Back Pain: Intervertebral Disc Conditions

The term ‘disc’ is short for the ‘intervertebral discs’, the spongy cushions that separate the block-like bones (vertebrae) of the spine. These discs have a number of important functions including shock absorption, keeping the vertebral column stable and giving the vertebrae ‘pivot points’ to allow movement. 

A disc is made of two parts: the elastic outer shell (annulus fibrosis) and the jelly-like contents (nucleus pulposis). It can handle quite a lot of pressure without damage, but certain types of pressure can damage the shell and push its contents out. 

Symptoms of disc problems

The symptoms of a damaged disc can vary according to its location and severity. Many people who show evidence on scanning of damaged discs have no symptoms. This means that, most commonly, there are no symptoms at all. However, general signs may include:

• Back pain
• Pain radiating down the legs
• Worsening pain associated with bending over or sitting down for a long time
• Worsening pain associated with activities like coughing or sneezing
• Numbness or pins-and-needles in an arm or leg.

Risk factors for disc problems

Some people are more susceptible to disc problems than others. Risk factors include:

• Obesity
• Poor muscle tone
• Lack of regular exercise
• Cigarette smoking
• Advancing age
• Poor posture
• Incorrect lifting techniques.

Often, however, there is no recognisable risk factor present.

Types of disc problems

Common disc-related problems include degenerative disc disease, ruptured (or ‘slipped’) disc and sciatica (nerve pain).

Degenerative disc disease

The discs of a young child are plump and moist, but the water content reduces with age until the discs are comparatively thin and hard. As a result of this, friction between the bones is thought to increase, resulting in growths called bone spurs around the discs.

In many cases, these age-related changes cause no problems, but some people experience a painful condition called degenerative disc disease. The most common symptom is back pain caused by holding the same position (either sitting or standing) for too long. It’s among the most common causes of chronic back pain in older people. 

Ruptured disc

The term ‘slipped disc’ suggests that a disc has moved out of position, but this is not accurate. The discs are held firmly in place by various structures (including ligaments, muscles and the vertebrae themselves).

Terms like ‘ruptured’, ‘herniated’ or ‘prolapsed’ describe the situation better, as the real problem is not that the entire disc ‘slips’, but rather that a crack in the tough outer shell of the disc allows the soft jelly-like contents to ooze out. When this material comes into contact with other structures, especially the spinal nerves that run nearby, this can cause pain and alter nerve function. 

The most common site for a ruptured disc is the lower back, and chronic lower backache can be a symptom. As we get older, the risk of rupturing a disc declines because the discs dry out and the contents are less able to ooze through any cracks.

Sciatica

Sciatica is nerve pain from the sciatic nerve that runs from the spine into the buttock and down the back of the leg. A common cause of sciatica is a ruptured disc. The spinal cord normally has room to slide up and down inside the spinal column whenever the body moves. However, a bulging disc can protrude into the spinal column and press against the spinal nerves, hampering its movement and causing pain. 

Diagnosis of disc problems

Diagnosis of disc problems involves:

• Taking a medical history (to determine risk factors and predisposing conditions)
• A physical examination.

Other investigations are carried out if surgery may be required.

Treatment for disc problems

The majority of disc problems will resolve regardless of treatment. Bed rest is occasionally best for initial management of severe sciatica, but most people can keep active with some restrictions according to the level of pain. Good pain control and allowing the person to move is often a good approach. 

Some common treatments include:

• Heat treatment
• Regular massage
• An exercise program designed to improve strength and flexibility
• Non-steroidal anti-inflammatory drugs (NSAIDs) or steroids
• Pain-relieving medication
• An injection of anti-inflammatory steroids into the region of the disc
• Uncommonly, in severe cases of ruptured disc, an operation may be needed to trim the protruding bulge (laminectomy)
• Also uncommonly, in severe cases of degenerative disc disease, an operation may be needed to remove the disc and fuse together the two vertebrae on either side.

Remember, most disc problems resolve without specific treatment. 

Self-help for disc problems

Given time and the right conditions, a ruptured disc can heal itself. Ongoing maintenance can reduce the risk of disc problems in the future. Be guided by your doctor or health professional, but general suggestions include:

• Try not to sit still for long periods of time.
• Avoid lifting heavy objects.
• Remember that movements such as bending and twisting (especially at the same time) can increase pressure on your damaged disc.
• Work on increasing your abdominal strength. Strong stomach muscles help to support the back. People who work hard on their abdominal muscles probably have much less recurrence of back pain over the long term, but only if they keep doing the exercises.
• Pay attention to posture while sitting, standing and walking.
• Flexibility exercises, performed regularly, can improve mobility and help reduce muscle tension and back pain.
• Include a gentle program of back-strengthening exercises.
• Yoga is recommended by some practitioners as an excellent form of strengthening and stretching for people with back problems.

Other causes of back pain

There are many other causes of back pain, so see your doctor if pain is strong. Important other reasons for back pain include:

• Muscular pain – probably even more common than disc rupture. It is usually localised to the back, without the pain spreading to the legs and very likely to fix itself without specific treatment
• Fracture – especially in elderly people, or those with osteoporosis
• Malignancy – some cancers can present with back pain. See your doctor if you have strong pain, night pain, have experienced weight loss or any other symptoms you are worried about.

Where to get help

• Your doctor
• Physiotherapist
• Osteopath

Things to remember

• Intervertebral discs are spongy cushions found between the vertebrae of the spine.
• Common problems include degenerative disc disease and ruptured (or ‘slipped’) disc.
• Risk factors for disc problems include obesity, advancing age, lack of exercise and incorrect lifting techniques.

