HOW A DISC BECOMES PAINFUL

This post was taken from our 18 July 14 Spine-Health Powered Newsletter

Each spinal disc is a unique and well-designed structure in the spine. It is strong enough to resist terrific forces in multiple different planes of motion, yet it is still highly mobile and permits motion in multiple directions.

The disc has several functions, including acting as a shock absorber between the bony vertebral bodies.

DISC ANATOMY AND FUNCTION

The intervertebral disc has been likened to a jelly donut. It is comprised of a series of bands that form a tough outer layer, and soft, jelly-like material contained within.

    - Annulus Fibrosus - the disc's firm, tough outer layer

Nerves to the disc space only penetrate into the very outer portion of the annulus fibrosus. Even though there is little innervation to the disc, it can become a significant source of back pain if a tear in the annulus reaches the outer portion and the nerves become sensitized.

With continued degeneration, the nerves on the periphery of the disc will actually grow further into the disc space and become a source of pain.

    - Nucleus Pulposus - the jelly-like inner disc material

The inner material contained in the disc, the nucleus pulposus, contains a great deal of inflammatory proteins. If this inner disc material leaks out of the disc and comes in contact with a nerve root, it will inflame the nerve root and create pain down the leg (sciatica or lumbar radiculopathy) or down the arm (cervical radiculopathy).

When we are born, the disc is comprised of about 80% water, which gives it its spongy quality and allows it to function as a shock absorber. As we age, the water content decreases and the disc becomes less capable of acting as a shock absorber

In the same manner, if any of the inflammatory proteins within the disc space leak out to the outer annulus and touch the pain fibers in this area, it can create a lot of low back pain or neck pain. (See Figure 1)

The proteins within the disc space also change composition, and most of us will develop tears into the annulus fibrosus (the outer hard core of the disc).

Most people will have some level of disc degeneration by their sixth decade, yet most do not have back pain (see Figure 2).

Degenerated Disc on MRI Scan

Magnetic Resonance Imaging, called an MRI scan, has contributed a great deal to our understanding of degenerative disc disease and the natural degenerative process. With the advent of MRI technology, good anatomic detail of the disc can be imaged and correlated with the individual's pain.

Through studies with MRI scans, it was found that:

• A large number of young patients with chronic low back pain had evidence of disc degeneration on their MRI scans, and;
• Up to 30% of young healthy adults with no back pain had disc degeneration on their MRI scans.

Variability in Degenerative Disc Disease

It is not exactly clear why some degenerated discs are painful and some are not.

There is probably a variety of reasons that discs can become painful.

Some theories about pain from degenerative disc disease are:

• If a disc is injured or degenerated, it may become painful because of the resultant instability from the disc injury, which in turn can lead to an inflammatory reaction and causes low back pain.
• Some people seem to have nerve endings that penetrate more deeply into the outer annulus than others, and this is thought to make the degenerated disc more susceptible to becoming a source of pain.

 While the exact causes are not known, there is a generally agreed upon theory of how a disc degenerates over time,....... Click here to read the full article: http://www.spine-health.com/conditions/degenerative-disc-disease/how-disc-becomes-painful

CHIROPRACTIC MANIPULATION FOR THE CERVICAL SPINE

This post is taken from our 11 July 14 Spine-Health Powered Newsletter

Manipulation of the cervical spine or neck region is a common technique utilized by doctors of chiropractic for many patients complaining of neck, upper back, and shoulder/arm pain, as well as headaches. Read more about this first line of treatment for cervical spine conditions.

TYPES OF CHIROPRACTIC MANIPULATION

The goals of cervical adjustment include reduction of pain, improved motion, and restored function. There are two general approaches for cervical spine complaints:

- Manipulation - often thought of as the traditional chiropractic adjustment, or a high-velocity, low-amplitude (HVLA) technique

- Mobilization - which is a more gentle/less forceful adjustment, or a low-velocity, low-amplitude (LVLA) technique moving the joint through a tolerable range of motion.

A combination of the various approaches varies among patients depending on the chiropractor's preferred techniques, the patient's comfort and preferences, and the patient's response to the treatment, as well as both past experience and observations made during the course of treatment.

Adjunctive therapies may include massage, therapeutic heat and/or cold application, gentle stretching and strengthening exercises, and more.

THE “CRACKING” SOUND

The HVLA manipulation usually results in a release, called cavitation, which is created in part by gas escaping from the joint capsule when the joint is moved quickly within its passive range of motion, well within the tissue boundaries.

This type of chiropractic adjustment creates the typical cracking sound that is often associated with joint manipulation. It sounds similar to cracking one's knuckles.

While this cracking description of a chiropractic high-velocity, low- amplitude thrust may give an impression of something that is uncomfortable, many patients find the sensation is relieving and may provide immediate relief of painful symptoms.

GENTLE MOBILIZATION OR ADJUSTMENT?

There are several reasons a chiropractor may recommend gentle (LVLA) chiropractic techniques, such as: 

- Patient preference: Some patients do not feel comfortable with the traditional high-velocity thrust manipulation and prefer an approach that does not involve twisting their neck or joint "popping."

- Provider experience: Some chiropractors may favor one technique and most chiropractors utilize several approaches and often modify and adapt several techniques to the patient’s needs and preferences.

- Contraindications: Some patients may not be able to tolerate the traditional chiropractic adjustment based on past experience or a prior injury or condition.

GENTLE TECHNIQUES

If the patient cannot relax, or simply dislikes the cracking feeling or sound, a gentle form of chiropractic adjustment may be utilized. Some of these methods include a slower technique performed within the passive range of joint motion. 

• Cervical mobilization. The chiropractor manually moves the vertebra in the neck left to right, and vice versa, alternating between the side to side motion and a figure 8 movement, applied at varying degrees of moving the head forward, backward, and to the side and in rotation. This is a smooth, non-thrust type of stretch. 

• Cervical manual traction. The chiropractor gently pulls on the neck, stretching the cervical spine often varying the angle between flexion (forward) and extension (backward), based on comfort and searching for the correct angle to most efficiently reduce the tightness. 

• Cervical "drop" techniques. The chiropractor places a hand and/or finger over the spinal segment requiring the adjustment. A medium to high velocity, low amplitude thrust, or a non-thrust gradual increasing downward pressure is applied until the drop section / head piece of the table releases and drops a short distance. The goal is to reduce the fixation or restricted motion of the cervical vertebra assisted by the special table. 

TYPICAL CERVICAL PROBLEMS 

• Mechanical neck pain includes pain generated from muscle, tendons, joint capsules, ligaments and/or the fascia. This type of problem is a common cause of neck pain and stiffness. Most of the time, many of these tissues are simultaneously injured and can cause pain both locally as well as at a distance away from the injury site. 

• Cervical disc problems. Tears can develop in the cervical disc and/or the inside of the disc (the nucleus) can herniate through the outer part (the annulus) and trap or pinch the nerve root as it exits the spine. 

Cervical nerve root irritation can frequently refer pain down the arm and into the hand, usually affecting specific regions such as the 4th and 5th digits, the palm side thumb to 3rd fingers and/or the back of the hand on the thumb, index finger side of the hand, depending on which nerve root is irritated.

The above are two broad examples of types of cervical spine problems that may be treated with cervical spinal manipulation. The patient needs to receive a complete exam prior to cervical manipulation.




Click here to read the full article: http://www.spine-health.com/ treatment/chiropractic/chiropractic- manipulation-cervical-spine