A Physical Therapist’s training includes how to combine subjective history with objective measures and tests to determine an accurate diagnosis of a patient’s pain. Following an accurate diagnosis, the initial evaluation (or even in subsequent treatments) turns toward describing the areas of dysfunction to the patient and what measures will be taken to address them. Pertaining to the low back, we often use complex terminology to describe the injuries which some patients may not completely grasp. Below are some of the most commonly used terms:
- Spodylolisthesis: Forward or Anterior displacement of one vertebrae on the vertebrae below it. Varies in severity from causing no pain at all to compression of nerve roots or spinal cord, which may cause pain/numbness in one or both lower extremities.
- Sciatica: compression of the sciatic nerve or the nerve roots comprising it (mainly L5-S1, and less so L4) causing pain from the low back and gluteals and possibly extending down to the foot. Usually only occurring down one leg or the other. Common causes are disc herniation, lumbar/facet stenosis, degenerative disc disease, pregnancy, and piriformis syndrome.
- Degenerative Disc Disease: not truly a disease, but term used to describe normal degenerative changes of the discs in your spine. Vertebral discs are fluid based shock absorbers between the vertebrae that allow proper movement of each segment. As we age the discs break down from use and dehydration, causing limitations in vertebral mobility and affecting spinal stability which can lead to other injuries of the spine.
- Radicular Pain: also known as radiculopathy/radiculitis, is pain across the dermatome (sensory pattern) of a particular nerve root due to compression or injury at the nerve root level branching from the spinal cord. A common form is Sciatica. Common causes can be disc herniation, osteophytes, degenerative disc, and facet stenosis/arthropathy
- Bulging Disc: means the vertebral disc of the spine is injured but “contained.” A small bubble of the outer fibrous ring of the disc (annulus fibrosus) protrudes into the spinal canal, sometimes impinging on nerve roots and causing pain. There is no tearing of the disc and no portion of the gel-like center (nucleus pulposus) has leaked out.
- Herniated Disc: means the vertebral disc of the spine is injured and the disc is “not contained.” A tearing or rupture of the outer fibrous layer occurs and a portion of the gel-like center has leaked into the spinal canal. It may begin as a bulging disc but continued excessive pressure led to rupture. Usually associated with intense pain in the low back as well as radicular pain.
While the above terms are frequently used, the list is not all inclusive. Your best bet is that if Physical Therapist, or other medical professional, is describing a medical diagnosis or treatment plan for you and you do not understand a term, just ask them what they are referring to. We find that the more a patient understands about their own body and course of treatment, the more compliant they are and better results they tend to see.
By: Chris Lybarger, PT, DPT