Strength training in the treatment of degeneration of lumbar section of vertebral column.

Vertebral column degeneration is among the most common disorders. It causes significant losses due to worsening quality of life and work absenteeism. Because it also affects also people at production age it generates considerable direct and indirect costs. For instance, according to Rutkow in the USA, the yearly cost of treatment of this disorder in the 1980s was $ 16 billion [1]. Degeneration of the lumbar section of the vertebral column is correlated with morphological and radiological lesions; most commonly, radiculopathy caused by single or multi-level herniation or cauda equina syndrome resulting from spinal canal stenosis degeneration. Pain in the lumbar section of the vertebral column is a typical syndrome of this degeneration. Many authors have already focused on this topic [2, 3, 4, 5]. Examination of biochemical changes in intervertebral discs removed from young patients under 20 years of age, displayed similarities to intervertebral discs characteristic for the naturally-aging spinal cord [6, 7, 8]. Nociceptive pain in the lumbar section of the vertebral column is inflicted either by muscles or by vertebra with periosteum, joints and ligaments; sometimes also by blood vessels, mostly veins. Nerve roots and nerves are responsible for neuropathic pain [9]. In the subject literature there is a distinction between pain caused by nerve root compression by pathological structures and that inflicted by the pathology of spine moving segments [10, 11, 12, 13]. In both discopathy and pathological changes in the lumbar section of the spine, similar effectiveness of pain treatment is demonstrated. Often, the radiological picture shows a very advanced degeneration process which does not demonstrate itself through pain. In other cases, patients report a very high level of pain, even though radiographs, computed tomography or magnetic resonance imaging do not detect major anomalies. This is associated with the fact that experiencing pain is a complex process, influenced also by psychological factors, and therefore dependant on the psychological state of a patient [10, 12, 14, 15]. The spine muscles are responsible for the proper configuration of the vertebral column, just as in the osteoarticular system. Load on the vertebral column is reduced by half, thanks to muscles, but it must be remembered that after reaching the age of 40, muscle tissue is reduced with a rate of 1 kg/year and is replaced by fatty tissue [16]. This creates greater loads on the osteoarticular system, intervertebral discs overloads, functional blockage of facet joints and blockage of the sacroiliac joints. Additionally, it is accompanied by fascia movement impairment and painful ligament tension. Postexercise muscle pain caused by muscle structural changes, such as broken muscle fibres, ecchymoses or necrosis, occurs after 10–24 hours. Previously implemented treatment of sacral pain by immobilization turned out to be faulty, and nowadays there prevails the belief that exercises are indispensible and movement is recommended. Staying in bed has a negative influence on breathing and circulatory competences, mineralization, and patient’s psychics strengthening the feeling of severe health condition [17, 18, 19, 20]. Degeneration changes in the lumbar section of the vertebral column always begins with functional disorders of the locomotor system, with possible transient spinal pain. The degeneration disorder is characterized by progressive damage to the intervertebral disc and cartilage of facet joints, which causes functional and biomechanical disorders, overloading of the movable spinal column, as well as fascia movement impairment and painful ligament tension. This is followed by a destabilization with pathological movement, sclerosis of the facet joints’ surfaces and vertebral bodies, as well as intervertebral discs herniation, after which major changes in the ostearticular system, i.e. spinal stenosis, takes place. According to Styczyński, this state is called the reparation stage, since the creation of osteophytes and the rebuilding of vertebral bodies adjacent to degenerated intervertebral discs produces a bigger spinal support surface [21]. Therefore, this is a secondary adjustment of the vertebral column to perform supporting function, which was crippled by disc dehydration, weakening of the annulus fibrosus and longitudinal ligaments, as well as a weakening and disproportion of the vertebral muscles and other muscles stabilizing the vertebral column. Degeneration reduces spine competence and clinical symptoms appear after crossing the reduced competence threshold, or as an outcome of complications occurring due to the degeneration process. A degenerated intervertebral disc is biologically active. Blood vessels grow into it and the higher activity of tissue degradation enzymes is observed. Also, post-inflammatory cytokines, being the correlating element between degeneration and pain, appear [22, 23, 24]. Disc degradation products have low Ph and by penetrating degenerated annulus fibrosus they acidify the environment and cause chemical inflammation. Pain is accompanied by increased muscle tension and limited scope of movement, as well as diminishing physiologic spinal curvature. Intervertebral disc herniation displacement into the spinal cord canal may be asymptomatic, but it might inflict damage to the spinal cord or nerve roots [25, 26]. Abrupt displacement of nucleus pulposus into the spinal canal or intervertebral openings causes acute pain, which intensifies when coughing or sneezing.