This article originally appeared on www.betterhealth.vic.gov.au

Overuse injury: How to prevent training injuries

Thinking of starting a new physical activity program or ramping up your current training routine? If so, you may be at risk of an overuse injury — which could ultimately prevent you from being active. Find out what can cause an overuse injury and how to safely increase your activity level.

Common causes of overuse injury

An overuse injury is any type of muscle or joint injury, such as tendinitis or a stress fracture, that's caused by repetitive trauma. An overuse injury typically stems from:

• Training errors. Training errors can occur when you enthusiastically take on too much physical activity too quickly. Going too fast, exercising for too long or simply doing too much of one type of activity can strain your muscles and lead to an overuse injury.
• Technique errors. Improper technique can also take its toll on your body. If you use poor form as you do a set of strength training exercises, swing a golf club or throw a baseball, for example, you may overload certain muscles and cause an overuse injury.

Risk factors for overuse injury

Although an overuse injury can happen to anyone, you may be more prone to this type of injury if you have certain medical conditions. Overuse injuries are also more likely to occur as you get older — especially if you don't recognize the impact aging can have on your body and modify your routine accordingly.

For these reasons, it's a good idea to talk to your doctor ((*and health care team)) before starting a new activity or ramping up your current routine. Your doctor may offer tips to help make physical activity safer for you. If you have a muscle weakness in your hip, for example, your doctor may show you exercises to address the problem and prevent knee pain.

Avoiding overuse injury

Most overuse injuries are avoidable. To prevent an overuse injury:

• Use proper form and gear. Whether you're starting a new activity or you've been playing a sport for a long time, consider taking lessons. Using the correct technique is crucial to preventing overuse injuries. Also make sure you wear proper shoes for the activity. Consider replacing your shoes for every 300 miles you walk or run — or at least twice a year if you regularly exercise.
• Pace yourself. If you're starting a new fitness program, avoid becoming a weekend warrior. Compressing your physical activity for the week into two days can lead to an overuse injury. Instead, aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity — preferably spread throughout the week. It's also a good idea to take time to warm up before physical activity and cool down afterward.
• Gradually increase your activity level. When changing the intensity or duration of a physical activity, do so gradually. For example, if you want to increase the amount of weight you're using while strength training, increase it by no more than 10 percent each week until you reach your new goal.
• Mix up your routine. Instead of focusing on one type of exercise, build variety into your fitness program. Doing a variety of low-impact activities — such as walking, biking, swimming and water jogging — in moderation can help prevent overuse injuries by allowing your body to use different muscle groups. And be sure to do some type of strength training at least twice a week.

Recovering from overuse injury

If you suspect that you have an overuse injury, consult your doctor. He or she will likely ask you to take a break from the activity that caused the injury and recommend medication for any pain and inflammation.

Be sure to tell your doctor if you've recently made changes in your workout technique, intensity, duration, frequency or types of exercises. Identifying the cause of your overuse injury will help you correct the problem and avoid repeating it.

When you think the overuse injury has healed, ask your doctor to check that you've completely regained strength, motion, flexibility and balance before beginning the activity again. When you return to your activity, pay special attention to proper technique to avoid future injuries.

Playing it safe

Don't allow an overuse injury to prevent you from being physically active. By working with your doctor, listening to your body and pacing yourself, you can avoid this common setback and safely increase your activity level.


This article originally appeared on Drugs.com

The Pull of a Tight Psoas Muscle

The pull of a tight psoas muscle can take many forms and changes considerably as the muscle gets tighter. We’ll start by looking at what a well aligned psoas muscle can do for the body.

The psoas muscle, with the piriformis and gluteus maximus, are the only three muscles in the body that connect the legs to the spine. Together they essentially keep the pelvis and trunk upright on top of the legs. When you have a tight psoas muscle it is often on one side. In many instances both psoas can be tight but most often we are dealing with tightness on one side.

If the psoas muscle is happy it keeps the lumbar spine in its natural curve and allows the muscles of the spine to lengthen up supporting the whole trunk. But lets say that on the left side you have a tight psoas muscle, that leg bone will be pulled up into the hip socket slightly. This accounts for the concept of leg length discrepancy. We all have one leg shorter than the other and this is almost always the result of your tight psoas muscle. In some cases there might actually be a bone size difference, especially in the case of blunt force trauma such as car accidents and such. But for the most part our leg length discrepancy is due to a tight psoas muscle.

The pull of the tight psoas muscle that you can see in the picture above is a fairly classic pattern. I know that at any of my workshops I’ll be able to bring numerous people to the front of the room that exhibit this exact pattern.

And this pattern can be the cause of a many different manifestations of pain. Lower back pain, hip pain, groin pain and the list goes on. Releasing the psoas via exercises and posture work can help you find relief that we often think is no longer available.

When one psoas is tighter than the other, the leg is pulled up into the hip socket on the tight side and since one of the basic functions of the psoas is external rotation, that leg is often turned out more than the other.

In the trunk the image above shows that a tight psoas muscle can shorten the body on the tight side. This tightness manifests by a pulling up on the hip socket and a pulling down on the shoulder drawing the two bony landmarks closer to each other.

This is a little counter-intuitive because you might be thinking that if the right hip is higher the right shoulder should be higher as well but the tight psoas constricts that entire side of the body.

This is just one variation on the pull of a tight psoas. More severe tightness can lead to scoliosis and in extreme cases a hunchback.

Gentle release work that almost anyone can do can help you find relief from so many nagging issues that go undiagnosed and often leave you without any hope of healing because doctors, MRI’s and x-rays often report that seems to be no problem.


Article originally appeared on corewalking.com and is written by Jonathan FitzGordon.