5 facts you need to know if you have low back pain!

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  1. Spinal discs have a poor blood supply. They rely on the spinal joint movement to assist circulation.  Circulation is vital for repair and maintenance of the disc.
  2. If the movement is impaired, circulation deteriorates and the disc starts to degenerate and weaken.  This can be likened to a worn car tire. Over time the tire loses air, splits and may eventually blow out.
  3. The nerves are also affected. The damaged disc can irritate or even compress the disc.  The nerve has its own circulation which in turn becomes reduced.  The nerve will also degenerate over time.
  4. This picture will produce a wide array of symptoms as the joint goes thru each stage.  At times you may experience very acute sharp pain; at others, the pain may be a dull ache, but your lower limbs may start to feel uncomfortable.
  5. There may be times the pain is quite minimal.  This does not necessarily mean the disc is repaired or stable.  If the nerve is damaged it may not register pain.  Please keep this in mind.

Here’s some background information you need to know if you have back pain.

Types of discs:

  1. Disc tear: Small crack or micro-tear of the outer cartilage material called the annulus.
  1. Disc bulge: The soft jelly-like material in the middle of the disc starts to push to one side causing the disc to swell.
  1. Disc herniation: This soft jelly-like material ruptures thru the annulus rings and may extend beyond the outer margins of the disc.
  1. Disc Prolapse: A fragment of disc starts to break away.
  1. Disc Desiccation: The disc loses its fluidity and becomes rough, worn-down and worn-out.

Here’s what you can do at home if you have low back pain.

Dr. Andrew Arnold and At Cranbourne Family Chiropractic and Wellness Centre believe it is very important you try and keep as mobile as is possible.

This means do not sit or stand too long, i.e. ~30mins.  Use a hard-backed chair with lumbar support.  Try to lean back a little. Use an ice pack if acute.

So what happens when you injure your low back.

Slipped discs can affect all sorts of people of all ages, i.e. pregnancy; teenage gymnasts; older people etc. and occurs most commonly in the lumbar spine, at the bottom of the back. The term slipped disc is not strictly accurate, and the term prolapse better describes what happens.

Between each vertebra (the bones which make up the spinal column) there is what is called intervertebral discs. These discs consist of a tough outer fibrous layer that surrounds a gel-like nucleus. Repeated overuse during bending, lifting, and sporting activities can lead to degeneration of the outer layer of the disc. If this degeneration is sufficient the nucleus material is liable to prolapse out of the disc.

SIGNS AND SYMPTOMS

Usually, one offending movement (most commonly bending or lifting) will act as the ‘straw that broke the camel’s back’. As the nucleus material leaks out of the disc, the onset of pain in the back is sudden and severe. It may be relieved by changing position, but it can be made worse by flexed postures such as sitting. Coughing and sneezing increase the pressure within the disc and exacerbate the pain.

If the direction of the prolapse is back and to the side, it may press on what is called a nerve root, causing pain down one of the legs. Most commonly, the nerve roots affected produce pain in the sciatic nerve distribution, resulting in the condition known as sciatica. This can produce pain in the buttock, the hamstrings, and the back of the knee, the calf or the heel.

Pain management and treatment

Chiropractic, Myotherapy, Massage, and Naturopath supplements offer a real alternative to pain relief with or without drug medications.  The acute pain normally lasts for a few days however, it’s not always advised to rest. In fact, at Cranbourne Family Chiropractic and Wellness Centre we recommend specific stretches and movements to assist with alleviating the spasm and cramp. In most cases of a prolapsed disc, the symptoms can be relieved if the patient gets into a position of pelvic tilt, NOT low back extension. This can be achieved by standing, hyperextending your knees and feeling a contraction in your low back. Try holding this position for 3-5 seconds at a time. Your Chiropractor can ensure you are doing this properly.

This puts the spine in the opposite position to the in which the injury occurred. This encourages the prolapsed nucleus gel to recede into the disc. The outer layer of the disc will heal with scar tissue over a period of months, but the disc is vulnerable to re-injury and there will always be a weakness. For this reason, and to reduce the chances of a recurrence, the patient should follow the rehabilitation program set by a registered Chiropractor.

This will involve regaining the range of movement in the lumbar spine and strengthening the muscles which support the back.

Prevention and Long Term Care

Once a prolapsed disc has been experienced there will always be a weakness. In order to avoid a recurrence of the problem, it is important to take better care of the back in the future. An understanding of good exercise programs and posture care is necessary to achieve this. Viewed from the side the spine consists of a series of curves:

These curves increase the load-carrying capability of the spine. The lumbar part of the spine consists of a forward curve and as long as this is maintained, posture will be reasonably good. It is important that this improved posture is maintained during all activities, particularly when sitting for long periods – slumping should be avoided. A lumbar roll placed at the bottom of the back can be effective when sitting. Driving for long periods should be avoided. In the long term, good posture is maintained by increasing the muscular stability of the spine. This can be achieved through specific exercises.

Definitions – Sources of pain.

