• These conditions are not a major cause of low back pain in adults. It can, however, occur high-level adult athletes who take part in high-risk sports.

Signs and Symptoms

Lumbar stress fracture or slipped vertebra may be present if you experience:

• Low back pain with or without buttock or leg pain. If leg pain is present, it is felt into the thigh, but generally not below the knee.

• Muscle spasms in your low back, buttocks, and thighs.

• Difficulty or pain with walking or standing for long periods.

• Symptoms that are relieved by sitting, slouching, or bending forward.

• Pain with sports or manual labor.

• Pain with bending backward, twisting the spine, or with throwing.

• Decreased flexibility of the leg muscles.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes questions about your health history. Their goal is to assess the degree of your injury and to determine the cause and contributing factors. Your physical therapist also may gather information from forms you fill out before your first session. Their questions may include:

• How did your injury occur? Was there a single episode or did your condition become worse over time?

• How have you taken care of your condition? Have you seen other health care providers? Have you had imaging (e.g., X-ray, MRI) or other tests, and do you have the results of those tests?

• How long have you had pain? Did it come on suddenly or gradually?

• Does your pain occur with activity, at rest, or during the day or night?

• What activities or positions make your pain better or worse?

• Do you take part in activities like football, hockey, gymnastics, or competitive dance?

• Can you point with one finger to the area on your back that is painful?

• Do you have any other symptoms, such as fever, chills, or night sweats?

• Do you have trouble with bowel and bladder control?
  
  
  

After your physical therapist learns the specifics of your condition they will conduct a physical exam.

The physical exam most often will begin with watching some of the movements that were discussed in the interview. It will include the area of your main symptoms as well as other areas that may be involved, such as your hip. Your physical therapist may:

• Watch you walk.

• Have you bend forward to try to touch your toes, and bend back as far as you can.

• Ask you to stand on one leg and bend back.

• Ask you to turn your trunk from side to side.
  
  
  

Your physical therapist uses these tests to assess your leg and spine flexibility as well as your core strength. They may ask you if the testing changes your symptoms. They may gently but skillfully press specific areas of your low back and pelvis to see if they are painful. This information helps your physical therapist determine the cause of your pain, exactly where your pain is, and the best treatment to resolve your symptoms.

After the interview and physical exam, your physical therapist will discuss the findings with you. If your physical therapist suspects a stress fracture, they may refer you to an orthopedic or sports medicine doctor familiar with back injuries. The doctor may order imaging tests (X-ray, MRI) to confirm a diagnosis and rule out other conditions.

How Can a Physical Therapist Help?

Your physical therapist will design a targeted treatment program based on your condition and goals. It will be designed to safely return you to sport or daily activities. Your treatment plan may include:

Patient education. Your physical therapist will work with you to identify and change any external factors causing your pain. These factors can include the type and amount of exercise you do, your athletic activities, footwear, or the surfaces on which you practice and play. They may recommend changes in your daily activities.

Pain management. Your physical therapist will design a program to address your pain. This may include applying ice to the affected area. Applying heat also is helpful in some cases. Electrical stimulation gently targets nerve fibers that send pain signals to the brain. It also may be used together with ice to help relieve your pain. Your physical therapist also may recommend decreasing some activities that cause pain. Physical therapists are experts in prescribing pain-management techniques that reduce or avoid the need for medicines, including opioids.

Body mechanics. How you move and use your body for work and other activities can contribute to lumbar spine problems and pain. Your physical therapist will teach you how to improve your movements or body mechanics based on your daily activities. They also may make recommendations to improve the way you do certain activities, such as lifting and carrying objects.

Manual therapy. Often, manual therapy for lumbar stress fracture and slipped vertebra includes "soft tissue release" or massage for tight and sore muscle groups. These hands-on techniques may be used to correct tightness of muscles to promote normal movement.

Stretching exercises. Stretching exercises can help improve the flexibility of tight muscles. They also may help to improve movement in the spine and lower extremities and help decrease stress on the lumbar spine during daily activities.

