The spine is made up of 32 vertebrae, each one articulating with the one above and the one below. The Cervical, Thoracic, Lumbar and Sacral vertebrae all have slightly different angulations of attachment to their above and below vertebrae according to their functional level in the spine. Between each cylindrical shaped vertebral bone is a disc, which acts as a hydraulic absorber of compression down the spine. The disc absorbs shock to protect the nerve roots which emerge from gaps between each vertebra. These gaps are called foramina. The foramina are under strain with our activities of daily life and are susceptible to arthritic forms of wear and tear which may be related to occupations requiring heavy lifting such as a builder, gardener, engineer and some sports.
Under heavy loading, the outer edges of the foramen gap may start to produce “osteophytes” which are bony spurs and can grow enough length to impinge upon the sensitive nerve root exiting from the spine between the vertebrae.
Another cause of nerve root irritation is the notorious “slipped disc”
A vertebral disc has a fibrous outer layer surrounding a gelatinous interior. The disc not only absorbs shock but it also acts as a pivot between each vertebra. The disc does have a limit of strain it can take before the outer layer splits, allowing the jelly-like interior to ooze into the space reserved for the nerve root. The cause of this may not necessarily be long term wear and tear and could also be from a heavy lift or repeated compression such as in motor-cross, horse riding, jet-skiing, or a fall.
When a patient exhibits signs of nerve root irritation it is very helpful to see an X ray, although X rays cannot show us ligament or disc damage, they do show the posture of the spine, arthritic osteophyte formation and loading wear and tear. Although we cannot see the discs themselves, any narrowing of the gap between each vertebra gives us an indication as to which nerve root has been compromised.
Hopefully an X Ray will be sufficient for physiotherapy treatment to continue however if there exists sensory, muscular, or reflex deficiency, then an MRI scan may be needed.
An MRI scan shows the disc and any protrusions into the foramina where the nerves are exiting to go on to supply the legs. The scan can also show any other soft tissue anomalies such as ligament, tendon and muscular damage.
During a physiotherapy assessment sensation, muscle strength and reflexes will be tested including the Sciatic, Femoral, Tibial and Peroneal nerves which supply the leg and foot.
Posture and spinal mobility will be examined with palpation of each spinal process as well as the sacro-iliacs joints which connect the pelvis to the sacrum at the lower end of the spinal column. The hip joints should also be examined with a gait assessment and leg length measurements.
Tracey Evans
MCSP SRP COFIB Col 220 Physiotherapist
The Physiotherapy Centre
+34 609 353 805
+34 971 405 769