Muscles: Tissues that connect to our bones and when active generate our movement

Ligaments: Tissues that join bone to bone and act as a passive restraint to movement

Zygapophyseal joints: Most vertebrae have four of these small joints behind them, two at the top and two at the bottom. Also known as ‘facet’ joints.

Discs: Discs are the tissues that sit between the vertebrae. Discs have a strong outer wall with a gel-like center.

Dura: Dura is the name given to the outer fibrous of the three membranes surrounding the brain and spinal cord.

Nerve root: Nerve roots are formed when pairs of nerve rootlets from the spinal cord join together in the spinal canal. The nerve root becomes a spinal nerve when it leaves the spinal canal.

Other: Other sources of pain exist and in fact, any structure that has a nerve supply is a potential source of pain.

Definitions – mechanisms of pain.

Posture: Postural pain occurs when normal tissue is held at end range for prolonged periods of time.
No tissue damage needs to exist but the pain is a warning of potential damage. The pain goes when the tissue is taken away from the end range.

Dysfunction: Dysfunction pain occurs when abnormal or shortened tissue is taken to end range. The pain goes when the tissue is taken away from the end range.

Derangement: Derangement pain occurs when tissue is distorted in a particular direction. Derangement pain can be variable but always follows a particular pattern.

Disc Protrusion: Disc protrusion pain can occur when the gel-like center of a disc creates a bulge, usually in the back wall of the disc. This has also been called a prolapse or herniation. Back pain is the typical feature, leg pain may be present.

Disc Extrusion: Disc extrusion pain occurs when the gel-like center of a disc rupture, usually through the back wall of the disc. Back pain may go but now leg pain is the typical feature.

Disc Sequestration: Disc sequestration pain occurs after a piece of disc material breaks away from the disc and moves to interfere with normal joint or tissue function. Symptoms can be variable and can come and go in an instant

Radiculopathy: Refers to pain originating from nerve root irritation, typically caused by a disc bulge. Pain can extend below the knee or elbow. Radicular pain must have other associated neurological features

Cauda Equina Pressure: Cauda equina symptoms are a medical and surgical emergency. This is a result of a major disc rupture with the gel-like center being blasted back into the bunch of nerve roots called the Cauda equina. Loss of bladder or bowel function and other neurological signs are present.

Trauma: Pain from trauma will vary depending on the extent and type of tissues damaged. A typical inflammatory process occurs usually followed by a typical healing process.

Spinal Canal Stenosis: The hole running down through the back of each vertebra that contains the spinal cord is known as the spinal canal. Stenosis means the hole has narrowed for some reason, so the spinal cord or the descending nerve roots may become pressured with certain activities such a walking. Symptoms usually start with back pain but may progress into leg pains.

Foramina Stenosis: The hole formed between two vertebrae where the nerve exits the spinal canal is called the foramen. Stenosis means the hole has narrowed for some reason, so the nerve has less room to move and may get jammed or pinched with certain movements producing pain in the area the nerve supplies.

Adherent Nerve Root: Adherent usually means scar tissue has formed following trauma or surgery and anchored the nerve root to another structure limiting its movement. Pain occurs in the distribution of the nerve root only when the adherent nerve root is put under tension and at no other time.

Spondylolisthesis: Usually a defect in the bone at the rear area of the vertebrae called the ‘pars interarticularis’ can potentially allow the whole spinal column to slip forward on that vertebra. Symptoms arise due to the movement producing local mechanical trauma. There are five types of Spondylolisthesis and if active symptoms are usually worse with upright activities. Five to six percent of pain-free people have a spondylolisthesis on x-ray. An x-ray finding is not the diagnosis but it merely supports the diagnosis made in the clinic.

Ankylosing Spondylitis: A seronegative systemic rheumatic disorder causing inflammation and pain in spinal joints and large joints of the limbs. Often has a positive HLA-B27 tissue antigen with blood testing. Typically has back pain and early morning stiffness. Will begin to demonstrate decreased chest expansion may have a low-grade fever and feels fatigued. Occurs three times more often in men than in women.

Cancer: Pain from cancer can vary between individuals but is typically worse at night being quite severe and unremitting. Other clinical mechanical findings may or may not be present.

Psychogenic: Refers to pain originating in the mind either consciously or subconsciously. A real spinal condition may or may not exist but psychological factors make symptoms appear worse. Secondary gain is a common cause of psychogenic pain.

Fracture: Various spinal fractures are possible from sudden trauma like in a car accident or diving into shallow water. Fractures can also be caused by internal pathology such as cancer. Spinal cord damage is one of the greatest fears with a spinal fracture and if suspected every care must be taken to minimize movement of that area.

Degeneration: Pain from spinal degenerative changes (also called arthritis) not as common as most people believe and x-ray findings showing degeneration DO NOT confirm that is the cause of the symptoms. Clinical findings must be matched to the behavior of the symptoms. There are plenty of people with very degenerative (or arthritic) spines and no pain.