Strengthening exercises. Strengthening helps to make the lumbar spine, pelvis, and hip joints more stable. This, in turn, helps to reduce strain on tissues, and pain. These movements are focused on weak muscles, including the lower abdominal, pelvic floor, and buttocks muscles.

Functional training. Once your pain, strength, and motion improve you will need to safely move back into more demanding activities. To lessen your risk of repeated injury, it is important to learn safe, controlled movements. Based on your unique movement assessment and goals, your physical therapist will create a series of activities to help you use and move your body more correctly and safely for years to come.

Can This Injury or Condition Be Prevented?

Lumbar stress fracture and some types of slipped vertebra may be preventable by educating individuals who are at higher risk of injury.

For the growing young athlete, it is necessary to manage how much, how intensely, and how often you exercise. Parents and coaches should:

• Limit a child’s participation to one high-risk sport at a time during a season.

• Limit participation to only one team at a time during a season.

• Require and enforce one to two days of rest from training per week.

• Gradually increase training volume, intensity, and frequency when a person is starting a new sport or activity.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat lumbar stress fracture and slipped vertebra. However, you may want to consider:

• A physical therapist who is experienced in treating people with spine injuries and/or athletes. Some physical therapists have a practice with an orthopaedic or sports physical therapy focus.

• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedic and/or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
  
  

General tips when you are looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or from other health care providers.

• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who are athletes or active individuals with lumbar stress fracture.

• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of lumbar stress fracture and slipped vertebra. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Iwaki K, Sakai T, Hatayama D, et al. Physical features of pediatric patients with lumbar spondylolysis and effectiveness of rehabilitation. J Med Invest. 2018;65(3.4):177–83. Article Summary in PubMed.

Lawrence KJ, Elsar T, Stromberg R. Lumbar spondylolysis in the adolescent athlete. Phys Ther Sport. 2016;20:56–60. Article Summary in PubMed.

Schroeder GD, LaBelle CR, Mendoza M. The role of intense athletic activity on structural lumbar abnormalities in adolescent patients with symptomatic low back pain. Eur Spine J. 2016;25:2842–2848. Article Summary in PubMed.

Kim HJ, Green DW. Spondylolysis in the adolescent athlete. Curr Opin Pediatr. 2011;23(1):68–72. Article Summary in PubMed.

Kalichman L, Kim DH, Li L, et al. Spondylolysis and Spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009;34(2):199–205. Article Summary in PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Revised in 2020 by Susan Reischl, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, and reviewed by Stephen Reischl, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, on behalf of the Academy of Orthopaedic Physical Therapy. Authored in 2014 by Donna Merkel, PT.

6 Tips to Prevent New Parenting Injuries→

The months following the birth of a child are some of the most rewarding for new parents—and the most challenging to a new parent’s body. Lifting and carrying a child, picking up toys off of the floor, and pushing a stroller are normal daily tasks for moms and dads.  

Here are some tips on how using proper body mechanics to help ease the strains and stresses of parenting:

1. Lifting Your Child From the Floor 
When picking up your child from the floor, you should use a half-kneel lift:

First, stand close to your child on the floor. While keeping your back straight, place one foot slightly forward of the other foot, and bend your hips and knees to lower yourself onto one knee. Once down on the floor, grasp your child with both arms and hold him or her close to your body. Tighten your stomach muscles, push with your legs, and slowly return to the standing position.

To place your child onto the floor, the same half-kneel technique should be performed.

2. Carrying/Holding Your Child 
When holding or carrying your child, you should always hold him or her close to your body and balanced in the center of your body. Avoid holding your child in one arm and balanced on your hip. When using a child carrier, be sure to keep your back straight and your shoulders back to avoid straining your back and neck.

3. Picking up Toys From the Floor 
While straightening up and picking items off the floor, keep your head and back straight, and while bending at your waist, extend one leg off the floor straight behind you. You can also use the half-kneel technique discussed above, if several toys are within the same space.

