Let’s go a little deeper into this situation so that we can gain a better understanding.
The chances are that, when you present with these symptoms, you will have one of 2 problems occurring deep within your spine. You may have an annular tear or you may have a meniscal entrapment. Let’s delve a little deeper into the first scenario in this blog. My next blog will discuss the meniscal entrapment scenario.
An Annular Tear?
In between the vertebrae (bones) of your spine are intervertebral discs (IVD’s). They are built in to help your spine move better and to absorb shock. They consist of 2 different parts – an outer ring of cartilage called an annulus (annulus fibrosis), and an inner, softer, gel type material called the nucleus (nucleus pulposis).
Over time, when the IVD’s are either not getting enough blood supply or not getting enough movement, the nutrition to the disc becomes less than optimal and this can slowly causes the rings of cartilage to develop small tears or cracks in them. These tears will most likely be non-painful.
The pain and debilitation associated with annular tears is usually a case of “the straw that broke the camel’s back”. For example, you bend over to pick up a tissue off the floor and something goes!
What is happening inside you at this stage is that the inner gel like nucleus has squeezed its way through the cracks in the annulus and has made its way to the outer part of your annulus. The outer rings of the annulus have a nerve and (poor) blood supply and when the inflammatory proteins in the nucleus mix with the disc’s blood supply, you have an inflammatory reaction. It is felt as pain because your nerves are there to detect this reaction!
Even though you have only been in pain for a short period of time (we call this acute low back pain), you have had a long term (chronic) problem. Where you go from here is up to you. If you continue on your way and hope that the back pain and acute spasm goes away, you might be lucky – at least in the short term. When the acute inflammation goes away, your pain should as well. But there is a need to understand that your spine is vulnerable. If you twist awkwardly or load your spine up abnormally the nuclear material can push further out of your disc causing a disc bulge. This may progress to a disc protrusion or herniation. In these cases, because of the possibility of the nucleus pushing on the nerves exiting and in your spine, the pain associated with these problems may now radiate down your legs. At this stage you may have weakness in your lower limbs as well. Cauda equine syndrome (loss of bowel and/or bladder control) is an uncommon complication of the nucleus pushing out onto the lower nerves of your spine.
Let’s step back a little and understand that this is the undesired direction that we want to head in and we can do a few things about this. Focusing on healing the tears or cracks in the annulus is one thing that we can do. Attempting to suck some of the nucleus back towards the middle of the disc where it belongs is another.
The annulus has an extremely poor blood supply. In fact, it is often commented that the annulus has ‘no’ blood supply. Nutrients are required by the annulus to help heal and maintain its structure, but they cannot get there via the bloodstream. Nutrients must be pumped via movement. Quite simply, if we don’t move, the inner aspects of our annulus get poorly nourished and they gradually break down and they may not heal.
Short term treatment is aimed at reducing the inflammation and spasm. Low back spasm tends to dissipate in line with decreased inflammation.
Long term rehabilitation is aimed at allowing the spine to move better, thus giving the disc better nutrition (the ingredients for healing and repair). Treatment at your chiropractor might involve gentle tractional techniques that create a vucuum effect (negative pressure) in the nucleus and may aid in the retraction of the nuclear material. Gentle chiropractic adjustments may also allow for improved movement of the spine and improved nutrition to the disc.
At home you may be asked to perform certain exercises that give your spine both strength and flexibility.
At Catalyst Health and Wellness Group, we conduct a thorough initial consultation that enables you to receive a diagnosis and treatment plan. We inform you about your situation and give you short term (relief) and long term (rehabilitative) choices. We discuss your lifestyle and we provide referrals to appropriate health practitioners when this is necessary.
by Catalyst Chiropractic
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