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Back Pain
Sciatica
This is an umbrella term that just means that something is pressing on the sciatic nerve. This can happen from an intervertbral disc, stenosis of the spine, from the sacroiliac joint, from a muscle called the piriformis, arthritis, instability of the spine (hypermobility), and stiffness of the spine (hypomobility), just to name a few.
Discogenic
This is pain generated from an intervertebral disc. They can be bulged or herniated. One of the problems of getting an MRI is that you will most likely find some sort of disc issue. Only 25% of bulges actually produce symptoms and are often misdiagnosed (false positive). All too often we see patients with pain shooting down their leg and an MRI finds a disc issue. They elect for surgery based off of a recommendations from a surgeon and the pain is not alleviated. The true source of the pain may be elsewhere.
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Stenosis
This is a term that just means ‘narrowing’. This commonly affects the lumbar spine and is part of the aging process. As we get older, the discs lose water (as we tend to become dehydrated) and the vertebrae are allowed to sit like a stack on top of each other. The space between the vertebrae where the nerves exit the spine to supply the legs is narrowed. Add a bone spur or a bulged disc to this mix and it is even worse. The important thing to know is that extension of the spine (leaning back) will worsen this condition. This is a perfect example of why you shouldn’t just google back pain exercises.
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Arthritis
This is general wear and tear. It is a fact of life. It is not genetic, you didn’t catch it from your mother. The ends of bones have cartilage which allow joint surfaces to smoothly glide on each other. With age, overuse, and lack of muscle bulk around the joints, the cartilaginous surface wears away exposing raw bone. When in weight bearing positions, the exposed bone joint surfaces rubs against each other provoking inflammation (arth=joint, itis=inflammation). The spine is the most commonly affected joint. The medical term for arthritis of the spine is ‘spondylosis’.
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Hypermobility/Hypomobility
This just mean ‘loose’ or ‘stiff’, respectively. The way the physical therapist views the body is either too loose with pain or too stiff with pain. We are always trying to bring you back to the center of that spectrum. Hypermobility usually boils down to a lack of strength around a joint. Keep in mind that usually a person is not generally loose or stiff. What tends to happen is there is one joint that is stiff and the adjacent joints are loose to compensate.
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Sacroiliac dysfunction
This is the joint where your pelvis and sacrum meet. The pelvis is two bones and the sacrum is like a wedge driven between the two bones. The are the foundation of the spine. What we commonly see is what is called SI dysfunction, where one pelvis tips either forward or backward excessively, shearing the nerves that exit the sacrum. This will give you the appearance of having one leg longer than the other. This is easily corrected with what is called a ‘muscle energy technique’ or ‘MET’ for short.
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Piriformis syndrome
The piriformis muscle is a small, rope-like muscle that originates from your sacrum and attaches to your greater trochanter (hip bone). The thick sciatic nerve courses underneath this muscle. Under the nerve is bone. So if the piriformis is tight (which it commonly is) it can compress the nerve into the bone. Some unlucky individuals are even born with a nerve that perforates the piriformis muscle making it more difficult to deal with.
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Shoulder Pain
Impingement
This occurs when something pinches the rotator cuff or the bursa when reaching overhead or behind the back. The shoulder is a ball and socket joint, and the rotator cuff sits on top of the ball. There is a joint that sits on top of the ball for protection, and it is where the collar bone meets the spine of the scapula (AC joint). When reaching overhead, the rotator cuff bumps up against AC joint. There could be a number of causes to this. The mechanics of a ball and socket joint are such that when reaching up, the ball is supposed to descend down. Commonly, a tightens develops on the bottom side of the shoulder capsule which surrounds the shoulder joint. This tightness prevents the ball from descending down when reaching up. What happens instead is that the ball rises with the arm and the rotator cuff is pinched at the AC joint. There are other conditions that can cause or contribute to this such as congenital anomalies and posture.
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Labral tears/Bicep tears
These are coupled together because the bicep has two heads. The long head of the bicep goes through the shoulder joint and inserts into the labrum. The labrum of the shoulder lines the socket of the joint to deepen it for more joint congruence. When the long head of the bicep contract, it tugs on the labrum. The labrum is commonly injured from trauma to the shoulder, a forceful pull on the arm, or falling on an outstretched hand (FOOSH injury).
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Rotator cuff
Rotator cuff tendinitis is the same thing as shoulder impingement. If you let this continue to persist without treatment, it can turn into a tear. That mechanism where the rotator cuff rubs against the AC joint is like taking a rope and rubbing it against a sharp surface. It starts to fray, then tear, and sometimes completely ruptures. Especially with repetitive overhead movements such as golf or swimming.
Hip/Knee Pain
IT band
This is a large fibrous connective tissue that runs from your hip to your knee. This famously becomes irritated usually due to either an ankle mobility restriction or lateral hip weakness leading to a movement compensation that causes shearing of the hip. If untreated, it usually becomes a greater trochanteric (hip) bursitis. It can also affect the tracking of your kneecap because of its attachment to it. A lateral tracking knee cap will crack when you bend your knees.
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Knee arthritis
Wear and tear of the cartilage of the knee is an inevitable in life, but there are other variables that may accelerate it. Being knock-kneed or bow-legged can grind down on the sides of the joint. Having a job where you are on your knees such as in flooring, will add to degeneration. Injuries such as meniscus tears are like having a piece of sandpaper in the joint. The end result is a knee that swells with prolonged weight bearing.
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