4. Lifting Your Child Out of the Crib 
As you lift your child out of the crib, keep your feet shoulder-width apart and knees slightly bent. Arch your low back and, while keeping your head up, bend at your hips. With both arms, grasp your child and hold him or her close to your chest. Straighten your hips so you are in an upright position, and then extend your knees to return to a full stand. To return your child to the crib, use the same technique and always remember to keep your child close to your chest.

5. The Stroller 
When you are lifting your child from a stroller, stand directly in front of the child to avoid twisting your back. It is important to bend from your hips rather than from your lower back, much like rising from a squatting position.

When walking your child in a stroller, you will want to stay as close to the stroller as possible, allowing your back to remain straight and your shoulders back. The force to push the stroller should come from your entire body, not just your arms. Avoid pushing the stroller too far ahead of you because this will cause you to hunch your back and round your shoulders forward.

6. The Changing Table 
Before placing the baby on the changing table, it is essential to keep him or her at the center of your body. The table should be at the appropriate height for parental use. When changing your baby's diaper, the best table placement and height is directly in front of and slightly below the elbows. This helps avoid the type of bending and twisting that can cause injury.

Other tips:

• Place all diaper-changing materials within arm’s reach—for instance, in wide-set drawers directly below the changing area.

• You may wish to place one leg on a stool when you are using the changing table. This can help take strain off your back and neck.

Physical Therapy Guide to Spinal Stenosis→

It is estimated that as many as 80% of us will experience some form of back or neck pain at some point in our lifetimes. Spinal stenosis can be one cause of back and neck pain. It affects your vertebrae (the bones of your back), narrowing the openings within those bones where the spinal cord and nerves pass through.

What Is Spinal Stenosis?

Spinal stenosis is a narrowing within the vertebrae of the spinal column that results in too much pressure on the spinal cord (central stenosis) or nerves (lateral stenosis). Spinal stenosis may occur in the neck or in the low back.

The most common causes of spinal stenosis are related to the aging process in the spine:

• Osteoarthritis is a deterioration of the cartilage between joints. In response to this damage, the body often forms additional bone (called "bone spurs") to try to support the area. These bone spurs might cause pressure on the nerves at the point where the nerves exit the spinal canal.

• Normal aging can result in a flattening of the disks that provide space between each set of vertebrae. This narrowed space allows less room for the nerve to exit from the spinal cord.

• Spinal injuries, diseases of the bone (such as Paget disease), spinal tumors, and thickening of certain spinal ligaments also may lead to spinal stenosis.

 In most cases, symptoms of spinal stenosis can be effectively managed with physical therapy and other conservative treatments. Only the most severe cases of spinal stenosis need surgery or spinal injections.

Signs and Symptoms

Spinal stenosis may cause symptoms such as:

• Pain, numbness, tingling, or weakness in your arms and shoulders, legs, or trunk

• Occasional problems with bowel or bladder function

If you have spinal stenosis in the neck (cervical spinal stenosis), you may have weakness, numbness, and pain in one or both arms and often in the legs, depending on which nerves are affected. You may or may not have pain in the neck itself.

If you have spinal stenosis in the low back (lumbar spinal stenosis), you may have pain, numbness, and weakness in the low back and one or both legs, but not in the arms. Your symptoms may get worse with walking and improve with sitting.

How Is It Diagnosed?

Because the symptoms of spinal stenosis are often similar to those of other age-related conditions, a careful diagnosis is important. Your physical therapist will conduct a thorough evaluation, including a review of your medical history, and will use screening tools to determine the likelihood of spinal stenosis. Your physical therapist may:

• Ask you very specific questions about the location and nature of your pain, weakness, and other symptoms

• Ask you to fill out a body diagram to indicate specific areas of pain, numbness, and tingling

• Perform tests of muscle strength and sensation to determine the severity of the pressure on the nerve root

• Examine your posture and observe how you walk and perform other activities

• Measure the range of motion of your spine and your arms and legs

• Use manual therapy to evaluate the mobility of the joints and muscles in your spine

• Test the strength of important muscle groups

If you have muscle weakness, loss of sensation, or severe pain, diagnostic tests such as an X-ray or MRI may be needed. Physical therapists work closely with physicians and other healthcare providers to ensure that an accurate diagnosis is made and the appropriate treatment is provided.