Neurogenic Claudication: The hole running down through the back of each vertebra that contains the spinal cord is known as the spinal canal. Stenosis means the hole has narrowed for some reason, so the spinal cord or the descending nerve roots may become pressured with certain activities such a walking. Symptoms are commonly felt in both calves and known as neurogenic claudication.

Instability: Instability means joints between vertebrae have lost their natural passive restraints to movement, so uncontrolled movement may occur causing mechanical deformation and pain. An apparent decrease in active or muscular strength and endurance around the spine has also been called instability. In any case, the pain will only be felt in the presence of mechanical deformation of tissue, not by the movement itself. Surgeons tend to fuse vertebrae together when they believe they are unstable.

Arthritis: Pain from spinal degenerative changes is not as common as most people believe and x-ray findings showing degeneration DO NOT confirm that is the cause of the symptoms. Clinical findings must be matched to the behavior of the symptoms. There are plenty of people with very degenerative/arthritic spines and no pain.

Other: There are other mechanisms of back-related pain which will not be covered here in these brief definitions.

Definitions – Types of Radiology.

X-rays: An x-ray (also known as a roentgen ray) is electromagnetic radiation that can be passed through the body to a photographic plate. When used this way it is known as Radiography. The more rays that are absorbed through tissue the whiter the tissue looks on the film. That is why bones look white on x-ray as they can absorb more of the rays. Soft tissue such as muscles, ligaments, and discs do not absorb they raise as much, so they do not show up as clearly.

A spinal x-ray can show essential information of the spinal bony structure, the overall alignment of the spine and the relationship of one bone to another.

Spine x-rays are usually taken from the front and the side and occasionally at different angles. This is done to obtain all views of the spine. Dynamic x-rays are also required occasionally. This involves the spinal x-ray taken at the limits of spinal motion to assess for any abnormal movements or instability.

CT Scan: Computerized Tomography (CT) is when a series of x-ray beams are passed through the body area of interest, which a computer then transforms into high-resolution 2-dimensional images or ‘slices’ of the area. A CT Scan is useful in viewing the spinal bony structure. It is also performed sometimes after a myelogram to increase the visibility of the spinal cord and nerves in the spinal canal.

Also known as Computerized Axial Tomography (CAT scans) or Computerized Transverse Axial Tomography.

Myelogram: A Myelogram involves injecting a special contrast or dye into the Dural sac (the tissue that surrounds the spinal cord and nerves), and then performing an X-ray or CT Scan, which shows the contrast as white. This allows an assessment of the spinal canal dimensions and spinal cord/nerve contours. This test is of particular use to assess a spinal cord or nerve root compression.

MRI: Magnetic Resonance Imaging (MRI) is when a person is placed in a strong magnetic field and then measuring the emitted radiation from the patient as the magnetic field is turned off. Different tissues give off different signals, which are used to compute an image at almost any required angle. This gives detailed visual information on a film about the tissue. The MRI can analyze bone tissue as well as soft tissue such as discs, nerves, ligaments, and muscles.

It should be noted that disc bulges are quite commonly found with MRI’s. A recent study demonstrated that 76% of normal, asymptomatic people had a disc bulge on an MRI.

A clinical examination, as conducted by therapists with the same training as Australian Spine Institute Directors has been found to be more accurate than MRI scans in determining painful from non-painful discs in the low back area.

Discogram: A special contrast or dye is injected into a disc which increases pressure within the disc. If the injection reproduces the patient’s pain it is considered a positive sign for the cause of pain. The location of the needle is verified by X-ray.

Following the injection an X-ray or CT Scan is taken which shows up the special contrast or dye inside the disc. This demonstrates any internal disc damage and can highlight a bulging area.

Bone Scan: A bone scan involves injecting a small amount of radioactive Technetium, a tracer, into the body. The tracer is rapidly eliminated by the body via the kidneys. Areas of bone that are healing or have abnormal activity can hold on to the tracer in higher amounts. Bone conditions that show increased uptake of the tracer include fractures, tumors, arthritis, stress injuries, and infection

Definitions – Types of pain.

Chemical pain        Refers mainly to pain caused by tissue inflammation

Mechanical pain    Refers mainly to pain caused by deformation of tissue usually by tension or compression

Somatic pain          Refers to pain from a local body tissue but usually not including organs

Referred pain         Refers to the pain felt in an area away from the tissue producing the pain

Radicular Pain       Refers to pain originating from nerve root irritation, which can extend below the knee or elbow. Radicular pain must have other associated neurological features

Neurogenic pain    Refers to pain originating in the nervous system

Vascular pain         Refers to pain caused by changes in blood flow

Psychological pain    Refers to pain originating in the mind either consciously or subconsciously.

Other                          Refers to other types of pain that are known to exist.

About the Author:

Dr. Andrew Arnold is the Principal Chiropractor and owner, Cranbourne Family Chiropractic and Wellness Centre, married to Dr. Linda Wilson, the Stress Specialist and has two children, Isaac and Bella. He lives in Melbourne, Australia.

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