Posture and Spine
What are the spine changes that occur with aging that might change PD posture?
As we age, some degenerative or arthritic changes in the spine are normal causing loss of height and increased back stiffness. With aging, spinal posture becomes more rigid and usually in a slight forward bent position. Frequently there is rounding of the shoulders, a forward head, an increased thoracic kyphosis (forward curve around ribcage) and decreased lumbar lordosis (low back curve).
These changes can be more pronounced if a person spends a lot of their time in a forward bent position such as prolonged sitting at a desk or chair over the years. A loss of hydration in the intervertebral discs and degenerative arthritis causes narrowing of the outlets for the spinal nerves. The degenerative changes can be slowed with activity, strengthening, and postural exercises and drinking adequate amounts of water.
The spine can also change shape with arthritis and degenerative changes that effect the bones or vertebral body or disk. Degenerative changes in the spine are normal, however there are advanced changes that cause pain and are not part of the normal aging process. These include bulging or herniated disc diseases, spondylosis, stenosis and spondylolisthesis.
In disc diseases, there is a loss of hydration as well as changes in the makeup of the disc tissue itself allowing for cracks in the outer layers of tissue. The softer disc material can cause bulging or protruding of the outer layers or a full herniation where the inner material pushes out beyond the rim of the disc. Problems arise when a nerve is pinched causing the traditional pattern of disc pain with radiating pain usually down the outside or back of an arm or leg.
Other common changes include spondylosis, which is caused by osteophyte formation or bony spur formation on the vertbebral body which can pinch a nerve. Stenosis is also due to osteophyte production around the openings of the vertebra where the spinal nerves exit. These problems often cause pain when standing and walking and are relieved with sitting, whereas, disc pain is increased with sitting and decreased with standing. Finally, spondylolisthesis can also be seen in the aging spine. This is a break in the support structure of the vertebra itself and may cause a slipping of one vertebra forward on another. This may cause increased pain with backward bending and decreased pain with forward bending.
How does back pain related to musculoskeletal disease differ from back pain due to a ‘pinched nerve or other nerve problem?
Musculoskeletal pain is usually limited to the spine and surrounding muscles themselves. This can be an aching with certain positions such as sitting or walking, prolonged positions, movement or changing positions. You may also experience this upon awakening in the morning or at the end of the day when your muscles are tired.
Pain originating from a pinched nerve or other nerve problem may be sharp, burning or deep aching in nature. This pain frequently radiates, which means it is caused by a nerve pinched in the low back but you feel the pain in the front or back of your leg or even in your foot.
See your healthcare provider if you are experiencing back problems to determine the cause and next step in therapy (medicines, physical therapy, massage, chiropractic manipulation and other manual muscle techniques, weight loss, and sometimes surgery). If you are undergoing physical therapy you will likely get a list of exercises to do at home. The most common scenario is that people stop doing these exercises when their pain improves. Consider these exercises a life-long prescription. Many back problems are due to progressive changes over the years and problems will recur without a little attention to body mechanics, and targeted exercises.
Author: Patricia Chalk, PT and Ann Zylstra, PT