Research shows that in all but the most extreme cases of spinal stenosis (usually involving muscle weakness or high levels of pain), conservative care, such as physical therapy, achieves better results than surgery.

How Can a Physical Therapist Help?

Your physical therapist's overall purpose is to help you continue to participate in your daily activities and life roles. He or she will design a treatment program based on both the findings of the evaluation and your personal goals. The treatment program likely will be a combination of exercises.

Your physical therapist will design a specialized treatment program to meet your unique needs and goals. Your program may include:

Gentle Movement. Your physical therapist may teach you specific movements to help take pressure off the nerve root, which can help alleviate pain.

Stretching and Range-of-Motion Exercises. You may learn specific exercises to improve mobility in the joints and muscles of your spine and your extremities. Improving motion in a joint is often the key to pain relief.

Strengthening Exercises. Strong trunk (abdomen and back) muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off your spinal joints.

Aerobic Exercise. You may learn aerobic exercise movements to increase your tolerance for activities that might have been affected by the spinal stenosis, such as walking.

This might sound like a lot of exercise, but don't worry: research shows that the more exercise you can handle, the quicker you'll get rid of your pain and other symptoms!

Your physical therapist may decide to use a combination of other treatments as well, including:

Manual Therapy. Your physical therapist may conduct manual (hands-on) therapy such as massage to improve the mobility of stiff joints that may be contributing to your symptoms.

Use of Equipment. Your physical therapist may prescribe the use of rehabilitation equipment—such as a special harness device that attaches to a treadmill to help reduce pressure on the spinal nerves during walking.

Postural Education. You may learn to relieve pressure on the nerves by making simple changes in how you stand, walk, and sit.

Can This Injury or Condition Be Prevented?

Spinal stenosis usually is a natural result of aging. Research has not yet shown us a way to prevent it. However, we do know that you can make choices that lessen the impact of spinal stenosis on your life and even slow its progression.

• Regular exercise strengthens the muscles that support your back, keeps the spinal joints flexible, and helps you maintain a healthy body weight.

• Using supportive chairs and mattresses and avoiding activities that can lead to injury—such as heavy, awkward, or repetitive lifting—can help protect your back.

Your physical therapist can help you develop a fitness program that takes into account your spinal stenosis. There are some exercises that are better than others for people with spinal stenosis, and your physical therapist can educate you about what exercises and activities you should avoid. For instance, because walking is usually more painful than sitting, bicycling may be a better way for you to get regular physical activity. All low back pain is different and unique to each individual. Your physical therapist will design a specialized exercise program for you based on your movement exam, your health profile, and your goals.

Real Life Experiences

Deborah is a 67-year-old office worker with a longstanding history of back and leg pain on both sides. She recently had shoulder surgery and, with the help of a physical therapist, recovered well. Now, however, after a full day at work, sitting at a computer sometimes for hours, she experiences low back pain that lasts into the night.

She has started to ask her daughter to pick up groceries for her at the local store, because she is afraid that lifting the bags will aggravate her back pain. She has also made excuses to her local walking group the past two weekends because walking any distance becomes too painful. Just last night, the pain caused Deborah to wake up three times. She decides to call the physical therapy practice where she received treatment for her shoulder.

After performing an extensive evaluation, Deborah’s new physical therapist, who focuses on treating patients with low back pain, concludes she most likely has lumbar spinal stenosis. She recommends treatments to increase Deborah’s overall strength, including:

• Exercises that involve flexing of the lumbar spine

• Manual physical therapy of the hips, lumbar spine, and upper back (thoracic spine) to improve motion in the joints and relieve pressure on the spine and nerves

• A home-exercise program that includes specific exercises; instructions for modifying activities such as sleeping, walking, and housework; and suggestions for pain-relieving treatments

Physical therapists may use a special harness-type device attached to a treadmill that helps to reduce pressure on the spinal nerves during walking. Deborah's physical therapist adds this "unweighting" treatment to her program.

