Massage & Bodywork

January/February 2011

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pathology perspectives BY RUTH WERNER SPINAL TONGUE TWISTERS Understanding Low-Back Pain: Spondylosis, Spondylolysis, and Spondylolisthesis Back pain seems an inevitable part of the human condition. Certainly, it is the mainstay of many bodywork practitioners' careers. In the starkest terms, one person's back pain is another's job security. It would be possible to invest hundreds of thousands of words into the genesis and treatment of common back pain scenarios. For the purposes of this setting, however, we will hone in on three connected, but distinct, causes of low- back pain. Their names are intimidating to look at, their impact on a person's quality of life can be profound, and … massage can be an invaluable tool for managing them. For this reason, it is worth the effort to unravel the mysteries of spondylosis, spondylolysis, and spondylolisthesis. LOW-BACK PAIN VOCABULARY A little Greek goes a long way in understanding low-back pain terminology: • spondylo-: vertebrae. • -lyso: loosening. • -olisthesis: slippage. • -osis: pathologic condition. So, spondylosis is a pathologic condition of the spine. It is sometimes referred to as osteoarthritis of the spine, although there are some technical differences. Spondylolysis is a loosening of the vertebrae; this refers to a structural defect at the vertebral arch. And spondylolisthesis is an anterior slippage of the vertebral body, often in concert with either or both spondylosis and spondylolysis. SPONDYLOSIS: PATHOLOGIC CONDITION OF THE SPINE While often used as a synonym for osteoarthritis, spondylosis is a broader problem that encompasses age and wear-and-tear-related changes to the vertebrae, joints, joint capsules, and ligaments of the spine. It is most common in the cervical and lumbar vertebrae, because the rib cage protects the thoracic spine from the mechanical forces that act on the neck and low back. The problems spondylosis can cause in the neck are significant, but this discussion will focus on how spondylosis affects the lumbar spine. Osteophytes. A distinguishing feature of spondylosis that is not seen with other spine conditions is the growth of osteophytes, or bone spurs on the vertebrae. These can grow on the facets, impairing movement at these gliding joints, or on the vertebral bodies. Osteophytes cause pain when they interfere with the spinal cord or spinal nerve roots, but otherwise they may be completely silent. Ossification of ligaments. Another issue that distinguishes spondylosis from osteoarthritis is calcium deposits along key spinal ligaments. The anterior longitudinal ligament runs on the anterior aspect of the vertebral bodies, and the posterior longitudinal ligament runs along the posterior aspect of the vertebral bodies, on the anterior side of the vertebral foramina. earn CE hours at your convenience: abmp's online education center, 99

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