A rower presents to the training room with complaints of mid-back pain that is exacerbated by rowing and prolong sitting. Also states that compressive forces in the weight room like squats increase her mid-back pain. The MRI showed schmorl’s nodes at T6/7. She would like to continue rowing, can you give her a prognosis and explain to her what a schmorl’s node is and present to her the best treatment options? Think of what muscles affect the T6/7 area and what the demands of rowing are.
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A schmorl’s node is an inferior disc protrusion of the nucleus pulposis. The material which would usually be contained by the annulus fibrosis is allowed to protrude inferiorly because of bony degeneration of the vertebral body.
Tx:
1. discontinue any midback-loading exercises (squats, dead lifts)
2. Release splenius cervicis, spinalis, middle traps, spinalis thoracis (possible distal connections to T6/T7)
3. Retrain multifidus with MET
4. No mobilization due to degeneration and inability to categorize into flex/ext group.
5. Retrain core with side planks, V’s with rowing, bird dogs, etc.
6. Traction machine
Prognosis:
Rest at least one week to calm acute symptoms. NSAIDS to control pain. Train to row properly without back extension. Ergometer at low resistance to teach proper technique. Re-evaluate after one week.