Deborah’s physical therapist explains the expected course of spinal stenosis treatment. Deborah learns that recovery may be slow and may require patience and hard work on the part of both herself and her physical therapist. They agree to “team up” for the weeks ahead to improve Deborah’s strength and overall fitness, relieve her pain, and get her moving well again.

After 6 weeks of treatment, Deborah is able to shop for her groceries again, complete all of her daily activities, and walk 20 minutes 2 times per day without any limitations. She calls the leader of her weekend walking group to say she’ll see them next Saturday morning!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have spinal stenosis. You may want to consider:

• A physical therapist who is experienced in treating people with pain, orthopedic, or musculoskeletal diagnoses.

• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

• Get recommendations from family and friends or from other health care providers.

• When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with spinal stenosis.

• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of spinal stenosis. The articles report recent research and give an overview of the standards of practice for the treatment of DDD both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Cook C, Brown C, Michael K, et al. The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiotherapy Research International. 2010. doi: 10.1002/pri.500. [Epub ahead of print] Article Summary on PubMed.

Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009;9:545-50. Article Summary on PubMed.

Sugioka T, Hayashino Y, Konno S, et al. Predictive value of self-reported patient information for the identification of lumbar spinal stenosis. Fam Pract. 2008;25:237–244. Article Summary on PubMed.

Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P. Clinical Guidelines: Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491. Article Summary on PubMed.

Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine. 2006;31;2541–2549. Article Summary on PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by Chris Bise, PT, DPT. Reviewed by the editorial board.

Degenerative Disk Disease→

What Is Degenerative Disk Disease?

Your spine is made up of 33 vertebrae that are stacked on top of one another. Between each of these vertebrae is a rubbery piece of cartilage called an "intervertebral disk." (See images: Degenerative Disk Disease - Cervical | Lumbar.) Imagine the disk as a tire, with gelatin filling the hole in the tire. The tire is called the "annulus," and the gelatin is called the "nucleus." When we're young—under 30 years of age—the disk is made mostly of gelatin. As we age, and sometimes with injury, we start to lose some of that gelatin and the volume of the disk decreases, resulting in less space between the vertebrae. The disk becomes flatter and less flexible, leaving less space between each set of vertebrae. Sometimes bone spurs form in response to this degeneration of the disk, which could make the spine stiff. Often, this flattening and additional stiffness to the spine is not at all painful.  However, in some cases, when the rough surfaces of the vertebral joints rub together, pain and inflammation may result. The nerve root, the point where a spinal nerve exits the spine and extends to other parts of the body, may become irritated or compressed.

Disk degeneration may occur throughout several regions of the spine, or it may be limited to 1 disk. Degeneration does not always lead to pain. For some people, however, it can cause a great deal of pain and disability.

You are more likely to develop DDD if you:

• Smoke
• Are obese
• Do heavy physical work
• Don't get very much exercise

How Does it Feel?

With DDD, you may experience mild to intense neck and back pain—or no pain at all:

• A degenerative disk in the neck may cause pain in the arm, shoulder, or neck.
• A degenerative disk in the low back may cause pain in the back, buttocks, or legs.

The pain is often made worse by sitting, bending, and reaching. It may be worse first thing in the morning and after staying in any one position for a long time.

In severe cases, when DDD results in pressure on the nerve root, it can lead to numbness, tingling, and even weakness in the arms or legs.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes a review of your medical history, and will use screening tools to determine the likelihood of DDD. For example, your physical therapist may:

• Ask you very specific questions about the location and behavior of your pain, weakness, and other symptoms
• Ask you to fill out a body diagram to indicate specific areas of pain, numbness, and tingling
• Perform tests of muscle strength and sensation to determine the presence of pressure on the nerve
• Examine your posture and observe how you walk and perform other activities
• Measure the range of motion of your spine and your arms and legs
• Use manual (hands-on) therapy to evaluate the mobility of the joints and muscles in your spine
• Test the strength of important muscle groups

If you have muscle weakness, loss of sensation, or severe pain, diagnostic tests, such as an X-ray or MRI, may be needed. However, X-ray evidence of wearing in the joints of the spine is found in people with back pain as well as in many who have never experienced back pain. Studies have shown that disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of those aged 50 to 55 years. Do not panic if your X-ray or MRI shows “problems” with your discs; these are normal changes that happen from the age of 20 years and onward. Physical therapists work closely with physicians and other health care providers to make certain that an accurate diagnosis is made and the appropriate treatment is provided.

