It is important to know some basic conditions and terms.
Spina Bifida – birth defect caused by an incomplete closure of one or more vertebral arches of
the spine. There are different levels of severity, ranging from benign and clinically insignificant, to
severe and life threatening malformations of the spinal cord. The spinal membranes and cord may
protrude through the absence of vertebral arches (called clefts).
Basic Recommendations: Extension is bad, neutral spine is bad.
Spondylolisthesis – translation of a superior vertebrae in relation to its inferior segment. This
may, or may not be caused by instability, and it is essential to rule out instability. This may be
caused by degenerative changes of the facet joints and intervertebral discs, or by congenital
or traumatic disruption of the pars interarticularis of the upper of the two vertebrae. It most
commonly occurs in the lumbar spine.
Basic Recommendations: Refer to a doctor for evaluation and diagnostic imaging to rule out
instability. Avoid lumbar extension in most cases. Flexion feels okay but may make things worse.
Emphasize a neutral spine during functional movements. Follow doctor’s guidelines.
Stenosis – abnormal narrowing in an anatomic tube structure. Our focus will be spinal stenosis,
which is narrowing of the spinal canal or intervertebral foramena. This is due to degenerative
changes of the facet joints, uncovertebral joints and intervertebral discs. This is often
accompanied by neurological symptoms.
Basic Recommendations: Slight flexion feels better but may make things worse. Follow the
doctors guidelines on this one.
Herniated Disc – pathological condition in which a tear in the outer, fibrous ring (annuls fibrosus)
of an intervertebral disc allows the soft ,central portion (nucleus pulposus) to be extruded
towards the outside.
Normally it is a further development of a previously existing disc protrusion or bulge. This is a
condition in which the outermost layers of the annulus fibrosus are still intact, but tears on the
inner layers will allow the nucleus pulposus to create a bulge when the disc is under pressure.
Basic Recommendations: spinal sparing techniques, core stabilization, balance and
proprioceptive training. It is important to work within the client’s boundaries and to communicate
with their treatment provider in order to set guidelines for exercise prescription.
Impingement – refers to closure of a space through which a nerve, tendon, or blood vessel may
run, causing friction and disrupting the structure’s movement or position. A nerve impingement,
such as carpal tunnel syndrome is a condition in which the nerve becomes trapped in the tunnel
by scar tissue, degenerative changes and/or inflammation. This is different from a primary
glenohumeral impingement, in which the acromion process develops a spike-like projection that
frays the supraspinatus tendon below it.
Basic recommendations: Nerve impingement – neural flossing. Glenohumeral
impingement – scapular stabilization. Flexibility of the prime movers.