Monthly ArchiveSeptember 2008



Writer's Block 27 Sep 2008 02:58 pm

Writer’s Block Sept 27

Sept 27, 2008

Declaring War on Neck Pain

Heat Therapy to the Rescue

Compared to most therapies heat is pretty hard to beat. It’s very inexpensive, it’s easy to do, it doesn’t require an appointment and it carries no side affects. You can do it while relaxing at home and there are even portable heat wraps you can use in the car or at work.

Physical therapists will often combine heat therapy with other treatment modalities, such as ice therapy, electro therapy, stretching and exercise. Heat therapy is highly effective for anyone looking for a non-pharmaceutical form of back pain relief.

Read more…

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Writer's Block 20 Sep 2008 03:22 pm

Writer’s Block Sept 20

Sept. 20, 2008

Back Pain and Anger

oibabycc.0

Yikes! Looks like somebody tried to swipe her Cheerios.

Which reminds me, here’s a portion of an email I received a while back that I decided to save — not because it was unusual — but because it was so typical of the type of thing I hear over and over again…

“I was 40 yrs old and I had never had any back problems prior to this incident. I had lower back discomfort beginning over 10 months ago now from what was over exerting myself while overhead lifting some sheetrock on a scaffold. Looking back I am so regretful, what a dummy that stuff was way heavy and I just got pissed off, we where trying to get this piece to fit and with all the stress in my life at the time and it being 95 plus degrees, I just lost my cool and at the moment was not thinking about my back…”

I can just see your head nodding and you’re thinking, “Yeah… been there, done that.”

And since this is something that seems to affect us all to one degree or another, I decided to look into this problem to see if there wasn’t something we could learn from it.

Read more…

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Writer's Block 13 Sep 2008 08:36 pm

Writer’s Block Sept 13

Sept. 13, 2008

What Causes Herniated Discs?

femback2

Welcome back. Last time we took a look at general spinal anatomy with a particular emphasis on just how the disc is made. In a nutshell we saw that…

The intervertebral disc is basically made up of two parts and is often compared to a jelly donut. This donut-like structure is porous much like a sponge and (when healthy) is filled with fluid.

The center of this disc contains a jelly-like sack called the nucleus that — along with the fluid in the disc itself — acts like a hydraulic shock absorber.

The outer portion of the donut is called the annulus and is a series of concentric rings of fibrous connective tissue that surrounds the nucleus much like a ring of forts built one inside the other.

We ended by asking the question how can a disc fail? I believe the answer to that question has to do with:

  1. Disc degeneration
  2. Hydraulic pressure

The Root Cause of Disc Degeneration

The first part of the equation lies in the fact that the disc does not have a blood flow. It obtains its moisture and nutrients by a pumping action as the vertebrae above and below lift, flex and bend in all directions. Without this pumping movement of the vertebrae, the disk will not be able to replenish its moisture content and will dry out. It will literally starve to death.

As those once tough fibrous rings lose their moisture and dry out they begin to crack and delaminate just like an old rotten piece of plywood. Allow this degeneration to continue unchecked for year upon year and it becomes quite easy to see how a soft sack of jelly could break through that once formidable fortress.

Medical professionals have named this condition degenerative disc disease.

The Effect of Hydraulic Pressure

The second part of the answer lies in simple physics.

In physics, stress is classified according to type such as tensile strength (stretching the object), torsional strength (twisting the object), shear strength (lateral tearing of the object), and compressive strength (load bearing ability).

lol2

Of course, the normal intervertebral disc is designed to withstand all of these stress factors, but the two that appear to have the most impact on herniation are twisting and compressive loading. For now, let’s just focus on compressive loading.

“Under spine compression the nucleus pressurizes, applying hydraulic forces to the end plates vertically and to the inner annulus laterally. This causes the annulus collagen fibers to bulge outward and become tensed.”
- McGill, page 44 [1]

If you’ve ever experienced a leaky basement, you’ve observed first hand the power of hydraulic pressure. Given the slightest crack, water under pressure can penetrate even the thick concrete walls of your basement.