Research shows that in all but the most extreme cases (usually involving muscle weakness or high levels of pain), conservative care, such as physical therapy, has better results than surgery. Research also shows that results from conservative care and surgery are the same after 18 months post operatively.

After the evaluation, if your physical therapist suspects you have DDD and there are no major medical problems, treatment can begin right away.

How Can a Physical Therapist Help?

Your physical therapist's overall purpose is to help you continue to participate in your daily activities and life roles. Your physical therapist will design a treatment program based on both the findings of the evaluation and your personal goals. The treatment program may include:

Stretching and flexibility exercises. Your physical therapist will teach you specific exercises to improve movement in the joints and muscles of your spine, arms, and legs. Improving motion in a joint is often the key to pain relief.

Strengthening exercises. Strong trunk muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off your spinal joints.

Aerobic exercise. Regular aerobic exercise, such as walking, swimming, or taking a low-impact aerobics class, has been shown to help relieve pain, promote a healthy body weight, and improve overall strength and mobility—all important factors in managing DDD.

This might sound like a lot of exercise, but don't worry, research shows that the more exercise you can handle, the quicker you'll get rid of your pain and other symptoms.

Your treatment program may also include:

Manual therapy. Your physical therapist may apply manual (hands-on) therapy, such as massage, to improve movement in stiff joints and tight muscles that may be contributing to your symptoms.

Posture and body mechanics education. Your physical therapist may show you how to make small changes in how you sit, stand, bend, and lift—even in how you sleep—to help relieve your pain and help you manage your condition on your own.

Note: Studies show that recurrence of neck and low back pain is common when a condition such as DDD is not properly treated. Regular performance of the exercises your physical therapist chooses for you is extremely important to make sure your pain does not return.

Can this Injury or Condition be Prevented?

DDD is a natural result of aging. However, you can make choices that lessen its impact on your life and slow its progression. Your local physical therapy clinic can offer you advice on staying strong and fit. Some physical therapy clinics conduct regular educational seminars to help people in the community learn to take care of their backs and necks. Your physical therapist can help you develop a fitness program that takes into account your DDD. There are some exercises that are better than others for people with DDD, and your physical therapist will choose the right ones for you. For instance:

• Exercising in water can often be a great way to stay physically active when other forms of exercise are painful.
• Exercises involving repetitive twisting and bending need to be performed with some caution. If you start to notice some aching or pain after exercising, consult with a health care professional, such as a physical therapist, who can improve the way you move—and help reduce or eliminate your back or neck symptoms.
• Weight-training exercises, though important, need to be done with proper form to avoid stress to the back and neck. Your physical therapist will work with you to ensure your weight training is safe and effective.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have DDD. You may want to consider:

• A physical therapist who is experienced in treating people with pain, orthopedic, or musculoskeletal, diagnoses.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
• You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with DDD.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of degenerative disk disease. The articles report recent research and give an overview of the standards of practice for treatment of DDD both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther. 2009;89:9–25. Free Article.

Beattie PF. Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology, and lumbar magnetic resonance imaging findings. J Orthop Sports Phys Ther. 2008;38:329–340. Free Article.

Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [published correction appears in: Diagnosis and treatment of low back pain. Ann Intern Med. 2008]. Ann Intern Med. 2007;147:478–491. Free Article.

Roh JS, Teng AL, Yoo JU, et al. Degenerative disorders of the lumbar and cervical spine. Orthop Clin North Am. 2005:36:255–262. Article Summary on PubMed.

Authored by Chris Bise, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.