"Slipped
disc", and "putting discs back" are
both terms bandied about, but what are these discs,
how do they go wrong and how can we look after them?
Discs
are the spongy bits between the bones in our backs.
They are made up of a central fluid-filled cavity
surrounded by fibrous outer rings. They provide nourishment
to the bones, act as shock absorbers to protect the
spine and increase spinal mobility. As we get older
the discs loose their fluidity and shrink. This is
the main reason we get shorter as we get older. This
process is called disc degeneration.
When
discs are still fluid, they can undergo minor injuries
that slowly weaken the outer layers. Eventually, often
after a relatively minor incident, they can spring
a leak (think of toothpaste squirting out of a tube).
This typically occurs between 30 and 50 years of age
and is called a disc herniation or prolapse ("slipped
disc"). The disc fluid then leaks out and irritates
the surrounding tissues causing inflammation that
can lead to pressure on the spinal nerves, leading
in turn to leg pain. On top of this is crippling muscle
spasm as the body tries to protect the spine. In most
cases the symptoms will ease within 3 months as inflammation
reduces and the irritating disc fluid is broken down
and absorbed. In rare cases this does not happen,
or the herniation is so large that the pain is unbearable,
and spinal surgery is necessary (less than 10% of
cases). Recovery can be hastened by improving spinal
mechanics, (seeing your osteopath), keeping active
and avoiding further stress to the disc.
An
early warning sign of disc damage is a disc bulge
where muscle spasm and stiffness occur but ease off
within weeks rather than months. Although less painful
and quicker to heal, it is important to heed the warning
- a disc bulge which is not managed could develop
into a herniation.
To
avoid damaging your discs stay fit and active, avoid
excessive weight gain, and avoid unaccustomed heavy
work without prior preparation.
Diverting
Disc Disasters Part 2- Volume 3 Issue 2 September
2004
In the last issue we dealt with relatively young discs
and how they can be damaged through injury. This time
we will be discussing the older, more mature disc.
The
discs have a fluid centre, allowing them to act as
shock absorbers to protect the spine, increase its
flexibility and provide nutrition to the bone itself.
As we get older discs start to degenerate. This means
they loose fluid and start to shrink, leading to more
strain being put on the spinal joints as the shock
absorbing properties of the disc diminish. The spine
becomes stiffer and local muscles and ligaments are
also put under increasing strain. This can lead to
back pain which may spread into the buttocks, hip
and front of the thigh. This general ache is worsened
with sitting for long periods and responds well to
movement.
With
severe degeneration pressure can be put on the spinal
nerves causing classic sciatic pain (pain running
down the back of the leg into the calf and foot) with
tingling, pins and needles and in some cases numbness.
So
what can be done? Keeping active and supple will greatly
reduce the amount of degeneration and its effects
on mobility. Healthy eating, staying fit and avoiding
excessive weight gain will also help reduce the risk.
Physical
treatment can be very successful for disc disease.
Although we can't reverse the process we can make
a big difference to quality of life. Working on increasing
mobility in the spine and reducing surrounding muscle
tension can reduce the pain and increase activity
levels. Keeping active will then help to reduce further
degeneration. Improving local circulation will reduce
inflammation and improve nutrition to the bone. Specific
exercises to strengthen muscles will also help protect
the spine.
So
it's not all doom and gloom. Although all of us will
have some level of degeneration in our spines by fifty,
we can reduce its effect by simple measures which
are part of a general healthy lifestyle.
It's
what you do with what you've got - Volume 3 Issue
2 September 2004
There is no doubt that medicine has made some great
advances in recent decades, not least in the field
of diagnostic medicine. X-rays have been around for
a long time and they are now backed up with other,
more advanced forms of imaging such as MRI scans.
The X-rays were great at showing what was happening
with the boney structures but the modern day scans
get to tell us about all the tissues. Fantastic news
for the surgeon who wants to know exactly what he
will find if it comes to surgery.
However,
it's easy to get carried away with what shows up on
the X-rays and scans. As osteopaths we often get patients
who have been through the GP, physiotherapist, and
orthopaedic surgeon route. The scans show exactly
where and what the problem is but it could be argued
that it's not always the whole picture. It certainly
isn't the holistic picture.
If
the X-ray or scan has shown wear and tear or degeneration
in the spine and the doctors have said that this is
the cause of the pain how come the pain varies so
much from day to day? The structure of the spine doesn't
vary from day to day but one day can be quite comfortable
when another can be filled with pain and stiffness.
Obviously it's not just what shows up on the scan
that is important. If there is wear and tear in the
spine it's also about how you use (or abuse) the spine
and what you do with the healthy areas of the body
to compensate for the problem area.
It's
easy to find disease. That's what X-rays and scans
are all about. The skill is to find health and to
promote that health. If you're in pain one day and
not the next we need to find out what you did on the
good day with the aim of creating more good days.
In cases of arthritis, osteopathy will not be able
to reverse the wear and tear process, but by working
with the muscles and soft tissues, stiffness, spasm
and pain can be relieved. Working on the healthy areas
of the body will spread the strain and tension away
from the arthritic joints. This is why the hips, upper
back, and neck will often be treated along with the
low back even if the scan only showed arthritic changes
or disc degeneration in the lumbar spine.
Studies
have been done which involved taking MRI scans of
groups of people only to find that many of the people
scanned were walking around completely symptom free
despite the fact that the scans indicated significant
degenerative changes going on. So just remember that
it's not what you've got, it's what you do with what
you've got that's important