When compressive force is applied to the disc, McGill noted that pressure is applied to the nucleus. This pressure pushes the nucleus in the opposite direction of the applied force. (In physics, this is known as “cause and effect.”)

For example, if the pressure is applied to the front of the disc — such as in the act of sitting or bending forward — the nucleus will be squeezed towards the rear. If the fortress walls of the annulus are weakened, this hydrostatic pressure will begin to force the jelly-like nucleus through those walls.

Repeatedly apply this rearward pressure on the nucleus and it will eventually work its way through the walls of the fortress until it breaks completely through into the spinal canal.

herniated disc schematic with text

This is not a sudden process. McGill has demonstrated that this requires a great deal of pressure and many thousands of repetitive cycles of forward bending.

“While no herniations were produced with 260 N (Newtons) of compressive load and up to 85,000 flexion cycles, herniations were produced with 867 N of load and 22,000 to 28,000 cycles, and with 1472 N and only 5000 to 9500 cycles (Callaghan and McGill, 2001).” [1]

McGill’s research involved mechanically flexing spinal segments taken from swine (since they closely match the human spine) until those segments failed. While they did this, they tracked the migration of the nucleus as it pushed its way through the walls of the annulus.

It is probably not feasible to test for the effects of constant static pressure since it would most likely take months if not years before a single test specimen would fail. But I think we can safely speculate that constant hydrostatic pressure (hours spent in a sitting / bent forward posture) would most likely produce similar results.

Do You Know Where Your Nucleus Is?

old_lady2

If you’re spending hours in a classroom, hours riding in cars, hours a day working at a desk and hours sitting on the couch at home, your discs are probably not getting pumped enough to adequately replenish the moisture lost during all that downtime.

Add to that the constant static pressure of the bent forward posture that sitting entails — squeezing the nucleus in one direction — and you don’t have to be Einstein to figure out the end result. The nucleus is going to seek the path of least resistance.

This is starting to get lengthy and we have much more to cover on this subject, but I’m going to jump ahead a bit and give you what I initially intended to put at the end of this series:

My Personal Disc Rehabilitation Philosophy

I believe that disc rehabilitation needs to focus on two main goals:

  1. Centering the nucleus
  2. Restoring the moisture content of the disc

The Do’s:

  • Gentle mobilization (disc hydrating) techniques are imperative and should be performed as frequently as possible throughout the day, everyday.
  • Gentle stretching can be helpful especially for applying a reverse compressive load. (More on this later.)
  • Apply gentle decompression techniques frequently throughout the day, everyday.

The Don’ts:

I maintain that gentle rehabilitation techniques should be utilized at all times, therefore:

  • Forceful twisting motions should never be applied.
  • Sudden, high velocity motions should never be applied.
  • Weight bearing exercises or any similar strenuous activity that increases compression loading on the disc should be avoided until the annulus has been fully restored to a healthy state. The time frame for this will vary with the individual.

With all of the above, be sure to check with your doctor or physical therapist before proceeding on your own. There may be extenuating circumstances that will require you to modify your particular home exercise program.

In most instances, you can rebuild your herniated discs with a home exercise program, but enlisting your doctor or a well-trained physical therapist to help you monitor the situation — and advise you along the way — may just mean the difference between success and failure.

Yes, it is possible to go it on your own. But why not make a little extra investment and, thereby, stack the odds in your favor?

Until next time,
Dean

References:

1. McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 44-47) Human Kinetics (2007)

2. Tampier C, Drake JD, Callaghan JP, McGill SM. Progressive disc herniation: an investigation of the mechanism using radiologic, histochemical, and microscopic dissection techniques on a porcine model. Spine. 2007 Dec 1;32(25):2869-74.

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